1
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Beswick DM, Liu CM, Overdevest JB, Zemke A, Khatiwada A, Gudis DA, Miller JE, Kimple A, Tervo JP, DiMango E, Goralski JL, Keating C, Senior B, Stapleton AL, Eshaghian PH, Mace JC, Markarian K, Alt JA, Bodner TE, Chowdhury NI, Getz AE, Hwang PH, Khanwalker A, Lee JT, Li DA, Norris M, Nayak JV, Owens C, Patel ZM, Poch K, Schlosser RJ, Smith KA, Smith TL, Soler ZM, Suh JD, Turner GA, Wang MB, Saavedra MT, Taylor Cousar JL. Predictors of Sinonasal Improvement After Highly Effective Modulator Therapy in Adults with Cystic Fibrosis. Laryngoscope 2024. [PMID: 38634358 DOI: 10.1002/lary.31438] [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: 12/22/2023] [Revised: 03/04/2024] [Accepted: 03/25/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVES The 22-question SinoNasal Outcome Test (SNOT-22) assesses chronic rhinosinusitis (CRS) severity. We aimed to identify predictors of SNOT-22 score improvement following highly effective modulator therapy (HEMT) initiation and to corroborate the SNOT-22 minimal clinically important difference (MCID) in adults with cystic fibrosis (CF). METHODS Prospective observational data was pooled from four studies across 10 US centers investigating people with CF (PwCF) and CRS. Three studies evaluated HEMT's impact on CRS. For participants enrolled prior to HEMT initiation, SNOT-22 scores were obtained at baseline and after 3-6 months of HEMT. Multivariate regression identified predictors of improvement. Cronbach's alpha and four distribution-based methods were used to assess internal consistency and calculate the MCID of the SNOT-22. RESULTS A total of 184 PwCF participated with mean baseline SNOT-22 scores ranging from 18.1 to 56.7. Cronbach's alpha was ≥0.90 across sites. Participants at sites with pre- and post-HEMT data reported improvement in SNOT-22 scores after initiating HEMT (all p < 0.05). Worse baseline SNOT-22 score (odds ratio (OR): 1.05, p < 0.001, 95% CI: 1.02-1.08), F508del homozygosity (OR: 4.30, p = 0.040, 95% CI: 1.14-18.99), and absence of prior modulator therapy (OR: 4.99, p = 0.017, 95% CI: 1.39-20.11) were associated with greater SNOT-22 improvement. The mean MCID calculated via distribution-based methods was 8.5. CONCLUSION Worse baseline sinonasal symptoms, F508del homozygosity, and absence of prior modulator therapy predicted greater improvement after HEMT initiation. The mean MCID for SNOT-22 in PwCF is 8.5 points, similar to non-CF individuals with CRS, and provides a threshold specifically for PwCF. The SNOT-22 has strong internal consistency in PwCF. LEVEL OF EVIDENCE 3 Laryngoscope, 2024.
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Affiliation(s)
- Daniel M Beswick
- Department of Otolaryngology-Head and Neck Surgery, University of California, Los Angeles, California, U.S.A
| | - Christine M Liu
- Department of Otolaryngology-Head and Neck Surgery, University of California, Los Angeles, California, U.S.A
| | - Jonathan B Overdevest
- Department of Otolaryngology-Head and Neck Surgery, Columbia University, New York, New York, U.S.A
| | - Anna Zemke
- Division of Pulmonary Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Aastha Khatiwada
- Department of Biostatistics, National Jewish Health, Denver, Colorado, U.S.A
| | - David A Gudis
- Department of Otolaryngology-Head and Neck Surgery, Columbia University, New York, New York, U.S.A
| | - Jessa E Miller
- Department of Otolaryngology-Head and Neck Surgery, University of California, Los Angeles, California, U.S.A
| | - Adam Kimple
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, U.S.A
| | - Jeremy P Tervo
- Department of Otolaryngology-Head and Neck Surgery, Columbia University, New York, New York, U.S.A
| | - Emily DiMango
- Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University, New York, New York, U.S.A
| | - Jennifer L Goralski
- Department of Pulmonary Medicine, University of North Carolina, Chapel Hill, North Carolina, U.S.A
| | - Claire Keating
- Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University, New York, New York, U.S.A
| | - Brent Senior
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, U.S.A
| | - Amanda L Stapleton
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Patricia H Eshaghian
- Department of Pulmonary Medicine, University of California, Los Angeles, California, U.S.A
| | - Jess C Mace
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, U.S.A
| | - Karolin Markarian
- CTSI, David Geffen School of Medicine, University of California, Los Angeles, California, U.S.A
| | - Jeremiah A Alt
- Department of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, U.S.A
| | - Todd E Bodner
- Department of Psychology, Portland State University, Portland, Oregon, U.S.A
| | - Naweed I Chowdhury
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt Health, Nashville, Tennessee, U.S.A
| | - Anne E Getz
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Aurora, Colorado, U.S.A
| | - Peter H Hwang
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California, U.S.A
| | - Ashoke Khanwalker
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Aurora, Colorado, U.S.A
| | - Jivianne T Lee
- Department of Otolaryngology-Head and Neck Surgery, University of California, Los Angeles, California, U.S.A
| | - Douglas A Li
- Department of Pulmonary Medicine, University of California, Los Angeles, California, U.S.A
| | - Meghan Norris
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, U.S.A
| | - Jayakar V Nayak
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California, U.S.A
| | - Cameran Owens
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Aurora, Colorado, U.S.A
| | - Zara M Patel
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California, U.S.A
| | - Katie Poch
- Department of Medicine, National Jewish Health, Denver, Colorado, U.S.A
| | - Rodney J Schlosser
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Greenville, South Carolina, U.S.A
| | - Kristine A Smith
- Department of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, U.S.A
| | - Timothy L Smith
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, U.S.A
| | - Zachary M Soler
- Department of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, U.S.A
| | - Jeffrey D Suh
- Department of Otolaryngology-Head and Neck Surgery, University of California, Los Angeles, California, U.S.A
| | - Grant A Turner
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, U.S.A
| | - Marilene B Wang
- Department of Otolaryngology-Head and Neck Surgery, University of California, Los Angeles, California, U.S.A
| | - Milene T Saavedra
- Department of Medicine, National Jewish Health, Denver, Colorado, U.S.A
| | - Jennifer L Taylor Cousar
- Department of Medicine, National Jewish Health, Denver, Colorado, U.S.A
- Department of Pediatrics, National Jewish Health, Denver, Colorado, U.S.A
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2
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Miller JE, Taylor-Cousar JL, Overdevest JB, Khatiwada A, Mace JC, Alt JA, Bodner TE, Chowdhury NI, DiMango EA, Eshaghian PH, Getz AE, Gudis DA, Han EJ, Hwang PH, Keating CL, Khanwalkar A, Kimple AJ, Lee JT, Li D, Markarian K, Norris M, Nayak JV, Owens C, Patel ZM, Poch K, Schlosser RJ, Smith KA, Smith TL, Soler ZM, Suh JD, Tervo JP, Turner GA, Wang MB, Saavedra MT, Beswick DM. Determining the minimal clinically important difference for the questionnaire of olfactory disorders in people with cystic fibrosis and factors associated with improvement after highly effective modulator therapy. Int Forum Allergy Rhinol 2023. [PMID: 38145393 DOI: 10.1002/alr.23312] [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: 08/27/2023] [Revised: 11/21/2023] [Accepted: 12/05/2023] [Indexed: 12/26/2023]
Abstract
INTRODUCTION Olfactory dysfunction (OD) is common among people with cystic fibrosis (PwCF). The Questionnaire of Olfactory Disorders (QOD) is a validated instrument that evaluates olfactory-specific quality-of-life. The QOD minimal clinically important difference (MCID) and factors associated with olfactory improvement after elexacaftor/tezacaftor/ivacaftor have not been determined for PwCF. METHODS Prospective observational data were pooled from three studies that enrolled adult PwCF with chronic rhinosinusitis (CRS). QOD scores and disease characteristics were assessed. To evaluate internal consistency and calculate the QOD MCID, Cronbach's alpha and four distribution-based methods were employed. For participants who enrolled prior to elexacaftor/tezacaftor/ivacaftor, QOD scores were obtained at baseline and after elexacaftor/tezacaftor/ivacaftor initiation. Multivariable regression was used to identify factors associated with QOD improvement. RESULTS Of 129 PwCF included, 65 had QOD scores before and 3-6 months after starting elexacaftor/tezacaftor/ivacaftor. Mean baseline QOD score was 6.5 ± 7.9. Mean Cronbach's alpha was ≥0.85. The MCID estimates were as follows: Cohen's effect size = 1.6, standard error of measurement = 2.5, ½ baseline standard deviation = 4.0, and minimal detectable change = 6.9. Mean MCID was 3.7. Of those with pre/post elexacaftor/tezacaftor/ivacaftor QOD scores, the mean change in QOD was -1.3 ± 5.4. After elexacaftor/tezacaftor/ivacaftor, QOD improvement surpassed the MCID in 22% of participants (14/65). Worse baseline QOD scores and nasal polyps were associated with improved QOD scores after elexacaftor/tezacaftor/ivacaftor (both p < 0.04). CONCLUSION The QOD MCID in PwCF was estimated to be 3.7. Elexacaftor/tezacaftor/ivacaftor led to qualitative but not clinically meaningful improvements in QOD score for most PwCF; PwCF with worse baseline QOD scores and nasal polyps improved in a clinically significant manner.
