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Khan MA, Sherbini N, Alyami S, Al-Harbi A, Alrajhi S, Abdullah R, AlGhamdi D, Rajendram R, Bamefleh H, Al-Jahdali H. Role of Multidisciplinary Team Meetings in the Diagnosis and Management of Diffuse Parenchymal Lung Diseases in a Tertiary Care Hospital. Avicenna J Med 2023; 13:230-236. [PMID: 38144909 PMCID: PMC10736212 DOI: 10.1055/s-0043-1776063] [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] [Indexed: 12/26/2023] Open
Abstract
Background Decisions on the management of interstitial lung diseases (ILD) and prognostication require an accurate diagnosis. It has been proposed that multidisciplinary team (MDT) meetings for ILD (ILD-MDT) improve these decisions in challenging cases of ILD. However, most studies in this field have been based on the decisions of individual clinicians and there are few reports on the outcomes of the ILD-MDT approach. We therefore describe the experience of the ILD-MDT meetings at our institution. Methods A single-center retrospective review of the electronic health care records of patients discussed in the ILD-MDT meetings at our institution from February 2016 to January 2021 was performed. At out institution, at each ILD-MDT meeting, the referring pulmonologist presents the clinical history and the results of all relevant investigations including serology, blood gas analyses, lung function tests, bronchoscopy, and bronchoalveolar lavage. A radiologist then describes the imaging including serial computed tomography (CT) scans. When available, the findings on lung biopsy are presented by a pathologist. Subsequent discussions lead to a consensus on the diagnosis and further management. Results The study included 121 patients, comprising 71 (57%) males and 76 nonsmokers (62.8%), with a mean age of 65 years (range: 25-93 years). The average number of comorbidities was 2.4 (range: 0-7). Imaging-based diagnoses were usual interstitial pneumonia (UIP)/chronic hypersensitivity pneumonitis (CHP) in 32 (26%) patients, UIP in 20 (17%) patients, probable UIP in 27 (22%) patients, nonspecific interstitial pneumonia in 11 (9%) patients, and indeterminate interstitial lung abnormalities (ILA) in 10 (8%) patients. The most common consensus clinical diagnosis after an ILD-MDT discussion was chronic hypersensitivity pneumonitis/idiopathic pulmonary fibrosis in 17 patients (14%), followed by idiopathic pulmonary fibrosis and connective tissue disease associated interstitial lung disease in 16 patients (13%), CHP in 11 patients (9.1%), and ILA in 10 patients (8.4%). Only a 42 patients (35%) required surgical lung biopsy for confirmation of the diagnosis. Conclusion This study describes the characteristics of the patients discussed in the ILD-MDT meetings with emphasis on their clinical, radiological, and laboratory data to reach a diagnosis and management plan. The decisions on commencement of antifibrotics or immunosuppressive therapy for patients with various ILDs are also made during these ILD-MDT meetings. This descriptive study could help other health care professionals regarding the structure of their ILD-MDT meetings and with discussions about diagnostic and care decisions for diffused parenchymal lung disease patients.
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Affiliation(s)
- Mohammad Ayaz Khan
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia
- Division of Pulmonary, Ministry of National Guard-Health Affairs, Department of Medicine, Riyadh, Saudi Arabia
| | - Nahid Sherbini
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia
- Internal Medicine Division, Ministry of National Guard-Health Affairs, Department of Medicine, Madinah, Saudi Arabia
| | - Sami Alyami
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia
- Division of Pulmonary, Ministry of National Guard-Health Affairs, Department of Medicine, Riyadh, Saudi Arabia
| | - Abdullah Al-Harbi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia
- Division of Pulmonary, Ministry of National Guard-Health Affairs, Department of Medicine, Riyadh, Saudi Arabia
| | - Suliman Alrajhi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia
- Department of Imaging, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Reem Abdullah
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia
- Division of Pulmonary, Ministry of National Guard-Health Affairs, Department of Medicine, Riyadh, Saudi Arabia
| | - Dhafer AlGhamdi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia
- Division of Pulmonary, Ministry of National Guard-Health Affairs, Department of Medicine, Riyadh, Saudi Arabia
| | - Rajkumar Rajendram
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia
- Internal Medicine Division, Ministry of National Guard-Health Affairs, Department of Medicine, Riyadh, Saudi Arabia
