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Verleden SE, Hendriks JMH, Lapperre TS. Reply to Polverino: Clearing the Air: Innovations in Imaging for Early Detection and Management of Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2024; 209:1044-1045. [PMID: 38227940 DOI: 10.1164/rccm.202312-2329le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 01/16/2024] [Indexed: 01/18/2024] Open
Affiliation(s)
- Stijn E Verleden
- Division of Thoracic Surgery, Antwerp Surgical Training Anatomy and Research Centre
- LEARN, Lung Research Antwerp, University of Antwerp, Wilrijk (Antwerp), Belgium; and
- Department of Thoracic and Vascular Surgery and
- Department of Pulmonology, University Hospital Antwerp, Edegem, Belgium
| | - Jeroen M H Hendriks
- Division of Thoracic Surgery, Antwerp Surgical Training Anatomy and Research Centre
- LEARN, Lung Research Antwerp, University of Antwerp, Wilrijk (Antwerp), Belgium; and
- Department of Thoracic and Vascular Surgery and
| | - Therese S Lapperre
- Laboratory of Experimental Medicine and Pediatrics, and
- LEARN, Lung Research Antwerp, University of Antwerp, Wilrijk (Antwerp), Belgium; and
- Department of Pulmonology, University Hospital Antwerp, Edegem, Belgium
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2
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Ackermann M, Werlein C, Plucinski E, Leypold S, Kühnel MP, Verleden SE, Khalil HA, Länger F, Welte T, Mentzer SJ, Jonigk DD. The role of vasculature and angiogenesis in respiratory diseases. Angiogenesis 2024:10.1007/s10456-024-09910-2. [PMID: 38580869 DOI: 10.1007/s10456-024-09910-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 02/11/2024] [Indexed: 04/07/2024]
Abstract
In European countries, nearly 10% of all hospital admissions are related to respiratory diseases, mainly chronic life-threatening diseases such as COPD, pulmonary hypertension, IPF or lung cancer. The contribution of blood vessels and angiogenesis to lung regeneration, remodeling and disease progression has been increasingly appreciated. The vascular supply of the lung shows the peculiarity of dual perfusion of the pulmonary circulation (vasa publica), which maintains a functional blood-gas barrier, and the bronchial circulation (vasa privata), which reveals a profiled capacity for angiogenesis (namely intussusceptive and sprouting angiogenesis) and alveolar-vascular remodeling by the recruitment of endothelial precursor cells. The aim of this review is to outline the importance of vascular remodeling and angiogenesis in a variety of non-neoplastic and neoplastic acute and chronic respiratory diseases such as lung infection, COPD, lung fibrosis, pulmonary hypertension and lung cancer.
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Affiliation(s)
- Maximilian Ackermann
- Institute of Pathology, University Clinics of RWTH University, Aachen, Germany.
- Institute of Pathology and Molecular Pathology, Helios University Clinic Wuppertal, University of Witten/Herdecke, Witten, Germany.
- Institute of Anatomy, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany.
| | | | - Edith Plucinski
- Institute of Pathology, Hannover Medical School, Hannover, Germany
| | - Sophie Leypold
- Institute of Pathology, University Clinics of RWTH University, Aachen, Germany
| | - Mark P Kühnel
- Institute of Pathology, University Clinics of RWTH University, Aachen, Germany
- Member of the German Center for Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
| | - Stijn E Verleden
- Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), University of Antwerp, Antwerp, Belgium
| | - Hassan A Khalil
- Division of Thoracic and Cardiac Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, USA
- Laboratory of Adaptive and Regenerative Biology, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Florian Länger
- Institute of Pathology, University Clinics of RWTH University, Aachen, Germany
| | - Tobias Welte
- Member of the German Center for Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Steven J Mentzer
- Division of Thoracic and Cardiac Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, USA
- Laboratory of Adaptive and Regenerative Biology, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Danny D Jonigk
- Institute of Pathology, University Clinics of RWTH University, Aachen, Germany
- Member of the German Center for Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
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3
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Pavlisko EN, Adam BA, Berry GJ, Calabrese F, Cortes-Santiago N, Glass CH, Goddard M, Greenland JR, Kreisel D, Levine DJ, Martinu T, Verleden SE, Weigt SS, Roux A. The 2022 Banff Meeting Lung Report. Am J Transplant 2024; 24:542-548. [PMID: 37931751 DOI: 10.1016/j.ajt.2023.10.022] [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: 08/22/2023] [Accepted: 10/11/2023] [Indexed: 11/08/2023]
Abstract
The Lung Session of the 2022 16th Banff Foundation for Allograft Pathology Conference-held in Banff, Alberta-focused on non-rejection lung allograft pathology and novel technologies for the detection of allograft injury. A multidisciplinary panel reviewed the state-of-the-art of current histopathologic entities, serologic studies, and molecular practices, as well as novel applications of digital pathology with artificial intelligence, gene expression analysis, and quantitative image analysis of chest computerized tomography. Current states of need as well as prospective integration of the aforementioned tools and technologies for complete assessment of allograft injury and its impact on lung transplant outcomes were discussed. Key conclusions from the discussion were: (1) recognition of limitations in current standard of care assessment of lung allograft dysfunction; (2) agreement on the need for a consensus regarding the standardized approach to the collection and assessment of pathologic data, inclusive of all lesions associated with graft outcome (eg, non-rejection pathology); and (3) optimism regarding promising novel diagnostic modalities, especially minimally invasive, which should be integrated into large, prospective multicenter studies to further evaluate their utility in clinical practice for directing personalized therapies to improve graft outcomes.
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Affiliation(s)
- Elizabeth N Pavlisko
- Department of Pathology, Duke University Medical Center, Durham, North Carolina, USA.
| | - Benjamin A Adam
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Canada
| | - Gerald J Berry
- Department of Pathology, Stanford University, Stanford, California, USA
| | - Fiorella Calabrese
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova Medical School, Padova, Italy
| | - Nahir Cortes-Santiago
- Department of Pathology and Immunology, Texas Children's Hospital, Houston, Texas, USA
| | - Carolyn H Glass
- Department of Pathology, Duke University Medical Center, Durham, North Carolina, USA
| | - Martin Goddard
- Pathology Department, Royal Papworth Hospital, NHS Trust, Papworth Everard, Cambridge, UK
| | - John R Greenland
- Department of Medicine, University of California, San Francisco, USA; Veterans Affairs Health Care System, San Francisco, California, USA
| | - Daniel Kreisel
- Department of Surgery, Department of Pathology and Immunology, Washington University, St. Louis, Missouri, USA
| | - Deborah J Levine
- Division of Pulmonary, Allergy, and Critical Care Medicine, Stanford University, California, USA
| | - Tereza Martinu
- Division of Respirology, Department of Medicine, University Health Network and University of Toronto, Toronto, Ontario, Canada; Toronto Lung Transplant Program, University Health Network, Toronto, Ontario, Canada
| | - Stijn E Verleden
- Lung Transplant Unit, Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium; Department of ASTARC, University of Antwerp, Wilrijk, Belgium
| | - S Sam Weigt
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Antoine Roux
- Department of Respiratory Medicine, Foch Hospital, Suresnes, France
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4
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Verleden SE, Hendriks JMH, Snoeckx A, Mai C, Mentens Y, Callebaut W, De Belie B, Van Schil PE, Verplancke V, Janssens A, Jacob J, Pakzad A, Conlon TM, Guvenc G, Yildirim AÖ, Pauwels P, Koljenovic S, Kwakkel-Van Erp JM, Lapperre TS. Small Airway Disease in Pre-Chronic Obstructive Pulmonary Disease with Emphysema: A Cross-Sectional Study. Am J Respir Crit Care Med 2024; 209:683-692. [PMID: 38055196 DOI: 10.1164/rccm.202301-0132oc] [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: 01/20/2023] [Accepted: 12/06/2023] [Indexed: 12/07/2023] Open
Abstract
Rationale: Small airway disease is an important pathophysiological feature of chronic obstructive pulmonary disease (COPD). Recently, "pre-COPD" has been put forward as a potential precursor stage of COPD that is defined by abnormal spirometry findings or significant emphysema on computed tomography (CT) in the absence of airflow obstruction. Objective: To determine the degree and nature of (small) airway disease in pre-COPD using microCT in a cohort of explant lobes/lungs. Methods: We collected whole lungs/lung lobes from patients with emphysematous pre-COPD (n = 10); Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage I (n = 6), II (n = 6), and III/IV (n = 7) COPD; and controls (n = 10), which were analyzed using CT and microCT. The degree of emphysema and the number and morphology of small airways were compared between groups, and further correlations were investigated with physiologic measures. Airway and parenchymal pathology was also validated with histopathology. Measurements and Main Results: The numbers of transitional bronchioles and terminal bronchioles per milliliter of lung were significantly lower in pre-COPD and GOLD stages I, II, and III/IV COPD compared with controls. In addition, the number of alveolar attachments of the transitional bronchioles and terminal bronchioles was also lower in pre-COPD and all COPD groups compared with controls. We did not find any differences between the pre-COPD and COPD groups in CT or microCT measures. The percentage of emphysema on CT showed the strongest correlation with the number of small airways in the COPD groups. Histopathology showed an increase in the mean chord length and a decrease in alveolar surface density in pre-COPD and all GOLD COPD stages compared with controls. Conclusions: Lungs of patients with emphysematous pre-COPD already show fewer small airways and airway remodeling even in the absence of physiologic airway obstruction.
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Affiliation(s)
- Stijn E Verleden
- Division of Thoracic Surgery, Antwerp Surgical Training, Anatomy and Research Centre
- Department of Thoracic and Vascular Surgery
- Department of Pulmonology
| | - Jeroen M H Hendriks
- Division of Thoracic Surgery, Antwerp Surgical Training, Anatomy and Research Centre
- Department of Thoracic and Vascular Surgery
| | - Annemiek Snoeckx
- Department of Molecular Morphology Microscopy, Faculty of Medicine and Health Sciences
- Department of Radiology
| | | | - Yves Mentens
- Department of Pulmonology, General Hospital Herentals, Herentals, Belgium
| | - Wim Callebaut
- Department of Pulmonology, General Hospital Voorkempen, Malle, Belgium
| | - Bruno De Belie
- Department of Pulmonology, General Hospital, Rumst, Belgium
| | - Paul E Van Schil
- Division of Thoracic Surgery, Antwerp Surgical Training, Anatomy and Research Centre
- Department of Thoracic and Vascular Surgery
| | | | | | - Joseph Jacob
- Department of Radiology, University College London Hospitals National Health Service Foundation Trust, London, United Kingdom
| | - Ashkan Pakzad
- Department of Radiology, University College London Hospitals National Health Service Foundation Trust, London, United Kingdom
| | - Thomas M Conlon
- Comprehensive Pneumology Center, Institute of Lung Health and Immunity, Helmholtz Munich, Munich, Germany; and
| | - Guney Guvenc
- Comprehensive Pneumology Center, Institute of Lung Health and Immunity, Helmholtz Munich, Munich, Germany; and
| | - Ali Önder Yildirim
- Comprehensive Pneumology Center, Institute of Lung Health and Immunity, Helmholtz Munich, Munich, Germany; and
- Institute of Experimental Pneumology, University Hospital, Ludwig-Maximilians University, Munich, Germany
| | - Patrick Pauwels
- Center for Oncologic Research, and
- Department of Pathology, University Hospital Antwerp, Edegem, Belgium
| | - Senada Koljenovic
- Center for Oncologic Research, and
- Department of Pathology, University Hospital Antwerp, Edegem, Belgium
| | - Johanna M Kwakkel-Van Erp
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium
- Department of Pulmonology
| | - Thérèse S Lapperre
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium
- Department of Pulmonology
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5
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Carlier FM, Detry B, Lecocq M, Collin AM, Planté-Bordeneuve T, Gérard L, Verleden SE, Delos M, Rondelet B, Janssens W, Ambroise J, Vanaudenaerde BM, Gohy S, Pilette C. The memory of airway epithelium damage in smokers and COPD patients. Life Sci Alliance 2024; 7:e202302341. [PMID: 38158219 PMCID: PMC10756916 DOI: 10.26508/lsa.202302341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 12/08/2023] [Accepted: 12/11/2023] [Indexed: 01/03/2024] Open
Abstract
Chronic obstructive pulmonary disease (COPD), a devastating and irreversible lung disease, causes structural and functional defects in the bronchial epithelium, the (ir)reversibility of which remains unexplored in vitro. This study aimed to investigate the persistence of COPD-related epithelial defects in long-term airway epithelial cultures derived from non-smokers, smokers, and COPD patients. Barrier function, polarity, cell commitment, epithelial-to-mesenchymal transition, and inflammation were evaluated and compared with native epithelium characteristics. The role of inflammation was explored using cytokines. We show that barrier dysfunction, compromised polarity, and lineage abnormalities observed in smokers and COPD persisted for up to 10 wk. Goblet cell hyperplasia was associated with recent cigarette smoke exposure. Conversely, increased IL-8/CXCL-8 release and abnormal epithelial-to-mesenchymal transition diminished over time. These ex vivo observations matched surgical samples' abnormalities. Cytokine treatment induced COPD-like changes in control cultures and reactivated epithelial-to-mesenchymal transition in COPD cells. In conclusion, these findings suggest that the airway epithelium of smokers and COPD patients retains a multidimensional memory of its original state and previous cigarette smoke-induced injuries, maintaining these abnormalities for extended periods.
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Affiliation(s)
- François M Carlier
- https://ror.org/02495e989 Pole of Pneumology, ENT, and Dermatology, Institute of Experimental and Clinical Research, Université Catholique de Louvain, Brussels, Belgium
- Department of Pneumology, CHU Mont-Godinne UCL Namur, Yvoir, Belgium
- Lung Transplant Centre, CHU Mont-Godinne UCL Namur, Yvoir, Belgium
| | - Bruno Detry
- https://ror.org/02495e989 Pole of Pneumology, ENT, and Dermatology, Institute of Experimental and Clinical Research, Université Catholique de Louvain, Brussels, Belgium
| | - Marylène Lecocq
- https://ror.org/02495e989 Pole of Pneumology, ENT, and Dermatology, Institute of Experimental and Clinical Research, Université Catholique de Louvain, Brussels, Belgium
| | - Amandine M Collin
- https://ror.org/02495e989 Pole of Pneumology, ENT, and Dermatology, Institute of Experimental and Clinical Research, Université Catholique de Louvain, Brussels, Belgium
| | - Thomas Planté-Bordeneuve
- https://ror.org/02495e989 Pole of Pneumology, ENT, and Dermatology, Institute of Experimental and Clinical Research, Université Catholique de Louvain, Brussels, Belgium
| | - Ludovic Gérard
- https://ror.org/02495e989 Pole of Pneumology, ENT, and Dermatology, Institute of Experimental and Clinical Research, Université Catholique de Louvain, Brussels, Belgium
| | - Stijn E Verleden
- Department of Chronic Diseases, Metabolism and Ageing, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Monique Delos
- Department of Pathology, CHU Mont-Godinne UCL Namur, Yvoir, Belgium
| | - Benoît Rondelet
- Lung Transplant Centre, CHU Mont-Godinne UCL Namur, Yvoir, Belgium
- Deparment of Cardiovascular and Thoracic Surgery, CHU Mont-Godinne UCL Namur, Yvoir, Belgium
| | - Wim Janssens
- Department of Chronic Diseases, Metabolism and Ageing, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Jérôme Ambroise
- https://ror.org/02495e989 Centre de Technologies Moléculaires Appliquées, Institute of Experimental and Clinical Research, Université Catholique de Louvain, Brussels, Belgium
| | - Bart M Vanaudenaerde
- Department of Chronic Diseases, Metabolism and Ageing, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Sophie Gohy
- https://ror.org/02495e989 Pole of Pneumology, ENT, and Dermatology, Institute of Experimental and Clinical Research, Université Catholique de Louvain, Brussels, Belgium
- Department of Pneumology, Cliniques Universitaires St-Luc, Brussels, Belgium
- Cystic Fibrosis Reference Center, Cliniques Universitaires St-Luc, Brussels, Belgium
| | - Charles Pilette
- https://ror.org/02495e989 Pole of Pneumology, ENT, and Dermatology, Institute of Experimental and Clinical Research, Université Catholique de Louvain, Brussels, Belgium
- Department of Pneumology, Cliniques Universitaires St-Luc, Brussels, Belgium
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6
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Ram S, Verleden SE, Kumar M, Bell AJ, Pal R, Ordies S, Vanstapel A, Dubbeldam A, Vos R, Galban S, Ceulemans LJ, Frick AE, Van Raemdonck DE, Verschakelen J, Vanaudenaerde BM, Verleden GM, Lama VN, Neyrinck AP, Galban CJ. Computed tomography-based machine learning for donor lung screening before transplantation. J Heart Lung Transplant 2024; 43:394-402. [PMID: 37778525 DOI: 10.1016/j.healun.2023.09.018] [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: 03/22/2023] [Revised: 09/21/2023] [Accepted: 09/25/2023] [Indexed: 10/03/2023] Open
Abstract
BACKGROUND Assessment and selection of donor lungs remain largely subjective and experience based. Criteria to accept or decline lungs are poorly standardized and are not compliant with the current donor pool. Using ex vivo computed tomography (CT) images, we investigated the use of a CT-based machine learning algorithm for screening donor lungs before transplantation. METHODS Clinical measures and ex situ CT scans were collected from 100 cases as part of a prospective clinical trial. Following procurement, donor lungs were inflated, placed on ice according to routine clinical practice, and imaged using a clinical CT scanner before transplantation while stored in the icebox. We trained and tested a supervised machine learning method called dictionary learning, which uses CT scans and learns specific image patterns and features pertaining to each class for a classification task. The results were evaluated with donor and recipient clinical measures. RESULTS Of the 100 lung pairs donated, 70 were considered acceptable for transplantation (based on standard clinical assessment) before CT screening and were consequently implanted. The remaining 30 pairs were screened but not transplanted. Our machine learning algorithm was able to detect pulmonary abnormalities on the CT scans. Among the patients who received donor lungs, our algorithm identified recipients who had extended stays in the intensive care unit and were at 19 times higher risk of developing chronic lung allograft dysfunction within 2 years posttransplant. CONCLUSIONS We have created a strategy to ex vivo screen donor lungs using a CT-based machine learning algorithm. As the use of suboptimal donor lungs rises, it is important to have in place objective techniques that will assist physicians in accurately screening donor lungs to identify recipients most at risk of posttransplant complications.
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Affiliation(s)
- Sundaresh Ram
- Department of Radiology, University of Michigan, Ann Arbor, Michigan; Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan
| | - Stijn E Verleden
- Lung Transplant Unit, Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium; Department of ASTARC, University of Antwerp, Wilrijk, Belgium
| | - Madhav Kumar
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan
| | - Alexander J Bell
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Ravi Pal
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Sofie Ordies
- Lung Transplant Unit, Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Arno Vanstapel
- Lung Transplant Unit, Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium; Department of Imaging & Pathology, KU Leuven, Leuven, Belgium
| | | | - Robin Vos
- Lung Transplant Unit, Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Stefanie Galban
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Laurens J Ceulemans
- Lung Transplant Unit, Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Anna E Frick
- Lung Transplant Unit, Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Dirk E Van Raemdonck
- Lung Transplant Unit, Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | | | - Bart M Vanaudenaerde
- Lung Transplant Unit, Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Geert M Verleden
- Lung Transplant Unit, Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Vibha N Lama
- Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan
| | - Arne P Neyrinck
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Craig J Galban
- Department of Radiology, University of Michigan, Ann Arbor, Michigan; Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan.
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7
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Verleden GM, Hendriks JMH, Verleden SE. The diagnosis and management of chronic lung allograft dysfunction. Curr Opin Pulm Med 2024:00063198-990000000-00139. [PMID: 38305383 DOI: 10.1097/mcp.0000000000001053] [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: 02/03/2024]
Abstract
PURPOSE OF REVIEW Chronic lung allograft dysfunction (CLAD) remains a life-threatening complication following lung transplantation. Different CLAD phenotypes have recently been defined, based on the combination of pulmonary function testing and chest computed tomography (CT) scanning and spurred renewed interests in differential diagnosis, risk factors and management of CLAD. RECENT FINDINGS Given their crucial importance in the differential diagnosis, we will discuss the latest development in assessing the pulmonary function and chest CT scan, but also their limitations in proper CLAD phenotyping, especially with regards to patients with baseline allograft dysfunction. Since no definitive treatment exists, it remains important to timely identify clinical risk factors, but also to assess the presence of specific patterns or biomarkers in tissue or in broncho alveolar lavage in relation to CLAD (phenotypes). We will provide a comprehensive overview of the latest advances in risk factors and biomarker research in CLAD. Lastly, we will also review novel preventive and curative treatment strategies for CLAD. SUMMARY Although this knowledge has significantly advanced the field of lung transplantation, more research is warranted because CLAD remains a life-threatening complication for all lung transplant recipients.
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Affiliation(s)
| | - Jeroen M H Hendriks
- Department of Thoracic and Vascular Surgery, University Hospital Antwerp, Edegem
- Department of ASTARC, University of Antwerp, Wilrijk, Belgium
| | - Stijn E Verleden
- Department of Pneumology
- Department of Thoracic and Vascular Surgery, University Hospital Antwerp, Edegem
- Department of ASTARC, University of Antwerp, Wilrijk, Belgium
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8
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Verleden SE, Lapperre TS, Snoeckx A, Wen W, Yogeswaran SK, Verleden GM, Verplancke V, Wener RRL, Koljenovic S, Peeters DJE, Hendriks JMH. Interalveolar pore morphology in (pre-)COPD stages and associations with small airways. Eur Respir J 2024; 63:2302263. [PMID: 38423590 DOI: 10.1183/13993003.02263-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 01/31/2024] [Indexed: 03/02/2024]
Affiliation(s)
- Stijn E Verleden
- Division of Thoracic Surgery, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), University of Antwerp, Wilrijk, Belgium
- Dept of Thoracic and Vascular Surgery, University Hospital Antwerp, Edegem, Belgium
- Dept of Pulmonology, University Hospital Antwerp, Edegem, Belgium
| | - Therese S Lapperre
- Dept of Pulmonology, University Hospital Antwerp, Edegem, Belgium
- Laboratory of Experimental Medicine and Pediatrics (LEMP), University of Antwerp, Wilrijk, Belgium
| | - Annemiek Snoeckx
- Dept of Radiology, University Hospital Antwerp, Edegem, Belgium
- mVISION, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Wen Wen
- Division of Thoracic Surgery, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), University of Antwerp, Wilrijk, Belgium
- Dept of Thoracic and Vascular Surgery, University Hospital Antwerp, Edegem, Belgium
| | - Suresh K Yogeswaran
- Dept of Thoracic and Vascular Surgery, University Hospital Antwerp, Edegem, Belgium
| | - Geert M Verleden
- Dept of Pulmonology, University Hospital Antwerp, Edegem, Belgium
| | | | - Reinier R L Wener
- Dept of Pulmonology, University Hospital Antwerp, Edegem, Belgium
- Laboratory of Experimental Medicine and Pediatrics (LEMP), University of Antwerp, Wilrijk, Belgium
| | | | | | - Jeroen M H Hendriks
- Division of Thoracic Surgery, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), University of Antwerp, Wilrijk, Belgium
- Dept of Thoracic and Vascular Surgery, University Hospital Antwerp, Edegem, Belgium
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9
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Goos T, Dubbeldam A, Vermant M, Gogaert S, De Sadeleer LJ, De Crem N, De Langhe E, Yserbyt J, Weynand B, Carlon MS, Verschakelen J, Vermeer S, Verleden SE, Wuyts WA. Intrafamilial Correlation and Variability in the Clinical Evolution of Pulmonary Fibrosis. Chest 2023; 164:1476-1480. [PMID: 37437878 DOI: 10.1016/j.chest.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 06/23/2023] [Accepted: 07/05/2023] [Indexed: 07/14/2023] Open
Affiliation(s)
- Tinne Goos
- BREATHE, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Adriana Dubbeldam
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Marie Vermant
- BREATHE, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Stefan Gogaert
- BREATHE, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Laurens J De Sadeleer
- BREATHE, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium; Institute of Lung Biology and Disease and Comprehensive Pneumology Center, Helmholtz Zentrum Muenchen, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Nico De Crem
- Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Ellen De Langhe
- Division of Rheumatology, University Hospitals Leuven, Leuven, Belgium
| | - Jonas Yserbyt
- Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Birgit Weynand
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Marianne S Carlon
- BREATHE, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | | | - Sascha Vermeer
- Center for Human Genetics, University Hospitals Leuven, Leuven, Belgium
| | - Stijn E Verleden
- Department of Antwerp Surgical Training, Anatomy and Research Centre, University of Antwerp, Edegem, Belgium; Department of Respiratory Medicine, University Hospital Antwerp, Edegem, Belgium
| | - Wim A Wuyts
- BREATHE, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium; Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium.