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Affiliation(s)
- Jessa E Miller
- Department of Otolaryngology-Head and Neck Surgery, University of California, Los Angeles, California, USA
| | - Jennifer L Taylor-Cousar
- Department of Medicine, National Jewish Health, Denver, Colorado, USA
- Department of Pediatrics, National Jewish Health, Denver, Colorado, USA
| | - Jonathan B Overdevest
- Department of Otolaryngology-Head and Neck Surgery, Columbia University, New York, New York, USA
| | - Aastha Khatiwada
- Department of Biostatistics, National Jewish Health, Denver, Colorado, USA
| | - Jess C Mace
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health Sciences University, Portland, Oregon, USA
| | - Jeremiah A Alt
- Department of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Todd E Bodner
- Department of Psychology, Portland State University, Portland, Oregon, USA
| | - Naweed I Chowdhury
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt Health, Nashville, Tennessee, USA
| | - Emily A DiMango
- Department of Medicine, Columbia University, New York, New York, USA
| | - Patricia H Eshaghian
- Department of Pulmonary Medicine, University of California, Los Angeles, California, USA
| | - Anne E Getz
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Aurora, Colorado, USA
| | - David A Gudis
- Department of Otolaryngology-Head and Neck Surgery, Columbia University, New York, New York, USA
| | - Ethan J Han
- Department of Otolaryngology-Head and Neck Surgery, University of California, Los Angeles, California, USA
| | - Peter H Hwang
- Department of Otolaryngology-Head and Neck Surgery, Stanford Medicine, Palo Alto, California, USA
| | - Claire L Keating
- Department of Medicine, Columbia University, New York, New York, USA
| | - Ashoke Khanwalkar
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Aurora, Colorado, USA
| | - Adam J Kimple
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Jivianne T Lee
- Department of Otolaryngology-Head and Neck Surgery, University of California, Los Angeles, California, USA
| | - Douglas Li
- Department of Pulmonary Medicine, University of California, Los Angeles, California, USA
| | - Karolin Markarian
- David Geffen School of Medicine, University of California, CTSI, Los Angeles, California, USA
| | - Meghan Norris
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Jayakar V Nayak
- Department of Otolaryngology-Head and Neck Surgery, Stanford Medicine, Palo Alto, California, USA
| | - Cameran Owens
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Aurora, Colorado, USA
| | - Zara M Patel
- Department of Otolaryngology-Head and Neck Surgery, Stanford Medicine, Palo Alto, California, USA
| | - Katie Poch
- Department of Medicine, National Jewish Health, Denver, Colorado, USA
| | - Rodney J Schlosser
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Kristine A Smith
- Department of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Timothy L Smith
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health Sciences University, Portland, Oregon, USA
| | - Zachary M Soler
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jeffrey D Suh
- Department of Otolaryngology-Head and Neck Surgery, University of California, Los Angeles, California, USA
| | - Jeremy P Tervo
- Vagelos College of Physicians & Surgeons, Columbia University, New York, New York, USA
| | - Grant A Turner
- Department of Pulmonary Medicine, University of California, Los Angeles, California, USA
| | - Marilene B Wang
- Department of Otolaryngology-Head and Neck Surgery, University of California, Los Angeles, California, USA
| | - Milene T Saavedra
- Department of Medicine, National Jewish Health, Denver, Colorado, USA
| | - Daniel M Beswick
- Department of Otolaryngology-Head and Neck Surgery, University of California, Los Angeles, California, USA
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Lu S, Chen K, Song K, Pilewski JM, Gunn BM, Poch KR, Rysavy NM, Vestal BE, Saavedra MT, Kolls JK. Systems serology in cystic fibrosis: Anti-Pseudomonas IgG1 responses and reduced lung function. Cell Rep Med 2023; 4:101210. [PMID: 37852181 PMCID: PMC10591031 DOI: 10.1016/j.xcrm.2023.101210] [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: 11/22/2022] [Revised: 05/04/2023] [Accepted: 09/06/2023] [Indexed: 10/20/2023]
Abstract
Nearly one-half of patients with cystic fibrosis (CF) carry the homozygous F508del mutation in the cystic fibrosis transmembrane conductance regulator (CFTR) gene but exhibit variable lung function phenotypes. How adaptive immunity influences their lung function remains unclear, particularly the serological antibody responses to antigens from mucoid Pseudomonas in sera from patients with CF with varying lung function. Sera from patients with CF with reduced lung function show higher anti-outer membrane protein I (OprI) immunoglobulin G1 (IgG1) titers and greater antibody-mediated complement deposition. Induction of anti-OprI antibody isotypes with complement activity enhances lung inflammation in preclinical mouse models. This enhanced inflammation is absent in immunized Rag2-/- mice and is transferrable to unimmunized mice through sera. In a CF cohort undergoing treatment with elexacaftor-tezacaftor-ivacaftor, the declination in anti-OprI IgG1 titers is associated with lung function improvement and reduced hospitalizations. These findings suggest that antibody responses to specific Pseudomonas aeruginosa (PA) antigens worsen lung function in patients with CF.
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Affiliation(s)
- Shiping Lu
- Department of Immunology and Microbiology, Tulane University, New Orleans, LA, USA; Center for Translational Research in Infection and Inflammation, School of Medicine, Tulane University, New Orleans, LA, USA
| | - Kong Chen
- Division of Pulmonary, Allergy and Critical Care Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kejing Song
- Center for Translational Research in Infection and Inflammation, School of Medicine, Tulane University, New Orleans, LA, USA
| | - Joseph M Pilewski
- Division of Pulmonary, Allergy and Critical Care Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Bronwyn M Gunn
- Paul G. Allen School of Global Health, Washington State University, Pullman, WA, USA
| | | | | | - Brian E Vestal
- Center for Genes, Environment and Health, National Jewish Health, Denver, CO, USA
| | | | - Jay K Kolls
- Center for Translational Research in Infection and Inflammation, School of Medicine, Tulane University, New Orleans, LA, USA.
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4
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Nick JA, Malcolm KC, Hisert KB, Wheeler EA, Rysavy NM, Poch K, Caceres S, Lovell VK, Armantrout E, Saavedra MT, Calhoun K, Chatterjee D, Aboellail I, De P, Martiniano SL, Jia F, Davidson RM. Culture independent markers of nontuberculous mycobacterial (NTM) lung infection and disease in the cystic fibrosis airway. Tuberculosis (Edinb) 2023; 138:102276. [PMID: 36417800 PMCID: PMC10965158 DOI: 10.1016/j.tube.2022.102276] [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: 10/15/2022] [Revised: 11/12/2022] [Accepted: 11/15/2022] [Indexed: 11/18/2022]
Abstract
Nontuberculous mycobacteria (NTM) are opportunistic pathogens that affect a relatively small but significant portion of the people with cystic fibrosis (CF), and may cause increased morbidity and mortality in this population. Cultures from the airway are the only test currently in clinical use for detecting NTM. Culture techniques used in clinical laboratories are insensitive and poorly suited for population screening or to follow progression of disease or treatment response. The lack of sensitive and quantitative markers of NTM in the airway impedes patient care and clinical trial design, and has limited our understanding of patterns of acquisition, latency and pathogenesis of disease. Culture-independent markers of NTM infection have the potential to overcome many of the limitations of standard NTM cultures, especially the very slow growth, inability to quantitate bacterial burden, and low sensitivity due to required decontamination procedures. A range of markers have been identified in sputum, saliva, breath, blood, urine, as well as radiographic studies. Proposed markers to detect presence of NTM or transition to NTM disease include bacterial cell wall products and DNA, as well as markers of host immune response such as immunoglobulins and the gene expression of circulating leukocytes. In all cases the sensitivity of culture-independent markers is greater than standard cultures; however, most do not discriminate between various NTM species. Thus, each marker may be best suited for a specific clinical application, or combined with other markers and traditional cultures to improve diagnosis and monitoring of treatment response.