| | - Hana Bamefleh
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia
- Department of Pathology and laboratory, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Hamdan Al-Jahdali
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia
- Division of Pulmonary, Ministry of National Guard-Health Affairs, Department of Medicine, Riyadh, Saudi Arabia
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de Silva TA, Apte S, Voisey J, Spann K, Tan M, Divithotawela C, Chambers D, O’Sullivan B. Single-Cell Profiling of Cells in the Lung of a Patient with Chronic Hypersensitivity Pneumonitis Reveals Inflammatory Niche with Abundant CD39+ T Cells with Functional ATPase Phenotype: A Case Study. Int J Mol Sci 2023; 24:14442. [PMID: 37833889 PMCID: PMC10572861 DOI: 10.3390/ijms241914442] [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: 08/15/2023] [Revised: 09/13/2023] [Accepted: 09/20/2023] [Indexed: 10/15/2023] Open
Abstract
This study investigated immune cell characteristics in chronic hypersensitivity pneumonitis (HP), focusing on CD39-expressing cells' impact on inflammation and tissue remodelling. Lung tissue from an HP patient was analysed using single-cell transcriptomics, flow cytometry, and gene expression profiling. The tissue revealed diverse cell types like macrophages, T cells, fibroblasts, and regulatory T cells (Tregs). CD39-expressing Tregs exhibited heightened ATP hydrolysis capacity and regulatory gene expression. CD39hi cells displayed markers of both Tregs and proinflammatory Th17 cells, suggesting transitional properties. Communication networks involving molecules like SPP1, collagen, CSF1, and IL-1β were identified, hinting at interactions between cell types in HP pathogenesis. This research provides insights into the immune response and cell interactions in chronic HP. CD39-expressing cells dual nature as Tregs and Th17 cells suggests a role in modulating lung inflammation, potentially affecting disease progression. These findings lay the groundwork for further research, underscoring CD39-expressing cells as potential therapeutic targets in HP.
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Affiliation(s)
- Tharushi Ayanthika de Silva
- Centre for Genomics and Personalised Health, Faculty of Health, School of Biomedical Sciences, Queensland University of Technology (QUT), Brisbane, QLD 4000, Australia
- Queensland Lung Transplant Service, Ground Floor, Clinical Sciences Building, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD 4000, Australia
| | - Simon Apte
- Queensland Lung Transplant Service, Ground Floor, Clinical Sciences Building, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD 4000, Australia
- Facility of Clinical Medicine, The University of Queensland, Brisbane, QLD 4000, Australia
| | - Joanne Voisey
- Centre for Genomics and Personalised Health, Faculty of Health, School of Biomedical Sciences, Queensland University of Technology (QUT), Brisbane, QLD 4000, Australia
| | - Kirsten Spann
- Centre for Immunology and Infection Control, Faculty of Health, School of Biomedical Sciences, Queensland University of Technology (QUT), Brisbane, QLD 4000, Australia
| | - Maxine Tan
- Queensland Lung Transplant Service, Ground Floor, Clinical Sciences Building, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD 4000, Australia
- Facility of Clinical Medicine, The University of Queensland, Brisbane, QLD 4000, Australia
| | - Chandima Divithotawela
- Queensland Lung Transplant Service, Ground Floor, Clinical Sciences Building, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD 4000, Australia
| | - Daniel Chambers
- Centre for Genomics and Personalised Health, Faculty of Health, School of Biomedical Sciences, Queensland University of Technology (QUT), Brisbane, QLD 4000, Australia
- Queensland Lung Transplant Service, Ground Floor, Clinical Sciences Building, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD 4000, Australia
- Facility of Clinical Medicine, The University of Queensland, Brisbane, QLD 4000, Australia
| | - Brendan O’Sullivan
- Centre for Genomics and Personalised Health, Faculty of Health, School of Biomedical Sciences, Queensland University of Technology (QUT), Brisbane, QLD 4000, Australia
- Queensland Lung Transplant Service, Ground Floor, Clinical Sciences Building, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD 4000, Australia
- Facility of Clinical Medicine, The University of Queensland, Brisbane, QLD 4000, Australia
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Elkhatib WY, Helgeson SA, Baig HZ, Lee AS. Impact of concomitant gastroesophageal reflux disease symptomology on prognosis and pulmonary function of chronic hypersensitivity pneumonitis. Lung India 2023; 40:406-411. [PMID: 37787352 PMCID: PMC10553774 DOI: 10.4103/lungindia.lungindia_107_23] [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: 03/13/2023] [Revised: 06/07/2023] [Accepted: 06/17/2023] [Indexed: 10/04/2023] Open