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10
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Orlitová M, Verbelen T, Frick AE, Vanstapel A, Van Beersel D, Ordies S, Van Slambrouck J, Kaes J, Jin X, Coudyzer W, Verleden SE, Verleden GM, Vanaudenaerde BM, Van Raemdonck DE, Vos R, Ceulemans LJ, Claus P, Neyrinck AP. The hemodynamic interplay between pulmonary ischemia-reperfusion injury and right ventricular function in lung transplantation: a translational porcine model. Am J Physiol Lung Cell Mol Physiol 2023; 325:L675-L688. [PMID: 37724349 DOI: 10.1152/ajplung.00281.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 09/06/2023] [Accepted: 09/13/2023] [Indexed: 09/20/2023] Open
Abstract
Lung transplantation (LTx) is a challenging procedure. Following the process of ischemia-reperfusion injury, the transplanted pulmonary graft might become severely damaged, resulting in primary graft dysfunction. In addition, during the intraoperative window, the right ventricle (RV) is at risk of acute failure. The interaction of right ventricular function with lung injury is, however, poorly understood. We aimed to address this interaction in a translational porcine model of pulmonary ischemia-reperfusion injury. Advanced pulmonary and hemodynamic assessment was used, including right ventricular pressure-volume loop analysis. The acute model was based on clamping and unclamping of the left lung hilus, respecting the different hemodynamic phases of a clinical lung transplantation. We found that forcing entire right ventricular cardiac output through a lung suffering from ischemia-reperfusion injury increased afterload (pulmonary vascular resistance from baseline to end experiment P < 0.0001) and induced right ventricular failure (RVF) in 5/9 animals. Notably, we identified different compensation patterns in failing versus nonfailing ventricles (arterial elastance P = 0.0008; stroke volume P < 0.0001). Furthermore, increased vascular pressure and flow produced by the right ventricle resulted in higher pulmonary injury, as measured by ex vivo CT density (correlation: pressure r = 0.8; flow r = 0.85). Finally, RV ischemia as measured by troponin-T was negatively correlated with pulmonary injury (r = -0.76); however, troponin-T values did not determine RVF in all animals. In conclusion, we demonstrate a delicate balance between development of pulmonary ischemia-reperfusion injury and right ventricular function during lung transplantation. Furthermore, we provide a physiological basis for potential benefit of extracorporeal life support technology.NEW & NOTEWORTHY In contrast to the abundant literature of mechanical pulmonary artery clamping to increase right ventricular afterload, we developed a model adding a biological factor of pulmonary ischemia-reperfusion injury. We did not only focus on the right ventricular behavior, but also on the interaction with the injured lung. We are the first to describe this interaction while addressing the hemodynamic intraoperative phases of clinical lung transplantation.
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Affiliation(s)
- Michaela Orlitová
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Tom Verbelen
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Anna E Frick
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Arno Vanstapel
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Dieter Van Beersel
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
- Department of Anesthesiology, University Hospitals Leuven, Leuven, Belgium
| | - Sofie Ordies
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
- Department of Anesthesiology, University Hospitals Leuven, Leuven, Belgium
| | - Jan Van Slambrouck
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Janne Kaes
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Xin Jin
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Walter Coudyzer
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Stijn E Verleden
- Antwerp Surgical Training, Anatomy and Research Center, University of Antwerp, Antwerp, Belgium
| | - Geert M Verleden
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
- Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Bart M Vanaudenaerde
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Dirk E Van Raemdonck
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Robin Vos
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
- Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Laurens J Ceulemans
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Piet Claus
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Arne P Neyrinck
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
- Department of Anesthesiology, University Hospitals Leuven, Leuven, Belgium
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11
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Reichmann J, Verleden SE, Kühnel M, Kamp JC, Werlein C, Neubert L, Müller JH, Bui TQ, Ackermann M, Jonigk D, Salditt T. Human lung virtual histology by multi-scale x-ray phase-contrast computed tomography. Phys Med Biol 2023; 68. [PMID: 37167977 DOI: 10.1088/1361-6560/acd48d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 05/11/2023] [Indexed: 05/13/2023]
Abstract
As the central organ of the respiratory system, the human lung is responsible for supplying oxygen to the blood, which reaches the erythrocytes by diffusion through the alveolar walls and is then distributed throughout the body. By exploiting the difference in electron density detected by a phase shift in soft tissue, high-resolution X-ray phase-contrast computed tomography (XPCT) can resolve biological structures in a sub-μm range, shedding new light on the three-dimensional structure of the lungs, physiological functions and pathological mechanisms.

This work presents both synchrotron and laboratory XPCT results of postmortem tissue from autopsies and biopsies embedded with various preparation protocols such as precision-cut lung slices, cryogenically fixed lung tissue, as well as paraffin and alcohol fixed tissue. The selection of pathological abnormalities includes channel of Lambert, bronchus-associated lymphoid tissue, alveolar capillary dysplasia with misalignment of pulmonary veins. Subsequently, quantification and visualization approaches are presented.

The overall high image quality even of in-house XPCT scans for the case of FFPE biopsies can be exploited for a wide range of pulmonary pathologies and translated to dedicated and optimized instrumentation which could be operated in clinical setting. By using synchrotron radiation, contrast can be further increased to resolve sub-μm sized features down to the sub-cellular level. The results demonstrate that a wide range of preparation protocols including sample mounting in liquids can be used. 

With XPCT, poorly understood 3D structures can be identified in larger volume overview and subsequently studied in more detail at higher resolution. With the full 3D structure, the respective physiological functions of airways or vascular networks, and the different pathophysiologic mechanisms can be elucidated or at least underpinned with structural data. Moreover, synchrotron data can be used to validate laboratory protocols and provide ground truth for standardizing the method.

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Affiliation(s)
- Jakob Reichmann
- University of Göttingen Institute for X-Ray Physics, Friedrich-Hund-Platz 1, Gottingen, Niedersachsen, 37077, GERMANY
| | - Stijn E Verleden
- Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), University of Antwerp, Universiteitsplein 1, Antwerpen, 2000, BELGIUM
| | - Mark Kühnel
- Institute of Pathology, Hannover Medical School, Carl-Neuberg-Straße 1, Hannover, Niedersachsen, 30625, GERMANY
| | - Jan C Kamp
- Biomedical Research in Endstage and Obstructive Lung Disease , German Center for Lung Research, Carl-Neuberg-Str. 1, Hannover, Niedersachsen, 30625, GERMANY
| | - Christopher Werlein
- Institute of Pathology, Hannover Medical School, Carl-Neuberg-Straße 1, Hannover, Niedersachsen, 30625, GERMANY
| | - Lavinia Neubert
- Institute of Pathology, Hannover Medical School, Carl-Neuberg-Straße 1, Hannover, Niedersachsen, 30625, GERMANY
| | - Jan-Hendrik Müller
- University of Göttingen Institute for X-Ray Physics, Friedrich-Hund-Platz 1, Gottingen, Niedersachsen, 37077, GERMANY
| | - Thanh Quynh Bui
- University of Göttingen Institute for X-Ray Physics, Friedrich-Hund-Platz 1, Gottingen, Niedersachsen, 37077, GERMANY
| | - Maximilian Ackermann
- Institute of Pathology and Department of Molecular Pathology, HELIOS University Hospital Wuppertal, Heusnerstraße 40, Wuppertal, Nordrhein-Westfalen, 42283, GERMANY
| | - Danny Jonigk
- RWTH Aachen University Medical Faculty, Pauwelsstraße 30, Aachen, Nordrhein-Westfalen, 52074, GERMANY
| | - Tim Salditt
- University of Göttingen Institute for X-Ray Physics, Friedrich-Hund-Platz 1, Gottingen, Niedersachsen, 37077, GERMANY
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12
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Brunet J, Walsh CL, Wagner WL, Bellier A, Werlein C, Marussi S, Jonigk DD, Verleden SE, Ackermann M, Lee PD, Tafforeau P. Preparation of large biological samples for high-resolution, hierarchical, synchrotron phase-contrast tomography with multimodal imaging compatibility. Nat Protoc 2023; 18:1441-1461. [PMID: 36859614 DOI: 10.1038/s41596-023-00804-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 12/12/2022] [Indexed: 03/03/2023]
Abstract
Imaging across different scales is essential for understanding healthy organ morphology and pathophysiological changes. The macro- and microscale three-dimensional morphology of large samples, including intact human organs, is possible with X-ray microtomography (using laboratory or synchrotron sources). Preparation of large samples for high-resolution imaging, however, is challenging due to limitations such as sample shrinkage, insufficient contrast, movement of the sample and bubble formation during mounting or scanning. Here, we describe the preparation, stabilization, dehydration and mounting of large soft-tissue samples for X-ray microtomography. We detail the protocol applied to whole human organs and hierarchical phase-contrast tomography at the European Synchrotron Radiation Facility, yet it is applicable to a range of biological samples, including complete organisms. The protocol enhances the contrast when using X-ray imaging, while preventing sample motion during the scan, even with different sample orientations. Bubbles trapped during mounting and those formed during scanning (in the case of synchrotron X-ray imaging) are mitigated by multiple degassing steps. The sample preparation is also compatible with magnetic resonance imaging, computed tomography and histological observation. The sample preparation and mounting require 24-36 d for a large organ such as a whole human brain or heart. The preparation time varies depending on the composition, size and fragility of the tissue. Use of the protocol enables scanning of intact organs with a diameter of 150 mm with a local voxel size of 1 μm. The protocol requires users with expertise in handling human or animal organs, laboratory operation and X-ray imaging.
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Affiliation(s)
- J Brunet
- Department of Mechanical Engineering, University College London, London, UK.
- European Synchrotron Radiation Facility, Grenoble, France.
| | - C L Walsh
- Department of Mechanical Engineering, University College London, London, UK.
| | - W L Wagner
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
- Translational Lung Research Centre Heidelberg (TLRC), German Lung Research Centre (DZL), Heidelberg, Germany
| | - A Bellier
- Laboratoire d'Anatomie des Alpes Françaises (LADAF), Université Grenoble Alpes, Grenoble, France
| | - C Werlein
- Institute of Pathology, Hannover Medical School, Hannover, Germany
| | - S Marussi
- Department of Mechanical Engineering, University College London, London, UK
| | - D D Jonigk
- Institute of Pathology, Hannover Medical School, Hannover, Germany
- Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH), German Lung Research Centre (DZL), Hannover, Germany
| | - S E Verleden
- Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), University of Antwerp, Antwerp, Belgium
| | - M Ackermann
- Institute of Pathology and Molecular Pathology, Helios University Clinic Wuppertal, University of Witten/Herdecke, Wuppertal, Germany
- Institute of Functional and Clinical Anatomy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Peter D Lee
- Department of Mechanical Engineering, University College London, London, UK.
- Research Complex at Harwell, Didcot, UK.
| | - Paul Tafforeau
- European Synchrotron Radiation Facility, Grenoble, France.
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13
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Claes E, Wener R, Neyrinck AP, Coppens A, Van Schil PE, Janssens A, Lapperre TS, Snoeckx A, Wen W, Voet H, Verleden SE, Hendriks JMH. Innovative Invasive Loco-Regional Techniques for the Treatment of Lung Cancer. Cancers (Basel) 2023; 15:cancers15082244. [PMID: 37190172 DOI: 10.3390/cancers15082244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/02/2023] [Accepted: 04/03/2023] [Indexed: 05/17/2023] Open
Abstract
Surgical resection is still the standard treatment for early-stage lung cancer. A multimodal treatment consisting of chemotherapy, radiotherapy and/or immunotherapy is advised for more advanced disease stages (stages IIb, III and IV). The role of surgery in these stages is limited to very specific indications. Regional treatment techniques are being introduced at a high speed because of improved technology and their possible advantages over traditional surgery. This review includes an overview of established and promising innovative invasive loco-regional techniques stratified based on the route of administration, including endobronchial, endovascular and transthoracic routes, a discussion of the results for each method, and an overview of their implementation and effectiveness.
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Affiliation(s)
- Erik Claes
- ASTARC (Antwerp Surgical Training, Anatomy and Research Centre), University Hospital Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
- Department of Thoracic and Vascular Surgery, University Hospital Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
| | - Reinier Wener
- Department of Pulmonology, University Hospital Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
| | - Arne P Neyrinck
- Department of Thoracic and Vascular Surgery, University Hospital Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
- Anesthesia and Algology Unit, Department of Cardiovascular Sciences, KU Leuven, 3000 Leuven, Belgium
| | - Axelle Coppens
- ASTARC (Antwerp Surgical Training, Anatomy and Research Centre), University Hospital Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
- Department of Thoracic and Vascular Surgery, University Hospital Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
| | - Paul E Van Schil
- ASTARC (Antwerp Surgical Training, Anatomy and Research Centre), University Hospital Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
- Department of Thoracic and Vascular Surgery, University Hospital Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
| | - Annelies Janssens
- Department of Thoracic Oncology, University Hospital Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
| | - Thérèse S Lapperre
- Department of Pulmonology, University Hospital Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
- LEMP (Laboratory of Experimental Medicine and Pediatrics), University Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - Annemiek Snoeckx
- Faculty of Medicine and Health Sciences, University Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium
- Department of Radiology, University Hospital Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
| | - Wen Wen
- Department of Thoracic and Vascular Surgery, University Hospital Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
| | - Hanne Voet
- Department of Pulmonology, University Hospital Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
- LEMP (Laboratory of Experimental Medicine and Pediatrics), University Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - Stijn E Verleden
- ASTARC (Antwerp Surgical Training, Anatomy and Research Centre), University Hospital Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
- Department of Thoracic and Vascular Surgery, University Hospital Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
- Department of Pulmonology, University Hospital Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
| | - Jeroen M H Hendriks
- ASTARC (Antwerp Surgical Training, Anatomy and Research Centre), University Hospital Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
- Department of Thoracic and Vascular Surgery, University Hospital Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
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14
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Verleden SE, Vanstapel A, Jacob J, Goos T, Hendriks J, Ceulemans LJ, Van Raemdonck DE, De Sadeleer L, Vos R, Kwakkel-van Erp JM, Neyrinck AP, Verleden GM, Boone MN, Janssens W, Wauters E, Weynand B, Jonigk DD, Verschakelen J, Wuyts WA. Radiologic and Histologic Correlates of Early Interstitial Lung Changes in Explanted Lungs. Radiology 2023; 307:e221145. [PMID: 36537894 PMCID: PMC7614383 DOI: 10.1148/radiol.221145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 10/13/2022] [Accepted: 11/04/2022] [Indexed: 12/24/2022]
Abstract
Background Interstitial lung abnormalities (ILAs) reflect imaging features on lung CT scans that are compatible with (early) interstitial lung disease. Despite accumulating evidence regarding the incidence, risk factors, and prognosis of ILAs, the histopathologic correlates of ILAs remain elusive. Purpose To determine the correlation between radiologic and histopathologic findings in CT-defined ILAs in human lung explants. Materials and Methods Explanted lungs or lobes from participants with radiologically documented ILAs were prospectively collected from 2010 to 2021. These specimens were air-inflated, frozen, and scanned with CT and micro-CT (spatial resolution of 0.7 mm and 90 μm, respectively). Subsequently, the lungs were cut and sampled with core biopsies. At least five samples per lung underwent micro-CT and subsequent histopathologic assessment with semiquantitative remodeling scorings. Based on area-specific radiologic scoring, the association between radiologic and histopathologic findings was assessed. Results Eight lung explants from six donors (median age at explantation, 71 years [range, 60-83 years]; four men) were included (unused donor lungs, n = 4; pre-emptive lobectomy for oncologic indications, n = 2). Ex vivo CT demonstrated ground-glass opacification, reticulation, and bronchiectasis. Micro-CT and histopathologic examination demonstrated that lung abnormalities were frequently paraseptal and associated with fibrosis and lymphocytic inflammation. The histopathologic results showed varying degrees of fibrosis in areas that appeared normal on CT scans. Regions of reticulation on CT scans generally had greater fibrosis at histopathologic analysis. Vasculopathy and bronchiectasis were also often present at histopathologic examination of lungs with ILAs. Fully developed fibroblastic foci were rarely observed. Conclusion This study demonstrated direct histologic correlates of CT-defined interstitial lung abnormalities. © RSNA, 2022 Supplemental material is available for this article. See also the editorial by Jeudy in this issue.
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Affiliation(s)
- Stijn E. Verleden
- From the Department of Chronic Diseases and Metabolism, BREATHE
(S.E.V., A.V., T.G., L.J.C., D.E.V.R., L.D.S., R.V., G.M.V., W.J., E.W.,
W.A.W.), Department of Cardiovascular Sciences (A.P.N.), and Department of
Imaging and Pathology (B.W., J.V.), KU Leuven, Herestraat 49, 3000 Leuven,
Belgium; Department of ASTARC, University of Antwerp, Antwerp, Belgium (S.E.V.,
J.H.); Department of Respiratory Medicine (S.E.V., J.M.K.v.E.) and Department of
Thoracic and Vascular Surgery (S.E.V., J.H.), University Hospital Antwerp,
Antwerp, Belgium; Department of Respiratory Medicine (J.J.) and Centre for
Medical Image Computing (J.J.), University College London, London, UK;
Department of Thoracic Surgery, University Hospital Leuven, Leuven, Belgium
(L.J.C., D.E.V.R.); Department of Physics and Astronomy, Ghent University,
Ghent, Belgium (M.N.B.); Institute of Pathology, Hannover Medical School,
Hannover, Germany (D.D.J.); and Biomedical Research in Endstage and Obstructive
Lung Disease Hannover (BREATH), Member of the German Center for Lung Research
(DZL), Hannover, Germany (D.D.J.)
| | - Arno Vanstapel
- From the Department of Chronic Diseases and Metabolism, BREATHE
(S.E.V., A.V., T.G., L.J.C., D.E.V.R., L.D.S., R.V., G.M.V., W.J., E.W.,
W.A.W.), Department of Cardiovascular Sciences (A.P.N.), and Department of
Imaging and Pathology (B.W., J.V.), KU Leuven, Herestraat 49, 3000 Leuven,
Belgium; Department of ASTARC, University of Antwerp, Antwerp, Belgium (S.E.V.,
J.H.); Department of Respiratory Medicine (S.E.V., J.M.K.v.E.) and Department of
Thoracic and Vascular Surgery (S.E.V., J.H.), University Hospital Antwerp,
Antwerp, Belgium; Department of Respiratory Medicine (J.J.) and Centre for
Medical Image Computing (J.J.), University College London, London, UK;
Department of Thoracic Surgery, University Hospital Leuven, Leuven, Belgium
(L.J.C., D.E.V.R.); Department of Physics and Astronomy, Ghent University,
Ghent, Belgium (M.N.B.); Institute of Pathology, Hannover Medical School,
Hannover, Germany (D.D.J.); and Biomedical Research in Endstage and Obstructive
Lung Disease Hannover (BREATH), Member of the German Center for Lung Research
(DZL), Hannover, Germany (D.D.J.)
| | - Joseph Jacob
- From the Department of Chronic Diseases and Metabolism, BREATHE
(S.E.V., A.V., T.G., L.J.C., D.E.V.R., L.D.S., R.V., G.M.V., W.J., E.W.,
W.A.W.), Department of Cardiovascular Sciences (A.P.N.), and Department of
Imaging and Pathology (B.W., J.V.), KU Leuven, Herestraat 49, 3000 Leuven,
Belgium; Department of ASTARC, University of Antwerp, Antwerp, Belgium (S.E.V.,
J.H.); Department of Respiratory Medicine (S.E.V., J.M.K.v.E.) and Department of
Thoracic and Vascular Surgery (S.E.V., J.H.), University Hospital Antwerp,
Antwerp, Belgium; Department of Respiratory Medicine (J.J.) and Centre for
Medical Image Computing (J.J.), University College London, London, UK;
Department of Thoracic Surgery, University Hospital Leuven, Leuven, Belgium
(L.J.C., D.E.V.R.); Department of Physics and Astronomy, Ghent University,
Ghent, Belgium (M.N.B.); Institute of Pathology, Hannover Medical School,
Hannover, Germany (D.D.J.); and Biomedical Research in Endstage and Obstructive
Lung Disease Hannover (BREATH), Member of the German Center for Lung Research
(DZL), Hannover, Germany (D.D.J.)
| | - Tinne Goos
- From the Department of Chronic Diseases and Metabolism, BREATHE
(S.E.V., A.V., T.G., L.J.C., D.E.V.R., L.D.S., R.V., G.M.V., W.J., E.W.,
W.A.W.), Department of Cardiovascular Sciences (A.P.N.), and Department of
Imaging and Pathology (B.W., J.V.), KU Leuven, Herestraat 49, 3000 Leuven,
Belgium; Department of ASTARC, University of Antwerp, Antwerp, Belgium (S.E.V.,
J.H.); Department of Respiratory Medicine (S.E.V., J.M.K.v.E.) and Department of
Thoracic and Vascular Surgery (S.E.V., J.H.), University Hospital Antwerp,
Antwerp, Belgium; Department of Respiratory Medicine (J.J.) and Centre for
Medical Image Computing (J.J.), University College London, London, UK;
Department of Thoracic Surgery, University Hospital Leuven, Leuven, Belgium
(L.J.C., D.E.V.R.); Department of Physics and Astronomy, Ghent University,
Ghent, Belgium (M.N.B.); Institute of Pathology, Hannover Medical School,
Hannover, Germany (D.D.J.); and Biomedical Research in Endstage and Obstructive
Lung Disease Hannover (BREATH), Member of the German Center for Lung Research
(DZL), Hannover, Germany (D.D.J.)
| | - Jeroen Hendriks
- From the Department of Chronic Diseases and Metabolism, BREATHE
(S.E.V., A.V., T.G., L.J.C., D.E.V.R., L.D.S., R.V., G.M.V., W.J., E.W.,
W.A.W.), Department of Cardiovascular Sciences (A.P.N.), and Department of
Imaging and Pathology (B.W., J.V.), KU Leuven, Herestraat 49, 3000 Leuven,
Belgium; Department of ASTARC, University of Antwerp, Antwerp, Belgium (S.E.V.,
J.H.); Department of Respiratory Medicine (S.E.V., J.M.K.v.E.) and Department of
Thoracic and Vascular Surgery (S.E.V., J.H.), University Hospital Antwerp,
Antwerp, Belgium; Department of Respiratory Medicine (J.J.) and Centre for
Medical Image Computing (J.J.), University College London, London, UK;
Department of Thoracic Surgery, University Hospital Leuven, Leuven, Belgium
(L.J.C., D.E.V.R.); Department of Physics and Astronomy, Ghent University,
Ghent, Belgium (M.N.B.); Institute of Pathology, Hannover Medical School,
Hannover, Germany (D.D.J.); and Biomedical Research in Endstage and Obstructive
Lung Disease Hannover (BREATH), Member of the German Center for Lung Research
(DZL), Hannover, Germany (D.D.J.)
| | - Laurens J. Ceulemans
- From the Department of Chronic Diseases and Metabolism, BREATHE
(S.E.V., A.V., T.G., L.J.C., D.E.V.R., L.D.S., R.V., G.M.V., W.J., E.W.,
W.A.W.), Department of Cardiovascular Sciences (A.P.N.), and Department of
Imaging and Pathology (B.W., J.V.), KU Leuven, Herestraat 49, 3000 Leuven,
Belgium; Department of ASTARC, University of Antwerp, Antwerp, Belgium (S.E.V.,
J.H.); Department of Respiratory Medicine (S.E.V., J.M.K.v.E.) and Department of
Thoracic and Vascular Surgery (S.E.V., J.H.), University Hospital Antwerp,
Antwerp, Belgium; Department of Respiratory Medicine (J.J.) and Centre for
Medical Image Computing (J.J.), University College London, London, UK;
Department of Thoracic Surgery, University Hospital Leuven, Leuven, Belgium
(L.J.C., D.E.V.R.); Department of Physics and Astronomy, Ghent University,
Ghent, Belgium (M.N.B.); Institute of Pathology, Hannover Medical School,
Hannover, Germany (D.D.J.); and Biomedical Research in Endstage and Obstructive
Lung Disease Hannover (BREATH), Member of the German Center for Lung Research
(DZL), Hannover, Germany (D.D.J.)
| | - Dirk E. Van Raemdonck
- From the Department of Chronic Diseases and Metabolism, BREATHE
(S.E.V., A.V., T.G., L.J.C., D.E.V.R., L.D.S., R.V., G.M.V., W.J., E.W.,
W.A.W.), Department of Cardiovascular Sciences (A.P.N.), and Department of
Imaging and Pathology (B.W., J.V.), KU Leuven, Herestraat 49, 3000 Leuven,
Belgium; Department of ASTARC, University of Antwerp, Antwerp, Belgium (S.E.V.,
J.H.); Department of Respiratory Medicine (S.E.V., J.M.K.v.E.) and Department of
Thoracic and Vascular Surgery (S.E.V., J.H.), University Hospital Antwerp,
Antwerp, Belgium; Department of Respiratory Medicine (J.J.) and Centre for
Medical Image Computing (J.J.), University College London, London, UK;
Department of Thoracic Surgery, University Hospital Leuven, Leuven, Belgium
(L.J.C., D.E.V.R.); Department of Physics and Astronomy, Ghent University,
Ghent, Belgium (M.N.B.); Institute of Pathology, Hannover Medical School,
Hannover, Germany (D.D.J.); and Biomedical Research in Endstage and Obstructive
Lung Disease Hannover (BREATH), Member of the German Center for Lung Research
(DZL), Hannover, Germany (D.D.J.)
| | - Laurens De Sadeleer
- From the Department of Chronic Diseases and Metabolism, BREATHE
(S.E.V., A.V., T.G., L.J.C., D.E.V.R., L.D.S., R.V., G.M.V., W.J., E.W.,
W.A.W.), Department of Cardiovascular Sciences (A.P.N.), and Department of
Imaging and Pathology (B.W., J.V.), KU Leuven, Herestraat 49, 3000 Leuven,
Belgium; Department of ASTARC, University of Antwerp, Antwerp, Belgium (S.E.V.,
J.H.); Department of Respiratory Medicine (S.E.V., J.M.K.v.E.) and Department of
Thoracic and Vascular Surgery (S.E.V., J.H.), University Hospital Antwerp,
Antwerp, Belgium; Department of Respiratory Medicine (J.J.) and Centre for
Medical Image Computing (J.J.), University College London, London, UK;
Department of Thoracic Surgery, University Hospital Leuven, Leuven, Belgium
(L.J.C., D.E.V.R.); Department of Physics and Astronomy, Ghent University,
Ghent, Belgium (M.N.B.); Institute of Pathology, Hannover Medical School,
Hannover, Germany (D.D.J.); and Biomedical Research in Endstage and Obstructive
Lung Disease Hannover (BREATH), Member of the German Center for Lung Research
(DZL), Hannover, Germany (D.D.J.)