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Affiliation(s)
- Jerry A Nick
- Department of Medicine, National Jewish Health, Denver, CO, 80206, USA; Department of Medicine, University of Colorado School of Medicine, Aurora, CO, 80045, USA.
| | - Kenneth C Malcolm
- Department of Medicine, National Jewish Health, Denver, CO, 80206, USA
| | - Katherine B Hisert
- Department of Medicine, National Jewish Health, Denver, CO, 80206, USA; Department of Medicine, University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - Emily A Wheeler
- Department of Medicine, National Jewish Health, Denver, CO, 80206, USA
| | - Noel M Rysavy
- Department of Medicine, National Jewish Health, Denver, CO, 80206, USA
| | - Katie Poch
- Department of Medicine, National Jewish Health, Denver, CO, 80206, USA
| | - Silvia Caceres
- Department of Medicine, National Jewish Health, Denver, CO, 80206, USA
| | - Valerie K Lovell
- Department of Medicine, National Jewish Health, Denver, CO, 80206, USA
| | - Emily Armantrout
- Department of Medicine, National Jewish Health, Denver, CO, 80206, USA
| | - Milene T Saavedra
- Department of Medicine, National Jewish Health, Denver, CO, 80206, USA; Department of Medicine, University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - Kara Calhoun
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - Delphi Chatterjee
- Mycobacteria Research Laboratories, Department of Microbiology, Immunology and Pathology, Colorado State University, 1682 Campus Delivery, Fort Collins, CO, 80523, USA
| | - Ibrahim Aboellail
- Mycobacteria Research Laboratories, Department of Microbiology, Immunology and Pathology, Colorado State University, 1682 Campus Delivery, Fort Collins, CO, 80523, USA
| | - Prithwiraj De
- Mycobacteria Research Laboratories, Department of Microbiology, Immunology and Pathology, Colorado State University, 1682 Campus Delivery, Fort Collins, CO, 80523, USA
| | - Stacey L Martiniano
- Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - Fan Jia
- Center for Genes, Environment, and Health, National Jewish Health, Denver, CO, 80206, USA
| | - Rebecca M Davidson
- Center for Genes, Environment, and Health, National Jewish Health, Denver, CO, 80206, USA
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Malcolm KC, Wheeler EA, Calhoun K, Lenhart-Pendergrass PM, Rysavy N, Poch KR, Caceres SM, Saavedra MT, Nick JA. Specificity of Immunoglobulin Response to Nontuberculous Mycobacteria Infection in People with Cystic Fibrosis. Microbiol Spectr 2022; 10:e0187422. [PMID: 35863022 PMCID: PMC9430546 DOI: 10.1128/spectrum.01874-22] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 06/18/2022] [Indexed: 11/29/2022] Open
Abstract
Nontuberculous mycobacteria (NTM) infections are increasingly prevalent in chronic lung diseases, including cystic fibrosis (CF). Mycobacterium abscessus is of particular concern due to relatively greater virulence and intrinsic antimicrobial resistance. Airway culture identification, the standard method for detecting pulmonary infection, is hindered by low sensitivity, long culture times, and reliance on sputum production or lavage. A culture-independent test for detecting NTM infection could complement, or replace, sputum culture, which is becoming more difficult to obtain with reduced sputum production by people with CF (pwCF) on highly effective modulator therapy. We describe an assay for the detection of plasma anti-M. abscessus antibodies of pwCF to antigens from M. abscessus lysates. Anti-M. abscessus IgG and IgA, but not IgM, discriminated with high specificity subjects infected with M. abscessus from those infected by M. avium complex, and from those with distant or no NTM infections. The IgG3 subclass predominated with minor contributions by other subclasses. Both aqueous and organic soluble antigens were recognized by plasma IgG. A validation cohort measuring IgG and IgG3 identified M. abscessus positive subjects, and elevated IgG was sustained over several years. These studies show the benefit of M. abscessus cell lysates to detect plasma IgG of subjects with CF and M. abscessus infections. Subclass analysis suggests that IgG3 is the predominant subtype in these subjects with chronic bacterial infections suggesting a defect in class maturation. Serodiagnosis could be useful to monitor M. abscessus group infections in chronic lung disease as an adjunct or alternative to culture. IMPORTANCE Lung infections with nontuberculous mycobacteria (NTM), and particularly Mycobacterium abscessus, a pathogen with high antibiotic resistance, are of great concern due to poor clinical outcomes and challenging detection in people with cystic fibrosis and other diseases. Standard detection methods are insensitive and increasingly difficult. We describe the measurement of NTM-specific antibodies from plasma to identify subjects infected with M. abscessus. The assay is sensitive and provides information on the immune response to NTM infections. This assay could be used to help identify subjects with NTM pulmonary infections and track disease progression, either alone or in conjunction with other tests.
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Affiliation(s)
- Kenneth C Malcolm
- Department of Medicine, National Jewish Healthgrid.240341.0, Denver, Colorado, USA
- Department of Medicine, University of Colorado, Aurora, Colorado, USA
| | - Emily A Wheeler
- Department of Medicine, National Jewish Healthgrid.240341.0, Denver, Colorado, USA
| | - Kara Calhoun
- Department of Medicine, University of Colorado, Aurora, Colorado, USA
| | | | - Noel Rysavy
- Department of Medicine, National Jewish Healthgrid.240341.0, Denver, Colorado, USA
| | - Katie R Poch
- Department of Medicine, National Jewish Healthgrid.240341.0, Denver, Colorado, USA
| | - Silvia M Caceres
- Department of Medicine, National Jewish Healthgrid.240341.0, Denver, Colorado, USA
| | - Milene T Saavedra
- Department of Medicine, National Jewish Healthgrid.240341.0, Denver, Colorado, USA
- Department of Medicine, University of Colorado, Aurora, Colorado, USA
| | - Jerry A Nick
- Department of Medicine, National Jewish Healthgrid.240341.0, Denver, Colorado, USA
- Department of Medicine, University of Colorado, Aurora, Colorado, USA
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Arriaza LR, Massey CJ, Humphries SM, Beswick DM, Saavedra MT, Ramakrishnan VR. CFTR-related disorder in an adult with refractory chronic rhinosinusitis: A missed diagnosis and novel mutation. Int Forum Allergy Rhinol 2021; 11:1135-1137. [PMID: 33823074 DOI: 10.1002/alr.22792] [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] [Received: 02/05/2021] [Revised: 02/11/2021] [Accepted: 02/12/2021] [Indexed: 11/09/2022]
Affiliation(s)
| | - Conner J Massey
- Department of Otolaryngology, University of Colorado, Aurora, Colorado, USA
| | | | - Daniel M Beswick
- Department of Head and Neck Surgery, University of California, Los Angeles, Los Angeles, California, USA
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7
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Beswick DM, Saavedra MT. Stakeholder feedback informs investigations for chronic rhinosinusitis in cystic fibrosis. Int Forum Allergy Rhinol 2020; 11:79-80. [PMID: 32996261 DOI: 10.1002/alr.22705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/09/2020] [Accepted: 09/10/2020] [Indexed: 01/20/2023]
Affiliation(s)
- Daniel M Beswick
- Department of Otolaryngology, University of Colorado, Aurora, CO.,Division of Specialty Services, National Jewish Health, Denver, CO
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8
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De P, Amin AG, Graham B, Martiniano SL, Caceres SM, Poch KR, Jones MC, Saavedra MT, Malcolm KC, Nick JA, Chatterjee D. Urine lipoarabinomannan as a marker for low-risk of NTM infection in the CF airway. J Cyst Fibros 2020; 19:801-807. [PMID: 32624408 DOI: 10.1016/j.jcf.2020.06.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 10/02/2019] [Revised: 06/16/2020] [Accepted: 06/17/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND Individuals with Cystic fibrosis (CF) are the most vulnerable population for pulmonary infection with nontuberculous mycobacteria (NTM). Screening, diagnosis, and assessment of treatment response currently depend on traditional culture techniques, but sputum analysis for NTM in CF is challenging, and associated with a low sensitivity. The cell wall lipoarabinomannan (LAM), a lipoglycan found in all mycobacterial species, and has been validated as a biomarker in urine for active Mycobacterium tuberculosis infection. METHODS Urine from a CF cohort (n = 44) well-characterized for NTM infection status by airway cultures was analyzed for LAM by gas chromatography/mass spectrometry. All subjects with positive sputum cultures for NTM had varying amounts of LAM in their urine. No LAM was detected in subjects who never had a positive culture (14/45). One individual initially classified as NTM sputum negative subsequently developed NTM disease 657 days after the initial urine LAM testing. Repeat urine LAM testing turned positive, correlating to her positive NTM status. Subjects infected with subspecies of M. abscessus had greater LAM quantities than those infected with M. avium complex (MAC). There was no correlation with disease activity or treatment status and LAM quantity. A TB Capture ELISA using anti-LAM antibodies demonstrated very poor sensitivity in identifying individuals with positive NTM sputum cultures. CONCLUSION These findings support the conclusion that urine LAM related to NTM infection may be a useful screening test to determine patients at low risk for having a positive NTM sputum culture, as part of a lifetime screening strategy in the CF population.