Abstract
Background and Objectives Comorbid risk factors in chronic hypersensitivity pneumonitis (CHP) are poorly characterised. Gastroesophageal reflux disease (GERD) is linked to interstitial lung diseases like idiopathic pulmonary fibrosis (IPF), but its association and treatment in CHP is less understood. This study aims to understand the role and prevalence of GERD in CHP, plus the effect of GERD treatment on lung function and mortality. Methods A tertiary referral centre panel was retrospectively reviewed for 214 patients diagnosed with CHP based on clinical history, bronchoalveolar lavage fluid analysis, imaging and histopathology. GERD diagnostic criteria included symptomology, acid suppressive therapy use and diagnostic testing. CHP patients with GERD (n = 89) and without GERD (n = 125) were compared via descriptive statistical analysis. Pulmonary function, GERD diagnosis plus treatment and other comorbidities were evaluated against CHP outcomes. Results Respective differences between diagnosis and study termination dates in the GERD population versus without GERD for functional vital capacity (FVC) were - 1 L vs - 2.5 L, diffusing capacity of the lungs for carbon monoxide (DLCO) were - 2 mL/min/mmHg versus - 1 mL/min/mmHg, per cent alive at the time of study 88% versus 81%, median date of survival 574.5 versus 850 and supplemental oxygen requirement 41% versus 37%. GERD prevalence was higher in CHP patients relative to the general population. No statistical significance was found between survival curves, oxygen requirement, smoking history, FVC, or DLCO. Conclusions GERD could be a harmful comorbidity in CHP though may not necessarily affect survival or functional outcomes. This aligns with previous IPF studies, though remains controversial. Further research is needed regarding this association and treatment benefit.
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Affiliation(s)
| | - Scott A. Helgeson
- Department of Pulmonary and Critical Care Medicine, Mayo Clinic Florida, USA
| | - Hassan Z. Baig
- Department of Pulmonary and Critical Care Medicine, Mayo Clinic Florida, USA
| | - Augustine S. Lee
- Department of Pulmonary and Critical Care Medicine, Mayo Clinic Florida, USA
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Okuda R, Takemura T, Misumi T, Hagiwara E, Ogura T. Multidisciplinary Discussion for Fibrotic Hypersensitivity Pneumonitis with a Positive Antigen Avoidance. J Asthma Allergy 2023; 16:473-479. [PMID: 37168674 PMCID: PMC10166106 DOI: 10.2147/jaa.s409042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 04/29/2023] [Indexed: 05/13/2023] Open
Abstract
Background In the two fibrotic hypersensitivity pneumonitis (fHP) diagnostic guidelines, the multidisciplinary discussion (MDD) is required to be performed in diagnosis of fHP, as in idiopathic pulmonary fibrosis (IPF) diagnostic guideline. Although some patients with fHP can improve disease condition during antigen avoidance, which can facilitate the diagnosis of fHP, it is unclear if MDD is necessary in all patients with suspected fHP who improved an antigen avoidance. Objective To investigate the diagnosis of fHP via MDD with positive antigen avoidance tests (AATs) and the clinical diagnosis with positive AATs. Methods A single-center, retrospective study was conducted. Between 2012 and 2019, patients with fHP were enrolled in the study. Patients in the MDD diagnostic group consisted of patients diagnosed with MDD, including histopathology findings and positive ATTs, and patients in the clinical diagnostic group were diagnosed by two respiratory physicians and had positive ATTs. Results AAT was performed on 72 of 219 patients, and 58 had positive AATs. The study included 37 patients in the MDD diagnosis group and 21 patients in the clinical diagnosis group. No significant differences in overall survival (OS) were detected between the two groups (HR: 1.99 [95% CI: 0.82‒4.83], p = 0.127). The conducting MDD was not a risk factor for OS; only <79% forced vital capacity was a risk factor in the multivariate Cox hazard regression analysis. No significant difference in annual changes of forced vital capacity, diffusion of the lung for carbon monoxide and Krebs von den Lungen-6 between the MDD diagnostic and the clinical diagnostic groups were observed (p = 0.41, 0.79, and 0.81, respectively). Conclusion In patients with positive AATs, the disease progression of the MDD diagnostic and the clinical diagnostic groups were similar. Therefore, MDD could not be necessary in all patients with suspected fHP who had positive AATs.