| | - Robin Vos
- From the Department of Chronic Diseases and Metabolism, BREATHE
(S.E.V., A.V., T.G., L.J.C., D.E.V.R., L.D.S., R.V., G.M.V., W.J., E.W.,
W.A.W.), Department of Cardiovascular Sciences (A.P.N.), and Department of
Imaging and Pathology (B.W., J.V.), KU Leuven, Herestraat 49, 3000 Leuven,
Belgium; Department of ASTARC, University of Antwerp, Antwerp, Belgium (S.E.V.,
J.H.); Department of Respiratory Medicine (S.E.V., J.M.K.v.E.) and Department of
Thoracic and Vascular Surgery (S.E.V., J.H.), University Hospital Antwerp,
Antwerp, Belgium; Department of Respiratory Medicine (J.J.) and Centre for
Medical Image Computing (J.J.), University College London, London, UK;
Department of Thoracic Surgery, University Hospital Leuven, Leuven, Belgium
(L.J.C., D.E.V.R.); Department of Physics and Astronomy, Ghent University,
Ghent, Belgium (M.N.B.); Institute of Pathology, Hannover Medical School,
Hannover, Germany (D.D.J.); and Biomedical Research in Endstage and Obstructive
Lung Disease Hannover (BREATH), Member of the German Center for Lung Research
(DZL), Hannover, Germany (D.D.J.)
| | - Johanna M. Kwakkel-van Erp
- From the Department of Chronic Diseases and Metabolism, BREATHE
(S.E.V., A.V., T.G., L.J.C., D.E.V.R., L.D.S., R.V., G.M.V., W.J., E.W.,
W.A.W.), Department of Cardiovascular Sciences (A.P.N.), and Department of
Imaging and Pathology (B.W., J.V.), KU Leuven, Herestraat 49, 3000 Leuven,
Belgium; Department of ASTARC, University of Antwerp, Antwerp, Belgium (S.E.V.,
J.H.); Department of Respiratory Medicine (S.E.V., J.M.K.v.E.) and Department of
Thoracic and Vascular Surgery (S.E.V., J.H.), University Hospital Antwerp,
Antwerp, Belgium; Department of Respiratory Medicine (J.J.) and Centre for
Medical Image Computing (J.J.), University College London, London, UK;
Department of Thoracic Surgery, University Hospital Leuven, Leuven, Belgium
(L.J.C., D.E.V.R.); Department of Physics and Astronomy, Ghent University,
Ghent, Belgium (M.N.B.); Institute of Pathology, Hannover Medical School,
Hannover, Germany (D.D.J.); and Biomedical Research in Endstage and Obstructive
Lung Disease Hannover (BREATH), Member of the German Center for Lung Research
(DZL), Hannover, Germany (D.D.J.)
| | - Arne P. Neyrinck
- From the Department of Chronic Diseases and Metabolism, BREATHE
(S.E.V., A.V., T.G., L.J.C., D.E.V.R., L.D.S., R.V., G.M.V., W.J., E.W.,
W.A.W.), Department of Cardiovascular Sciences (A.P.N.), and Department of
Imaging and Pathology (B.W., J.V.), KU Leuven, Herestraat 49, 3000 Leuven,
Belgium; Department of ASTARC, University of Antwerp, Antwerp, Belgium (S.E.V.,
J.H.); Department of Respiratory Medicine (S.E.V., J.M.K.v.E.) and Department of
Thoracic and Vascular Surgery (S.E.V., J.H.), University Hospital Antwerp,
Antwerp, Belgium; Department of Respiratory Medicine (J.J.) and Centre for
Medical Image Computing (J.J.), University College London, London, UK;
Department of Thoracic Surgery, University Hospital Leuven, Leuven, Belgium
(L.J.C., D.E.V.R.); Department of Physics and Astronomy, Ghent University,
Ghent, Belgium (M.N.B.); Institute of Pathology, Hannover Medical School,
Hannover, Germany (D.D.J.); and Biomedical Research in Endstage and Obstructive
Lung Disease Hannover (BREATH), Member of the German Center for Lung Research
(DZL), Hannover, Germany (D.D.J.)
| | - Geert M. Verleden
- From the Department of Chronic Diseases and Metabolism, BREATHE
(S.E.V., A.V., T.G., L.J.C., D.E.V.R., L.D.S., R.V., G.M.V., W.J., E.W.,
W.A.W.), Department of Cardiovascular Sciences (A.P.N.), and Department of
Imaging and Pathology (B.W., J.V.), KU Leuven, Herestraat 49, 3000 Leuven,
Belgium; Department of ASTARC, University of Antwerp, Antwerp, Belgium (S.E.V.,
J.H.); Department of Respiratory Medicine (S.E.V., J.M.K.v.E.) and Department of
Thoracic and Vascular Surgery (S.E.V., J.H.), University Hospital Antwerp,
Antwerp, Belgium; Department of Respiratory Medicine (J.J.) and Centre for
Medical Image Computing (J.J.), University College London, London, UK;
Department of Thoracic Surgery, University Hospital Leuven, Leuven, Belgium
(L.J.C., D.E.V.R.); Department of Physics and Astronomy, Ghent University,
Ghent, Belgium (M.N.B.); Institute of Pathology, Hannover Medical School,
Hannover, Germany (D.D.J.); and Biomedical Research in Endstage and Obstructive
Lung Disease Hannover (BREATH), Member of the German Center for Lung Research
(DZL), Hannover, Germany (D.D.J.)
| | - Matthieu N. Boone
- From the Department of Chronic Diseases and Metabolism, BREATHE
(S.E.V., A.V., T.G., L.J.C., D.E.V.R., L.D.S., R.V., G.M.V., W.J., E.W.,
W.A.W.), Department of Cardiovascular Sciences (A.P.N.), and Department of
Imaging and Pathology (B.W., J.V.), KU Leuven, Herestraat 49, 3000 Leuven,
Belgium; Department of ASTARC, University of Antwerp, Antwerp, Belgium (S.E.V.,
J.H.); Department of Respiratory Medicine (S.E.V., J.M.K.v.E.) and Department of
Thoracic and Vascular Surgery (S.E.V., J.H.), University Hospital Antwerp,
Antwerp, Belgium; Department of Respiratory Medicine (J.J.) and Centre for
Medical Image Computing (J.J.), University College London, London, UK;
Department of Thoracic Surgery, University Hospital Leuven, Leuven, Belgium
(L.J.C., D.E.V.R.); Department of Physics and Astronomy, Ghent University,
Ghent, Belgium (M.N.B.); Institute of Pathology, Hannover Medical School,
Hannover, Germany (D.D.J.); and Biomedical Research in Endstage and Obstructive
Lung Disease Hannover (BREATH), Member of the German Center for Lung Research
(DZL), Hannover, Germany (D.D.J.)
| | - Wim Janssens
- From the Department of Chronic Diseases and Metabolism, BREATHE
(S.E.V., A.V., T.G., L.J.C., D.E.V.R., L.D.S., R.V., G.M.V., W.J., E.W.,
W.A.W.), Department of Cardiovascular Sciences (A.P.N.), and Department of
Imaging and Pathology (B.W., J.V.), KU Leuven, Herestraat 49, 3000 Leuven,
Belgium; Department of ASTARC, University of Antwerp, Antwerp, Belgium (S.E.V.,
J.H.); Department of Respiratory Medicine (S.E.V., J.M.K.v.E.) and Department of
Thoracic and Vascular Surgery (S.E.V., J.H.), University Hospital Antwerp,
Antwerp, Belgium; Department of Respiratory Medicine (J.J.) and Centre for
Medical Image Computing (J.J.), University College London, London, UK;
Department of Thoracic Surgery, University Hospital Leuven, Leuven, Belgium
(L.J.C., D.E.V.R.); Department of Physics and Astronomy, Ghent University,
Ghent, Belgium (M.N.B.); Institute of Pathology, Hannover Medical School,
Hannover, Germany (D.D.J.); and Biomedical Research in Endstage and Obstructive
Lung Disease Hannover (BREATH), Member of the German Center for Lung Research
(DZL), Hannover, Germany (D.D.J.)
| | - Els Wauters
- From the Department of Chronic Diseases and Metabolism, BREATHE
(S.E.V., A.V., T.G., L.J.C., D.E.V.R., L.D.S., R.V., G.M.V., W.J., E.W.,
W.A.W.), Department of Cardiovascular Sciences (A.P.N.), and Department of
Imaging and Pathology (B.W., J.V.), KU Leuven, Herestraat 49, 3000 Leuven,
Belgium; Department of ASTARC, University of Antwerp, Antwerp, Belgium (S.E.V.,
J.H.); Department of Respiratory Medicine (S.E.V., J.M.K.v.E.) and Department of
Thoracic and Vascular Surgery (S.E.V., J.H.), University Hospital Antwerp,
Antwerp, Belgium; Department of Respiratory Medicine (J.J.) and Centre for
Medical Image Computing (J.J.), University College London, London, UK;
Department of Thoracic Surgery, University Hospital Leuven, Leuven, Belgium
(L.J.C., D.E.V.R.); Department of Physics and Astronomy, Ghent University,
Ghent, Belgium (M.N.B.); Institute of Pathology, Hannover Medical School,
Hannover, Germany (D.D.J.); and Biomedical Research in Endstage and Obstructive
Lung Disease Hannover (BREATH), Member of the German Center for Lung Research
(DZL), Hannover, Germany (D.D.J.)
| | - Birgit Weynand
- From the Department of Chronic Diseases and Metabolism, BREATHE
(S.E.V., A.V., T.G., L.J.C., D.E.V.R., L.D.S., R.V., G.M.V., W.J., E.W.,
W.A.W.), Department of Cardiovascular Sciences (A.P.N.), and Department of
Imaging and Pathology (B.W., J.V.), KU Leuven, Herestraat 49, 3000 Leuven,
Belgium; Department of ASTARC, University of Antwerp, Antwerp, Belgium (S.E.V.,
J.H.); Department of Respiratory Medicine (S.E.V., J.M.K.v.E.) and Department of
Thoracic and Vascular Surgery (S.E.V., J.H.), University Hospital Antwerp,
Antwerp, Belgium; Department of Respiratory Medicine (J.J.) and Centre for
Medical Image Computing (J.J.), University College London, London, UK;
Department of Thoracic Surgery, University Hospital Leuven, Leuven, Belgium
(L.J.C., D.E.V.R.); Department of Physics and Astronomy, Ghent University,
Ghent, Belgium (M.N.B.); Institute of Pathology, Hannover Medical School,
Hannover, Germany (D.D.J.); and Biomedical Research in Endstage and Obstructive
Lung Disease Hannover (BREATH), Member of the German Center for Lung Research
(DZL), Hannover, Germany (D.D.J.)
| | - Danny D. Jonigk
- From the Department of Chronic Diseases and Metabolism, BREATHE
(S.E.V., A.V., T.G., L.J.C., D.E.V.R., L.D.S., R.V., G.M.V., W.J., E.W.,
W.A.W.), Department of Cardiovascular Sciences (A.P.N.), and Department of
Imaging and Pathology (B.W., J.V.), KU Leuven, Herestraat 49, 3000 Leuven,
Belgium; Department of ASTARC, University of Antwerp, Antwerp, Belgium (S.E.V.,
J.H.); Department of Respiratory Medicine (S.E.V., J.M.K.v.E.) and Department of
Thoracic and Vascular Surgery (S.E.V., J.H.), University Hospital Antwerp,
Antwerp, Belgium; Department of Respiratory Medicine (J.J.) and Centre for
Medical Image Computing (J.J.), University College London, London, UK;
Department of Thoracic Surgery, University Hospital Leuven, Leuven, Belgium
(L.J.C., D.E.V.R.); Department of Physics and Astronomy, Ghent University,
Ghent, Belgium (M.N.B.); Institute of Pathology, Hannover Medical School,
Hannover, Germany (D.D.J.); and Biomedical Research in Endstage and Obstructive
Lung Disease Hannover (BREATH), Member of the German Center for Lung Research
(DZL), Hannover, Germany (D.D.J.)
| | - Johny Verschakelen
- From the Department of Chronic Diseases and Metabolism, BREATHE
(S.E.V., A.V., T.G., L.J.C., D.E.V.R., L.D.S., R.V., G.M.V., W.J., E.W.,
W.A.W.), Department of Cardiovascular Sciences (A.P.N.), and Department of
Imaging and Pathology (B.W., J.V.), KU Leuven, Herestraat 49, 3000 Leuven,
Belgium; Department of ASTARC, University of Antwerp, Antwerp, Belgium (S.E.V.,
J.H.); Department of Respiratory Medicine (S.E.V., J.M.K.v.E.) and Department of
Thoracic and Vascular Surgery (S.E.V., J.H.), University Hospital Antwerp,
Antwerp, Belgium; Department of Respiratory Medicine (J.J.) and Centre for
Medical Image Computing (J.J.), University College London, London, UK;
Department of Thoracic Surgery, University Hospital Leuven, Leuven, Belgium
(L.J.C., D.E.V.R.); Department of Physics and Astronomy, Ghent University,
Ghent, Belgium (M.N.B.); Institute of Pathology, Hannover Medical School,
Hannover, Germany (D.D.J.); and Biomedical Research in Endstage and Obstructive
Lung Disease Hannover (BREATH), Member of the German Center for Lung Research
(DZL), Hannover, Germany (D.D.J.)
| | - Wim A. Wuyts
- From the Department of Chronic Diseases and Metabolism, BREATHE
(S.E.V., A.V., T.G., L.J.C., D.E.V.R., L.D.S., R.V., G.M.V., W.J., E.W.,
W.A.W.), Department of Cardiovascular Sciences (A.P.N.), and Department of
Imaging and Pathology (B.W., J.V.), KU Leuven, Herestraat 49, 3000 Leuven,
Belgium; Department of ASTARC, University of Antwerp, Antwerp, Belgium (S.E.V.,
J.H.); Department of Respiratory Medicine (S.E.V., J.M.K.v.E.) and Department of
Thoracic and Vascular Surgery (S.E.V., J.H.), University Hospital Antwerp,
Antwerp, Belgium; Department of Respiratory Medicine (J.J.) and Centre for
Medical Image Computing (J.J.), University College London, London, UK;
Department of Thoracic Surgery, University Hospital Leuven, Leuven, Belgium
(L.J.C., D.E.V.R.); Department of Physics and Astronomy, Ghent University,
Ghent, Belgium (M.N.B.); Institute of Pathology, Hannover Medical School,
Hannover, Germany (D.D.J.); and Biomedical Research in Endstage and Obstructive
Lung Disease Hannover (BREATH), Member of the German Center for Lung Research
(DZL), Hannover, Germany (D.D.J.)
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15
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Ram S, Verleden SE, Kumar M, Bell AJ, Pal R, Ordies S, Vanstapel A, Dubbeldam A, Vos R, Galban S, Ceulemans LJ, Frick AE, Van Raemdonck DE, Verschakelen J, Vanaudenaerde BM, Verleden GM, Lama VN, Neyrinck AP, Galban CJ. CT-based Machine Learning for Donor Lung Screening Prior to Transplantation. medRxiv 2023:2023.03.28.23287705. [PMID: 37034670 PMCID: PMC10081423 DOI: 10.1101/2023.03.28.23287705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Background Assessment and selection of donor lungs remains largely subjective and experience based. Criteria to accept or decline lungs are poorly standardized and are not compliant with the current donor pool. Using ex vivo CT images, we investigated the use of a CT-based machine learning algorithm for screening donor lungs prior to transplantation. Methods Clinical measures and ex-situ CT scans were collected from 100 cases as part of a prospective clinical trial. Following procurement, donor lungs were inflated, placed on ice according to routine clinical practice, and imaged using a clinical CT scanner prior to transplantation while stored in the icebox. We trained and tested a supervised machine learning method called dictionary learning , which uses CT scans and learns specific image patterns and features pertaining to each class for a classification task. The results were evaluated with donor and recipient clinical measures. Results Of the 100 lung pairs donated, 70 were considered acceptable for transplantation (based on standard clinical assessment) prior to CT screening and were consequently implanted. The remaining 30 pairs were screened but not transplanted. Our machine learning algorithm was able to detect pulmonary abnormalities on the CT scans. Among the patients who received donor lungs, our algorithm identified recipients who had extended stays in the ICU and were at 19 times higher risk of developing CLAD within 2 years post-transplant. Conclusions We have created a strategy to ex vivo screen donor lungs using a CT-based machine learning algorithm. As the use of suboptimal donor lungs rises, it is important to have in place objective techniques that will assist physicians in accurately screening donor lungs to identify recipients most at risk of post-transplant complications.
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Affiliation(s)
- Sundaresh Ram
- Department of Radiology, University of Michigan, Ann Arbor, MI, United States
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, United States
| | - Stijn E Verleden
- Lung Transplant Unit, Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
- Department of Imaging & Pathology, KU Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Madhav Kumar
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, United States
| | - Alexander J. Bell
- Department of Radiology, University of Michigan, Ann Arbor, MI, United States
| | - Ravi Pal
- Department of Radiology, University of Michigan, Ann Arbor, MI, United States
| | - Sofie Ordies
- Lung Transplant Unit, Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Arno Vanstapel
- Lung Transplant Unit, Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
- Department of Imaging & Pathology, KU Leuven, Leuven, Belgium
| | | | - Robin Vos
- Lung Transplant Unit, Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Stefanie Galban
- Department of Radiology, University of Michigan, Ann Arbor, MI, United States
| | - Laurens J. Ceulemans
- Lung Transplant Unit, Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Anna E. Frick
- Lung Transplant Unit, Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Dirk E. Van Raemdonck
- Lung Transplant Unit, Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | | | - Bart M. Vanaudenaerde
- Lung Transplant Unit, Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Geert M. Verleden
- Lung Transplant Unit, Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Vibha N Lama
- Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Arne P. Neyrinck
- Lung Transplant Unit, Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Craig J. Galban
- Department of Radiology, University of Michigan, Ann Arbor, MI, United States
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, United States
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16
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Frick AE, Orlitová M, Bleeser T, Vanstapel A, Claes S, Schols D, Mathyssen C, Ceulemans LJ, Vos R, Verleden GM, Vanaudenaerde BM, Verleden SE, Van Raemdonck DE, Neyrinck AP. Can we attenuate ischaemia-reperfusion injury of allografts in a porcine left lung transplant models by adsorption of cytokines? Eur J Cardiothorac Surg 2022; 63:6754812. [PMID: 36214633 DOI: 10.1093/ejcts/ezac483] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 09/09/2022] [Accepted: 10/07/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Primary graft dysfunction resulting from ischaemia-reperfusion injury remains a major obstacle after lung transplantation (LTx) and is associated with morbidity and mortality. Continuous release of inflammatory cytokines, due to the process of ischaemia and reperfusion, triggers a complex cascade of apoptosis and necrosis resulting in graft dysfunction. Previous studies demonstrated successful graft improvement by cytokine filtration during ex vivo lung perfusion. We hypothesize that plasma cytokine filtration with CytoSorb® during in vivo graft perfusion immediately after implantation may attenuate ischaemia-reperfusion injury after left LTx in a porcine model. METHODS Left porcine LTx was performed with allografts preserved for 24 h at 4°C. In the treatment group [T] (n = 7), a veno-venous shunt was created to insert the cytokine filter (CytoSorbents, Berlin, Germany). In the sham group [S] (n = 4), the shunt was created without the filter. Haemodynamic parameters, lung mechanics, blood gases and plasma cytokines were assessed during 6 h in vivo reperfusion. RESULTS During 6 h of reperfusion, significant differences in plasma pro-inflammatory cytokine [interferon (IFN)-α, IFN-γ and interleukin (IL)-6] concentrations were observed between [T] and [S], but surprisingly with higher plasma levels in the [T] group. Plasma concentrations of other pro-inflammatory cytokines (IL-1β, IL-12p40, IL-4, IL-6, IL-8, IFN-α, IFN-γ and tumour necrosis factor-α) and anti-inflammatory cytokines (IL-10) did not find any evidence for a difference. Furthermore, our study failed to show meaningful difference in haemodynamics and blood gases. Also, no statistically significant differences were found between [T] and [S] in biopsies and wet-to-dry ratio at the end of the experiment. CONCLUSIONS In our porcine left LTx model cytokine filtration did not achieve the intended effect. This is in contrast to previous studies with CytoSorb use during ex vivo lung perfusion as a surrogate LTx model. Our findings might highlight the fact that the theoretical benefit of inserting an additional cytokine adsorber to improve graft function in clinical practice should be critically evaluated with further studies.
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Affiliation(s)
| | | | - Tom Bleeser
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Arno Vanstapel
- Leuven Lung Transplant Unit, BREATHE, Department of Chronic Diseases and Metabolism (Chrometa), KU Leuven, Leuven, Belgium
| | - Sandra Claes
- Laboratory of Virology and Chemotherapy, Department of Microbiology and Immunology, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
| | - Dominique Schols
- Laboratory of Virology and Chemotherapy, Department of Microbiology and Immunology, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
| | - Carolien Mathyssen
- Leuven Lung Transplant Unit, BREATHE, Department of Chronic Diseases and Metabolism (Chrometa), KU Leuven, Leuven, Belgium
| | - Laurens J Ceulemans
- Leuven Lung Transplant Unit, BREATHE, Department of Chronic Diseases and Metabolism (Chrometa), KU Leuven, Leuven, Belgium.,Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Robin Vos
- Leuven Lung Transplant Unit, BREATHE, Department of Chronic Diseases and Metabolism (Chrometa), KU Leuven, Leuven, Belgium
| | - Geert M Verleden
- Leuven Lung Transplant Unit, BREATHE, Department of Chronic Diseases and Metabolism (Chrometa), KU Leuven, Leuven, Belgium
| | - Bart M Vanaudenaerde
- Leuven Lung Transplant Unit, BREATHE, Department of Chronic Diseases and Metabolism (Chrometa), KU Leuven, Leuven, Belgium
| | - Stijn E Verleden
- Department of ASTARC, University of Antwerp, Antwerp, Belgium.,Division of Pneumology, University Hospital Antwerp, Edegem, Belgium.,Division of Thoracic and Vascular Surgery, University Hospital Antwerp, Edegem, Belgium
| | - Dirk E Van Raemdonck
- Leuven Lung Transplant Unit, BREATHE, Department of Chronic Diseases and Metabolism (Chrometa), KU Leuven, Leuven, Belgium.,Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Arne P Neyrinck
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
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17
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Ackermann M, Kamp JC, Werlein C, Walsh CL, Stark H, Prade V, Surabattula R, Wagner WL, Disney C, Bodey AJ, Illig T, Leeming DJ, Karsdal MA, Tzankov A, Boor P, Kühnel MP, Länger FP, Verleden SE, Kvasnicka HM, Kreipe HH, Haverich A, Black SM, Walch A, Tafforeau P, Lee PD, Hoeper MM, Welte T, Seeliger B, David S, Schuppan D, Mentzer SJ, Jonigk DD. The fatal trajectory of pulmonary COVID-19 is driven by lobular ischemia and fibrotic remodelling. EBioMedicine 2022; 85:104296. [PMID: 36206625 PMCID: PMC9535314 DOI: 10.1016/j.ebiom.2022.104296] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/14/2022] [Accepted: 09/16/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND COVID-19 is characterized by a heterogeneous clinical presentation, ranging from mild symptoms to severe courses of disease. 9-20% of hospitalized patients with severe lung disease die from COVID-19 and a substantial number of survivors develop long-COVID. Our objective was to provide comprehensive insights into the pathophysiology of severe COVID-19 and to identify liquid biomarkers for disease severity and therapy response. METHODS We studied a total of 85 lungs (n = 31 COVID autopsy samples; n = 7 influenza A autopsy samples; n = 18 interstitial lung disease explants; n = 24 healthy controls) using the highest resolution Synchrotron radiation-based hierarchical phase-contrast tomography, scanning electron microscopy of microvascular corrosion casts, immunohistochemistry, matrix-assisted laser desorption ionization mass spectrometry imaging, and analysis of mRNA expression and biological pathways. Plasma samples from all disease groups were used for liquid biomarker determination using ELISA. The anatomic/molecular data were analyzed as a function of patients' hospitalization time. FINDINGS The observed patchy/mosaic appearance of COVID-19 in conventional lung imaging resulted from microvascular occlusion and secondary lobular ischemia. The length of hospitalization was associated with increased intussusceptive angiogenesis. This was associated with enhanced angiogenic, and fibrotic gene expression demonstrated by molecular profiling and metabolomic analysis. Increased plasma fibrosis markers correlated with their pulmonary tissue transcript levels and predicted disease severity. Plasma analysis confirmed distinct fibrosis biomarkers (TSP2, GDF15, IGFBP7, Pro-C3) that predicted the fatal trajectory in COVID-19. INTERPRETATION Pulmonary severe COVID-19 is a consequence of secondary lobular microischemia and fibrotic remodelling, resulting in a distinctive form of fibrotic interstitial lung disease that contributes to long-COVID. FUNDING This project was made possible by a number of funders. The full list can be found within the Declaration of interests / Acknowledgements section at the end of the manuscript.