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Affiliation(s)
- Prithwiraj De
- Mycobacteria Research Laboratories, Department of Microbiology, Immunology and Pathology, Colorado State University, 1682 Campus Delivery, Fort Collins, CO 80523, United States
| | - Anita G Amin
- Mycobacteria Research Laboratories, Department of Microbiology, Immunology and Pathology, Colorado State University, 1682 Campus Delivery, Fort Collins, CO 80523, United States
| | - Barbara Graham
- Mycobacteria Research Laboratories, Department of Microbiology, Immunology and Pathology, Colorado State University, 1682 Campus Delivery, Fort Collins, CO 80523, United States
| | - Stacey L Martiniano
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - Silvia M Caceres
- Department of Medicine, National Jewish Health, Denver, Colorado, United States
| | - Katie R Poch
- Department of Medicine, National Jewish Health, Denver, Colorado, United States
| | - Marion C Jones
- Department of Medicine, National Jewish Health, Denver, Colorado, United States
| | - Milene T Saavedra
- Department of Medicine, National Jewish Health, Denver, Colorado, United States
| | - Kenneth C Malcolm
- Department of Medicine, National Jewish Health, Denver, Colorado, United States
| | - Jerry A Nick
- Department of Medicine, National Jewish Health, Denver, Colorado, United States.
| | - Delphi Chatterjee
- Mycobacteria Research Laboratories, Department of Microbiology, Immunology and Pathology, Colorado State University, 1682 Campus Delivery, Fort Collins, CO 80523, United States.
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Pohl K, Nichols DP, Taylor-Cousar JL, Saavedra MT, Strand MJ, Nick JA, Bratcher PE. Corticosteroid use and increased CXCR2 levels on leukocytes are associated with lumacaftor/ivacaftor discontinuation in cystic fibrosis patients homozygous for the F508del CFTR mutation. PLoS One 2018; 13:e0209026. [PMID: 30540818 PMCID: PMC6291130 DOI: 10.1371/journal.pone.0209026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Accepted: 11/27/2018] [Indexed: 12/12/2022] Open
Abstract
Cystic fibrosis (CF) is the most common life-shortening genetic disease and is caused by mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene. Several current therapies aim at improving availability and/or function of the mutant CFTR proteins. The combination therapeutic lumacaftor/ivacaftor (Orkambi, luma/iva) partially corrects folding and potentiates CFTR function impaired by the F508del mutation. Despite the potential for clinical benefit, a substantial number of patients discontinue treatment due to intolerable adverse effects. The aim of the present study is to identify differences between individuals who continued treatment and those who discontinued due to adverse respiratory effects to potentially inform treatment decisions. Clinical data from the year prior to treatment initiation were analyzed from 82 patients homozygous for the F508del mutation treated at the Colorado Adult CF Program. Blood samples were collected from 30 of these subjects before initiation of treatment to examine expression of circulating leukocyte surface antigens and cytokines. Clinical and demographic characteristics were analyzed along with inflammatory markers to determine biomarkers of drug discontinuation. The use of oral prednisone and/or nasal budesonide in the year prior to luma/iva initiation was more prevalent in CF subjects who did not tolerate luma/iva (82% vs. 43%). Increased age, but not gender or initial lung function, was associated with higher probability of discontinuing treatment due to side effects overall. Worse lung function (lower ppFEV1, ppFEF25-75 ≤ 60%) was associated with higher incidence of discontinuing treatment due to pulmonary adverse effects. In a nested cohort of patients, increased surface levels of CXCR2 on CD14+CD16- monocytes were associated with discontinuation. Overall, the patients who tolerated luma/iva were distinguishable from those who did not tolerate the drug based on clinical and cellular markers obtained prior to treatment initiation.
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Affiliation(s)
- Kerstin Pohl
- Department of Medicine, National Jewish Health, Denver, CO, United States of America
| | - David P. Nichols
- Department of Pediatrics, University of Washington, Seattle, WA, United States of America
| | - Jennifer L. Taylor-Cousar
- Department of Medicine, National Jewish Health, Denver, CO, United States of America
- Department of Pediatrics, National Jewish Health, Denver, CO, United States of America
- University of Colorado School of Medicine, Aurora, CO, United States of America
| | - Milene T. Saavedra
- Department of Medicine, National Jewish Health, Denver, CO, United States of America
- University of Colorado School of Medicine, Aurora, CO, United States of America
| | - Matthew J. Strand
- Biostatistics and Bioinformatics, National Jewish Health, Denver, CO, United States of America
| | - Jerry A. Nick
- Department of Medicine, National Jewish Health, Denver, CO, United States of America
- University of Colorado School of Medicine, Aurora, CO, United States of America
| | - Preston E. Bratcher
- Department of Pediatrics, National Jewish Health, Denver, CO, United States of America
- * E-mail:
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10
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Nichols DP, Happoldt CL, Bratcher PE, Caceres SM, Chmiel JF, Malcolm KC, Saavedra MT, Saiman L, Taylor-Cousar JL, Nick JA. Impact of azithromycin on the clinical and antimicrobial effectiveness of tobramycin in the treatment of cystic fibrosis. J Cyst Fibros 2016; 16:358-366. [PMID: 28025037 DOI: 10.1016/j.jcf.2016.12.003] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [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: 08/25/2016] [Revised: 11/30/2016] [Accepted: 12/01/2016] [Indexed: 12/24/2022]
Abstract
BACKGROUND Concomitant use of oral azithromycin and inhaled tobramycin occurs in approximately half of US cystic fibrosis (CF) patients. Recent data suggest that this combination may be antagonistic. METHODS Test the hypothesis that azithromycin reduces the clinical benefits of tobramycin by analyses of clinical trial data, in vitro modeling of P. aeruginosa antibiotic killing, and regulation of the MexXY efflux pump. RESULTS Ongoing administration of azithromycin associates with reduced ability of inhaled tobramycin, as compared with aztreonam, to improve lung function and quality of life in a completed clinical trial. In users of azithromycin FEV1 (L) increased 0.8% during a 4-week period of inhaled tobramycin and an additional 6.4% during a subsequent 4-week period of inhaled aztreonam (P<0.005). CFQ-R respiratory symptom score decreased 1.8 points during inhaled tobramycin and increased 8.3 points during subsequent inhaled aztreonam (P<0.001). A smaller number of trial participants not using azithromycin had similar improvement in lung function and quality of life scores during inhaled tobramycin and inhaled aztreonam. In vitro, azithromycin selectively reduced the bactericidal effects tobramycin in cultures of clinical strains of P. aeruginosa, while up regulating antibiotic resistance through MexXY efflux. CONCLUSIONS Azithromycin appears capable of reducing the antimicrobial benefits of tobramycin by inducing adaptive bacterial stress responses in P. aeruginosa, suggesting that these medications together may not be optimal chronic therapy for at least some patients.
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Affiliation(s)
- Dave P Nichols
- Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, United States.
| | - Carrie L Happoldt
- Department of Pediatrics, National Jewish Health, Denver, CO, United States
| | - Preston E Bratcher
- Department of Pediatrics, National Jewish Health, Denver, CO, United States
| | - Silvia M Caceres
- Department of Medicine, National Jewish Health, Denver, CO, United States; University of Colorado School of Medicine, Aurora, CO, United States
| | - James F Chmiel
- Department of Pediatrics, Rainbow Babies & Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Kenneth C Malcolm
- Department of Medicine, National Jewish Health, Denver, CO, United States; University of Colorado School of Medicine, Aurora, CO, United States
| | - Milene T Saavedra
- Department of Medicine, National Jewish Health, Denver, CO, United States; University of Colorado School of Medicine, Aurora, CO, United States
| | - Lisa Saiman
- Department of Pediatrics, Columbia University Medical Center, New York, NY, United States
| | - Jennifer L Taylor-Cousar
- Department of Pediatrics, National Jewish Health, Denver, CO, United States; Department of Medicine, National Jewish Health, Denver, CO, United States; University of Colorado School of Medicine, Aurora, CO, United States
| | - Jerry A Nick
- Department of Medicine, National Jewish Health, Denver, CO, United States; University of Colorado School of Medicine, Aurora, CO, United States
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Nick JA, Caceres SM, Kret JE, Poch KR, Strand M, Faino AV, Nichols DP, Saavedra MT, Taylor-Cousar JL, Geraci MW, Burnham EL, Fessler MB, Suratt BT, Abraham E, Moss M, Malcolm KC. Extremes of Interferon-Stimulated Gene Expression Associate with Worse Outcomes in the Acute Respiratory Distress Syndrome. PLoS One 2016; 11:e0162490. [PMID: 27606687 PMCID: PMC5015849 DOI: 10.1371/journal.pone.0162490] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 08/01/2016] [Indexed: 01/11/2023] Open
Abstract
Acute Respiratory Distress Syndrome (ARDS) severity may be influenced by heterogeneity of neutrophil activation. Interferon-stimulated genes (ISG) are a broad gene family induced by Type I interferons, often as a response to viral infections, which evokes extensive immunomodulation. We tested the hypothesis that over- or under-expression of immunomodulatory ISG by neutrophils is associated with worse clinical outcomes in patients with ARDS. Genome-wide transcriptional profiles of circulating neutrophils isolated from patients with sepsis-induced ARDS (n = 31) and healthy controls (n = 19) were used to characterize ISG expression. Hierarchical clustering of expression identified 3 distinct subject groups with Low, Mid and High ISG expression. ISG accounting for the greatest variability in expression were identified (MX1, IFIT1, and ISG15) and used to analyze a prospective cohort at the Colorado ARDS Network site. One hundred twenty ARDS patients from four urban hospitals were enrolled within 72 hours of initiation of mechanical ventilation. Circulating neutrophils were isolated from patients and expression of ISG determined by PCR. Samples were stratified by standard deviation from the mean into High (n = 21), Mid, (n = 82) or Low (n = 17) ISG expression. Clinical outcomes were compared between patients with High or Low ISG expression to those with Mid-range expression. At enrollment, there were no differences in age, gender, co-existing medical conditions, or type of physiologic injury between cohorts. After adjusting for age, race, gender and BMI, patients with either High or Low ISG expression had significantly worse clinical outcomes than those in the Mid for number of 28-day ventilator- and ICU-free days (P = 0.0006 and 0.0004), as well as 90-day mortality and 90-day home with unassisted breathing (P = 0.02 and 0.004). These findings suggest extremes of ISG expression by circulating neutrophils from ARDS patients recovered early in the syndrome are associated with poorer clinical outcomes.