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Affiliation(s)
- Ryo Okuda
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
- Correspondence: Ryo Okuda, Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomioka-higashi, Kanazawa-ku, Yokohama, Japan, Tel +81-45-701-9581, Email
| | - Tamiko Takemura
- Department of Pathology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Toshihiro Misumi
- Department of Data Science, National Cancer Center Hospital East, Chiba, Japan
| | - Eri Hagiwara
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Takashi Ogura
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
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5
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Mendonça Almeida L, Fernandes AL, Gouveia Cardoso C, Lima B, Neves I, Novais-Bastos H, Caetano Mota P, Melo N, Souto Moura C, Guimarães S, Carvalho A, Cunha R, Pereira JM, Morais A. Mortality risk prediction with ILD-GAP index in a fibrotic hypersensitivity pneumonitis cohort. Ther Adv Respir Dis 2022; 16:17534666221135316. [PMID: 36476249 PMCID: PMC9742694 DOI: 10.1177/17534666221135316] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Fibrotic hypersensitivity pneumonitis (fHP) is associated with significant morbidity and mortality. Interstitial lung disease-gender-age-physiology (ILD-GAP) performance in fHP outside the initial cohort was never performed. AIM To assess the ILD-GAP index's ability to predict mortality in a Portuguese cohort of patients with fHP and analyse whether other clinical variables add value. METHODS Retrospective analysis of fHP cohort in two Portuguese ILD centres. The baseline ILD-GAP index was calculated. Survival was analysed in months; mortality was the primary outcome. Univariate and multivariate analyses to identify mortality risk factors were performed. RESULTS A total of 141 patients were included. Fifty-three patients (37.6%) died during the follow-up. The usual interstitial pneumonia (UIP) pattern was found in 49.6%, and their survival was inferior to non-UIP [32 months (interquartile range, IQR = 19, 60) versus 52 months (IQR = 28, 98), p = 0.048]. Patients with an ILD-GAP index higher than three double their risk of mortality [hazard ratio (HR) = 6.48, 95% confidence interval (CI) = (3.03-13.96)] when compared with the patients with an index between 2 and 3 [HR = 3.04, 95% CI = (1.62-5.71)] adjusting for acute exacerbation history. Even though UIP patients had worse survival, it did not reach statistical significance when UIP pattern was added to this model. Acute exacerbation history was an independent risk factor for mortality; however, ILD-GAP still predicted mortality after adjusting for this factor. PaO2 and 6-minute walk test desaturation were not significant risk factors. CONCLUSION ILD-GAP index is a good predictor for mortality in fHP, even after adjusting for other mortality risk factors.
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Affiliation(s)
| | | | | | - Bruno Lima
- Oficina de Bioestatística, Porto, Portugal
| | - Inês Neves
- Pulmonology Department, Hospital Pedro Hispano, Matosinhos, Portugal
| | - Hélder Novais-Bastos
- Pulmonology Department, Centro Hospitalar e Universitário São João, Porto, Portugal,Faculty of Medicine, University of Porto, Porto, Portugal,i3S – Institute for Research and Innovation in Health/Instituto de Investigação e Inovação em Saúde da Universidade do Porto, Porto, Portugal
| | - Patrícia Caetano Mota
- Pulmonology Department, Centro Hospitalar e Universitário São João, Porto, Portugal,Faculty of Medicine, University of Porto, Porto, Portugal
| | - Natália Melo
- Pulmonology Department, Centro Hospitalar e Universitário São João, Porto, Portugal
| | - Conceição Souto Moura
- Faculty of Medicine, University of Porto, Porto, Portugal,Pathology Department, Centro Hospitalar e Universitário São João, Porto, Portugal
| | - Susana Guimarães
- Faculty of Medicine, University of Porto, Porto, Portugal,Pathology Department, Centro Hospitalar e Universitário São João, Porto, Portugal
| | - André Carvalho
- Faculty of Medicine, University of Porto, Porto, Portugal,Radiology Department, Centro Hospitalar e Universitário São João, Porto, Portugal
| | - Rui Cunha
- Faculty of Medicine, University of Porto, Porto, Portugal,Radiology Department, Centro Hospitalar e Universitário São João, Porto, Portugal
| | - José Miguel Pereira
- Faculty of Medicine, University of Porto, Porto, Portugal,Radiology Department, Centro Hospitalar e Universitário São João, Porto, Portugal
| | - António Morais
- Pulmonology Department, Centro Hospitalar e Universitário São João, Porto, Portugal,Faculty of Medicine, University of Porto, Porto, Portugal,i3S – Institute for Research and Innovation in Health/Instituto de Investigação e Inovação em Saúde da Universidade do Porto, Porto, Portugal