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Affiliation(s)
- Maximilian Ackermann
- Institute of Pathology and Molecular Pathology, Helios University Clinic Wuppertal, University of Witten/Herdecke, Germany
- Institute of Functional and Clinical Anatomy, University Medical Center of the Johannes Gutenberg-University Mainz, Germany
| | - Jan C. Kamp
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
- Member of the German Center for Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
| | - Christopher Werlein
- Member of the German Center for Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
- Institute of Pathology, Hannover Medical School, Hannover, Germany
| | - Claire L. Walsh
- Centre for Advanced Biomedical Imaging, University College London, UK
| | - Helge Stark
- Member of the German Center for Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
- Institute of Pathology, Hannover Medical School, Hannover, Germany
| | - Verena Prade
- Research Unit Analytical Pathology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
| | - Rambabu Surabattula
- Institute of Translational Immunology and Research Center for Immune Therapy, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Willi L. Wagner
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
- Member of the German Center for Lung Research (DZL), Translational Lung Research Center Heidelberg (TLRC), Heidelberg, Germany
| | - Catherine Disney
- Department of Mechanical Engineering, University College London, UK
| | | | - Thomas Illig
- Member of the German Center for Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
- Hannover Unified Biobank, Hannover Medical School, Hannover Medical School, Germany
| | - Diana J. Leeming
- Hannover Unified Biobank, Hannover Medical School, Hannover Medical School, Germany
| | | | - Alexandar Tzankov
- Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
| | - Peter Boor
- Institute of Pathology, RWTH Aachen University Hospital, Aachen, Germany
| | - Mark P. Kühnel
- Member of the German Center for Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
- Institute of Pathology, Hannover Medical School, Hannover, Germany
| | - Florian P. Länger
- Member of the German Center for Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
- Institute of Pathology, Hannover Medical School, Hannover, Germany
| | - Stijn E. Verleden
- Department of Thoracic Surgery, University Hospital Antwerp Edegem, Belgium
| | - Hans M. Kvasnicka
- Institute of Pathology and Molecular Pathology, Helios University Clinic Wuppertal, University of Witten/Herdecke, Germany
| | - Hans H. Kreipe
- Institute of Pathology, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Member of the German Center for Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
- Department of Cardiothoracic, Transplantation, and Vascular Surgery, Hannover Medical School, Germany
| | - Stephen M. Black
- Department of Cellular Biology and Pharmacology, Center for Translational Research, Florida International University, USA
| | - Axel Walch
- Nordic Bioscience Biomarkers and Research, Herlev, Denmark
| | - Paul Tafforeau
- European Synchrotron Radiation Facility, Grenoble, France
| | - Peter D. Lee
- Hannover Unified Biobank, Hannover Medical School, Hannover Medical School, Germany
| | - Marius M. Hoeper
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
- Member of the German Center for Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
| | - Tobias Welte
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
- Member of the German Center for Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
| | - Benjamin Seeliger
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
- Member of the German Center for Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
| | - Sascha David
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Detlef Schuppan
- Institute of Translational Immunology and Research Center for Immune Therapy, University Medical Center, Johannes Gutenberg University, Mainz, Germany
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Steven J. Mentzer
- Laboratory of Adaptive and Regenerative Biology, Harvard Medical School, Brigham & Women's Hospital, Boston, United States
| | - Danny D. Jonigk
- Member of the German Center for Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
- Institute of Pathology, Hannover Medical School, Hannover, Germany
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18
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Verleden GM, Vos R, Godinas L, Verleden SE, Van Raemdonck DE, Ceulemans LJ. Natural decline in pulmonary function following bilateral lung transplantation: a single-center study. Eur Respir J 2022; 60:13993003.00633-2022. [DOI: 10.1183/13993003.00633-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 08/11/2022] [Indexed: 11/05/2022]
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19
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Xian RP, Walsh CL, Verleden SE, Wagner WL, Bellier A, Marussi S, Ackermann M, Jonigk DD, Jacob J, Lee PD, Tafforeau P. A multiscale X-ray phase-contrast tomography dataset of a whole human left lung. Sci Data 2022; 9:264. [PMID: 35654864 PMCID: PMC9163096 DOI: 10.1038/s41597-022-01353-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 05/03/2022] [Indexed: 11/09/2022] Open
Abstract
Technological advancements in X-ray imaging using bright and coherent synchrotron sources now allows the decoupling of sample size and resolution while maintaining high sensitivity to the microstructures of soft, partially dehydrated tissues. The continuous developments in multiscale X-ray imaging resulted in hierarchical phase-contrast tomography, a comprehensive approach to address the challenge of organ-scale (up to tens of centimeters) soft tissue imaging with resolution and sensitivity down to the cellular level. Using this technique, we imaged ex vivo an entire human left lung at an isotropic voxel size of 25.08 μm along with local zooms down to 6.05-6.5 μm and 2.45-2.5 μm in voxel size. The high tissue contrast offered by the fourth-generation synchrotron source at the European Synchrotron Radiation Facility reveals the complex multiscale anatomical constitution of the human lung from the macroscopic (centimeter) down to the microscopic (micrometer) scale. The dataset provides comprehensive organ-scale 3D information of the secondary pulmonary lobules and delineates the microstructure of lung nodules with unprecedented detail.
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Affiliation(s)
- R Patrick Xian
- Department of Mechanical Engineering, University College London, London, UK.
| | - Claire L Walsh
- Department of Mechanical Engineering, University College London, London, UK
| | - Stijn E Verleden
- Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), University of Antwerp, Wilrijk, Belgium
| | - Willi L Wagner
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
- Translational Lung Research Centre Heidelberg (TLRC), German Lung Research Centre (DZL), Heidelberg, Germany
| | - Alexandre Bellier
- Laboratoire d'Anatomie des Alpes Françaises (LADAF), Université Grenoble Alpes, Grenoble, France
| | - Sebastian Marussi
- Department of Mechanical Engineering, University College London, London, UK
| | - Maximilian Ackermann
- Institute of Pathology and Molecular Pathology, Helios University Clinic Wuppertal, University of Witten/Herdecke, Wuppertal, Germany
- Institute of Functional and Clinical Anatomy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Danny D Jonigk
- Institute of Pathology, Hannover Medical School, Hannover, Germany
- Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH), German Lung Research Centre (DZL), Hannover, Germany
| | - Joseph Jacob
- Centre for Medical Image Computing, University College London, London, UK
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Peter D Lee
- Department of Mechanical Engineering, University College London, London, UK.
| | - Paul Tafforeau
- European Synchrotron Radiation Facility, Grenoble, France.
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20
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De Sadeleer LJ, Verleden SE, Schupp JC, McDonough JE, Goos T, Yserbyt J, Bargagli E, Rottoli P, Kaminski N, Prasse A, Wuyts WA. BAL Transcriptomes Characterize Idiopathic Pulmonary Fibrosis Endotypes With Prognostic Impact. Chest 2022; 161:1576-1588. [PMID: 35063449 PMCID: PMC9424328 DOI: 10.1016/j.chest.2021.12.668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 12/06/2021] [Accepted: 12/27/2021] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Given the plethora of pathophysiologic mechanisms described in idiopathic pulmonary fibrosis (IPF), we hypothesize that the mechanisms driving fibrosis in IPF may be different from one patient to another. RESEARCH QUESTION Do IPF endotypes exist and are they associated with outcome? STUDY DESIGN AND METHODS Using a publicly available gene expression dataset retrieved from BAL samples of patients with IPF and control participants (GSE70867), we clustered IPF samples based on a dimension reduction algorithm specifically designed for -omics data, called DDR Tree. After clustering, gene set enrichment analysis was performed for functional annotation, associations with clinical variables and prognosis were investigated, and differences in transcriptional regulation were determined using motif enrichment analysis. The findings were validated in three independent publicly available gene expression datasets retrieved from IPF blood samples. RESULTS One hundred seventy-six IPF samples from three centers were clustered in six IPF clusters, with distinct functional enrichment. Although clinical characteristics did not differ between the clusters, one cluster conferred worse sex-age-physiology score-corrected survival, whereas another showed a numeric trend toward worse survival (P = .08). The first was enriched for increased epithelial and innate and adaptive immunity signatures, whereas the other showed important telomere and mitochondrial dysfunction, loss of proteostasis, and increased myofibroblast signatures. The existence of these two endotypes, including the impact on survival of the immune endotype, was validated in three independent validation cohorts. Finally, we identified transcription factors regulating the expression of endotype-specific survival-associated genes. INTERPRETATION Gene expression-based endotyping in IPF is feasible and can inform clinical evolution. As endotype-specific pathways and survival-associated transcription factors are identified, endotyping may open up the possibility of endotype-tailored therapy.
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Affiliation(s)
- Laurens J De Sadeleer
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department CHROMETA, KU Leuven, Leuven, Belgium; Unit of Interstitial Lung Diseases, Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium.
| | - Stijn E Verleden
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department CHROMETA, KU Leuven, Leuven, Belgium; Antwerp Surgical Training, Anatomy and Research Centre, Antwerp University, Antwerp, Belgium
| | - Jonas C Schupp
- Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, CT; Department of Pulmonology, Hannover Medical School, Hannover, Germany
| | - John E McDonough
- Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, CT
| | - Tinne Goos
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department CHROMETA, KU Leuven, Leuven, Belgium; Unit of Interstitial Lung Diseases, Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Jonas Yserbyt
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department CHROMETA, KU Leuven, Leuven, Belgium
| | - Elena Bargagli
- Respiratory Diseases and Lung Transplantation Unit, AOUS and Siena University, Siena, Italy
| | - Paola Rottoli
- Specialization School in Respiratory Diseases, Siena University, Siena, Italy
| | - Naftali Kaminski
- Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, CT
| | - Antje Prasse
- Department of Pulmonology, Hannover Medical School, Hannover, Germany; Fraunhofer Institute for Toxicology and Experimental Medicine, Hannover, Germany; German Centre for Lung Research, BREATH, Hannover, Germany; Department of Pneumology, University Medical Centre, Freiburg, Germany
| | - Wim A Wuyts
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department CHROMETA, KU Leuven, Leuven, Belgium; Unit of Interstitial Lung Diseases, Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
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21
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Goos T, Verleden SE, De Sadeleer LJ, Van Herck A, Sacreas A, Vanstapel A, Kaes J, Geudens V, Aelbrecht C, Ruttens D, Lambrechts D, Vermeer S, Ceulemans LJ, Van Raemdonck DE, Godinas L, Yserbyt J, Vanaudenaerde BM, Verleden GM, Vos R, Wuyts WA. The MUC5B Promoter Polymorphism is Not Associated With Non-ILD Chronic Respiratory Diseases or Post-transplant Outcome. Transpl Int 2022; 35:10159. [PMID: 35651878 PMCID: PMC9149783 DOI: 10.3389/ti.2022.10159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 03/17/2022] [Indexed: 11/05/2022]
Abstract
The MUC5B promoter polymorphism (rs35705950) has been associated with interstitial lung disease (ILD) and with prolonged pre-transplant survival in idiopathic pulmonary fibrosis (IPF), but no information is available regarding its prevalence in other respiratory diseases and its influence on post-transplant outcome. We included the Leuven lung transplantation cohort between 1991 and 2015 (n = 801). We assessed the minor allele frequency (MAF) of the MUC5B variant in the entire study cohort and investigated the influence of recipient MUC5B promoter polymorphism on post-transplant outcome in patients who were transplanted after 2004. MUC5B was successfully genotyped in 746 patients. The MAF was significantly higher in ILD (17.6%) compared to chronic obstructive pulmonary disease (COPD)/emphysema (9.3%), cystic fibrosis (CF)/bronchiectasis (BRECT) (7.5%) and pulmonary hypertension (PHT) (7.4%) (p < 0.001). No association was observed between rs35705950 and chronic lung allograft dysfunction (CLAD)/graft loss in the ILD population [CLAD: HR 1.37 95% CI (0.70-2.68); graft loss: HR 1.02 95% CI (0.55-1.89)], nor the entire study cohort [CLAD: HR 0.96 95% CI (0.69-1.34); graft loss: HR 0.97 95% CI (0.70-1.35)]. The MUC5B promoter polymorphism is a very specific predictive factor for the presence of pulmonary fibrosis as it is only associated with pulmonary fibrosis and not with other chronic respiratory diseases. While the MUC5B promoter variant is associated with better pre-transplant survival among IPF patients, recipient MUC5B promoter variant does not play a role in post-transplant outcome.
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Affiliation(s)
- Tinne Goos
- BREATHE, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Stijn E. Verleden
- BREATHE, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
- Department of ASTARC, University of Antwerp, Edegem, Belgium
- Department of Respiratory Medicine, University Hospital Antwerp, Edegem, Belgium
- Department of Thoracic and Vascular Surgery, University Hospital Antwerp, Edegem, Belgium
| | | | - Anke Van Herck
- BREATHE, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Annelore Sacreas
- BREATHE, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Arno Vanstapel
- BREATHE, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Janne Kaes
- BREATHE, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Vincent Geudens
- BREATHE, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Celine Aelbrecht
- BREATHE, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - David Ruttens
- Department of Pulmonary Medicine, Ziekenhuis Oost Limburg, Genk, Belgium
- Department of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Diether Lambrechts
- Center for Cancer Biology, VIB, Leuven, Belgium
- Laboratory of Translational Genetics, Department of Human Genetics, KU Leuven, Leuven, Belgium
| | - Sascha Vermeer
- Center for Human Genetics, University Hospitals Leuven, Leuven, Belgium
| | - Laurens J. Ceulemans
- BREATHE, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Dirk E. Van Raemdonck
- BREATHE, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Laurent Godinas
- BREATHE, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
- Department of Respiratory Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Jonas Yserbyt
- BREATHE, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
- Department of Respiratory Medicine, University Hospitals Leuven, Leuven, Belgium
| | | | - Geert M. Verleden
- BREATHE, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
- Department of Respiratory Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Robin Vos
- BREATHE, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
- Department of Respiratory Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Wim A. Wuyts
- BREATHE, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
- Department of Respiratory Medicine, University Hospitals Leuven, Leuven, Belgium
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22
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Vandervelde CM, Vos R, Vanluyten C, Fieuws S, Verleden SE, Van Slambrouck J, De Leyn P, Coosemans W, Nafteux P, Decaluwé H, Van Veer H, Depypere L, Dauwe DF, De Troy E, Ingels CM, Neyrinck AP, Jochmans I, Vanaudenaerde BM, Godinas L, Verleden GM, Van Raemdonck DE, Ceulemans LJ. Impact of anastomosis time during lung transplantation on primary graft dysfunction. Am J Transplant 2022; 22:1418-1429. [PMID: 35029023 DOI: 10.1111/ajt.16957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 01/07/2022] [Accepted: 01/08/2022] [Indexed: 01/25/2023]
Abstract
Primary graft dysfunction (PGD) is a major obstacle after lung transplantation (LTx), associated with increased early morbidity and mortality. Studies in liver and kidney transplantation revealed prolonged anastomosis time (AT) as an independent risk factor for impaired short- and long-term outcomes. We investigated if AT during LTx is a risk factor for PGD. In this retrospective single-center cohort study, we included all first double lung transplantations between 2008 and 2016. The association of AT with any PGD grade 3 (PGD3) within the first 72 h post-transplant was analyzed by univariable and multivariable logistic regression analysis. Data on AT and PGD was available for 427 patients of which 130 (30.2%) developed PGD3. AT was independently associated with the development of any PGD3 ≤72 h in uni- (odds ratio [OR] per 10 min 1.293, 95% confidence interval [CI 1.136-1.471], p < .0001) and multivariable (OR 1.205, 95% CI [1.022-1.421], p = .03) logistic regression analysis. There was no evidence that the relation between AT and PGD3 differed between lung recipients from donation after brain death versus donation after circulatory death donors. This study identified AT as an independent risk factor for the development of PGD3 post-LTx. We suggest that the implantation time should be kept short and the lung cooled to decrease PGD-related morbidity and mortality post-LTx.
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Affiliation(s)
| | - Robin Vos
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium.,Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Cedric Vanluyten
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Steffen Fieuws
- Department of Public Health, Interuniversity Centre for Biostatistics and Statistical Bioinformatics, KU Leuven, Leuven, Belgium
| | - Stijn E Verleden
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Jan Van Slambrouck
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.,Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Paul De Leyn
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.,Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Willy Coosemans
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.,Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Philippe Nafteux
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.,Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Herbert Decaluwé
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.,Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Hans Van Veer
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.,Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Lieven Depypere
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.,Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Dieter F Dauwe
- Department of Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Erwin De Troy
- Department of Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Catherine M Ingels
- Department of Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Arne P Neyrinck
- Department of Cardiovascular Sciences, KU Leuven University, Leuven, Belgium.,Department of Anesthesiology, University Hospitals Leuven, Leuven, Belgium
| | - Ina Jochmans
- Transplantation Group, Lab Abdominal Transplant Surgery, Department of Microbiology, Immunology, and Transplantation, KU Leuven, Leuven, Belgium.,Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Bart M Vanaudenaerde
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Laurent Godinas
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Geert M Verleden
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium.,Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Dirk E Van Raemdonck
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.,Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Laurens J Ceulemans
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.,Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
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23
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Xu F, Vasilescu DM, Kinose D, Tanabe N, Ng KW, Coxson HO, Cooper JD, Hackett TL, Verleden SE, Vanaudenaerde BM, Stevenson CS, Lenburg ME, Spira A, Tan WC, Sin DD, Ng RT, Hogg JC. The molecular and cellular mechanisms associated with the destruction of terminal bronchioles in COPD. Eur Respir J 2022; 59:2101411. [PMID: 34675046 DOI: 10.1183/13993003.01411-2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 09/27/2021] [Indexed: 11/05/2022]
Abstract
RATIONALE Peripheral airway obstruction is a key feature of chronic obstructive pulmonary disease (COPD), but the mechanisms of airway loss are unknown. This study aims to identify the molecular and cellular mechanisms associated with peripheral airway obstruction in COPD. METHODS Ten explanted lung specimens donated by patients with very severe COPD treated by lung transplantation and five unused donor control lungs were sampled using systematic uniform random sampling (SURS), resulting in 240 samples. These samples were further examined by micro-computed tomography (CT), quantitative histology and gene expression profiling. RESULTS Micro-CT analysis showed that the loss of terminal bronchioles in COPD occurs in regions of microscopic emphysematous destruction with an average airspace size of ≥500 and <1000 µm, which we have termed a "hot spot". Based on microarray gene expression profiling, the hot spot was associated with an 11-gene signature, with upregulation of pro-inflammatory genes and downregulation of inhibitory immune checkpoint genes, indicating immune response activation. Results from both quantitative histology and the bioinformatics computational tool CIBERSORT, which predicts the percentage of immune cells in tissues from transcriptomic data, showed that the hot spot regions were associated with increased infiltration of CD4 and CD8 T-cell and B-cell lymphocytes. INTERPRETATION The reduction in terminal bronchioles observed in lungs from patients with COPD occurs in a hot spot of microscopic emphysema, where there is upregulation of IFNG signalling, co-stimulatory immune checkpoint genes and genes related to the inflammasome pathway, and increased infiltration of immune cells. These could be potential targets for therapeutic interventions in COPD.
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Affiliation(s)
- Feng Xu
- The Centre for Heart Lung Innovation, The University of British Columbia, located at St Paul's Hospital, Vancouver, BC, Canada
| | - Dragoş M Vasilescu
- The Centre for Heart Lung Innovation, The University of British Columbia, located at St Paul's Hospital, Vancouver, BC, Canada
| | - Daisuke Kinose
- The Centre for Heart Lung Innovation, The University of British Columbia, located at St Paul's Hospital, Vancouver, BC, Canada
- Division of Respiratory Medicine, Department of Medicine, Shiga University of Medical Science, Shiga, Japan
| | - Naoya Tanabe
- The Centre for Heart Lung Innovation, The University of British Columbia, located at St Paul's Hospital, Vancouver, BC, Canada
- Dept of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | | | - Harvey O Coxson
- The Centre for Heart Lung Innovation, The University of British Columbia, located at St Paul's Hospital, Vancouver, BC, Canada
| | - Joel D Cooper
- Division of Thoracic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Tillie-Louise Hackett
- The Centre for Heart Lung Innovation, The University of British Columbia, located at St Paul's Hospital, Vancouver, BC, Canada
| | - Stijn E Verleden
- Laboratory of Respiratory Diseases, BREATHE, Dept of CHROMETA, KU Leuven, Leuven, Belgium
| | | | | | - Marc E Lenburg
- Division of Computational Biomedicine, Dept of Medicine, Boston University, Boston, MA, USA
| | - Avrum Spira
- Division of Computational Biomedicine, Dept of Medicine, Boston University, Boston, MA, USA
| | - Wan C Tan
- The Centre for Heart Lung Innovation, The University of British Columbia, located at St Paul's Hospital, Vancouver, BC, Canada
| | - Don D Sin
- The Centre for Heart Lung Innovation, The University of British Columbia, located at St Paul's Hospital, Vancouver, BC, Canada
| | - Raymond T Ng
- The Centre for Heart Lung Innovation, The University of British Columbia, located at St Paul's Hospital, Vancouver, BC, Canada
- Dept of Computer Science, The University of British Columbia, Vancouver, BC, Canada
| | - James C Hogg
- The Centre for Heart Lung Innovation, The University of British Columbia, located at St Paul's Hospital, Vancouver, BC, Canada
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24
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Verleden SE, Braubach P, Werlein C, Plucinski E, Kuhnel MP, Snoeckx A, El Addouli H, Welte T, Haverich A, Laenger FP, Dettmer S, Pauwels P, Verplancke V, Van Schil PE, Lapperre T, Kwakkel-Van-Erp JM, Ackermann M, Hendriks JMH, Jonigk D. From Macroscopy to Ultrastructure: An Integrative Approach to Pulmonary Pathology. Front Med (Lausanne) 2022; 9:859337. [PMID: 35372395 PMCID: PMC8965844 DOI: 10.3389/fmed.2022.859337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 02/07/2022] [Indexed: 11/30/2022] Open
Abstract
Pathology and radiology are complimentary tools, and their joint application is often crucial in obtaining an accurate diagnosis in non-neoplastic pulmonary diseases. However, both come with significant limitations of their own: Computed Tomography (CT) can only visualize larger structures due to its inherent–relatively–poor resolution, while (histo) pathology is often limited due to small sample size and sampling error and only allows for a 2D investigation. An innovative approach of inflating whole lung specimens and subjecting these subsequently to CT and whole lung microCT allows for an accurate matching of CT-imaging and histopathology data of exactly the same areas. Systematic application of this approach allows for a more targeted assessment of localized disease extent and more specifically can be used to investigate early mechanisms of lung diseases on a morphological and molecular level. Therefore, this technique is suitable to selectively investigate changes in the large and small airways, as well as the pulmonary arteries, veins and capillaries in relation to the disease extent in the same lung specimen. In this perspective we provide an overview of the different strategies that are currently being used, as well as how this growing field could further evolve.
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Affiliation(s)
- Stijn E. Verleden
- Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Antwerp University, Antwerp, Belgium
- Division of Pneumology, University Hospital Antwerp, Edegem, Belgium
- Department of Thoracic and Vascular Surgery, University Hospital Antwerp, Edegem, Belgium
| | - Peter Braubach
- Member of the German Center for Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
- Institute for Pathology, Hannover Medical School, Hannover, Germany
| | | | - Edith Plucinski
- Member of the German Center for Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
- Institute for Pathology, Hannover Medical School, Hannover, Germany
| | - Mark P. Kuhnel
- Member of the German Center for Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
- Institute for Pathology, Hannover Medical School, Hannover, Germany
| | - Annemiek Snoeckx
- Division of Radiology, University Hospital Antwerp and University of Antwerp, Edegem, Belgium
| | - Haroun El Addouli
- Division of Radiology, University Hospital Antwerp and University of Antwerp, Edegem, Belgium
| | - Tobias Welte
- Member of the German Center for Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
- Division of Pneumology, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Member of the German Center for Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
- Division of Thoracic Surgery, Hannover Medical School, Hannover, Germany
| | - Florian P. Laenger
- Member of the German Center for Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
- Institute for Pathology, Hannover Medical School, Hannover, Germany
| | - Sabine Dettmer
- Member of the German Center for Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
- Department of Radiology, Hannover Medical School, Hannover, Germany
| | - Patrick Pauwels
- Division of Pathology, University Hospital Antwerp, Edegem, Belgium
| | | | - Paul E. Van Schil
- Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Antwerp University, Antwerp, Belgium
- Department of Thoracic and Vascular Surgery, University Hospital Antwerp, Edegem, Belgium
| | - Therese Lapperre
- Division of Pneumology, University Hospital Antwerp, Edegem, Belgium
- Laboratory of Experimental Medicine and Pediatrics (LEMP), Antwerp University, Antwerp, Belgium
| | - Johanna M. Kwakkel-Van-Erp
- Division of Pneumology, University Hospital Antwerp, Edegem, Belgium
- Laboratory of Experimental Medicine and Pediatrics (LEMP), Antwerp University, Antwerp, Belgium
| | - Maximilian Ackermann
- Institute of Pathology and Department of Molecular Pathology, Helios University Clinic Wuppertal, University of Witten-Herdecke, Witten, Germany
- Institute of Functional and Clinical Anatomy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Jeroen M. H. Hendriks
- Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Antwerp University, Antwerp, Belgium
- Department of Thoracic and Vascular Surgery, University Hospital Antwerp, Edegem, Belgium
| | - Danny Jonigk
- Member of the German Center for Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
- Institute for Pathology, Hannover Medical School, Hannover, Germany
- *Correspondence: Danny Jonigk
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25
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Einarsson GG, Vanaudenaerde BM, Spence CD, Lee AJ, Boon M, Verleden GM, Elborn JS, Dupont LJ, Van Raemdonck D, Gilpin DF, Vos R, Verleden SE, Tunney MM. Microbial Community Composition in Explanted Cystic Fibrosis and Control Donor Lungs. Front Cell Infect Microbiol 2022; 11:764585. [PMID: 35368453 PMCID: PMC8966769 DOI: 10.3389/fcimb.2021.764585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 12/13/2021] [Indexed: 11/13/2022] Open
Abstract
To date, investigations of the microbiota in the lungs of people with Cystic Fibrosis (PWCF) have primarily focused on microbial community composition in luminal mucus, with fewer studies observing the microbiota in tissue samples from explanted lung tissue. Here, we analysed both tissue and airway luminal mucus samples extracted from whole explanted lungs of PWCF and unused donor lungs. We determined if the lung microbiota in end-stage CF varied within and between patients, was spatially heterogeneous and related to localized structural damage. Microbial community composition was determined by Illumina MiSeq sequencing and related to the CF-Computed Tomography (CT) score and features of end-stage lung disease on micro-CT. Ninety-eight CF tissue (n=11 patients), 20 CF luminal mucus (n=8 patients) and 33 donor tissue (n=4 patients) samples were analysed. Additionally, we compared 20 paired CF tissue and luminal mucus samples that enabled a direct “geographical” comparison of the microbiota in these two niches. Significant differences in microbial communities were apparent between the 3 groups. However, overlap between the three groups, particularly between CF and donor tissue and CF tissue and CF luminal mucus was also observed. Microbial diversity was lower in CF luminal mucus compared to CF tissue, with dominance higher in luminal mucus. For both CF and donor tissue, intra- and inter-patient variability in ecological parameters was observed. No relationships were observed between ecological parameters and CF-CT score, or features of end-stage lung disease. The end-stage CF lung is characterised by a low diversity microbiota, differing within and between individuals. No clear relationship was observed between regional microbiota variation and structural lung damage.