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Affiliation(s)
- Jerry A. Nick
- Department of Medicine, National Jewish Health, Denver, Colorado, United States of America
- Division of Pulmonary Science and Critical Care Medicine, Department of Medicine, University of Colorado Denver School of Medicine, Aurora, Colorado, United States of America
| | - Silvia M. Caceres
- Department of Medicine, National Jewish Health, Denver, Colorado, United States of America
| | - Jennifer E. Kret
- St Louis County Department of Public Health, Berkeley, Missouri, United States of America
| | - Katie R. Poch
- Department of Medicine, National Jewish Health, Denver, Colorado, United States of America
| | - Matthew Strand
- Division of Biostatistics and Bioinformatics, National Jewish Health, Denver, Colorado, United States of America
| | - Anna V. Faino
- Division of Biostatistics and Bioinformatics, National Jewish Health, Denver, Colorado, United States of America
| | - David P. Nichols
- Department of Pediatrics, National Jewish Health, Denver, Colorado, United States of America
| | - Milene T. Saavedra
- Department of Medicine, National Jewish Health, Denver, Colorado, United States of America
- Division of Pulmonary Science and Critical Care Medicine, Department of Medicine, University of Colorado Denver School of Medicine, Aurora, Colorado, United States of America
| | - Jennifer L. Taylor-Cousar
- Department of Medicine, National Jewish Health, Denver, Colorado, United States of America
- Division of Pulmonary Science and Critical Care Medicine, Department of Medicine, University of Colorado Denver School of Medicine, Aurora, Colorado, United States of America
| | - Mark W. Geraci
- Division of Pulmonary Science and Critical Care Medicine, Department of Medicine, University of Colorado Denver School of Medicine, Aurora, Colorado, United States of America
| | - Ellen L. Burnham
- Division of Pulmonary Science and Critical Care Medicine, Department of Medicine, University of Colorado Denver School of Medicine, Aurora, Colorado, United States of America
| | - Michael B. Fessler
- Immunity, Inflammation, and Disease Laboratory, National Institute of Environmental Health Sciences, NIH, Research Triangle Park, North Carolina, United States of America
| | - Benjamin T. Suratt
- Department of Medicine, University of Vermont College of Medicine, Burlington, Vermont, United States of America
| | - Edward Abraham
- Office of the Dean, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States of America
| | - Marc Moss
- Division of Pulmonary Science and Critical Care Medicine, Department of Medicine, University of Colorado Denver School of Medicine, Aurora, Colorado, United States of America
| | - Kenneth C. Malcolm
- Department of Medicine, National Jewish Health, Denver, Colorado, United States of America
- Division of Pulmonary Science and Critical Care Medicine, Department of Medicine, University of Colorado Denver School of Medicine, Aurora, Colorado, United States of America
- * E-mail:
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12
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Taylor-Cousar JL, Wiley C, Felton LA, St Clair C, Jones M, Curran-Everett D, Poch K, Nichols DP, Solomon GM, Saavedra MT, Accurso FJ, Nick JA. Pharmacokinetics and tolerability of oral sildenafil in adults with cystic fibrosis lung disease. J Cyst Fibros 2014; 14:228-36. [PMID: 25466700 DOI: 10.1016/j.jcf.2014.10.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 09/30/2014] [Accepted: 10/20/2014] [Indexed: 10/24/2022]
Abstract
RATIONALE Airway inflammation is central to cystic fibrosis (CF) pathophysiology. Pre-clinical models have shown that phosphodiesterase inhibitors (PDEi) like sildenafil have anti-inflammatory activity. PDEi have not been studied in CF subjects. OBJECTIVES We evaluated the pharmacokinetics, tolerability, and safety of sildenafil in subjects with CF. Sputum biomarkers were used to explore efficacy. METHODS An open-label pilot study of oral sildenafil administration was conducted in adults with mild to moderate CF lung disease. Subjects received oral sildenafil 20 or 40 mg p.o. t.i.d. for 6 weeks. MEASUREMENTS AND MAIN RESULTS Twenty subjects completed the study. Estimated elimination rate constants were statistically different in subjects with CF compared to previously published non-CF subjects. Side effects were generally mild. There were no drug-related serious adverse events. Sputum neutrophil elastase activity decreased. CONCLUSIONS Subjects with CF may eliminate sildenafil at a faster rate than non-CF subjects. Sildenafil administration was safe in subjects with CF and decreased sputum elastase activity. Sildenafil warrants further study as an anti-inflammatory in CF.
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Affiliation(s)
- J L Taylor-Cousar
- Department of Medicine, National Jewish Health, 1400 Jackson Street, Denver, CO 80206, United States; Department of Pediatrics, National Jewish Health, 1400 Jackson Street, Denver, CO 80206, United States.
| | - C Wiley
- Department of Pharmaceutical Sciences, College of Pharmacy, University of New Mexico, Albuquerque, NM, United States
| | - L A Felton
- Department of Pharmaceutical Sciences, College of Pharmacy, University of New Mexico, Albuquerque, NM, United States
| | - C St Clair
- Department of Medicine, National Jewish Health, 1400 Jackson Street, Denver, CO 80206, United States
| | - M Jones
- Department of Medicine, National Jewish Health, 1400 Jackson Street, Denver, CO 80206, United States
| | - D Curran-Everett
- Division of Biostatistics and Bioinformatics, National Jewish Health, 1400 Jackson Street, Denver, CO 80206, United States; Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Denver, Denver, CO 80262, United States
| | - K Poch
- Department of Medicine, National Jewish Health, 1400 Jackson Street, Denver, CO 80206, United States
| | - D P Nichols
- Department of Medicine, National Jewish Health, 1400 Jackson Street, Denver, CO 80206, United States; Department of Pediatrics, National Jewish Health, 1400 Jackson Street, Denver, CO 80206, United States
| | - G M Solomon
- Internal Medicine, University of Alabama, 1720 2nd Ave South, Birmingham, AL 35294, United States
| | - M T Saavedra
- Department of Medicine, National Jewish Health, 1400 Jackson Street, Denver, CO 80206, United States
| | - F J Accurso
- Department of Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado, 13123 E 16th Ave, Aurora, CO 80045, United States
| | - J A Nick
- Department of Medicine, National Jewish Health, 1400 Jackson Street, Denver, CO 80206, United States
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Caceres SM, Malcolm KC, Taylor-Cousar JL, Nichols DP, Saavedra MT, Bratton DL, Moskowitz SM, Burns JL, Nick JA. Enhanced in vitro formation and antibiotic resistance of nonattached Pseudomonas aeruginosa aggregates through incorporation of neutrophil products. Antimicrob Agents Chemother 2014; 58:6851-60. [PMID: 25182651 PMCID: PMC4249413 DOI: 10.1128/aac.03514-14] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [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: 06/17/2014] [Accepted: 08/28/2014] [Indexed: 11/20/2022] Open
Abstract
Pseudomonas aeruginosa is a major pathogen in cystic fibrosis (CF) lung disease. Children with CF are routinely exposed to P. aeruginosa from the natural environment, and by adulthood, 80% of patients are chronically infected. P. aeruginosa in the CF airway exhibits a unique biofilm-like structure, where it grows in small clusters or aggregates of bacteria in association with abundant polymers of neutrophil-derived components F-actin and DNA, among other components. These aggregates differ substantially in size and appearance compared to surface-attached in vitro biofilm models classically utilized for studies but are believed to share properties of surface-attached biofilms, including antibiotic resistance. However, little is known about the formation and function of surface-independent modes of biofilm growth, how they might be eradicated, and quorum sensing communication. To address these issues, we developed a novel in vitro model of P. aeruginosa aggregates incorporating human neutrophil-derived products. Aggregates grown in vitro and those found in CF patients' sputum samples were morphologically similar; viable bacteria were distributed in small pockets throughout the aggregate. The lasA quorum sensing gene was differentially expressed in the presence of neutrophil products. Importantly, aggregates formed in the presence of neutrophils acquired resistance to tobramycin, which was lost when the aggregates were dispersed with DNase, and antagonism of tobramycin and azithromycin was observed. This novel yet simple in vitro system advances our ability to model infection of the CF airway and will be an important tool to study virulence and test alternative eradication strategies against P. aeruginosa.
