1
|
Labaki WW. FEV 1: More Than a Measurement of Lung Function, A Biomarker of Health. Am J Respir Crit Care Med 2024; 209:1181-1182. [PMID: 38315965 DOI: 10.1164/rccm.202401-0090ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 02/05/2024] [Indexed: 02/07/2024] Open
Affiliation(s)
- Wassim W Labaki
- Division of Pulmonary and Critical Care Medicine University of Michigan Ann Arbor, Michigan
| |
Collapse
|
2
|
Ferrera MC, Lopez CL, Murray S, Jain RG, Labaki WW, Make BJ, Han MK. Risk Factors for Chronic Obstructive Pulmonary Disease Exacerbations among Individuals without a History of Recent Exacerbations: A COPDGene Analysis. Ann Am Thorac Soc 2024; 21:421-427. [PMID: 37796613 PMCID: PMC10913771 DOI: 10.1513/annalsats.202209-751oc] [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: 09/02/2022] [Accepted: 10/04/2023] [Indexed: 10/07/2023] Open
Abstract
Rationale: Acute exacerbations of chronic obstructive pulmonary disease (AE-COPD) are detrimental events in the natural history of COPD, but the risk factors associated with future exacerbations in the absence of a history of recent exacerbations are not fully understood. Objectives: To identify risk factors for COPD exacerbations among participants in the Genetic Epidemiology of COPD Study (COPDGene) without a history of exacerbation in the previous year. Methods: We identified participants with a smoking history enrolled in COPDGene who had COPD (defined as forced expiratory volume in 1 second [FEV1]/forced vital capacity < 0.70), no exacerbation in the year before their second study site visit, and who completed at least one longitudinal follow-up questionnaire in the following 36 months. We used univariable and multivariable zero-inflated negative binomial regression models to identify risk factors associated with increased rates of exacerbation. Each risk factor's regression coefficient (β) was rounded to the nearest 0.25 and incorporated into a graduated risk score. Results: Among the 1,528 participants with a smoking history and COPD enrolled in COPDGene without exacerbation in the year before their second study site visit, 508 participants (33.2%) had at least one moderate or severe exacerbation in the 36 months studied. Gastroesophageal reflux disease, chronic bronchitis, high symptom burden (as measured by Modified Medical Research Council Dyspnea Scale and COPD Assessment Test), and lower FEV1% predicted were associated with an increased risk of exacerbation. Each 1-point increase in our graduated risk score was associated with a 25-30% increase in exacerbation rate in the 36 months studied. Conclusions: In patients with COPD without a recent history of exacerbations, gastroesophageal reflux disease, chronic bronchitis, high symptom burden, and lower lung function are associated with increased risk of future exacerbation using a simple risk score that can be used in clinical practice.