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Affiliation(s)
- Gisli G. Einarsson
- Halo Research Group, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, United Kingdom
- *Correspondence: Gisli G. Einarsson,
| | - Bart M. Vanaudenaerde
- Leuven Lung Transplant Unit, Department of Chronic Diseases, Metabolism and Ageing, KU Leuven, Leuven, Belgium
| | - Christopher D. Spence
- Halo Research Group, School of Pharmacy, Queen’s University Belfast, Belfast, United Kingdom
| | - Andrew J. Lee
- Halo Research Group, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, United Kingdom
| | - Mieke Boon
- Department of Pediatics, Cystic Fibrosis Center, UZ Leuven, Leuven, Belgium
| | - Geert M. Verleden
- Leuven Lung Transplant Unit, Department of Chronic Diseases, Metabolism and Ageing, KU Leuven, Leuven, Belgium
| | - J. Stuart Elborn
- Halo Research Group, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, United Kingdom
| | - Lieven J. Dupont
- Leuven Lung Transplant Unit, Department of Chronic Diseases, Metabolism and Ageing, KU Leuven, Leuven, Belgium
| | - Dirk Van Raemdonck
- Leuven Lung Transplant Unit, Department of Chronic Diseases, Metabolism and Ageing, KU Leuven, Leuven, Belgium
| | - Deirdre F. Gilpin
- Halo Research Group, School of Pharmacy, Queen’s University Belfast, Belfast, United Kingdom
| | - Robin Vos
- Leuven Lung Transplant Unit, Department of Chronic Diseases, Metabolism and Ageing, KU Leuven, Leuven, Belgium
| | - Stijn E. Verleden
- Leuven Lung Transplant Unit, Department of Chronic Diseases, Metabolism and Ageing, KU Leuven, Leuven, Belgium
- Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), University of Antwerp (UA), Wilrijk, Belgium
- Department of Thoracic & Vascular Surgery, University Hospital Antwerp (UZA), Edegem, Belgium
- Department of Pneumology, University Hospital Antwerp (UZA), Edegem, Belgium
| | - Michael M. Tunney
- Halo Research Group, School of Pharmacy, Queen’s University Belfast, Belfast, United Kingdom
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26
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Günes Günsel G, Conlon TM, Jeridi A, Kim R, Ertüz Z, Lang NJ, Ansari M, Novikova M, Jiang D, Strunz M, Gaianova M, Hollauer C, Gabriel C, Angelidis I, Doll S, Pestoni JC, Edelmann SL, Kohlhepp MS, Guillot A, Bassler K, Van Eeckhoutte HP, Kayalar Ö, Konyalilar N, Kanashova T, Rodius S, Ballester-López C, Genes Robles CM, Smirnova N, Rehberg M, Agarwal C, Krikki I, Piavaux B, Verleden SE, Vanaudenaerde B, Königshoff M, Dittmar G, Bracke KR, Schultze JL, Watz H, Eickelberg O, Stoeger T, Burgstaller G, Tacke F, Heissmeyer V, Rinkevich Y, Bayram H, Schiller HB, Conrad M, Schneider R, Yildirim AÖ. The arginine methyltransferase PRMT7 promotes extravasation of monocytes resulting in tissue injury in COPD. Nat Commun 2022; 13:1303. [PMID: 35288557 PMCID: PMC8921220 DOI: 10.1038/s41467-022-28809-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 02/01/2022] [Indexed: 12/13/2022] Open
Abstract
Extravasation of monocytes into tissue and to the site of injury is a fundamental immunological process, which requires rapid responses via post translational modifications (PTM) of proteins. Protein arginine methyltransferase 7 (PRMT7) is an epigenetic factor that has the capacity to mono-methylate histones on arginine residues. Here we show that in chronic obstructive pulmonary disease (COPD) patients, PRMT7 expression is elevated in the lung tissue and localized to the macrophages. In mouse models of COPD, lung fibrosis and skin injury, reduced expression of PRMT7 associates with decreased recruitment of monocytes to the site of injury and hence less severe symptoms. Mechanistically, activation of NF-κB/RelA in monocytes induces PRMT7 transcription and consequential mono-methylation of histones at the regulatory elements of RAP1A, which leads to increased transcription of this gene that is responsible for adhesion and migration of monocytes. Persistent monocyte-derived macrophage accumulation leads to ALOX5 over-expression and accumulation of its metabolite LTB4, which triggers expression of ACSL4 a ferroptosis promoting gene in lung epithelial cells. Conclusively, inhibition of arginine mono-methylation might offer targeted intervention in monocyte-driven inflammatory conditions that lead to extensive tissue damage if left untreated. Chronic obstructive pulmonary disease is a progressive and incurable chronic condition that involves accumulation of inflammatory macrophages in the lung tissue. Authors here show in mouse models of lung disease that PRMT7, a protein arginine methyltransferase, is an important regulator of recruitment and the pro-inflammatory phenotype of macrophages.
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27
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De Sadeleer LJ, McDonough JE, Schupp JC, Yan X, Vanstapel A, Van Herck A, Everaerts S, Geudens V, Sacreas A, Goos T, Aelbrecht C, Nawrot TS, Martens DS, Schols D, Claes S, Verschakelen JA, Verbeken EK, Ackermann M, Decottignies A, Mahieu M, Hackett TL, Hogg JC, Vanaudenaerde BM, Verleden SE, Kaminski N, Wuyts WA. Lung Microenvironments and Disease Progression in Fibrotic Hypersensitivity Pneumonitis. Am J Respir Crit Care Med 2022; 205:60-74. [PMID: 34724391 PMCID: PMC8865586 DOI: 10.1164/rccm.202103-0569oc] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Rationale: Fibrotic hypersensitivity pneumonitis (fHP) is an interstitial lung disease caused by sensitization to an inhaled allergen. Objectives: To identify the molecular determinants associated with progression of fibrosis. Methods: Nine fHP explant lungs and six unused donor lungs (as controls) were systematically sampled (4 samples/lung). According to microcomputed tomography measures, fHP cores were clustered into mild, moderate, and severe fibrosis groups. Gene expression profiles were assessed using weighted gene co-expression network analysis, xCell, gene ontology, and structure enrichment analysis. Gene expression of the prevailing molecular traits was also compared with idiopathic pulmonary fibrosis (IPF). The explant lung findings were evaluated in separate clinical fHP cohorts using tissue, BAL samples, and computed tomography scans. Measurements and Main Results: We found six molecular traits that associated with differential lung involvement. In fHP, extracellular matrix and antigen presentation/sensitization transcriptomic signatures characterized lung zones with only mild structural and histological changes, whereas signatures involved in honeycombing and B cells dominated the transcriptome in the most severely affected lung zones. With increasing disease severity, endothelial function was progressively lost, and progressive disruption in normal cellular homeostatic processes emerged. All six were also found in IPF, with largely similar associations with disease microenvironments. The molecular traits correlated with in vivo disease behavior in a separate clinical fHP cohort. Conclusions: We identified six molecular traits that characterize the morphological progression of fHP and associate with in vivo clinical behavior. Comparing IPF with fHP, the transcriptome landscape was determined considerably by local disease extent rather than by diagnosis alone.
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Affiliation(s)
- Laurens J. De Sadeleer
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism (CHROMETA),,Unit for Interstitial Lung Diseases, Department of Respiratory Diseases
| | - John E. McDonough
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism (CHROMETA),,Pulmonary, Critical Care, and Sleep Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Jonas C. Schupp
- Pulmonary, Critical Care, and Sleep Medicine, Yale University School of Medicine, New Haven, Connecticut;,Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Xiting Yan
- Pulmonary, Critical Care, and Sleep Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Arno Vanstapel
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism (CHROMETA),,Department of Histopathology, and
| | - Anke Van Herck
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism (CHROMETA)
| | - Stephanie Everaerts
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism (CHROMETA),,Unit for Interstitial Lung Diseases, Department of Respiratory Diseases
| | - Vincent Geudens
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism (CHROMETA)
| | - Annelore Sacreas
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism (CHROMETA)
| | - Tinne Goos
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism (CHROMETA),,Unit for Interstitial Lung Diseases, Department of Respiratory Diseases
| | - Celine Aelbrecht
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism (CHROMETA)
| | - Tim S. Nawrot
- Department of Public Health and Primary Care, and,Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium
| | - Dries S. Martens
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium
| | - Dominique Schols
- Department of Microbiology, Immunology, and Transplantation, Rega Institute, KU Leuven, Leuven, Belgium
| | - Sandra Claes
- Department of Microbiology, Immunology, and Transplantation, Rega Institute, KU Leuven, Leuven, Belgium
| | | | | | - Maximilian Ackermann
- Institute of Functional and Clinical Anatomy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany;,Institute of Pathology and Molecular Pathology, Helios University Clinic Wuppertal, University of Witten/Herdecke, Wuppertal, Germany
| | - Anabelle Decottignies
- Telomeres Research Group, Genetic and Epigenetic Alterations of Genomes, de Duve Institute, Université Catholique de Louvain, Brussels, Belgium
| | - Manon Mahieu
- Telomeres Research Group, Genetic and Epigenetic Alterations of Genomes, de Duve Institute, Université Catholique de Louvain, Brussels, Belgium
| | - Tillie-Louise Hackett
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada; and
| | - James C. Hogg
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada; and
| | - Bart M. Vanaudenaerde
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism (CHROMETA)
| | - Stijn E. Verleden
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism (CHROMETA),,Antwerp Surgical Training, Anatomy and Research Centre, Antwerp University, Antwerp, Belgium
| | - Naftali Kaminski
- Pulmonary, Critical Care, and Sleep Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Wim A. Wuyts
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism (CHROMETA),,Unit for Interstitial Lung Diseases, Department of Respiratory Diseases
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28
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Ackermann M, Tafforeau P, Wagner WL, Walsh C, Werlein C, Kühnel MP, Länger FP, Disney C, Bodey AJ, Bellier A, Verleden SE, Lee PD, Mentzer SJ, Jonigk DD. The Bronchial Circulation in COVID-19 Pneumonia. Am J Respir Crit Care Med 2021; 205:121-125. [PMID: 34734553 PMCID: PMC8865596 DOI: 10.1164/rccm.202103-0594im] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Maximilian Ackermann
- Institute of Functional and Clinical Anatomy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.,HELIOS Universitatsklinikum Wuppertal, 60865, Institute of Pathology and Molecular Pathology, Wuppertal, Germany;
| | - Paul Tafforeau
- European Synchrotron Radiation Facility, 55553, Grenoble, France
| | - Willi L Wagner
- University Hospital Heidelberg, 27178, Dept. Diagnostic and Interventional Radiology, Heidelberg, Germany
| | - Claire Walsh
- University College London, 4919, Centre for Advanced Biomedical Imaging, London, United Kingdom of Great Britain and Northern Ireland
| | | | - Mark P Kühnel
- Medical School of Hannover, Institute of Pathology, Hannover, Germany
| | | | - Catherine Disney
- University College London, 4919, London, United Kingdom of Great Britain and Northern Ireland
| | - Andrew J Bodey
- Diamond Light Source Ltd, 120796, Didcot, United Kingdom of Great Britain and Northern Ireland
| | - Alexandre Bellier
- Grenoble Universites, 133618, French Alps Laboratory of Anatomy (LADAF) , Grenoble, France
| | - Stijn E Verleden
- Katholieke Universiteit Leuven and Universitair Ziekenhuis Gasthuisberg, Lung Transplant Unit, Leuven, Belgium
| | - Peter D Lee
- University College London, 4919, Department of Mechanical Engineering, London, United Kingdom of Great Britain and Northern Ireland
| | - Steven J Mentzer
- Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Danny D Jonigk
- Hannover Medical School, Institute of Pathology , Hannover, Germany
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29
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Goos T, De Sadeleer LJ, Yserbyt J, De Langhe E, Dubbeldam A, Verbeken EK, Verleden GM, Vermant M, Verschakelen J, Vos R, Weynand B, Verleden SE, Wuyts WA. Defining and predicting progression in non-IPF interstitial lung disease. Respir Med 2021; 189:106626. [PMID: 34627007 DOI: 10.1016/j.rmed.2021.106626] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 09/02/2021] [Accepted: 09/22/2021] [Indexed: 11/24/2022]
Abstract
Randomized placebo-controlled trials demonstrated the efficacy of antifibrotic treatment in non-IPF progressive fibrosing ILD (fILD). Currently, there is no consensus on how progression should be defined and clinical data of non-IPF fILD patients in a real-world setting are scarce. Non-IPF fILD patients presenting at the University Hospitals Leuven between 2012 and 2016 were included. Different definitions of progression according to the selection criteria of the INBUILD, RELIEF and the uILD study were retrospectively evaluated at every hospital visit. Univariate and multivariate analyses were performed to identify predictors of progression and mortality. The study cohort comprised 120 patients; 68.3%, 54.2% and 65.8% had progressive disease based on the INBUILD, RELIEF and uILD study, respectively. A large overlap of progressive fILD patients according to the different clinical trials was observed. Median transplant-free survival time of progressive fILD patients was 3.9, 3.9, 3.8 years and the median time-to-progression after diagnosis was 2.0, 3.1 and 2.3 years according to the INBUILD, RELIEF and uILD study, respectively. We identified several predictors of mortality, but only an underlying diagnosis of HP and uILD was independently associated with progression. Our data show a high prevalence of progressive fibrosis among non-IPF fILD patients and a discrepancy between predictors of mortality and progression. Mortality rate in fILD is high and the identification of progressive disease is only made late during the disease course. Moreover, future treatment decisions will be based upon disease behavior. Therefore, more predictors of progressive disease are needed to guide treatment decisions in the future.
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Affiliation(s)
- Tinne Goos
- BREATHE, Department of Chronic Diseases and Metabolism, KU Leuven, B-3000, Leuven, Belgium; Department of Respiratory Diseases, University Hospitals Leuven, B-3000, Leuven, Belgium
| | - Laurens J De Sadeleer
- BREATHE, Department of Chronic Diseases and Metabolism, KU Leuven, B-3000, Leuven, Belgium; Department of Respiratory Diseases, University Hospitals Leuven, B-3000, Leuven, Belgium
| | - Jonas Yserbyt
- BREATHE, Department of Chronic Diseases and Metabolism, KU Leuven, B-3000, Leuven, Belgium; Department of Respiratory Diseases, University Hospitals Leuven, B-3000, Leuven, Belgium
| | - Ellen De Langhe
- Division of Rheumatology, University Hospitals Leuven, B-3000, Leuven, Belgium
| | - Adriana Dubbeldam
- Department of Radiology, University Hospitals Leuven, B-3000, Leuven, Belgium
| | - Erik K Verbeken
- Department of Pathology, University Hospitals Leuven, B-3000, Leuven, Belgium
| | - Geert M Verleden
- BREATHE, Department of Chronic Diseases and Metabolism, KU Leuven, B-3000, Leuven, Belgium; Department of Respiratory Diseases, University Hospitals Leuven, B-3000, Leuven, Belgium
| | - Marie Vermant
- BREATHE, Department of Chronic Diseases and Metabolism, KU Leuven, B-3000, Leuven, Belgium; Department of Respiratory Diseases, University Hospitals Leuven, B-3000, Leuven, Belgium
| | - Johny Verschakelen
- Department of Radiology, University Hospitals Leuven, B-3000, Leuven, Belgium
| | - Robin Vos
- BREATHE, Department of Chronic Diseases and Metabolism, KU Leuven, B-3000, Leuven, Belgium; Department of Respiratory Diseases, University Hospitals Leuven, B-3000, Leuven, Belgium
| | - Birgit Weynand
- Department of Pathology, University Hospitals Leuven, B-3000, Leuven, Belgium
| | - Stijn E Verleden
- BREATHE, Department of Chronic Diseases and Metabolism, KU Leuven, B-3000, Leuven, Belgium
| | - Wim A Wuyts
- BREATHE, Department of Chronic Diseases and Metabolism, KU Leuven, B-3000, Leuven, Belgium; Department of Respiratory Diseases, University Hospitals Leuven, B-3000, Leuven, Belgium.
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30
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Happaerts S, Lorent N, Yserbyt J, Dupont LJ, Dooms C, Van Bleyenbergh P, Vanaudenaerde BM, Verleden SE, Ceulemans LJ, Van Raemdonck DE, Verleden GM, Vos R, Godinas L. Short and mid-term outcomes of lung transplant recipients with COVID-19. Transplantation 2021. [DOI: 10.1183/13993003.congress-2021.pa3492] [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: 11/05/2022]
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31
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Vanstapel A, Weynand B, Kaes J, Neyrinck AP, Ceulemans LJ, Vanaudenaerde BM, Vos R, Verleden GM, Ackermann M, Verleden SE. Interalveolar Pores Increase in Aging and Severe Airway Obstruction. Am J Respir Crit Care Med 2021; 204:862-865. [PMID: 34241578 DOI: 10.1164/rccm.202102-0530le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Arno Vanstapel
- KU Leuven, 26657, Department of Chronic Diseases, Metabolism and Ageing, Leuven, Belgium
| | - Birgit Weynand
- Universitaire Ziekenhuizen Leuven, 60182, Pathology, Leuven, Belgium
| | - Janne Kaes
- KU Leuven, 26657, Lung Transplant Unit, Leuven, Belgium
| | - Arne P Neyrinck
- KU Leuven, 26657, anesthesiology and lung transplant unit, Leuven, Belgium
| | | | - Bart M Vanaudenaerde
- KU Leuven, 26657, Clinical and Experimental Medicine - Laboratory of Respiratory Diseases, Leuven, Belgium
| | - Robin Vos
- KU Leuven, 26657, lung transplant unit, Leuven, Belgium
| | | | - Maximilian Ackermann
- Institute of Functional and Clinical Anatomy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Stijn E Verleden
- Katholieke Universiteit Leuven and Universitair Ziekenhuis Gasthuisberg, Lung Transplant Unit, Leuven, Belgium;
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32
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Van Rompaey W, Gheysens O, Deroose CM, Verleden SE, Vanaudenaerde BM, Ceulemans LJ, Van Raemdonck DE, Neyrinck AP, Verleden GM, Vos R. Diagnostic Yield of 18F-FDG PET After Lung Transplantation: A Single-center, Retrospective Cohort Study. Transplantation 2021; 105:1603-1609. [PMID: 32941392 DOI: 10.1097/tp.0000000000003456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND To investigate the diagnostic yield of 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) in lung transplant recipients. METHODS A single-center, retrospective cohort study including 234 18F-FDG PET examinations in 199 lung transplant recipients. Indication for PET referral, 18F-FDG PET diagnosis/findings and final clinical diagnosis were classified into 3 groups: malignancy, infection/inflammation not otherwise specified, and chronic lung allograft dysfunction with restrictive allograft syndrome phenotype. Sensitivity/specificity analysis was performed to determine accuracy of 18F-FDG PET in each group. RESULTS Sensitivity of 18F-FDG PET for malignancy was 91.4% (95% confidence interval, 82.5%-96.0%) and specificity was 82.3% (95% confidence interval, 74.5%-88.1%). Infection/inflammation not otherwise specified and restrictive allograft syndrome as indication for 18F-FDG PET comprised relatively small groups (14 and 31 cases, respectively). In addition, 18F-FDG PET revealed clinically relevant incidental findings in 15% of cases. CONCLUSIONS Referral for 18F-FDG PET after lung transplantation mainly occurred to confirm or rule out malignancy. In this specific setting, 18F-FDG PET has a high diagnostic yield. Accuracy of 18F-FDG PET for other indications is less clear, given small sample sizes. Clinically relevant diagnoses, unrelated to the primary indication for 18F-FDG PET, are found relatively often in this immunocompromised cohort.
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Affiliation(s)
- Winand Van Rompaey
- Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Olivier Gheysens
- Department of Nuclear Medicine, University Hospitals Leuven, Leuven, Belgium
- Division of Nuclear Medicine and Molecular Imaging, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
- Department of Nuclear Medicine, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Christophe M Deroose
- Department of Nuclear Medicine, University Hospitals Leuven, Leuven, Belgium
- Division of Nuclear Medicine and Molecular Imaging, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Stijn E Verleden
- Department of Chronic Diseases, Metabolism & Ageing (CHROMETA), Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Bart M Vanaudenaerde
- Department of Chronic Diseases, Metabolism & Ageing (CHROMETA), Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Laurens J Ceulemans
- Department of Chronic Diseases, Metabolism & Ageing (CHROMETA), Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Dirk E Van Raemdonck
- Department of Chronic Diseases, Metabolism & Ageing (CHROMETA), Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Arne P Neyrinck
- Department of Chronic Diseases, Metabolism & Ageing (CHROMETA), Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
- Department of Anesthesiology, University Hospitals Leuven, Leuven, Belgium
| | - Geert M Verleden
- Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
- Department of Chronic Diseases, Metabolism & Ageing (CHROMETA), Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Robin Vos
- Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
- Department of Chronic Diseases, Metabolism & Ageing (CHROMETA), Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
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33
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Frick AE, Verleden SE, Ordies S, Sacreas A, Vos R, Verleden GM, Vanaudenaerde BM, Claes S, Schols D, Van Raemdonck DE, Neyrinck AP. Early protein expression profile in bronchoalveolar lavage fluid and clinical outcomes in primary graft dysfunction after lung transplantation. Eur J Cardiothorac Surg 2021; 58:379-388. [PMID: 32267918 DOI: 10.1093/ejcts/ezaa043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 01/08/2020] [Accepted: 01/16/2020] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES Primary graft dysfunction (PGD) remains a major post-transplant complication and is associated with increased morbidity and mortality. Mechanisms evoking PGD are not completely clear, but inflammation plays a central role. We investigated the association between PGD and inflammatory proteins present in immediate postoperative bronchoalveolar lavage. METHODS All double-lung recipients transplanted at our institution from 2002 to 2018 were included in our study. We retrospectively selected 80 consecutive lung transplant recipients with different PGD grades (n = 20 for each PGD grades 0-1 to 2-3). In bronchoalveolar lavage performed within the first 24 h after donor aortic cross-clamping following lung transplantation, concentrations of 30 cytokines, chemokines and growth factors were assessed by enzyme-linked immunosorbent assay (ELISA) and correlated with donor and recipient demographics and outcomes. For analysis, 2 groups were defined: 'mild' PGD (grade 0-1) and 'severe' PGD (grades 2-3). RESULTS Significant differences between mild and severe PGD were found in 8 biomarkers [interleukin (IL)-6, IL-10, IL-13, eotaxin, granulocyte colony-stimulating factor, interferon γ, macrophage inflammatory protein 1α, surfactant protein D (SP-D); P < 0.05]. Increased IL-10 and IL-13, but none of the other proteins, were associated with short-term outcome (longer time to extubation; P = 0.005 and P < 0.0001; increased intensive care unit stay; P = 0.012 and P < 0.0001; and hospital stay; P = 0.041 and P = 0.002). There were no significant differences in donor and recipient characteristics between the groups. CONCLUSIONS Expression profiles of key inflammatory mediators in bronchoalveolar lavage fluid differed significantly between lung transplant recipients with severe versus mild PGD and correlated with clinical outcome variables. Further research should focus on the early mechanisms leading to PGD.