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6
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Katayanagi S, Setoguchi Y, Kitagawa S, Okamoto T, Miyazaki Y. Alternative Gene Expression by TOLLIP Variant Is Associated With Lung Function in Chronic Hypersensitivity Pneumonitis. Chest 2021; 161:458-469. [PMID: 34419427 DOI: 10.1016/j.chest.2021.08.052] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 08/03/2021] [Accepted: 08/04/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Chronic hypersensitivity pneumonitis (CHP) is a heterogeneous fibrotic interstitial pneumonia resulting from the immune response of susceptible individuals to inhaled antigens. Genetic predispositions have been suggested in CHP; however, the link between susceptibility genes and fibrotic progression has not been elucidated fully. Recent data suggest that variants in Toll-interacting protein (TOLLIP) are associated with lung diseases. RESEARCH QUESTION Can TOLLIP variants be associated with any clinical features in patients with CHP? STUDY DESIGN AND METHODS We genotyped rs5743899 and rs3750920 in TOLLIP and analyzed the association with clinical parameters in 101 patients with CHP (67 for the retrospective cohort and 34 for the prospective cohort). We evaluated the expression of TOLLIP and fibrogenic signals in affected lung tissues and periostin in sera. Furthermore, we performed immunologic analysis in the lungs and sera. RESULTS The rs5743899 GG genotype was associated with rapid deterioration in FVC over time, which demonstrated significant annual decline in the retrospective cohort (vs AA, P = .0006; vs AG, P < .0001), prospective cohort (vs AA, P < .0001; vs AG, P = .003), and combined cohort (both P < .0001). The patients with the GG genotype demonstrated lower transcription-translation levels of TOLLIP as well as increased phosphorylation of Smad2 and inhibitor of kappa B in the lung tissues and exhibited higher serum levels of periostin, IL-1α, IL-1β, IL-6, IL-8, tumor necrosis factor α, and IFN-γ. INTERPRETATION The functional changes by TOLLIP variant were associated with rapid FVC decline through dysregulated Smad/transforming growth factor β and NF-κB signaling in CHP.
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Affiliation(s)
- Shinji Katayanagi
- Department of Respiratory Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yasuhiro Setoguchi
- Department of Respiratory Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Sayoko Kitagawa
- Department of Respiratory Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tsukasa Okamoto
- Department of Respiratory Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yasunari Miyazaki
- Department of Respiratory Medicine, Tokyo Medical and Dental University, Tokyo, Japan
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7
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Vietri L, d'Alessandro M, Bergantini L, Carleo A, Cameli P, Mazzei MA, Sestini P, Bargagli E. Specificity of serum amyloid A as a biomarker of idiopathic pulmonary fibrosis. Intern Med J 2021; 50:1571-1574. [PMID: 33354874 DOI: 10.1111/imj.15113] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 01/31/2020] [Revised: 05/04/2020] [Accepted: 05/06/2020] [Indexed: 12/16/2022]
Abstract
Serum amyloid A (SAA) is an apo-lipoprotein produced by the liver in response to proinflammatory cytokines. Few data are available on SAA levels in patients with idiopathic pulmonary fibrosis (IPF), the most common idiopathic form of interstitial pneumonitis (ILD). This study compared SAA concentration in IPF patients to other ILD groups to explore its potential use as a clinical biomarker.
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Affiliation(s)
- Lucia Vietri
- Respiratory Diseases and Lung Transplantation, Department of Medical and Surgical Sciences and Neurosciences, Siena University Hospital, Siena, Italy
| | - Miriana d'Alessandro
- Respiratory Diseases and Lung Transplantation, Department of Medical and Surgical Sciences and Neurosciences, Siena University Hospital, Siena, Italy
| | - Laura Bergantini
- Respiratory Diseases and Lung Transplantation, Department of Medical and Surgical Sciences and Neurosciences, Siena University Hospital, Siena, Italy
| | - Alfonso Carleo
- Respiratory Diseases and Lung Transplantation, Department of Medical and Surgical Sciences and Neurosciences, Siena University Hospital, Siena, Italy
| | - Paolo Cameli
- Respiratory Diseases and Lung Transplantation, Department of Medical and Surgical Sciences and Neurosciences, Siena University Hospital, Siena, Italy
| | - Maria Antonietta Mazzei
- Imaging Unit, Department of Medical and Surgical Science and Neurosciences, Siena University Hospital, Siena, Italy