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Affiliation(s)
- Silvia M Caceres
- Department of Medicine, National Jewish Health, Denver, Colorado, USA
| | - Kenneth C Malcolm
- Department of Medicine, National Jewish Health, Denver, Colorado, USA Department of Medicine, University of Colorado, Denver, Aurora, Colorado, USA
| | - Jennifer L Taylor-Cousar
- Department of Medicine, National Jewish Health, Denver, Colorado, USA Department of Medicine, University of Colorado, Denver, Aurora, Colorado, USA
| | - David P Nichols
- Department of Medicine, National Jewish Health, Denver, Colorado, USA Department of Pediatrics, National Jewish Health, Denver, Colorado, USA Department of Medicine, University of Colorado, Denver, Aurora, Colorado, USA
| | - Milene T Saavedra
- Department of Medicine, National Jewish Health, Denver, Colorado, USA Department of Medicine, University of Colorado, Denver, Aurora, Colorado, USA
| | - Donna L Bratton
- Department of Pediatrics, National Jewish Health, Denver, Colorado, USA
| | - Samuel M Moskowitz
- Department of Pediatrics, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Jane L Burns
- Division of Pediatric Infectious Disease, Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington, USA
| | - Jerry A Nick
- Department of Medicine, National Jewish Health, Denver, Colorado, USA Department of Medicine, University of Colorado, Denver, Aurora, Colorado, USA
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Ferril GR, Nick JA, Getz AE, Barham HP, Saavedra MT, Taylor-Cousar JL, Nichols DP, Curran-Everett D, Kingdom TT, Ramakrishnan VR. Comparison of radiographic and clinical characteristics of low-risk and high-risk cystic fibrosis genotypes. Int Forum Allergy Rhinol 2014; 4:915-20. [PMID: 25224556 DOI: 10.1002/alr.21412] [Citation(s) in RCA: 20] [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: 04/15/2014] [Revised: 07/13/2014] [Accepted: 08/05/2014] [Indexed: 11/11/2022]
Abstract
BACKGROUND Patients with cystic fibrosis (CF) exhibit a wide range of disease severity, and can be broadly stratified into high-risk and low-risk groups based on cystic fibrosis transmembrane conductance regulator (CFTR) mutation class. Patients with a low-risk genotype are often diagnosed as adults, with milder disease and lower sweat chloride values. The aim of the current study was to better understand radiographic and clinical characteristics of sinus disease in adult CF patients within this risk category. METHODS Adult CF patients were retrospectively compared to a control group of patients with chronic rhinosinusitis. CF diagnostic testing and pulmonary characteristics were compared between high-risk and low-risk CF groups, and sinus CT findings were compared among all 3 groups. RESULTS When comparing CF cohorts (n = 25 and 30, respectively), earlier age at diagnosis (p < 0.001), higher sweat chloride values (p < 0.001), lower forced expiratory volume in 1 second (FEV1 ) values (p < 0.001), and a higher prevalence of pulmonary infection with Pseudomonas aeruginosa (p = 0.001) were found in the high-risk genotype group. A significantly increased incidence of sinus hypoplasia/aplasia and bony sclerosis was seen when comparing both CF groups to the control cohort (n = 30), as well as when comparing the high-risk and low-risk CF genotype cohorts. CONCLUSION The current study describes clinicopathologic findings of sinus disease in adult CF patients in the context of genotype severity. Our data demonstrate that while patients within a low-risk genotype cohort have generally milder lung disease, they retain classic radiographic findings of CF sinus disease that can help raise the index of suspicion for undiagnosed CF.
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Affiliation(s)
- Geoffrey R Ferril
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Aurora, CO
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Nick JA, Sanders LA, Ickes B, Briones NJ, Caceres SM, Malcolm KC, Brayshaw SJ, Chacon CS, Barboa CM, Jones MC, St Clair C, Taylor-Cousar JL, Nichols DP, Sagel SD, Strand M, Saavedra MT. Blood mRNA biomarkers for detection of treatment response in acute pulmonary exacerbations of cystic fibrosis. Thorax 2013; 68:929-37. [DOI: 10.1136/thoraxjnl-2012-202278] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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16
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Young RL, Malcolm KC, Kret JE, Caceres SM, Poch KR, Nichols DP, Taylor-Cousar JL, Saavedra MT, Randell SH, Vasil ML, Burns JL, Moskowitz SM, Nick JA. Neutrophil extracellular trap (NET)-mediated killing of Pseudomonas aeruginosa: evidence of acquired resistance within the CF airway, independent of CFTR. PLoS One 2011; 6:e23637. [PMID: 21909403 PMCID: PMC3164657 DOI: 10.1371/journal.pone.0023637] [Citation(s) in RCA: 168] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Accepted: 07/21/2011] [Indexed: 01/11/2023] Open
Abstract
The inability of neutrophils to eradicate Pseudomonas aeruginosa within the cystic fibrosis (CF) airway eventually results in chronic infection by the bacteria in nearly 80 percent of patients. Phagocytic killing of P. aeruginosa by CF neutrophils is impaired due to decreased cystic fibrosis transmembrane conductance regulator (CFTR) function and virulence factors acquired by the bacteria. Recently, neutrophil extracellular traps (NETs), extracellular structures composed of neutrophil chromatin complexed with granule contents, were identified as an alternative mechanism of pathogen killing. The hypothesis that NET-mediated killing of P. aeruginosa is impaired in the context of the CF airway was tested. P. aeruginosa induced NET formation by neutrophils from healthy donors in a bacterial density dependent fashion. When maintained in suspension through continuous rotation, P. aeruginosa became physically associated with NETs. Under these conditions, NETs were the predominant mechanism of killing, across a wide range of bacterial densities. Peripheral blood neutrophils isolated from CF patients demonstrated no impairment in NET formation or function against P. aeruginosa. However, isogenic clinical isolates of P. aeruginosa obtained from CF patients early and later in the course of infection demonstrated an acquired capacity to withstand NET-mediated killing in 8 of 9 isolates tested. This resistance correlated with development of the mucoid phenotype, but was not a direct result of the excess alginate production that is characteristic of mucoidy. Together, these results demonstrate that neutrophils can kill P. aeruginosa via NETs, and in vitro this response is most effective under non-stationary conditions with a low ratio of bacteria to neutrophils. NET-mediated killing is independent of CFTR function or bacterial opsonization. Failure of this response in the context of the CF airway may occur, in part, due to an acquired resistance against NET-mediated killing by CF strains of P. aeruginosa.
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Affiliation(s)
- Robert L Young
- Department of Medicine, National Jewish Health, Denver, Colorado, United States of America.
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Nick JA, Chacon CS, Brayshaw SJ, Jones MC, Barboa CM, St Clair CG, Young RL, Nichols DP, Janssen JS, Huitt GA, Iseman MD, Daley CL, Taylor-Cousar JL, Accurso FJ, Saavedra MT, Sontag MK. Effects of gender and age at diagnosis on disease progression in long-term survivors of cystic fibrosis. Am J Respir Crit Care Med 2010; 182:614-26. [PMID: 20448091 PMCID: PMC2937235 DOI: 10.1164/rccm.201001-0092oc] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.5] [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: 01/21/2010] [Accepted: 05/06/2010] [Indexed: 02/04/2023] Open
Abstract
RATIONALE Long-term survivors of cystic fibrosis (CF) (age > 40 yr) are a growing population comprising both patients diagnosed with classic manifestations in childhood, and nonclassic phenotypes typically diagnosed as adults. Little is known concerning disease progression and outcomes in these cohorts. OBJECTIVES Examine effects of age at diagnosis and gender on disease progression, setting of care, response to treatment, and mortality in long-term survivors of CF. METHODS Retrospective analysis of the Colorado CF Database (1992-2008), CF Foundation Registry (1992-2007), and Multiple Cause of Death Index (1992-2005). MEASUREMENTS AND MAIN RESULTS Patients with CF diagnosed in childhood and who survive to age 40 years have more severe CFTR genotypes and phenotypes compared with adult-diagnosed patients. However, past the age of 40 years the rate of FEV(1) decline and death from respiratory complications were not different between these cohorts. Compared with males, childhood-diagnosed females were less likely to reach age 40 years, experienced faster FEV(1) declines, and no survival advantage. Females comprised the majority of adult-diagnosed patients, and demonstrated equal FEV(1) decline and longer survival than males, despite a later age at diagnosis. Most adult-diagnosed patients were not followed at CF centers, and with increasing age a smaller percentage of CF deaths appeared in the Cystic Fibrosis Foundation Registry. However, newly diagnosed adults demonstrated sustained FEV(1) improvement in response to CF center care. CONCLUSIONS For patients with CF older than 40 years, the adult diagnosis correlates with delayed but equally severe pulmonary disease. A gender-associated disadvantage remains for females diagnosed in childhood, but is not present for adult-diagnosed females.