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Affiliation(s)
- Anna E Frick
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium.,Leuven Lung Transplant Unit, Department of Chronic Diseases, Metabolism and Ageing (Chrometa), KU Leuven, Leuven, Belgium
| | - Stijn E Verleden
- Leuven Lung Transplant Unit, Department of Chronic Diseases, Metabolism and Ageing (Chrometa), KU Leuven, Leuven, Belgium
| | - Sofie Ordies
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium.,Leuven Lung Transplant Unit, Department of Chronic Diseases, Metabolism and Ageing (Chrometa), KU Leuven, Leuven, Belgium
| | - Annelore Sacreas
- Leuven Lung Transplant Unit, Department of Chronic Diseases, Metabolism and Ageing (Chrometa), KU Leuven, Leuven, Belgium
| | - Robin Vos
- Leuven Lung Transplant Unit, Department of Chronic Diseases, Metabolism and Ageing (Chrometa), KU Leuven, Leuven, Belgium.,Department of Pneumology, University Hospitals Leuven, Leuven, Belgium
| | - Geert M Verleden
- Leuven Lung Transplant Unit, Department of Chronic Diseases, Metabolism and Ageing (Chrometa), KU Leuven, Leuven, Belgium.,Department of Pneumology, University Hospitals Leuven, Leuven, Belgium
| | - Bart M Vanaudenaerde
- Leuven Lung Transplant Unit, Department of Chronic Diseases, Metabolism and Ageing (Chrometa), KU Leuven, Leuven, Belgium
| | - Sandra Claes
- Laboratory of Virology and Chemotherapy, Department of Microbiology and Immunology, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
| | - Dominique Schols
- Laboratory of Virology and Chemotherapy, Department of Microbiology and Immunology, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
| | - Dirk E Van Raemdonck
- Leuven Lung Transplant Unit, Department of Chronic Diseases, Metabolism and Ageing (Chrometa), KU Leuven, Leuven, Belgium.,Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Arne P Neyrinck
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium.,Department of Anesthesiology, University Hospitals Leuven, Leuven, Belgium
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34
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Vanstapel A, Goldschmeding R, Broekhuizen R, Nguyen T, Sacreas A, Kaes J, Heigl T, Verleden SE, De Zutter A, Verleden G, Weynand B, Verbeken E, Ceulemans LJ, Van Raemdonck DE, Neyrinck AP, Schoemans HM, Vanaudenaerde BM, Vos R. Connective Tissue Growth Factor Is Overexpressed in Explant Lung Tissue and Broncho-Alveolar Lavage in Transplant-Related Pulmonary Fibrosis. Front Immunol 2021; 12:661761. [PMID: 34122421 PMCID: PMC8187127 DOI: 10.3389/fimmu.2021.661761] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 05/07/2021] [Indexed: 11/25/2022] Open
Abstract
Background Connective tissue growth factor (CTGF) is an important mediator in several fibrotic diseases, including lung fibrosis. We investigated CTGF-expression in chronic lung allograft dysfunction (CLAD) and pulmonary graft-versus-host disease (GVHD). Materials and Methods CTGF expression was assessed by quantitative real-time polymerase chain reaction (qPCR) and immunohistochemistry in end-stage CLAD explant lung tissue (bronchiolitis obliterans syndrome (BOS), n=20; restrictive allograft syndrome (RAS), n=20), pulmonary GHVD (n=9). Unused donor lungs served as control group (n=20). Next, 60 matched lung transplant recipients (BOS, n=20; RAS, n=20; stable lung transplant recipients, n=20) were included for analysis of CTGF protein levels in plasma and broncho-alveolar lavage (BAL) fluid at 3 months post-transplant, 1 year post-transplant, at CLAD diagnosis or 2 years post-transplant in stable patients. Results qPCR revealed an overall significant difference in the relative content of CTGF mRNA in BOS, RAS and pulmonary GVHD vs. controls (p=0.014). Immunohistochemistry showed a significant higher percentage and intensity of CTGF-positive respiratory epithelial cells in BOS, RAS and pulmonary GVHD patients vs. controls (p<0.0001). BAL CTGF protein levels were significantly higher at 3 months post-transplant in future RAS vs. stable or BOS (p=0.028). At CLAD diagnosis, BAL protein content was significantly increased in RAS patients vs. stable (p=0.0007) and BOS patients (p=0.042). CTGF plasma values were similar in BOS, RAS, and stable patients (p=0.74). Conclusions Lung CTGF-expression is increased in end-stage CLAD and pulmonary GVHD; and higher CTGF-levels are present in BAL of RAS patients at CLAD diagnosis. Our results suggest a potential role for CTGF in CLAD, especially RAS, and pulmonary GVHD.
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Affiliation(s)
- Arno Vanstapel
- Department of Chronic Diseases and Metabolism, Katholieke Universiteit, Leuven, Belgium.,Department of Pathology, University Hospital Leuven, Leuven, Belgium
| | - Roel Goldschmeding
- Department of Pathology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Roel Broekhuizen
- Department of Pathology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Tri Nguyen
- Department of Pathology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Annelore Sacreas
- Department of Chronic Diseases and Metabolism, Katholieke Universiteit, Leuven, Belgium
| | - Janne Kaes
- Department of Chronic Diseases and Metabolism, Katholieke Universiteit, Leuven, Belgium
| | - Tobias Heigl
- Department of Chronic Diseases and Metabolism, Katholieke Universiteit, Leuven, Belgium
| | - Stijn E Verleden
- Department of Chronic Diseases and Metabolism, Katholieke Universiteit, Leuven, Belgium
| | - Alexandra De Zutter
- Department of Microbiology, Immunology and Transplantation, Katholieke Universiteit, Leuven, Belgium
| | - Geert Verleden
- Department of Chronic Diseases and Metabolism, Katholieke Universiteit, Leuven, Belgium.,Department of Respiratory Diseases, Lung Transplant Unit, University Hospital Leuven, Leuven, Belgium
| | - Birgit Weynand
- Department of Chronic Diseases and Metabolism, Katholieke Universiteit, Leuven, Belgium.,Department of Pathology, University Hospital Leuven, Leuven, Belgium
| | - Erik Verbeken
- Department of Chronic Diseases and Metabolism, Katholieke Universiteit, Leuven, Belgium.,Department of Pathology, University Hospital Leuven, Leuven, Belgium
| | - Laurens J Ceulemans
- Department of Chronic Diseases and Metabolism, Katholieke Universiteit, Leuven, Belgium.,Department of Thoracic Surgery University Hospital Leuven, Leuven, Belgium
| | - Dirk E Van Raemdonck
- Department of Chronic Diseases and Metabolism, Katholieke Universiteit, Leuven, Belgium.,Department of Thoracic Surgery University Hospital Leuven, Leuven, Belgium
| | - Arne P Neyrinck
- Department of Cardiovascular Sciences, Katholieke Universiteit, Leuven, Belgium.,Department of Anesthesiology, University Hospital Leuven, Leuven, Belgium
| | | | - Bart M Vanaudenaerde
- Department of Chronic Diseases and Metabolism, Katholieke Universiteit, Leuven, Belgium
| | - Robin Vos
- Department of Chronic Diseases and Metabolism, Katholieke Universiteit, Leuven, Belgium.,Department of Respiratory Diseases, Lung Transplant Unit, University Hospital Leuven, Leuven, Belgium
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35
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Brugiere O, Verleden SE. Putting the spotlight on macrophage-derived cathepsin in the pathophysiology of obliterative bronchiolitis. Eur Respir J 2021; 57:57/5/2004607. [PMID: 33985982 DOI: 10.1183/13993003.04607-2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 01/19/2021] [Indexed: 11/05/2022]
Affiliation(s)
- Olivier Brugiere
- Lung Transplant Dept, Foch Hospital, Suresnes, France .,Inserm UMR S 1152, Physiopathologie et Epidémiologie des Maladies Respiratoires, Paris, France
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36
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Xu F, Tanabe N, Vasilescu DM, McDonough JE, Coxson HO, Ikezoe K, Kinose D, Ng KW, Verleden SE, Wuyts WA, Vanaudenaerde BM, Verschakelen J, Cooper JD, Lenburg ME, Morshead KB, Abbas AR, Arron JR, Spira A, Hackett TL, Colby TV, Ryerson CJ, Ng RT, Hogg JC. The transition from normal lung anatomy to minimal and established fibrosis in idiopathic pulmonary fibrosis (IPF). EBioMedicine 2021; 66:103325. [PMID: 33862585 PMCID: PMC8054143 DOI: 10.1016/j.ebiom.2021.103325] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 03/12/2021] [Accepted: 03/19/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The transition from normal lung anatomy to minimal and established fibrosis is an important feature of the pathology of idiopathic pulmonary fibrosis (IPF). The purpose of this report is to examine the molecular and cellular mechanisms associated with this transition. METHODS Pre-operative thoracic Multidetector Computed Tomography (MDCT) scans of patients with severe IPF (n = 9) were used to identify regions of minimal(n = 27) and established fibrosis(n = 27). MDCT, Micro-CT, quantitative histology, and next-generation sequencing were used to compare 24 samples from donor controls (n = 4) to minimal and established fibrosis samples. FINDINGS The present results extended earlier reports about the transition from normal lung anatomy to minimal and established fibrosis by showing that there are activations of TGFBI, T cell co-stimulatory genes, and the down-regulation of inhibitory immune-checkpoint genes compared to controls. The expression patterns of these genes indicated activation of a field immune response, which is further supported by the increased infiltration of inflammatory immune cells dominated by lymphocytes that are capable of forming lymphoid follicles. Moreover, fibrosis pathways, mucin secretion, surfactant, TLRs, and cytokine storm-related genes also participate in the transitions from normal lung anatomy to minimal and established fibrosis. INTERPRETATION The transition from normal lung anatomy to minimal and established fibrosis is associated with genes that are involved in the tissue repair processes, the activation of immune responses as well as the increased infiltration of CD4, CD8, B cell lymphocytes, and macrophages. These molecular and cellular events correlate with the development of structural abnormality of IPF and probably contribute to its pathogenesis.
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Affiliation(s)
- Feng Xu
- Center for Heart Lung Innovation, The University of British Columbia, Vancouver, Canada
| | - Naoya Tanabe
- Center for Heart Lung Innovation, The University of British Columbia, Vancouver, Canada; Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Dragos M Vasilescu
- Center for Heart Lung Innovation, The University of British Columbia, Vancouver, Canada
| | - John E McDonough
- Leuven Lung Transplant Unit, KU Leuven and UZ Gasthuisberg, Leuven, Belgium
| | - Harvey O Coxson
- Center for Heart Lung Innovation, The University of British Columbia, Vancouver, Canada
| | - Kohei Ikezoe
- Center for Heart Lung Innovation, The University of British Columbia, Vancouver, Canada
| | - Daisuke Kinose
- Center for Heart Lung Innovation, The University of British Columbia, Vancouver, Canada; Division of Respiratory Medicine, Department of Medicine, Shiga University of Medical Science, Shiga, Japan
| | | | - Stijn E Verleden
- Laboratory of Respiratory Diseases, BREATHE, Department of CHROMETA, KU Leuven, Leuven, Belgium
| | - Wim A Wuyts
- Leuven Lung Transplant Unit, KU Leuven and UZ Gasthuisberg, Leuven, Belgium
| | | | - Johny Verschakelen
- Leuven Lung Transplant Unit, KU Leuven and UZ Gasthuisberg, Leuven, Belgium
| | - Joel D Cooper
- Division of Thoracic Surgery, University of Pennsylvania, USA
| | | | | | | | | | - Avrum Spira
- Boston University Medical Center, Boston, MA, USA
| | - Tillie-Louise Hackett
- Center for Heart Lung Innovation, The University of British Columbia, Vancouver, Canada
| | - Thomas V Colby
- Department of Pathology and Laboratory Medicine, Mayo Clinic Arizona, USA
| | - Christopher J Ryerson
- Center for Heart Lung Innovation, The University of British Columbia, Vancouver, Canada; Department of Medicine, The University of British Columbia, Vancouver, Canada
| | - Raymond T Ng
- Department of Computer Science, The University of British Columbia, Vancouver, Canada
| | - James C Hogg
- Center for Heart Lung Innovation, The University of British Columbia, Vancouver, Canada
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37
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Godinas L, Dobbels F, Hulst L, Verbeeck I, De Coninck I, Berrevoets P, Schaevers V, Yserbyt J, Dupont LJ, Verleden SE, Vanaudenaerde BM, Ceulemans LJ, Van Raemdonck DE, Neyrinck A, Verleden GM, Vos R. Once daily tacrolimus conversion in lung transplantation: A prospective study on safety and medication adherence. J Heart Lung Transplant 2021; 40:467-477. [PMID: 33840608 DOI: 10.1016/j.healun.2021.02.017] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 02/17/2021] [Accepted: 02/24/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Lung transplantation (LTx) requires a calcineurin inhibitor-based immunosuppressive regimen. A once daily (QD) tacrolimus regimen was developed to increase medication adherence. However, data concerning its safety and efficacy in LTx are lacking. METHODS In this prospective study, stable LTx patients were consecutively converted from twice daily (BID) tacrolimus to QD tacrolimus on a 1 mg:1 mg basis. Trough level (Cmin), renal function, cholesterol, fasting glucose, potassium and lung function were monitored six months before and up to one year after conversion. Adherence and its barriers were assessed by self-reported questionnaires (Basel Assessment of Adherence to Immunosuppressive Medications Scale (BAASIS) and Identification of Medication Adherence Barriers questionnaire (IMAB)) and blood-based assays (mean Cmin and coefficient of variation (CV)). RESULTS We included 372 patients, in whom we observed a decrease in tacrolimus Cmin of 18.5% (p < 0.0001) post-conversion, requiring subsequent daily dose adaptations in both cystic fibrosis (CF) (n = 72) and non-CF patients (n = 300). We observed a small decrease in eGFR one year post-conversion (p = 0.024). No significant changes in blood creatinine, potassium, fasting glucose, cholesterol or rate of lung function decline were observed. In a subgroup of 166 patients, significantly fewer patients missed doses (8.4% vs. 19.3%, p = 0.016) or had irregular intake post-conversion (19.3% vs. 32.5%, p = 0.019). Mean Cmin and CV, as well as the total number of barriers, also decreased significantly post-conversion. CONCLUSIONS In LTx, conversion from BID to QD tacrolimus (1 mg:1 mg) requires close monitoring of tacrolimus Cmin. QD tacrolimus after transplantation is safe with respect to renal function, metabolic parameters and allograft function and improves LTx recipient adherence.
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Affiliation(s)
- Laurent Godinas
- Department of Respiratory Diseases, Lung Transplantation Group, UZ Leuven, Campus Gasthuisberg, Leuven, Belgium; Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department CHROMETA, KU Leuven, Leuven, Belgium.
| | - Fabienne Dobbels
- Academic Center for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Leni Hulst
- Department of Respiratory Diseases, Lung Transplantation Group, UZ Leuven, Campus Gasthuisberg, Leuven, Belgium
| | - Ive Verbeeck
- Academic Center for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Ines De Coninck
- Academic Center for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Pieter Berrevoets
- Academic Center for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Veronique Schaevers
- Department of Respiratory Diseases, Lung Transplantation Group, UZ Leuven, Campus Gasthuisberg, Leuven, Belgium
| | - Jonas Yserbyt
- Department of Respiratory Diseases, Lung Transplantation Group, UZ Leuven, Campus Gasthuisberg, Leuven, Belgium; Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department CHROMETA, KU Leuven, Leuven, Belgium
| | - Lieven J Dupont
- Department of Respiratory Diseases, Lung Transplantation Group, UZ Leuven, Campus Gasthuisberg, Leuven, Belgium; Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department CHROMETA, KU Leuven, Leuven, Belgium
| | - Stijn E Verleden
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department CHROMETA, KU Leuven, Leuven, Belgium
| | - Bart M Vanaudenaerde
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department CHROMETA, KU Leuven, Leuven, Belgium
| | - Laurens J Ceulemans
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department CHROMETA, KU Leuven, Leuven, Belgium; Department of Thoracic Surgery, Lung transplantation group, UZ Leuven, Campus Gasthuisberg, Leuven, Belgium
| | - Dirk E Van Raemdonck
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department CHROMETA, KU Leuven, Leuven, Belgium; Department of Thoracic Surgery, Lung transplantation group, UZ Leuven, Campus Gasthuisberg, Leuven, Belgium
| | - Arne Neyrinck
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department CHROMETA, KU Leuven, Leuven, Belgium; Department of Anesthesiology, Lung transplantation group, UZ Leuven, Campus Gasthuisberg, Leuven, Belgium
| | - Geert M Verleden
- Department of Respiratory Diseases, Lung Transplantation Group, UZ Leuven, Campus Gasthuisberg, Leuven, Belgium; Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department CHROMETA, KU Leuven, Leuven, Belgium
| | - Robin Vos
- Department of Respiratory Diseases, Lung Transplantation Group, UZ Leuven, Campus Gasthuisberg, Leuven, Belgium; Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department CHROMETA, KU Leuven, Leuven, Belgium
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38
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Frick AE, Orlitová M, Vanstapel A, Ordies S, Claes S, Schols D, Heigl T, Kaes J, Saez-Gimenez B, Vos R, Verleden GM, Vanaudenaerde B, Verleden SE, Van Raemdonck DE, Neyrinck AP. A novel experimental porcine model to assess the impact of differential pulmonary blood flow on ischemia-reperfusion injury after unilateral lung transplantation. Intensive Care Med Exp 2021; 9:4. [PMID: 33543363 PMCID: PMC7862464 DOI: 10.1186/s40635-021-00371-1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 01/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Primary graft dysfunction (PGD) remains a major obstacle after lung transplantation. Ischemia-reperfusion injury is a known contributor to the development of PGD following lung transplantation. We developed a novel approach to assess the impact of increased pulmonary blood flow in a large porcine single-left lung transplantation model. MATERIALS Twelve porcine left lung transplants were divided in two groups (n = 6, in low- (LF) and high-flow (HF) group). Donor lungs were stored for 24 h on ice, followed by left lung transplantation. In the HF group, recipient animals were observed for 6 h after reperfusion with partially clamping right pulmonary artery to achieve a higher flow (target flow 40-60% of total cardiac output) to the transplanted lung compared to the LF group, where the right pulmonary artery was not clamped. RESULTS Survival at 6 h was 100% in both groups. Histological, functional and biological assessment did not significantly differ between both groups during the first 6 h of reperfusion. injury was also present in the right native lung and showed signs compatible with the pathophysiological hallmarks of ischemia-reperfusion injury. CONCLUSIONS Partial clamping native pulmonary artery in large animal lung transplantation setting to study the impact of low versus high pulmonary flow on the development of ischemia reperfusion is feasible. In our study, differential blood flow had no effect on IRI. However, our findings might impact future studies with extracorporeal devices and represent a specific intra-operative problem during bilateral sequential single-lung transplantation.
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Affiliation(s)
| | | | - Arno Vanstapel
- BREATHE, Department of Chronic Diseases, Metabolism and Ageing (Chrometa), Leuven Lung Transplant Unit, KU Leuven, Leuven, Belgium
| | - Sofie Ordies
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Sandra Claes
- Laboratory of Virology and Chemotherapy, Department of Microbiology and Immunology, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
| | - Dominique Schols
- Laboratory of Virology and Chemotherapy, Department of Microbiology and Immunology, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
| | - Tobias Heigl
- BREATHE, Department of Chronic Diseases, Metabolism and Ageing (Chrometa), Leuven Lung Transplant Unit, KU Leuven, Leuven, Belgium
| | - Janne Kaes
- BREATHE, Department of Chronic Diseases, Metabolism and Ageing (Chrometa), Leuven Lung Transplant Unit, KU Leuven, Leuven, Belgium
| | - Berta Saez-Gimenez
- BREATHE, Department of Chronic Diseases, Metabolism and Ageing (Chrometa), Leuven Lung Transplant Unit, KU Leuven, Leuven, Belgium.,Lung Transplant Unit, Hospital Universitari Vall D'Hebron, Barcelona, Spain
| | - Robin Vos
- BREATHE, Department of Chronic Diseases, Metabolism and Ageing (Chrometa), Leuven Lung Transplant Unit, KU Leuven, Leuven, Belgium.,Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Geert M Verleden
- BREATHE, Department of Chronic Diseases, Metabolism and Ageing (Chrometa), Leuven Lung Transplant Unit, KU Leuven, Leuven, Belgium.,Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Bart Vanaudenaerde
- BREATHE, Department of Chronic Diseases, Metabolism and Ageing (Chrometa), Leuven Lung Transplant Unit, KU Leuven, Leuven, Belgium
| | - Stijn E Verleden
- BREATHE, Department of Chronic Diseases, Metabolism and Ageing (Chrometa), Leuven Lung Transplant Unit, KU Leuven, Leuven, Belgium
| | - Dirk E Van Raemdonck
- BREATHE, Department of Chronic Diseases, Metabolism and Ageing (Chrometa), Leuven Lung Transplant Unit, KU Leuven, Leuven, Belgium.,Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Arne P Neyrinck
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium.,Department of Anesthesiology, University Hospitals Leuven, Leuven, Belgium
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39
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Verleden SE, Vanstapel A, De Sadeleer L, Dubbeldam A, Goos T, Gyselinck I, Geudens V, Kaes J, Van Raemdonck DE, Ceulemans LJ, Yserbyt J, Vos R, Vanaudenaerde B, Weynand B, Verschakelen J, Wuyts WA. Distinct Airway Involvement in Subtypes of End-Stage Fibrotic Pulmonary Sarcoidosis. Chest 2021; 160:562-571. [PMID: 33440183 DOI: 10.1016/j.chest.2021.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/17/2020] [Accepted: 01/04/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Sarcoidosis is a systemic granulomatous disease that in most patients affects the lung. Pulmonary fibrotic sarcoidosis is clinically, radiologically, and pathologically a heterogeneous condition. Although substantial indirect evidence suggests small airways involvement, direct evidence currently is lacking. RESEARCH QUESTION What is the role of the (small) airways in fibrotic sarcoidosis? STUDY DESIGN AND METHODS Airway morphologic features were investigated in seven explant lungs with end-stage fibrotic sarcoidosis using a combination of CT scanning (large airways), micro-CT scanning (small airways), and histologic examination and compared with seven unused donor lungs as controls with specific attention focused on different radiologically defined sarcoidosis subtypes. RESULTS Patients with central bronchial distortion (n = 3), diffuse bronchiectasis (n = 3), and usual interstitial pneumonia pattern (n = 1) were identified based on CT scan, showing a decrease and narrowing of large airways, a similar airway number and increased airway diameter of more distal airways, or an increase in airway number and airway diameter, respectively, compared with control participants. The number of terminal bronchioles per milliliter and the total number of terminal bronchioles were decreased in all forms of fibrotic sarcoidosis. Interestingly, the number of terminal bronchioles was inversely correlated with the degree of fibrosis. Furthermore, we identified granulomatous remodeling as a cause of small airways loss using serial micro-CT scanning and histologic examination. INTERPRETATION The large airways are involved differentially in subtypes of sarcoidosis, but the terminal bronchioles universally are lost. This suggests that small airways loss forms an important aspect in the pathophysiologic features of fibrotic pulmonary sarcoidosis.
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Affiliation(s)
- Stijn E Verleden
- BREATHE, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium.
| | - Arno Vanstapel
- BREATHE, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Laurens De Sadeleer
- BREATHE, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | | | - Tinne Goos
- BREATHE, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Iwein Gyselinck
- BREATHE, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Vincent Geudens
- BREATHE, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Janne Kaes
- BREATHE, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Dirk E Van Raemdonck
- BREATHE, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium; Department of Thoracic Surgery, UH Leuven, Leuven, Belgium
| | - Laurens J Ceulemans
- BREATHE, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium; Department of Thoracic Surgery, UH Leuven, Leuven, Belgium
| | - Jonas Yserbyt
- BREATHE, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Robin Vos
- BREATHE, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Bart Vanaudenaerde
- BREATHE, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | | | | | - Wim A Wuyts
- BREATHE, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
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40
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Testelmans D, Schoovaerts K, Belge C, Verleden SE, Vos R, Verleden GM, Buyse B. Sleep-disordered breathing after lung transplantation: An observational cohort study. Am J Transplant 2021; 21:281-290. [PMID: 32519458 DOI: 10.1111/ajt.16130] [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: 04/10/2020] [Revised: 06/04/2020] [Accepted: 06/04/2020] [Indexed: 01/25/2023]
Abstract
Data concerning sleep-disordered breathing (SDB) after lung transplantation (LTX) are scarce. This study aims to analyze prevalence, associated factors, and impact on survival of moderate to severe SDB in a large cohort of consecutive LTX patients (n = 219). Patients underwent a diagnostic polysomnography 1 year after LTX. Moderate to severe SDB was present in 57.5% of patients, with the highest prevalence in chronic obstructive pulmonary disease/emphysema (71.1%) and pulmonary fibrosis (65.1%). SDB patients were older, mostly male, and had higher body mass index and neck circumference. Nocturnal diastolic and 24-hour blood pressures were higher in SDB patients. In 45 patients, polysomnography was also performed pre-LTX. Compared to pre-LTX, mean apnea/hypopnea index (AHI) increased significantly after LTX. A significant correlation was seen between lung function parameters and AHI, suggesting a role of decreased caudal traction on the pharynx. Presence of SDB had no impact on mortality or prevalence of chronic lung allograft dysfunction. However, survival was better in continuous positive airway pressure (CPAP) compliant SDB patients compared to SDB patients without CPAP treatment. These findings may be pertinent for systematic screening of SDB after LTX.