| | - Piersante Sestini
- Respiratory Diseases and Lung Transplantation, Department of Medical and Surgical Sciences and Neurosciences, Siena University Hospital, Siena, Italy
| | - Elena Bargagli
- Respiratory Diseases and Lung Transplantation, Department of Medical and Surgical Sciences and Neurosciences, Siena University Hospital, Siena, Italy
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8
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d'Alessandro M, Bergantini L, Cameli P, Lanzarone N, Antonietta Mazzei M, Alonzi V, Sestini P, Bargagli E. Serum KL-6 levels in pulmonary Langerhans' cell histiocytosis. Eur J Clin Invest 2020; 50:e13242. [PMID: 32307698 DOI: 10.1111/eci.13242] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 03/31/2020] [Accepted: 04/12/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND Serum Krebs von den Lungen-6 (sKL-6) is an high-molecular-weight (200 kDa) glycoprotein predominantly expressed by damaged alveolar type II cells, and it has been proposed as a potential biomarker of different ILD. This is a prognostic biomarker for chronic hypersensitivity pneumonitis (cHP) and idiopathic pulmonary fibrosis (IPF), two diseases that share several clinical and radiological features. Little data are available on the potential role of KL-6 in granulomatous and cystic interstitial lung diseases, including the orphan disease known as pulmonary Langerhans cell histiocytosis (PLCH). METHODS For the first time, sKL-6 concentrations were assayed and compared in 96 patients (17 PLCH, 22 IPF, 34 cHP) and 22 healthy controls. RESULTS Serum KL-6 concentrations were significantly higher in PLCH (599 ± 594 U/mL), IPF (1645 ± 846 U/mL) and cHP patients (1691 ± 1643 U/mL) than in healthy controls (268 U/mL) (P = .037). Area-under-the-curve values of sKL-6 were 73.4% between PLCH and healthy controls, 84.5% between IPF and PLCH and 78% between cHP and PLCH. An indirect correlation between sKL-6 concentrations and peripheral CD1a-positive cells was demonstrated (r = -0.82; P = .034). CONCLUSION Serum KL-6 concentrations were higher in PLCH patients than in controls, reflecting the alveolar damage typical of this rare interstitial lung disease.
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Affiliation(s)
- Miriana d'Alessandro
- Respiratory Diseases and Lung Transplantation, Department of Medical and Surgical Sciences & Neurosciences, Siena University Hospital, Siena, Italy
| | - Laura Bergantini
- Respiratory Diseases and Lung Transplantation, Department of Medical and Surgical Sciences & Neurosciences, Siena University Hospital, Siena, Italy
| | - Paolo Cameli
- Respiratory Diseases and Lung Transplantation, Department of Medical and Surgical Sciences & Neurosciences, Siena University Hospital, Siena, Italy
| | - Nicola Lanzarone
- Respiratory Diseases and Lung Transplantation, Department of Medical and Surgical Sciences & Neurosciences, Siena University Hospital, Siena, Italy
| | - Maria Antonietta Mazzei
- Imaging Unit, Department of Medical and Surgical Science & Neurosciences, Siena University Hospital, Siena, Italy
| | - Valerio Alonzi
- Respiratory Diseases and Lung Transplantation, Department of Medical and Surgical Sciences & Neurosciences, Siena University Hospital, Siena, Italy
| | - Piersante Sestini
- Respiratory Diseases and Lung Transplantation, Department of Medical and Surgical Sciences & Neurosciences, Siena University Hospital, Siena, Italy
| | - Elena Bargagli
- Respiratory Diseases and Lung Transplantation, Department of Medical and Surgical Sciences & Neurosciences, Siena University Hospital, Siena, Italy
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Hanzawa S, Tateishi T, Takemura T, Okada Y, Yamada Y, Noda M, Miyazaki Y, Inase N. The Analysis of Surgical Lung Biopsy and Explanted Lung Specimens Sheds Light on the Pathological Progression of Chronic Bird-related Hypersensitivity Pneumonitis. Intern Med 2019; 58:1145-1150. [PMID: 30568114 PMCID: PMC6522403 DOI: 10.2169/internalmedicine.1142-18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Chronic hypersensitivity pneumonitis is an interstitial pneumonia caused by an immunological reaction to the chronic inhalation of an antigen. Little is known, however, about the pathological change of the pulmonary lesions. A 33-year-old man was diagnosed with chronic bird-related hypersensitivity pneumonitis based on the findings of a surgical lung biopsy and an inhalation provocation test. He underwent lung transplantation at 8 years after the diagnosis because of disease progression. We conclude that the analysis of the explant suggests that the presence of extensive fibrosis in the centrilobular and perilobular area with bridging fibrosis is a form of pathological progression of chronic hypersensitivity pneumonitis.