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Affiliation(s)
- Jerry A Nick
- Adult Cystic Fibrosis Program, National Jewish Health, 1400 Jackson Street, Denver, CO 80206, USA.
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Zander KA, Saavedra MT, West J, Scapa V, Sanders L, Kingdom TT. Protein Microarray Analysis of Nasal Polyps from Aspirin-Sensitive and Aspirin-Tolerant Patients with Chronic Rhinosinusitis. Am J Rhinol Allergy 2009; 23:268-72. [DOI: 10.2500/ajra.2009.23.3314] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background The purpose of this study was to apply protein microarray technology to the study of sinonasal tissue and to identify differential protein expression in nasal polyps from aspirin-sensitive (AS) versus aspirin-tolerant (AT) patients with chronic rhinosinusitis (CRS) and CRS with nasal polyps (CRSwNPs). Methods Nasal polyp specimens were prospectively obtained from two groups of patients with CRSwNP. The test group (AS) consisted of five patients that were diagnosed with CRSwNP and intolerance to aspirin based on medical history and physical exam. The control group (AT) consisted of four AT patients with CRSwNP. Protein was extracted and labeled from harvested polyps and the Sigma Panorama Antibody Microarray–Cell Signaling Kit was used to identify differences in protein expression between the two polyp groups. Western blot analysis was used to validate the results of the protein microarray. Results The protein microarray showed a greater than twofold change in expression of both beta-adaptin and heat shock protein 70 (HSP70). Western blot analysis confirmed up-regulation of beta-adaptin and HSP70 in nasal polyp tissue from AS patients. Conclusion Pooled samples of AS and AT nasal polyps evaluated by protein microarray show distinct protein expression profiles in the stress response and receptor-mediated endocytosis pathways. This study establishes the successful application of protein microarray technology to study nasal polyposis, which in turn can be validated by Western blot analysis.
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Affiliation(s)
- Kelly A. Zander
- Department of Otolaryngology–Head and Neck Surgery University of Colorado Denver, Denver, Colorado
| | - Milene T. Saavedra
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Denver, Denver, Colorado
| | - James West
- Vanderbilt University, Nashville, Tennessee
| | - Victor Scapa
- Department of Otolaryngology–Head and Neck Surgery University of Colorado Denver, Denver, Colorado
| | - Linda Sanders
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Denver, Denver, Colorado
| | - Todd T. Kingdom
- Department of Otolaryngology–Head and Neck Surgery University of Colorado Denver, Denver, Colorado
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Pennock ND, Vaitaitis GM, Waid DM, Saavedra MT, Wagner, Jr DH. Expansion of CD4loCD14+CD40+ LKLF Hi CD4+ T cells correlates with acute pulmonary inflammation and provides a mechanism for impaired pathogen clearance in Cystic Fibrosis (39.24). The Journal of Immunology 2009. [DOI: 10.4049/jimmunol.182.supp.39.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Abstract
Cystic Fibrosis (CF) is characterized by chronic infection of the lung by bacterial pathogens with a subsequent robust but ineffectual neutrophilic immune response. As a result, patients' airways sustain irreversible injury, with respiratory failure accounting for >80% of deaths from the disease. Examination of lymphocyte/monocyte subsets in the peripheral blood of CF patients revealed a greatly expanded CD4+ T cell subset characterized by a very high expression level of the cell survival/quiescence transcription factor Lung Kruppel Like Factor, LKLF. Furthermore, cells exhibited co-expression of CD40 as well as the pattern recognition coreceptor CD14. Importantly, this observation was mirrored in airway submucosa and pulmonary lymph nodes isolated from CF lung transplant recipients. In a majority of patients, this expanded T cell subset from the peripheral blood was found to produce high levels of IL-4, which coincides with previous observations of Th-2 bias in CF patients infected with Pseudomonas aeruginosa. In vitro assays illustrated that simultaneous cross-linking of CD40 and CD3 on this T cell subset results in the elevation of LKLF. Paired with previous observations of elevated circulating soluble CD40 ligand in CF patients that correlate with worse pulmonary function, this data suggests a mechanism for the persistence of the deleterious Th-2 cytokine producing T cells that hamper the effectual clearance of lung pathogen. Importantly alterations in cell number within this T cell subtype from the peripheral blood correlate with observed severity of pulmonary inflammation and provide a means of evaluating efficacy of treatment. Research support;NIH:DDK (Wagner),Cystic Fibrosis Foundation(Saavedra)
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Affiliation(s)
| | | | - Dan M Waid
- 1Webb Waring Center, University of Colorado Denver, Aurora, CO
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Fulcher ML, Gabriel SE, Olsen JC, Tatreau JR, Gentzsch M, Livanos E, Saavedra MT, Salmon P, Randell SH. Novel human bronchial epithelial cell lines for cystic fibrosis research. Am J Physiol Lung Cell Mol Physiol 2008; 296:L82-91. [PMID: 18978040 DOI: 10.1152/ajplung.90314.2008] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Immortalization of human bronchial epithelial (hBE) cells often entails loss of differentiation. Bmi-1 is a protooncogene that maintains stem cells, and its expression creates cell lines that recapitulate normal cell structure and function. We introduced Bmi-1 and the catalytic subunit of telomerase (hTERT) into three non-cystic fibrosis (CF) and three DeltaF508 homozygous CF primary bronchial cell preparations. This treatment extended cell life span, although not as profoundly as viral oncogenes, and at passages 14 and 15, the new cell lines had a diploid karyotype. Ussing chamber analysis revealed variable transepithelial resistances, ranging from 200 to 1,200 Omega.cm(2). In the non-CF cell lines, short-circuit currents were stimulated by forskolin and inhibited by CFTR(inh)-172 at levels mostly comparable to early passage primary cells. CF cell lines exhibited no forskolin-stimulated current and minimal CFTR(inh)-172 response. Amiloride-inhibitable and UTP-stimulated currents were present, but at lower and higher amplitudes than in primary cells, respectively. The cells exhibited a pseudostratified morphology, with prominent apical membrane polarization, few apoptotic bodies, numerous mucous secretory cells, and occasional ciliated cells. CF and non-CF cell lines produced similar levels of IL-8 at baseline and equally increased IL-8 secretion in response to IL-1beta, TNF-alpha, and the Toll-like receptor 2 agonist Pam3Cys. Although they have lower growth potential and more fastidious growth requirements than viral oncogene transformed cells, Bmi-1/hTERT airway epithelial cell lines will be useful for several avenues of investigation and will help fill gaps currently hindering CF research and therapeutic development.
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Affiliation(s)
- M L Fulcher
- Univ. of North Carolina Cystic Fibrosis Center, CB 7248, Rm. 4011 Thurston-Bowles Bldg., Chapel Hill, NC 27599, USA
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Saavedra MT, Hughes GJ, Sanders LA, Carr M, Rodman DM, Coldren CD, Geraci MW, Sagel SD, Accurso FJ, West J, Nick JA. Circulating RNA transcripts identify therapeutic response in cystic fibrosis lung disease. Am J Respir Crit Care Med 2008; 178:929-38. [PMID: 18723435 DOI: 10.1164/rccm.200803-387oc] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
RATIONALE Circulating leukocyte RNA transcripts are systemic markers of inflammation, which have not been studied in cystic fibrosis (CF) lung disease. Although the standard assessment of pulmonary treatment response is FEV(1), a measure of airflow limitation, the lack of systemic markers to reflect changes in lung inflammation critically limits the testing of proposed therapeutics. OBJECTIVES We sought to prospectively identify and validate peripheral blood leukocyte genes that could mark resolution of pulmonary infection and inflammation using a model by which RNA transcripts could increase the predictive value of spirometry. METHODS Peripheral blood mononuclear cells were isolated from 10 patients with CF and acute pulmonary exacerbations before and after therapy. RNA expression profiling revealed that 10 genes significantly changed with treatment when compared with matched non-CF and control subjects with stable CF to establish baseline transcript abundance. Peripheral blood mononuclear cell RNA transcripts were prospectively validated, using real-time polymerase chain reaction amplification, in an independent cohort of acutely ill patients with CF (n = 14). Patients who responded to therapy were analyzed using general estimating equations and multiple logistic regression, such that changes in FEV(1)% predicted were regressed with transcript changes. MEASUREMENTS AND MAIN RESULTS Three genes, CD64, ADAM9, and CD36, were significant and independent predictors of a therapeutic response beyond that of FEV(1) alone (P < 0.05). In both cohorts, receiver operating characteristic analysis revealed greater accuracy when genes were combined with FEV(1). CONCLUSIONS Circulating mononuclear cell transcripts characterize a response to the treatment of pulmonary exacerbations. Even in small patient cohorts, changes in gene expression in conjunction with FEV(1) may enhance current outcomes measures for treatment response.