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Affiliation(s)
- Dries Testelmans
- Clinical Department of Respiratory Diseases, UZ Leuven - BREATHE, department CHROMETA, KU Leuven, Leuven, Belgium
| | - Kathleen Schoovaerts
- Clinical Department of Respiratory Diseases, UZ Leuven - BREATHE, department CHROMETA, KU Leuven, Leuven, Belgium
| | - Catharina Belge
- Clinical Department of Respiratory Diseases, UZ Leuven - BREATHE, department CHROMETA, KU Leuven, Leuven, Belgium
| | - Stijn E Verleden
- Laboratory of Respiratory diseases and Thoracic Surgery (BREATHE) Department CHROMETA, KU Leuven, Leuven, Belgium
| | - Robin Vos
- Clinical Department of Respiratory Diseases, UZ Leuven - BREATHE, department CHROMETA, KU Leuven, Leuven, Belgium
| | - Geert M Verleden
- Clinical Department of Respiratory Diseases, UZ Leuven - BREATHE, department CHROMETA, KU Leuven, Leuven, Belgium
| | - Bertien Buyse
- Clinical Department of Respiratory Diseases, UZ Leuven - BREATHE, department CHROMETA, KU Leuven, Leuven, Belgium
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41
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Ceulemans LJ, Van Slambrouck J, De Leyn P, Decaluwé H, Van Veer H, Depypere L, Ceuterick V, Verleden SE, Vanstapel A, Desmet S, Maes P, Van Ranst M, Lormans P, Meyfroidt G, Neyrinck AP, Vanaudenaerde BM, Van Wijngaerden E, Bos S, Godinas L, Carmeliet P, Verleden GM, Van Raemdonck DE, Vos R. Successful double-lung transplantation from a donor previously infected with SARS-CoV-2. Lancet Respir Med 2020; 9:315-318. [PMID: 33275902 PMCID: PMC7831530 DOI: 10.1016/s2213-2600(20)30524-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 10/22/2020] [Accepted: 11/03/2020] [Indexed: 12/24/2022]
Abstract
Lung transplantation from a donor previously infected with SARS-CoV-2
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Affiliation(s)
- Laurens J Ceulemans
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Lung Transplant Unit, KU Leuven, Leuven, Belgium.
| | - Jan Van Slambrouck
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Lung Transplant Unit, KU Leuven, Leuven, Belgium
| | - Paul De Leyn
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Lung Transplant Unit, KU Leuven, Leuven, Belgium
| | - Herbert Decaluwé
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Lung Transplant Unit, KU Leuven, Leuven, Belgium
| | - Hans Van Veer
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Lung Transplant Unit, KU Leuven, Leuven, Belgium
| | - Lieven Depypere
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Lung Transplant Unit, KU Leuven, Leuven, Belgium
| | - Vincent Ceuterick
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Stijn E Verleden
- Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Lung Transplant Unit, KU Leuven, Leuven, Belgium
| | - Arno Vanstapel
- Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Lung Transplant Unit, KU Leuven, Leuven, Belgium; Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Stefanie Desmet
- Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Piet Maes
- Department of Microbiology, Immunology and Transplantation, Clinical and Epidemiological Virology Division, Rega Institute, KU Leuven, Leuven, Belgium
| | - Marc Van Ranst
- Department of Microbiology, Immunology and Transplantation, Clinical and Epidemiological Virology Division, Rega Institute, KU Leuven, Leuven, Belgium
| | - Piet Lormans
- Department of Intensive Care Medicine, General Hospital AZ Delta, Roeselare, Belgium
| | - Geert Meyfroidt
- Department of Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium; Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
| | - Arne P Neyrinck
- Department of Anaesthesiology, University Hospitals Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Bart M Vanaudenaerde
- Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Lung Transplant Unit, KU Leuven, Leuven, Belgium
| | - Eric Van Wijngaerden
- Department of Internal Medicine, University Hospitals Leuven, Leuven, Belgium; Department of Microbiology, Immunology and Transplantation, Lab for Clinical Infectious and Inflammatory Disorders, KU Leuven, Leuven, Belgium
| | - Saskia Bos
- Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Laurent Godinas
- Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium; Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Lung Transplant Unit, KU Leuven, Leuven, Belgium
| | - Peter Carmeliet
- Laboratory of Angiogenesis and Vascular Metabolism, Center for Cancer Biology, VIB, Department of Oncology, Leuven Cancer Institute, KU Leuven, Leuven, Belgium
| | - Geert M Verleden
- Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium; Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Lung Transplant Unit, KU Leuven, Leuven, Belgium
| | - Dirk E Van Raemdonck
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Lung Transplant Unit, KU Leuven, Leuven, Belgium
| | - Robin Vos
- Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium; Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Lung Transplant Unit, KU Leuven, Leuven, Belgium
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42
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Ordies S, Orlitova M, Heigl T, Sacreas A, Van Herck A, Kaes J, Saez B, Vanstapel A, Ceulemans L, Vanaudenaerde BM, Vos R, Verschakelen J, Verleden GM, Verleden SE, Van Raemdonck DE, Neyrinck AP. Flow-controlled ventilation during EVLP improves oxygenation and preserves alveolar recruitment. Intensive Care Med Exp 2020; 8:70. [PMID: 33237343 PMCID: PMC7686942 DOI: 10.1186/s40635-020-00360-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 11/17/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ex vivo lung perfusion (EVLP) is a widespread accepted platform for preservation and evaluation of donor lungs prior to lung transplantation (LTx). Standard lungs are ventilated using volume-controlled ventilation (VCV). We investigated the effects of flow-controlled ventilation (FCV) in a large animal EVLP model. Fourteen porcine lungs were mounted on EVLP after a warm ischemic interval of 2 h and randomized in two groups (n = 7/group). In VCV, 7 grafts were conventionally ventilated and in FCV, 7 grafts were ventilated by flow-controlled ventilation. EVLP physiologic parameters (compliance, pulmonary vascular resistance and oxygenation) were recorded hourly. After 6 h of EVLP, broncho-alveolar lavage (BAL) was performed and biopsies for wet-to-dry weight (W/D) ratio and histology were taken. The left lung was inflated, frozen in liquid nitrogen vapors and scanned with computed tomography (CT) to assess regional distribution of Hounsfield units (HU). RESULTS All lungs endured 6 h of EVLP. Oxygenation was better in FCV compared to VCV (p = 0.01) and the decrease in lung compliance was less in FCV (p = 0.03). W/D ratio, pathology and BAL samples did not differ between both groups (p = 0.16, p = 0.55 and p = 0.62). Overall, CT densities tended to be less pronounced in FCV (p = 0.05). Distribution of CT densities revealed a higher proportion of well-aerated lung parts in FCV compared to VCV (p = 0.01). CONCLUSIONS FCV in pulmonary grafts mounted on EVLP is feasible and leads to improved oxygenation and alveolar recruitment. This ventilation strategy might prolong EVLP over time, with less risk for volutrauma and atelectrauma.
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Affiliation(s)
- Sofie Ordies
- Unit of Anesthesiology and Algology, Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium.,Department of Anesthesiology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.,Leuven Lung Transplant Group, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Michaela Orlitova
- Unit of Anesthesiology and Algology, Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium.,Leuven Lung Transplant Group, Katholieke Universiteit Leuven, Leuven, Belgium.,Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Tobias Heigl
- Leuven Lung Transplant Group, Katholieke Universiteit Leuven, Leuven, Belgium.,Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases, Metabolism and Ageing (CHROMETA), Katholieke Universiteit Leuven, Leuven, Belgium
| | - Annelore Sacreas
- Leuven Lung Transplant Group, Katholieke Universiteit Leuven, Leuven, Belgium.,Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases, Metabolism and Ageing (CHROMETA), Katholieke Universiteit Leuven, Leuven, Belgium
| | - Anke Van Herck
- Leuven Lung Transplant Group, Katholieke Universiteit Leuven, Leuven, Belgium.,Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases, Metabolism and Ageing (CHROMETA), Katholieke Universiteit Leuven, Leuven, Belgium.,Department of Pneumology, University Hospitals Leuven, Leuven, Belgium
| | - Janne Kaes
- Leuven Lung Transplant Group, Katholieke Universiteit Leuven, Leuven, Belgium.,Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases, Metabolism and Ageing (CHROMETA), Katholieke Universiteit Leuven, Leuven, Belgium
| | - Berta Saez
- Leuven Lung Transplant Group, Katholieke Universiteit Leuven, Leuven, Belgium.,Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases, Metabolism and Ageing (CHROMETA), Katholieke Universiteit Leuven, Leuven, Belgium.,Department of Pneumology, University Hospitals Leuven, Leuven, Belgium
| | - Arno Vanstapel
- Leuven Lung Transplant Group, Katholieke Universiteit Leuven, Leuven, Belgium.,Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases, Metabolism and Ageing (CHROMETA), Katholieke Universiteit Leuven, Leuven, Belgium.,Department of Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Laurens Ceulemans
- Leuven Lung Transplant Group, Katholieke Universiteit Leuven, Leuven, Belgium.,Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.,Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases, Metabolism and Ageing (CHROMETA), Katholieke Universiteit Leuven, Leuven, Belgium
| | - Bart M Vanaudenaerde
- Leuven Lung Transplant Group, Katholieke Universiteit Leuven, Leuven, Belgium.,Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases, Metabolism and Ageing (CHROMETA), Katholieke Universiteit Leuven, Leuven, Belgium
| | - Robin Vos
- Leuven Lung Transplant Group, Katholieke Universiteit Leuven, Leuven, Belgium.,Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases, Metabolism and Ageing (CHROMETA), Katholieke Universiteit Leuven, Leuven, Belgium.,Department of Pneumology, University Hospitals Leuven, Leuven, Belgium
| | | | - Geert M Verleden
- Leuven Lung Transplant Group, Katholieke Universiteit Leuven, Leuven, Belgium.,Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases, Metabolism and Ageing (CHROMETA), Katholieke Universiteit Leuven, Leuven, Belgium.,Department of Pneumology, University Hospitals Leuven, Leuven, Belgium
| | - Stijn E Verleden
- Leuven Lung Transplant Group, Katholieke Universiteit Leuven, Leuven, Belgium.,Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases, Metabolism and Ageing (CHROMETA), Katholieke Universiteit Leuven, Leuven, Belgium
| | - Dirk E Van Raemdonck
- Leuven Lung Transplant Group, Katholieke Universiteit Leuven, Leuven, Belgium.,Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.,Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases, Metabolism and Ageing (CHROMETA), Katholieke Universiteit Leuven, Leuven, Belgium
| | - Arne P Neyrinck
- Unit of Anesthesiology and Algology, Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium. .,Department of Anesthesiology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium. .,Leuven Lung Transplant Group, Katholieke Universiteit Leuven, Leuven, Belgium.
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43
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Kaes J, Van der Borght E, Vanstapel A, Van Herck A, Sacreas A, Heigl T, Vanaudenaerde BM, Godinas L, Van Raemdonck DE, Ceulemans LJ, Neyrinck AP, Vos R, Verleden GM, Verleden SE. Peripheral Blood Eosinophilia Is Associated with Poor Outcome Post-Lung Transplantation. Cells 2020; 9:E2516. [PMID: 33233857 PMCID: PMC7699939 DOI: 10.3390/cells9112516] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 11/13/2020] [Accepted: 11/18/2020] [Indexed: 12/11/2022] Open
Abstract
Eosinophils play a role in many chronic lung diseases. In lung transplantation (LTx), increased eosinophils in bronchoalveolar lavage (BAL) was associated with worse outcomes. However, the effect of peripheral blood eosinophilia after LTx has not been investigated thoroughly. A retrospective study was performed including all LTx patients between 2011-2016. Chronic lung allograft dysfunction (CLAD)-free and graft survival were compared between patients with high and low blood eosinophils using an 8% threshold ever during follow-up. A total of 102 patients (27.1%) had high blood eosinophils (≥8%) (45 before CLAD and 17 after, 40 had no CLAD) and 274 (72.9%) had low eosinophils (<8%). Patients with high blood eosinophils demonstrated worse graft survival (p = 0.0001) and CLAD-free survival (p = 0.003) compared to low eosinophils. Patients with both high blood and high BAL (≥2%) eosinophils ever during follow-up had the worst outcomes. Within the high blood eosinophil group, 23.5% had RAS compared to 3% in the group with low eosinophils (p < 0.0001). After multivariate analysis, the association between high blood eosinophils and graft and CLAD-free survival remained significant (p = 0.036, p = 0.013) independent of high BAL eosinophils and infection at peak blood eosinophilia, among others. LTx recipients with ever ≥8% blood eosinophils demonstrate inferior graft and CLAD-free survival, specifically RAS, which requires further prospective research.
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Affiliation(s)
- Janne Kaes
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, B-3000 Leuven, Belgium; (J.K.); (E.V.d.B.); (A.V.); (A.V.H.); (A.S.); (T.H.); (B.M.V.); (D.E.V.R.); (L.J.C.); (R.V.); (G.M.V.)
| | - Elise Van der Borght
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, B-3000 Leuven, Belgium; (J.K.); (E.V.d.B.); (A.V.); (A.V.H.); (A.S.); (T.H.); (B.M.V.); (D.E.V.R.); (L.J.C.); (R.V.); (G.M.V.)
| | - Arno Vanstapel
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, B-3000 Leuven, Belgium; (J.K.); (E.V.d.B.); (A.V.); (A.V.H.); (A.S.); (T.H.); (B.M.V.); (D.E.V.R.); (L.J.C.); (R.V.); (G.M.V.)
- Department of Pathology, UH Leuven, B-3000 Leuven, Belgium
| | - Anke Van Herck
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, B-3000 Leuven, Belgium; (J.K.); (E.V.d.B.); (A.V.); (A.V.H.); (A.S.); (T.H.); (B.M.V.); (D.E.V.R.); (L.J.C.); (R.V.); (G.M.V.)
- Department of Respiratory Diseases, Lung Transplant Unit, UH Leuven, B-3000 Leuven, Belgium;
| | - Annelore Sacreas
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, B-3000 Leuven, Belgium; (J.K.); (E.V.d.B.); (A.V.); (A.V.H.); (A.S.); (T.H.); (B.M.V.); (D.E.V.R.); (L.J.C.); (R.V.); (G.M.V.)
| | - Tobias Heigl
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, B-3000 Leuven, Belgium; (J.K.); (E.V.d.B.); (A.V.); (A.V.H.); (A.S.); (T.H.); (B.M.V.); (D.E.V.R.); (L.J.C.); (R.V.); (G.M.V.)
| | - Bart M. Vanaudenaerde
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, B-3000 Leuven, Belgium; (J.K.); (E.V.d.B.); (A.V.); (A.V.H.); (A.S.); (T.H.); (B.M.V.); (D.E.V.R.); (L.J.C.); (R.V.); (G.M.V.)
| | - Laurent Godinas
- Department of Respiratory Diseases, Lung Transplant Unit, UH Leuven, B-3000 Leuven, Belgium;
| | - Dirk E. Van Raemdonck
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, B-3000 Leuven, Belgium; (J.K.); (E.V.d.B.); (A.V.); (A.V.H.); (A.S.); (T.H.); (B.M.V.); (D.E.V.R.); (L.J.C.); (R.V.); (G.M.V.)
- Department of Thoracic Surgery, UH Leuven, B-3000 Leuven, Belgium
| | - Laurens J. Ceulemans
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, B-3000 Leuven, Belgium; (J.K.); (E.V.d.B.); (A.V.); (A.V.H.); (A.S.); (T.H.); (B.M.V.); (D.E.V.R.); (L.J.C.); (R.V.); (G.M.V.)
- Department of Thoracic Surgery, UH Leuven, B-3000 Leuven, Belgium
| | - Arne P. Neyrinck
- Laboratory of Anesthesiology and Algology, Department of Cardiovascular Sciences, KU Leuven, B-3000 Leuven, Belgium;
| | - Robin Vos
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, B-3000 Leuven, Belgium; (J.K.); (E.V.d.B.); (A.V.); (A.V.H.); (A.S.); (T.H.); (B.M.V.); (D.E.V.R.); (L.J.C.); (R.V.); (G.M.V.)
- Department of Respiratory Diseases, Lung Transplant Unit, UH Leuven, B-3000 Leuven, Belgium;
| | - Geert M. Verleden
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, B-3000 Leuven, Belgium; (J.K.); (E.V.d.B.); (A.V.); (A.V.H.); (A.S.); (T.H.); (B.M.V.); (D.E.V.R.); (L.J.C.); (R.V.); (G.M.V.)
- Department of Respiratory Diseases, Lung Transplant Unit, UH Leuven, B-3000 Leuven, Belgium;
| | - Stijn E. Verleden
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, B-3000 Leuven, Belgium; (J.K.); (E.V.d.B.); (A.V.); (A.V.H.); (A.S.); (T.H.); (B.M.V.); (D.E.V.R.); (L.J.C.); (R.V.); (G.M.V.)
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Tanabe N, Vasilescu DM, Hague CJ, Ikezoe K, Murphy DT, Kirby M, Stevenson CS, Verleden SE, Vanaudenaerde BM, Gayan-Ramirez G, Janssens W, Coxson HO, Paré PD, Hogg JC. Pathological Comparisons of Paraseptal and Centrilobular Emphysema in Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2020; 202:803-811. [PMID: 32485111 DOI: 10.1164/rccm.201912-2327oc] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Rationale: Although centrilobular emphysema (CLE) and paraseptal emphysema (PSE) are commonly identified on multidetector computed tomography (MDCT), little is known about the pathology associated with PSE compared with that of CLE.Objectives: To assess the pathological differences between PSE and CLE in chronic obstructive pulmonary disease (COPD).Methods: Air-inflated frozen lung specimens (n = 6) obtained from patients with severe COPD treated by lung transplantation were scanned with MDCT. Frozen tissue cores were taken from central (n = 8) and peripheral (n = 8) regions of each lung, scanned with micro-computed tomography (microCT), and processed for histology. The core locations were registered to the MDCT, and a percentage of PSE or CLE was assigned by radiologists to each of the regions. MicroCT scans were used to measure number and structural change of terminal bronchioles. Furthermore, microCT-based volume fractions of CLE and PSE allowed classifying cores into mild emphysema, CLE-dominant, and PSE-dominant.Measurements and Main Results: The percentages of PSE measured on MDCT and microCT were positively associated (P = 0.015). The number of terminal bronchioles per milliliter of lung and cross-sectional lumen area were significantly lower and wall area percentage was significantly higher in CLE-dominant regions compared with mild emphysema and PSE-dominant regions (all P < 0.05), whereas no difference was found between PSE-dominant and mild emphysema samples (all P > 0.5). Immunohistochemistry showed significantly higher infiltration of neutrophils (P = 0.002), but not of macrophages, CD4, CD8, or B cells, in PSE compared with CLE regions.Conclusions: The terminal bronchioles are relatively preserved, whereas neutrophilic inflammation is increased in PSE-dominant regions compared with CLE-dominant regions in patients with COPD.
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Affiliation(s)
- Naoya Tanabe
- Centre for Heart and Lung Innovation, St. Paul's Hospital, and.,Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | | | - Cameron J Hague
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kohei Ikezoe
- Centre for Heart and Lung Innovation, St. Paul's Hospital, and
| | - Darra T Murphy
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Miranda Kirby
- Centre for Heart and Lung Innovation, St. Paul's Hospital, and.,Department of Physics, Ryerson University, Toronto, Ontario, Canada
| | - Christopher S Stevenson
- Janssen Disease Interception Accelerator, Janssen Pharmaceutical Companies of Johnson and Johnson, Beerse, Belgium; and
| | - Stijn E Verleden
- Department of Chronic Disease, Metabolism and Aging, Laboratory of Respiratory Diseases, KU Leuven, Leuven, Belgium
| | - Bart M Vanaudenaerde
- Department of Chronic Disease, Metabolism and Aging, Laboratory of Respiratory Diseases, KU Leuven, Leuven, Belgium
| | - Ghislaine Gayan-Ramirez
- Department of Chronic Disease, Metabolism and Aging, Laboratory of Respiratory Diseases, KU Leuven, Leuven, Belgium
| | - Wim Janssens
- Department of Chronic Disease, Metabolism and Aging, Laboratory of Respiratory Diseases, KU Leuven, Leuven, Belgium
| | - Harvey O Coxson
- Centre for Heart and Lung Innovation, St. Paul's Hospital, and
| | - Peter D Paré
- Centre for Heart and Lung Innovation, St. Paul's Hospital, and
| | - James C Hogg
- Centre for Heart and Lung Innovation, St. Paul's Hospital, and
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45
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Heigl T, Saez-Gimenez B, Van Herck A, Kaes J, Sacreas A, Beeckmans H, Ambrocio GPL, Kwakkel-Van Erp H, Ordies S, Vanstapel A, Verleden SE, Neyrinck AP, Ceulemans LJ, Van Raemdonck DE, Verbeken E, Verleden GM, Vos R, Vanaudenaerde B. Free Airway C4d after Lung Transplantation - A Quantitative Analysis of Bronchoalveolar Lavage Fluid. Transpl Immunol 2020; 64:101352. [PMID: 33217540 DOI: 10.1016/j.trim.2020.101352] [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: 09/10/2020] [Revised: 11/07/2020] [Accepted: 11/07/2020] [Indexed: 01/23/2023]
Abstract
In recent years, the utility of vascular complement factor 4d (C4d) deposition as diagnostic tool for antibody mediated rejection (AMR) after lung transplantation, has become a controversial issue. We aimed to pinpoint the problematic nature of C4d as biomarker with a simple experiment. We quantified C4d in broncho-alveolar lavage (BAL) of lung transplant patients with diverse post-transplant complications in 3 different settings of clinically clear cases of: 1/ chronic lung allograft dysfunction (CLAD); 2/ acute complications acute rejection (AR), lymphocytic bronchiolitis (LB), antibody-mediated rejection (AMR) and respiratory infection (INF); 3/ patients with parallel C4d immunostaining and Anti-HLA. All groups were compared to BAL of stable patients. C4d was measured via standard ELISA. C4d was increased in CLAD, predominantly in RAS (p = 0.0026) but not in BOS (p = 0.89). C4d was increased in all acute events, AR (p = 0.0025), LB (p < 0.0001), AMR (p = 0.0034), infections (p < 0.0001). In patients with parallel C4d immunostaining and serum HLA antibodies, C4d was increased in C4d-/HLA- (p = 0.0011); C4d-/HLA+ (p = 0.013); HLA+/C4d + (p = 0.0081). A correlation of systemic C-reactive protein (CRP) with C4d was found in all patients (r = 0.49; p < 0.0001). We hypothesize that free C4d in BAL may only be representative of a general immune response in the transplanted lung.
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Affiliation(s)
- Tobias Heigl
- Department of Chronic Diseases, Metabolism & Ageing (CHROMETA), Laboratory of Respiratory Diseases & Thoracic Surgery (BREATHE), UZ/KU Leuven, Leuven, Belgium
| | - Berta Saez-Gimenez
- Department of Pneumology, University Hospital Vall d'Hebron, Barcelona, Spain
| | - Anke Van Herck
- Department of Chronic Diseases, Metabolism & Ageing (CHROMETA), Laboratory of Respiratory Diseases & Thoracic Surgery (BREATHE), UZ/KU Leuven, Leuven, Belgium
| | - Janne Kaes
- Department of Chronic Diseases, Metabolism & Ageing (CHROMETA), Laboratory of Respiratory Diseases & Thoracic Surgery (BREATHE), UZ/KU Leuven, Leuven, Belgium
| | - Annelore Sacreas
- Department of Chronic Diseases, Metabolism & Ageing (CHROMETA), Laboratory of Respiratory Diseases & Thoracic Surgery (BREATHE), UZ/KU Leuven, Leuven, Belgium
| | - Hanne Beeckmans
- Department of Chronic Diseases, Metabolism & Ageing (CHROMETA), Laboratory of Respiratory Diseases & Thoracic Surgery (BREATHE), UZ/KU Leuven, Leuven, Belgium
| | - Gene P L Ambrocio
- Department of Chronic Diseases, Metabolism & Ageing (CHROMETA), Laboratory of Respiratory Diseases & Thoracic Surgery (BREATHE), UZ/KU Leuven, Leuven, Belgium
| | - Hanneke Kwakkel-Van Erp
- Department of Chronic Diseases, Metabolism & Ageing (CHROMETA), Laboratory of Respiratory Diseases & Thoracic Surgery (BREATHE), UZ/KU Leuven, Leuven, Belgium; Department of Pneumology, University of Antwerp, Antwerp, Belgium
| | - Sofie Ordies
- Department of Chronic Diseases, Metabolism & Ageing (CHROMETA), Laboratory of Respiratory Diseases & Thoracic Surgery (BREATHE), UZ/KU Leuven, Leuven, Belgium
| | - Arno Vanstapel
- Department of Chronic Diseases, Metabolism & Ageing (CHROMETA), Laboratory of Respiratory Diseases & Thoracic Surgery (BREATHE), UZ/KU Leuven, Leuven, Belgium
| | - Stijn E Verleden
- Department of Chronic Diseases, Metabolism & Ageing (CHROMETA), Laboratory of Respiratory Diseases & Thoracic Surgery (BREATHE), UZ/KU Leuven, Leuven, Belgium
| | - Arne P Neyrinck
- Department of Chronic Diseases, Metabolism & Ageing (CHROMETA), Laboratory of Respiratory Diseases & Thoracic Surgery (BREATHE), UZ/KU Leuven, Leuven, Belgium
| | - Laurens J Ceulemans
- Department of Chronic Diseases, Metabolism & Ageing (CHROMETA), Laboratory of Respiratory Diseases & Thoracic Surgery (BREATHE), UZ/KU Leuven, Leuven, Belgium
| | - Dirk E Van Raemdonck
- Department of Chronic Diseases, Metabolism & Ageing (CHROMETA), Laboratory of Respiratory Diseases & Thoracic Surgery (BREATHE), UZ/KU Leuven, Leuven, Belgium
| | - Erik Verbeken
- Translational Cell and Tissue Research, KU Leuven and UZ Gasthuisberg, Leuven, Belgium
| | - Geert M Verleden
- Department of Chronic Diseases, Metabolism & Ageing (CHROMETA), Laboratory of Respiratory Diseases & Thoracic Surgery (BREATHE), UZ/KU Leuven, Leuven, Belgium
| | - Robin Vos
- Department of Chronic Diseases, Metabolism & Ageing (CHROMETA), Laboratory of Respiratory Diseases & Thoracic Surgery (BREATHE), UZ/KU Leuven, Leuven, Belgium
| | - Bart Vanaudenaerde
- Department of Chronic Diseases, Metabolism & Ageing (CHROMETA), Laboratory of Respiratory Diseases & Thoracic Surgery (BREATHE), UZ/KU Leuven, Leuven, Belgium.