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Affiliation(s)
- Satoshi Hanzawa
- Department of Respiratory Medicine, Tokyo Medical and Dental University, Japan
| | - Tomoya Tateishi
- Department of Respiratory Medicine, Tokyo Medical and Dental University, Japan
| | | | - Yoshinori Okada
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, Japan
| | - Yoshihito Yamada
- Department of Respiratory Medicine, Japan Railway Tokyo General Hospital, Japan
| | - Masafumi Noda
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, Japan
| | - Yasunari Miyazaki
- Department of Respiratory Medicine, Tokyo Medical and Dental University, Japan
| | - Naohiko Inase
- Department of Respiratory Medicine, Tokyo Medical and Dental University, Japan
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10
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Suzuki T, Tateishi T, Sakashita H, Kawahara T, Sema M, Shimada S, Watanabe Y, Akashi T, Inase N, Miyazaki Y. [A CASE OF ACUTE EXACERBATION OF CHRONIC BIRDRELATED HYPERSENSITIVITY PNEUMONITIS WITH A REMARKABLE ELEVATION OF ENVIRONMENTAL AVIAN ANTIGEN LEVELS]. Arerugi 2018; 67:954-958. [PMID: 30146628 DOI: 10.15036/arerugi.67.954] [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] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A man in his 60's with interstitial pneumonitis who was previously admitted to another hospital was transferred to our hospital for further investigations 6 years prior to an acute exacerbation. Given his history of avian contact, the presence of antibodies specific to avian antigen, and a positive result of the inhalation provocation test using pigeon dropping extracts, he was diagnosed with bird-related hypersensitivity pneumonitis (BRHP). As such, we instructed the patient to avoid exposure to avian antigen, and regularly measured the level of avian antigen in dust samples collected from his household environment. Despite avoiding the stimulus, corticosteroids and immunosuppressants were needed in view of progression of dyspnea after approximately five to six years. Four months after immunosuppressant therapy began, the patient suffered an acute exacerbation of BRHP and died. At this time, we found that the level of avian antigen was much higher than baseline. We suggest that exposure to high level of avian antigen is one cause of an acute exacerbation of BRHP.
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Affiliation(s)
- Takafumi Suzuki
- Department of Respiratory Medicine, Tokyo Medical and Dental University
| | - Tomoya Tateishi
- Department of Respiratory Medicine, Tokyo Medical and Dental University
| | | | - Tatsuo Kawahara
- Department of Respiratory Medicine, Tokyo Medical and Dental University
| | - Manabu Sema
- Department of Respiratory Medicine, Tokyo Medical and Dental University
| | - Sho Shimada
- Department of Respiratory Medicine, Tokyo Medical and Dental University
| | - Yuta Watanabe
- Department of Respiratory Medicine, Tokyo Medical and Dental University
| | - Takumi Akashi
- Department of Pathology, Tokyo Medical and Dental University
| | - Naohiko Inase
- Department of Respiratory Medicine, Tokyo Medical and Dental University
| | - Yasunari Miyazaki
- Department of Respiratory Medicine, Tokyo Medical and Dental University
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11
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Shibata S, Furusawa H, Inase N. Pirfenidone in chronic hypersensitivity pneumonitis: a real-life experience. Sarcoidosis Vasc Diffuse Lung Dis 2018; 35:139-142. [PMID: 32476893 DOI: 10.36141/svdld.v35i2.6170] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 08/21/2017] [Indexed: 11/02/2022]
Abstract
Background: Pirfenidone is an antifibrotic drug used for the treatment of idiopathic pulmonary fibrosis. Objectives: The aim of this study was to evaluate the efficacy of pirfenidone in patients with chronic hypersensitivity pneumonitis (HP). Methods: Twenty-three patients with chronic HP treated with pirfenidone were enrolled in this study based on a retrospective medical record review. Results: The change in vital capacity (VC) in the 6 months after the start of treatment (-152±56.1 ml) was significantly improved compared with that in the 6 months before treatment (-292±77.8 ml, p=0.047). No patients discontinued the treatment with adverse events. Conclusions: These results demonstrate that pirfenidone may reduce the decline of VC in patients with chronic HP without eliciting significant adverse events. (Sarcoidosis Vasc Diffuse Lung Dis 2018; 35: 139-142).