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Affiliation(s)
- Milene T Saavedra
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado School of Medicine, Denver, Colorado 80262, USA.
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Nold MF, Nold-Petry CA, Pott GB, Zepp JA, Saavedra MT, Kim SH, Dinarello CA. Endogenous IL-32 controls cytokine and HIV-1 production. J Immunol 2008; 181:557-65. [PMID: 18566422 DOI: 10.4049/jimmunol.181.1.557] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
IL-32, a proinflammatory cytokine that activates the p38MAPK and NF-kappaB pathways, induces other cytokines, for example, IL-1beta, IL-6, and TNF-alpha. This study investigated the role of endogenous IL-32 in HIV-1 infection by reducing IL-32 with small interfering (si)RNA in freshly infected PBMC and in the latently infected U1 macrophage cell line. When PBMC were pretreated with siRNA to IL-32 (siIL-32), IL-6, IFN-gamma, and TNF-alpha were reduced by 57, 51, and 36%, respectively, compared with scrambled siRNA. Cotransfection of NF-kappaB and AP-1 reporter constructs with siIL-32 decreased DNA binding of these transcription factors by 42 and 46%, respectively. Cytokine protein array analysis revealed that the inhibitory activity of siIL-32 primarily targeted Th1 and proinflammatory cytokines and chemokines, e.g., MIP-1alpha/beta. Unexpectedly, HIV-1 production (as measured by p24) increased 4-fold in these same PBMC when endogenous IL-32 was reduced. Because IFN-gamma was lower in siIL-32-treated PBMC, we blocked IFN-gamma bioactivity, which enhanced the augmentation of p24 by siIL-32. Furthermore, siIL-32 reduced the natural ligands of the HIV-1 coreceptors CCR5 (MIP-1alpha/beta and RANTES) and CXCR4 (SDF-1). Inhibition of endogenous IL-32 in U1 macrophages also increased HIV-1. When rhIL-32gamma was added to these cells, p24 levels fell by 72%; however, in the same cultures IFN-alpha increased 4-fold. Blockade of IFN-alpha/beta bioactivity in IL-32gamma-stimulated U1 cells revealed that IFN-alpha conveys the anti-HIV-1 effect of rhIL-32gamma. In summary, depletion of endogenous IL-32 reduced the levels of Th1 and proinflammatory cytokines but paradoxically increased p24, proposing IL-32 as a natural inhibitor of HIV-1.
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Affiliation(s)
- Marcel F Nold
- Department of Medicine, University of Colorado Health Sciences Center, Denver, CO 80262, USA
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Saavedra MT, Patterson AD, West J, Randell SH, Riches DW, Malcolm KC, Cool CD, Nick JA, Dinarello CA. Abrogation of anti-inflammatory transcription factor LKLF in neutrophil-dominated airways. Am J Respir Cell Mol Biol 2008; 38:679-88. [PMID: 18218994 DOI: 10.1165/rcmb.2007-0282oc] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
This is the first report to describe a role for Lung Kruppel-like Factor (LKLF or KLF2) in inflammatory airways diseases. In the present study, we identify that LKLF is constitutively expressed in the small airways of normal lungs; however, its expression disappears in severe airway diseases, such as cystic fibrosis (CF) and chronic obstructive pulmonary disease. LKLF from primary airway epithelial cells inhibits NF-kappaB-driven transcription induced by Pseudomonas aeruginosa 7-fold, but is down-regulated in the presence of TNF-alpha and activated human neutrophils. As a constitutively expressed protein, LKLF inhibits release of a key pro-inflammatory chemokine, IL-8, from airway epithelia. Its expression by lung epithelial cells is enhanced in the presence of TNF blockade. Thus, cytokine-mediated inhibition of LKLF by neutrophils may contribute to ongoing recruitment by promoting IL-8 release from airway epithelia. We conclude that, in neutrophil-dominated airway environments, such as that seen in CF, reduced LKLF activity releases a brake on pro-inflammatory cytokine production and thereby may contribute to the persistent inflammatory responses seen in CF airway disease.
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Affiliation(s)
- Milene T Saavedra
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado School of Medicine, Denver, Colorado, USA.
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Walker TS, Tomlin KL, Worthen GS, Poch KR, Lieber JG, Saavedra MT, Fessler MB, Malcolm KC, Vasil ML, Nick JA. Enhanced Pseudomonas aeruginosa biofilm development mediated by human neutrophils. Infect Immun 2005; 73:3693-701. [PMID: 15908399 PMCID: PMC1111839 DOI: 10.1128/iai.73.6.3693-3701.2005] [Citation(s) in RCA: 186] [Impact Index Per Article: 9.8] [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: 10/01/2004] [Revised: 11/18/2004] [Accepted: 01/20/2005] [Indexed: 11/20/2022] Open
Abstract
Cystic fibrosis (CF) lung disease features persistent neutrophil accumulation to the airways from the time of infancy. CF children are frequently exposed to Pseudomonas aeruginosa, and by adulthood, 80% of CF patients are chronically infected. The formation of biofilms is a particularly important phenotypic characteristic of P. aeruginosa that allows for bacterial survival despite aggressive antibiotic therapy and an exuberant immune response. Here, we show that the presence of neutrophils enhances initial P. aeruginosa biofilm development over a period of 72 h through the formation of polymers comprised of actin and DNA. F-actin was found to be a site of attachment for P. aeruginosa. These actin and DNA polymers are present in CF sputum, and disruption of the polymers dispersed the associated P. aeruginosa cells and reduced biofilm development. These findings demonstrate a potential maladaptation of the primary innate response. When the host fails to eradicate the infection, cellular components from necrotic neutrophils can serve as a biological matrix to facilitate P. aeruginosa biofilm formation.
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Affiliation(s)
- Travis S Walker
- National Jewish Medical and Research Center, D202, 1400 Jackson Street, Denver, CO 80206, USA
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Rodman DM, Polis JM, Heltshe SL, Sontag MK, Chacon C, Rodman RV, Brayshaw SJ, Huitt GA, Iseman MD, Saavedra MT, Taussig LM, Wagener JS, Accurso FJ, Nick JA. Late Diagnosis Defines a Unique Population of Long-term Survivors of Cystic Fibrosis. Am J Respir Crit Care Med 2005; 171:621-6. [PMID: 15591474 DOI: 10.1164/rccm.200403-404oc] [Citation(s) in RCA: 117] [Impact Index Per Article: 6.2] [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] [Indexed: 11/16/2022] Open
Abstract
Although the median survival for patients with cystic fibrosis (CF) is 32.9 years, a small group of patients live much longer. We analyzed the genotype and phenotype of CF patients 40 years and older seen between 1992 and 2004 at the National Jewish Medical and Research Center (n = 55). These patients were divided into two groups according to age at diagnosis: an early diagnosis (ED) group, median age at diagnosis 2.0 years (range 0.1-15 years, n = 28), and a late diagnosis (LD) group, median age of diagnosis 48.8 years (range 24-72.8 years, n = 27). Consistent with the hypothesis that the CFTR genotype affects the age at diagnosis, CFTR DeltaF508 homozygous individuals were more common in the ED group. Although patients in the ED group were predominantly male, the majority of LD patients were female. Patients with CF diagnosed late had a significantly lower prevalence of pancreatic insufficiency and CF-related diabetes, and better lung function. Fewer patients in the LD groups were infected with Pseudomonas aeruginosa, whereas a greater percentage had cultures positive for nontuberculous mycobacteria. This is the largest cohort of older patients with CF described to date, and our findings indicate that patients diagnosed as adults differ distinctly from survivors of long-term CF diagnosed as children.
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Affiliation(s)
- David M Rodman
- Center for Genetic Lung Disease, University of Colorado Health Sciences Center, 4200 East Ninth Avenue, Denver, CO 80262, USA.
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