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46
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Verleden SE, Braubach P, Kuehnel M, Dickgreber N, Brouwer E, Tittmann P, Laenger F, Jonigk D. Molecular approach to the classification of chronic fibrosing lung disease-there and back again. Virchows Arch 2020; 478:89-99. [PMID: 33169196 DOI: 10.1007/s00428-020-02964-9] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/21/2020] [Accepted: 10/30/2020] [Indexed: 11/26/2022]
Abstract
Chronic diffuse parenchymal lung disease (DPLD) is an umbrella term for a very heterogeneous group of lung diseases. Over the last decades, clinical, radiological and histopathological criteria have been established to define and separate these entities. More recently the clinical utility of this approach has been challenged as a unifying concept of pathophysiological mechanisms and a shared response to therapy across the disease spectrum have been described. In this review, we discuss molecular motifs for subtyping and the prediction of prognosis focusing on genetics and markers found in the blood, lavage and tissue. As a purely molecular classification so far lacks sufficient sensitivity and specificity for subtyping, it is not routinely used and not implemented in international guidelines. However, a better molecular characterization of lung disease with a more precise identification of patients with, for example, a risk for rapid disease progression would facilitate more accurate treatment decisions and hopefully contribute to better patients' outcomes.
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Affiliation(s)
- Stijn E Verleden
- Institute of Pathology, Hannover Medical School, Hannover, Germany.
- BREATHE Lab, Department of CHROMETA, KU Leuven, Leuven, Belgium.
| | - Peter Braubach
- Institute of Pathology, Hannover Medical School, Hannover, Germany
- Member of the German Center for Lung Research, Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH), Hannover, Germany
| | - Mark Kuehnel
- Institute of Pathology, Hannover Medical School, Hannover, Germany
- Member of the German Center for Lung Research, Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH), Hannover, Germany
| | - Nicolas Dickgreber
- Department of Respiratory Medicine and Thoracic Oncology, Ibbenbueren General Hospital, Ibbenbueren, Germany
| | - Emily Brouwer
- Institute of Pathology, Hannover Medical School, Hannover, Germany
- Member of the German Center for Lung Research, Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH), Hannover, Germany
| | - Pauline Tittmann
- Institute of Pathology, Hannover Medical School, Hannover, Germany
- Member of the German Center for Lung Research, Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH), Hannover, Germany
| | - Florian Laenger
- Institute of Pathology, Hannover Medical School, Hannover, Germany
- Member of the German Center for Lung Research, Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH), Hannover, Germany
| | - Danny Jonigk
- Institute of Pathology, Hannover Medical School, Hannover, Germany
- Member of the German Center for Lung Research, Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH), Hannover, Germany
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47
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Manaud G, Nossent EJ, Lambert M, Ghigna MR, Boët A, Vinhas MC, Ranchoux B, Dumas SJ, Courboulin A, Girerd B, Soubrier F, Bignard J, Claude O, Lecerf F, Hautefort A, Florio M, Sun B, Nadaud S, Verleden SE, Remy S, Anegon I, Bogaard HJ, Mercier O, Fadel E, Simonneau G, Vonk Noordegraaf A, Grünberg K, Humbert M, Montani D, Dorfmüller P, Antigny F, Perros F. Comparison of Human and Experimental Pulmonary Veno-Occlusive Disease. Am J Respir Cell Mol Biol 2020; 63:118-131. [PMID: 32209028 DOI: 10.1165/rcmb.2019-0015oc] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Pulmonary veno-occlusive disease (PVOD) occurs in humans either as a heritable form (hPVOD) due to biallelic inactivating mutations of EIF2AK4 (encoding GCN2) or as a sporadic form in older age (sPVOD). The chemotherapeutic agent mitomycin C (MMC) is a potent inducer of PVOD in humans and in rats (MMC-PVOD). Here, we compared human hPVOD and sPVOD, and MMC-PVOD pathophysiology at the histological, cellular, and molecular levels to unravel common altered pathomechanisms. MMC exposure in rats was associated primarily with arterial and microvessel remodeling, and secondarily by venous remodeling, when PVOD became symptomatic. In all forms of PVOD tested, there was convergent GCN2-dependent but eIF2α-independent pulmonary protein overexpression of HO-1 (heme oxygenase 1) and CHOP (CCAAT-enhancer-binding protein [C/EBP] homologous protein), two downstream effectors of GCN2 signaling and endoplasmic reticulum stress. In human PVOD samples, CHOP immunohistochemical staining mainly labeled endothelial cells in remodeled veins and arteries. Strong HO-1 staining was observed only within capillary hemangiomatosis foci, where intense microvascular proliferation occurs. HO-1 and CHOP stainings were not observed in control and pulmonary arterial hypertension lung tissues, supporting the specificity for CHOP and HO-1 involvement in PVOD pathobiology. In vivo loss of GCN2 (EIF2AK4 mutations carriers and Eif2ak4-/- rats) or in vitro GCN2 inhibition in cultured pulmonary artery endothelial cells using pharmacological and siRNA approaches demonstrated that GCN2 loss of function negatively regulates BMP (bone morphogenetic protein)-dependent SMAD1/5/9 signaling. Exogenous BMP9 was still able to reverse GCN2 inhibition-induced proliferation of pulmonary artery endothelial cells. In conclusion, we identified CHOP and HO-1 inhibition, and BMP9, as potential therapeutic options for PVOD.
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Affiliation(s)
- Grégoire Manaud
- Université Paris-Saclay-Faculté de Médecine, Le Kremlin-Bicêtre, France.,AP-HP, Centre de Référence de l'Hypertension Pulmonaire, Service de Pneumologie et Réanimation Respiratoire, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France.,UMRS 999, INSERM and Université Paris-Saclay, Laboratoire d'Excellence en Recherche sur le Médicament et l'Innovation Thérapeutique, and
| | - Esther J Nossent
- Amsterdam UMC, Vrije Universiteit Amsterdam, Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Mélanie Lambert
- Université Paris-Saclay-Faculté de Médecine, Le Kremlin-Bicêtre, France.,AP-HP, Centre de Référence de l'Hypertension Pulmonaire, Service de Pneumologie et Réanimation Respiratoire, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France.,UMRS 999, INSERM and Université Paris-Saclay, Laboratoire d'Excellence en Recherche sur le Médicament et l'Innovation Thérapeutique, and
| | | | - Angèle Boët
- Department of Research, Hôpital Marie Lannelongue, Le Plessis-Robinson, France
| | | | - Benoit Ranchoux
- Université Paris-Saclay-Faculté de Médecine, Le Kremlin-Bicêtre, France.,AP-HP, Centre de Référence de l'Hypertension Pulmonaire, Service de Pneumologie et Réanimation Respiratoire, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France.,UMRS 999, INSERM and Université Paris-Saclay, Laboratoire d'Excellence en Recherche sur le Médicament et l'Innovation Thérapeutique, and
| | - Sébastien J Dumas
- Université Paris-Saclay-Faculté de Médecine, Le Kremlin-Bicêtre, France.,AP-HP, Centre de Référence de l'Hypertension Pulmonaire, Service de Pneumologie et Réanimation Respiratoire, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France.,UMRS 999, INSERM and Université Paris-Saclay, Laboratoire d'Excellence en Recherche sur le Médicament et l'Innovation Thérapeutique, and
| | - Audrey Courboulin
- Université Paris-Saclay-Faculté de Médecine, Le Kremlin-Bicêtre, France.,AP-HP, Centre de Référence de l'Hypertension Pulmonaire, Service de Pneumologie et Réanimation Respiratoire, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France.,UMRS 999, INSERM and Université Paris-Saclay, Laboratoire d'Excellence en Recherche sur le Médicament et l'Innovation Thérapeutique, and
| | - Barbara Girerd
- Université Paris-Saclay-Faculté de Médecine, Le Kremlin-Bicêtre, France.,AP-HP, Centre de Référence de l'Hypertension Pulmonaire, Service de Pneumologie et Réanimation Respiratoire, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France.,UMRS 999, INSERM and Université Paris-Saclay, Laboratoire d'Excellence en Recherche sur le Médicament et l'Innovation Thérapeutique, and
| | - Florent Soubrier
- INSERM UMR_S 956, Pierre and Marie Curie Université (Paris 06), Paris, France
| | - Juliette Bignard
- INSERM UMR_S 956, Pierre and Marie Curie Université (Paris 06), Paris, France
| | - Olivier Claude
- INSERM UMR_S 956, Pierre and Marie Curie Université (Paris 06), Paris, France
| | - Florence Lecerf
- Université Paris-Saclay-Faculté de Médecine, Le Kremlin-Bicêtre, France.,AP-HP, Centre de Référence de l'Hypertension Pulmonaire, Service de Pneumologie et Réanimation Respiratoire, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France.,UMRS 999, INSERM and Université Paris-Saclay, Laboratoire d'Excellence en Recherche sur le Médicament et l'Innovation Thérapeutique, and
| | - Aurélie Hautefort
- Université Paris-Saclay-Faculté de Médecine, Le Kremlin-Bicêtre, France.,AP-HP, Centre de Référence de l'Hypertension Pulmonaire, Service de Pneumologie et Réanimation Respiratoire, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France.,UMRS 999, INSERM and Université Paris-Saclay, Laboratoire d'Excellence en Recherche sur le Médicament et l'Innovation Thérapeutique, and
| | - Monica Florio
- Cardio-Metabolic Disorders, Amgen Research, Amgen Inc., Thousand Oaks, California
| | - Banghua Sun
- Cardio-Metabolic Disorders, Amgen Research, Amgen Inc., Thousand Oaks, California
| | - Sophie Nadaud
- INSERM UMR_S 956, Pierre and Marie Curie Université (Paris 06), Paris, France
| | - Stijn E Verleden
- Laboratory of Respiratory Diseases and Thoracic Surgery, Department of Chronic Diseases, Metabolism and Ageing KU Leuven, Leuven, Belgium
| | - Séverine Remy
- INSERM UMR 1064, Center for Research in Transplantation and Immunology-ITUN et Transgenic Rats and Immunophenomic Platform, Nantes, France; and
| | - Ignacio Anegon
- INSERM UMR 1064, Center for Research in Transplantation and Immunology-ITUN et Transgenic Rats and Immunophenomic Platform, Nantes, France; and
| | - Harm Jan Bogaard
- Amsterdam UMC, Vrije Universiteit Amsterdam, Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Olaf Mercier
- Université Paris-Saclay-Faculté de Médecine, Le Kremlin-Bicêtre, France.,AP-HP, Centre de Référence de l'Hypertension Pulmonaire, Service de Pneumologie et Réanimation Respiratoire, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France.,UMRS 999, INSERM and Université Paris-Saclay, Laboratoire d'Excellence en Recherche sur le Médicament et l'Innovation Thérapeutique, and.,Service de Chirurgie Thoracique, Hôpital Marie Lannelongue, Le Plessis Robinson, France
| | - Elie Fadel
- Université Paris-Saclay-Faculté de Médecine, Le Kremlin-Bicêtre, France.,AP-HP, Centre de Référence de l'Hypertension Pulmonaire, Service de Pneumologie et Réanimation Respiratoire, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France.,UMRS 999, INSERM and Université Paris-Saclay, Laboratoire d'Excellence en Recherche sur le Médicament et l'Innovation Thérapeutique, and.,Service de Chirurgie Thoracique, Hôpital Marie Lannelongue, Le Plessis Robinson, France
| | - Gérald Simonneau
- Université Paris-Saclay-Faculté de Médecine, Le Kremlin-Bicêtre, France.,AP-HP, Centre de Référence de l'Hypertension Pulmonaire, Service de Pneumologie et Réanimation Respiratoire, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France.,UMRS 999, INSERM and Université Paris-Saclay, Laboratoire d'Excellence en Recherche sur le Médicament et l'Innovation Thérapeutique, and
| | - Anton Vonk Noordegraaf
- Amsterdam UMC, Vrije Universiteit Amsterdam, Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Katrien Grünberg
- Amsterdam UMC, Vrije Universiteit Amsterdam, Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Marc Humbert
- Université Paris-Saclay-Faculté de Médecine, Le Kremlin-Bicêtre, France.,AP-HP, Centre de Référence de l'Hypertension Pulmonaire, Service de Pneumologie et Réanimation Respiratoire, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France.,UMRS 999, INSERM and Université Paris-Saclay, Laboratoire d'Excellence en Recherche sur le Médicament et l'Innovation Thérapeutique, and
| | - David Montani
- Université Paris-Saclay-Faculté de Médecine, Le Kremlin-Bicêtre, France.,AP-HP, Centre de Référence de l'Hypertension Pulmonaire, Service de Pneumologie et Réanimation Respiratoire, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France.,UMRS 999, INSERM and Université Paris-Saclay, Laboratoire d'Excellence en Recherche sur le Médicament et l'Innovation Thérapeutique, and
| | - Peter Dorfmüller
- Université Paris-Saclay-Faculté de Médecine, Le Kremlin-Bicêtre, France.,AP-HP, Centre de Référence de l'Hypertension Pulmonaire, Service de Pneumologie et Réanimation Respiratoire, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France.,UMRS 999, INSERM and Université Paris-Saclay, Laboratoire d'Excellence en Recherche sur le Médicament et l'Innovation Thérapeutique, and.,Department of Pathology and.,Department of Pathology, University of Giessen and Marburg Lung Center, Justus-Liebig University Giessen, German Center for Lung Research, Giessen, Germany
| | - Fabrice Antigny
- Université Paris-Saclay-Faculté de Médecine, Le Kremlin-Bicêtre, France.,AP-HP, Centre de Référence de l'Hypertension Pulmonaire, Service de Pneumologie et Réanimation Respiratoire, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France.,UMRS 999, INSERM and Université Paris-Saclay, Laboratoire d'Excellence en Recherche sur le Médicament et l'Innovation Thérapeutique, and
| | - Frédéric Perros
- Université Paris-Saclay-Faculté de Médecine, Le Kremlin-Bicêtre, France.,AP-HP, Centre de Référence de l'Hypertension Pulmonaire, Service de Pneumologie et Réanimation Respiratoire, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France.,UMRS 999, INSERM and Université Paris-Saclay, Laboratoire d'Excellence en Recherche sur le Médicament et l'Innovation Thérapeutique, and
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Verleden SE, Kirby M, Everaerts S, Vanstapel A, McDonough JE, Verbeken EK, Braubach P, Boone MN, Aslam D, Verschakelen J, Ceulemans LJ, Neyrinck AP, Van Raemdonck DE, Vos R, Decramer M, Hackett TL, Hogg JC, Janssens W, Verleden GM, Vanaudenaerde BM. Small airway loss in the physiologically ageing lung: a cross-sectional study in unused donor lungs. Lancet Respir Med 2020; 9:167-174. [PMID: 33031747 DOI: 10.1016/s2213-2600(20)30324-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 07/01/2020] [Accepted: 07/01/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Physiological lung ageing is associated with a gradual decline in dynamic lung volumes and a progressive increase in residual volume due to diminished elastic recoil of the lung, loss of alveolar tissue, and lower chest wall compliance. However, the effects of ageing on the small airways (ie, airways <2·0 mm in diameter) remain largely unknown. By using a combination of ex-vivo conventional CT (resolution 1 mm), whole lung micro-CT (resolution 150 μm), and micro-CT of extracted cores (resolution 10 μm), we aimed to provide a multiresolution assessment of the small airways in lung ageing in a large cohort of never smokers. METHODS For this cross-sectional study, we included donor lungs collected from 32 deceased never-smoking donors (age range 16-83 years). Ex-vivo CT and whole lung high-resolution CT (micro-CT) were used to determine total airway numbers, stratified by airway diameter. Micro-CT was used to assess the number, length, and diameter of terminal bronchioles (ie, the last generation of conducting airways); mean linear intercept; and surface density in four lung tissue cores from each lung, extracted using a uniform sampling approach. Regression β coefficients are calculated using linear regression and polynomial models. FINDINGS Ex-vivo CT analysis showed an age-dependent decrease in the number of airways of diameter 2·0 mm to less than 2·5 mm (β coefficient per decade -0·119, 95% CI -0·193 to -0·045; R2=0·29) and especially in airways smaller than 2·0 mm in diameter (-0·158, -0·233 to -0·084; R2=0·47), between 30 and 80 years of age, but not of the larger (≥2·5 mm) diameter airways (-0·00781, -0·04409 to 0·02848; R2=0·0007). In micro-CT analysis of small airways, the total number of terminal bronchioles per lung increased until the age of 30 years, after which an almost linear decline in the number of terminal bronchioles was observed (β coefficient per decade -2035, 95% CI -2818 to -1252; R2=0·55), accompanied by a non-significant increase in alveolar airspace size (6·44, -0·57 to 13·45, R2=0·10). Moreover, this decrease in terminal bronchioles was associated with the age-related decline of pulmonary function predicted by healthy reference values. INTERPRETATION Loss of terminal bronchioles is an important structural component of age-related decline in pulmonary function of healthy, non-smoking individuals. FUNDING Research Foundation-Flanders, KU Leuven, Parker B Francis Foundation, UGent, Canadian Institutes for Health.
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Affiliation(s)
- Stijn E Verleden
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic diseases, Metabolism and Aging (CHROMETA), KU Leuven, Leuven, Belgium.
| | - Miranda Kirby
- Department of Physics, Ryerson University, Toronto, ON, Canada
| | - Stephanie Everaerts
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic diseases, Metabolism and Aging (CHROMETA), KU Leuven, Leuven, Belgium
| | - Arno Vanstapel
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic diseases, Metabolism and Aging (CHROMETA), KU Leuven, Leuven, Belgium
| | - John E McDonough
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic diseases, Metabolism and Aging (CHROMETA), KU Leuven, Leuven, Belgium
| | - Erik K Verbeken
- Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Peter Braubach
- Institute for Pathology, Hannover Medical School, Hannover, Germany
| | - Matthieu N Boone
- Department of Physics and Astronomy, Radiation Physics-Centre for X-ray Tomography, Ghent University, Ghent, Belgium
| | - Danesh Aslam
- Department of Physics, Ryerson University, Toronto, ON, Canada
| | | | - Laurens J Ceulemans
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic diseases, Metabolism and Aging (CHROMETA), KU Leuven, Leuven, Belgium
| | - Arne P Neyrinck
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Dirk E Van Raemdonck
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic diseases, Metabolism and Aging (CHROMETA), KU Leuven, Leuven, Belgium
| | - Robin Vos
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic diseases, Metabolism and Aging (CHROMETA), KU Leuven, Leuven, Belgium
| | - Marc Decramer
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic diseases, Metabolism and Aging (CHROMETA), KU Leuven, Leuven, Belgium
| | - Tillie L Hackett
- Centre for Heart Lung Innovation, St Paul's Hospital, Vancouver, BC, Canada
| | - James C Hogg
- Centre for Heart Lung Innovation, St Paul's Hospital, Vancouver, BC, Canada
| | - Wim Janssens
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic diseases, Metabolism and Aging (CHROMETA), KU Leuven, Leuven, Belgium
| | - Geert M Verleden
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic diseases, Metabolism and Aging (CHROMETA), KU Leuven, Leuven, Belgium
| | - Bart M Vanaudenaerde
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic diseases, Metabolism and Aging (CHROMETA), KU Leuven, Leuven, Belgium
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49
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Verleden SE, Von der Thüsen J, Roux A, Brouwers ES, Braubach P, Kuehnel M, Laenger F, Jonigk D. When tissue is the issue: A histological review of chronic lung allograft dysfunction. Am J Transplant 2020; 20:2644-2651. [PMID: 32185874 DOI: 10.1111/ajt.15864] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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: 01/30/2020] [Revised: 03/03/2020] [Accepted: 03/05/2020] [Indexed: 01/25/2023]
Abstract
Although chronic lung allograft dysfunction (CLAD) remains the major life-limiting factor following lung transplantation, much of its pathophysiology remains unknown. The discovery that CLAD can manifest both clinically and morphologically in vastly different ways led to the definition of distinct subtypes of CLAD. In this review, recent advances in our understanding of the pathophysiological mechanisms of the different phenotypes of CLAD will be discussed with a particular focus on tissue-based and molecular studies. An overview of the current knowledge on the mechanisms of the airway-centered bronchiolitis obliterans syndrome, as well as the airway and alveolar injuries in the restrictive allograft syndrome and also the vascular compartment in chronic antibody-mediated rejection is provided. Specific attention is also given to morphological and molecular markers for early CLAD diagnosis or histological changes associated with subsequent CLAD development. Evidence for a possible overlap between different forms of CLAD is presented and discussed. In the end, "tissue remains the (main) issue," as we are still limited in our knowledge about the actual triggers and specific mechanisms of all late forms of posttransplant graft failure, a shortcoming that needs to be addressed in order to further improve the outcome of lung transplant recipients.
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Affiliation(s)
- Stijn E Verleden
- Lab of Respiratory Diseases, BREATH, Department of CHROMETA, KU Leuven, Leuven, Belgium.,Institute of Pathology, Hannover Medical School (MHH), Hanover, Germany
| | - Jan Von der Thüsen
- Department of Pathology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Antoine Roux
- Pneumology, Adult Cystic Fibrosis Center and Lung Transplantation Department, Foch Hospital, Suresnes, France
| | - Emily S Brouwers
- Institute of Pathology, Hannover Medical School (MHH), Hanover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), The German Center for Lung Research (Deutsches Zentrum für Lungenforschung, DZL), Hannover Medical School (MHH), Hannover, Germany
| | - Peter Braubach
- Institute of Pathology, Hannover Medical School (MHH), Hanover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), The German Center for Lung Research (Deutsches Zentrum für Lungenforschung, DZL), Hannover Medical School (MHH), Hannover, Germany
| | - Mark Kuehnel
- Institute of Pathology, Hannover Medical School (MHH), Hanover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), The German Center for Lung Research (Deutsches Zentrum für Lungenforschung, DZL), Hannover Medical School (MHH), Hannover, Germany
| | - Florian Laenger
- Institute of Pathology, Hannover Medical School (MHH), Hanover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), The German Center for Lung Research (Deutsches Zentrum für Lungenforschung, DZL), Hannover Medical School (MHH), Hannover, Germany
| | - Danny Jonigk
- Institute of Pathology, Hannover Medical School (MHH), Hanover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), The German Center for Lung Research (Deutsches Zentrum für Lungenforschung, DZL), Hannover Medical School (MHH), Hannover, Germany
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50
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Vanstapel A, Verleden SE, Weynand B, Verbeken E, De Sadeleer L, Vanaudenaerde BM, Verleden GM, Vos R. Late-onset "acute fibrinous and organising pneumonia" impairs long-term lung allograft function and survival. Eur Respir J 2020; 56:13993003.02292-2019. [PMID: 32381491 DOI: 10.1183/13993003.02292-2019] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 04/16/2020] [Indexed: 01/17/2023]
Abstract
Acute fibrinous and organising pneumonia (AFOP) after lung transplantation is associated with a rapid decline in pulmonary function. However, the relation with chronic lung allograft dysfunction (CLAD) remains unclear. We investigated the association between detection of AFOP in lung allograft biopsies with clinically important endpoints.We reviewed lung allograft biopsies from 468 patients who underwent lung transplantation at the University Hospitals Leuven (2011-2017). AFOP was categorised as early new-onset (≤90 days post-transplant) or late new-onset (>90 days post-transplant); and associated with CLAD-free survival, graft survival, donor-specific antibodies, airway and blood eosinophilia.Early and late AFOP was detected in 24 (5%) and 30 (6%) patients, respectively. CLAD-free survival was significantly lower in patients with late AFOP (median survival 2.42 years; p<0.0001) compared with patients with early or without AFOP and specifically associated with development of restrictive allograft syndrome (OR 28.57, 95% CI 11.34-67.88; p<0.0001). Similarly, graft survival was significantly lower in patients with late AFOP (median survival 4.39 years; p<0.0001) compared with patients with early AFOP or without AFOP. Late AFOP was furthermore associated with detection of circulating donor-specific antibodies (OR 4.75, 95% CI 2.17-10.60; p=0.0004) compared with patients with early or without AFOP, and elevated airway and blood eosinophilia (p=0.043 and p=0.045, respectively) compared with early AFOP patients.Late new-onset AFOP is associated with a worse prognosis and high risk of CLAD development, specifically restrictive allograft syndrome. Our findings indicate that late new-onset AFOP might play a role in the early pathogenesis of restrictive allograft syndrome.
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Affiliation(s)
- Arno Vanstapel
- Dept of Chronic Diseases, Metabolism and Ageing, BREATHE, KU Leuven, Leuven, Belgium.,Dept of Pathology, UH Leuven, Leuven, Belgium
| | - Stijn E Verleden
- Dept of Chronic Diseases, Metabolism and Ageing, BREATHE, KU Leuven, Leuven, Belgium
| | | | | | - Laurens De Sadeleer
- Dept of Chronic Diseases, Metabolism and Ageing, BREATHE, KU Leuven, Leuven, Belgium
| | - Bart M Vanaudenaerde
- Dept of Chronic Diseases, Metabolism and Ageing, BREATHE, KU Leuven, Leuven, Belgium
| | - Geert M Verleden
- Dept of Chronic Diseases, Metabolism and Ageing, BREATHE, KU Leuven, Leuven, Belgium.,Dept of Respiratory Diseases, Lung Transplantation Unit, UH Leuven, Leuven, Belgium
| | - Robin Vos
- Dept of Chronic Diseases, Metabolism and Ageing, BREATHE, KU Leuven, Leuven, Belgium .,Dept of Respiratory Diseases, Lung Transplantation Unit, UH Leuven, Leuven, Belgium
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