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Affiliation(s)
- Sho Shibata
- Department of Respiratory Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Haruhiko Furusawa
- Department of Respiratory Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Naohiko Inase
- Department of Respiratory Medicine, Tokyo Medical and Dental University, Tokyo, Japan
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12
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Sema M, Miyazaki Y, Tsutsui T, Tomita M, Eishi Y, Inase N. Environmental levels of avian antigen are relevant to the progression of chronic hypersensitivity pneumonitis during antigen avoidance. Immun Inflamm Dis 2017; 6:154-162. [PMID: 29168324 PMCID: PMC5818447 DOI: 10.1002/iid3.202] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 09/24/2017] [Accepted: 09/29/2017] [Indexed: 11/11/2022]
Abstract
Background In chronic hypersensitivity pneumonitis (chronic HP), antigen avoidance is critical for disease management; however, complete avoidance is difficult because of unrecognized exposure to antigens. Recently, we revealed that the amount of avian antigen (AAA) in household dust at the time of diagnosis predicted the progression of chronic bird‐related HP. The purpose of this study is to evaluate the relationship between the prognosis of chronic bird‐related HP and the AAA that remained in the environment during antigen avoidance. Methods First, we measured the AAA in household dust of 28 consecutive patients (22 with chronic bird‐related HP and 6 with acute bird‐related HP) and 12 healthy volunteers. Second, we measured the AAA and collected questionnaires on the environmental conditions of the homes of 53 patients with various lung diseases, including bird‐related HP, to investigate the environmental parameters related to a higher AAA. Finally, we prospectively recruited 14 consecutive patients with chronic bird‐related HP, measured the AAA periodically, and collected clinical data. Results The AAA was higher in patients with chronic bird‐related HP at the time of diagnosis compared to healthy volunteers and was highest in patients with acute bird‐related HP. Logistic regression analysis showed that birds frequenting a residence was the only significant factor for a higher AAA (odds ratio, 5.686; 95%CI, 1.263–25.59; P = 0.024). There was a correlation between the mean AAA and decline of vital capacity for 1 year (r = −0.55; 95%CI −0.84 to −0.01; P = 0.043). Conclusion Measurements of the AAA after diagnosis predict the progression of chronic bird‐related HP. Avian antigen can exist in the indoor environment regardless of antigen avoidance. The presence of avian antigen in the indoor environment can be attributed to wild birds found outdoors.
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Affiliation(s)
- Manabu Sema
- Department of Respiratory Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Yasunari Miyazaki
- Department of Respiratory Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Toshiharu Tsutsui
- Department of Respiratory Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Makoto Tomita
- Department of Clinical Research Center, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Yoshinobu Eishi
- Department of Human Pathology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Naohiko Inase
- Department of Respiratory Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
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Tsutsui T, Miyazaki Y, Kuramochi J, Uchida K, Eishi Y, Inase N. The amount of avian antigen in household dust predicts the prognosis of chronic bird-related hypersensitivity pneumonitis. Ann Am Thorac Soc 2015; 12:1013-21. [PMID: 26010749 DOI: 10.1513/AnnalsATS.201412-569OC] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
RATIONALE Bird-related hypersensitivity pneumonitis is induced by inhalation of avian antigen. Evaluation to avoid repeated exposure to avian antigen is a key part of the treatment for bird-related hypersensitivity pneumonitis. It can be difficult, however, to reliably evaluate exposure to the antigen because bird-related hypersensitivity pneumonitis in its chronic form may be caused by unrecognized and indirect exposure. OBJECTIVE The purpose of the present study is to establish a method for measuring environmental avian antigen in patients with chronic bird-related hypersensitivity pneumonitis and to evaluate the clinical utility of the method. METHODS The amount of avian antigen was measured in samples of dust collected from the household environments of patients with chronic bird-related hypersensitivity pneumonitis. The patients whose clinical progress could be followed by periodic pulmonary function tests for 1 year were classified into a deterioration group and a stable group. Age, sex, smoking status, FVC % predicted, and the amount of avian antigen in household dust samples at the diagnosis of bird-related hypersensitivity pneumonitis, as well as survival, were determined and evaluated for each group. The total number of subjects was 23. MEASUREMENTS AND MAIN RESULTS The clinical condition deteriorated in 11 patients and remained stable in 12. The amount of avian antigen in household dust samples was significantly higher for the deterioration group than for the stable group. In logistic regression analysis, avian antigen was the only variable found to be significant for distinguishing between the two groups. The patients with higher amounts household dust avian antigen had a poor prognosis in the survival analysis. Avian antigen was the only variable to significantly influence the prognosis of chronic bird-related hypersensitivity pneumonitis. CONCLUSIONS The levels of exposure to avian antigen were related to disease progression and prognosis in chronic bird-related hypersensitivity pneumonitis.
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