Collapse
Affiliation(s)
- Michael C. Ferrera
- Division of Pulmonary and Critical Care Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | | | | | - Renu G. Jain
- GlaxoSmithKline, Research Triangle Park, North Carolina; and
| | - Wassim W. Labaki
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan
| | - Barry J. Make
- Division of Pulmonary, Critical Care, and Sleep Medicine, National Jewish Health, Denver, Colorado
| | - MeiLan K. Han
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan
| |
Collapse
|
3
|
Wang JM, Bell AJ, Ram S, Labaki WW, Hoff BA, Murray S, Kazerooni EA, Galban S, Hatt CR, Han MK, Galban CJ. Topologic Parametric Response Mapping Identifies Tissue Subtypes Associated with Emphysema Progression. Acad Radiol 2024; 31:1148-1159. [PMID: 37661554 PMCID: PMC11098545 DOI: 10.1016/j.acra.2023.08.003] [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: 06/09/2023] [Revised: 07/25/2023] [Accepted: 08/03/2023] [Indexed: 09/05/2023]
Abstract
RATIONALE AND OBJECTIVES Small airways disease (SAD) and emphysema are significant components of chronic obstructive pulmonary disease (COPD), a heterogenous disease where predicting progression is difficult. SAD, a principal cause of airflow obstruction in mild COPD, has been identified as a precursor to emphysema. Parametric Response Mapping (PRM) of chest computed tomography (CT) can help distinguish SAD from emphysema. Specifically, topologic PRM can define local patterns of both diseases to characterize how and in whom COPD progresses. We aimed to determine if distribution of CT-based PRM of functional SAD (fSAD) is associated with emphysema progression. MATERIALS AND METHODS We analyzed paired inspiratory-expiratory chest CT scans at baseline and 5-year follow up in 1495 COPDGene subjects using topological analyses of PRM classifications. By spatially aligning temporal scans, we mapped local emphysema at year five to baseline lobar PRM-derived topological readouts. K-means clustering was applied to all observations. Subjects were subtyped based on predominant PRM cluster assignments and assessed using non-parametric statistical tests to determine differences in PRM values, pulmonary function metrics, and clinical measures. RESULTS We identified distinct lobar imaging patterns and classified subjects into three radiologic subtypes: emphysema-dominant (ED), fSAD-dominant (FD), and fSAD-transition (FT: transition from healthy lung to fSAD). Relative to year five emphysema, FT showed rapid local emphysema progression (-57.5% ± 1.1) compared to FD (-49.9% ± 0.5) and ED (-33.1% ± 0.4). FT consisted primarily of at-risk subjects (roughly 60%) with normal spirometry. CONCLUSION The FT subtype of COPD may allow earlier identification of individuals without spirometrically-defined COPD at-risk for developing emphysema.
Collapse
Affiliation(s)
- Jennifer M Wang
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan (J.M.W., W.W.L., M.K.H.)
| | - Alexander J Bell
- Department of Radiology, University of Michigan, Ann Arbor, Michigan (A.J.B., S.R., B.A.H., E.A.K., S.G., C.R.H., C.J.G.)
| | - Sundaresh Ram
- Department of Radiology, University of Michigan, Ann Arbor, Michigan (A.J.B., S.R., B.A.H., E.A.K., S.G., C.R.H., C.J.G.); Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan (S.R.)
| | - Wassim W Labaki
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan (J.M.W., W.W.L., M.K.H.)
| | - Benjamin A Hoff
- Department of Radiology, University of Michigan, Ann Arbor, Michigan (A.J.B., S.R., B.A.H., E.A.K., S.G., C.R.H., C.J.G.)
| | - Susan Murray
- School of Public Health, University of Michigan, Ann Arbor, Michigan (S.M.)
| | - Ella A Kazerooni
- Department of Radiology, University of Michigan, Ann Arbor, Michigan (A.J.B., S.R., B.A.H., E.A.K., S.G., C.R.H., C.J.G.)
| | - Stefanie Galban
- Department of Radiology, University of Michigan, Ann Arbor, Michigan (A.J.B., S.R., B.A.H., E.A.K., S.G., C.R.H., C.J.G.)
| | - Charles R Hatt
- Department of Radiology, University of Michigan, Ann Arbor, Michigan (A.J.B., S.R., B.A.H., E.A.K., S.G., C.R.H., C.J.G.); Imbio, LLC, Minneapolis, Minnesota (C.R.H.)
| | - MeiLan K Han
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan (J.M.W., W.W.L., M.K.H.)
| | - Craig J Galban
- Department of Radiology, University of Michigan, Ann Arbor, Michigan (A.J.B., S.R., B.A.H., E.A.K., S.G., C.R.H., C.J.G.).
| |
Collapse
|
4
|
Bell AJ, Pal R, Labaki WW, Hoff BA, Wang JM, Murray S, Kazerooni EA, Galban S, Lynch DA, Humphries SM, Martinez FJ, Hatt CR, Han MK, Ram S, Galban CJ. Local heterogeneity of normal lung parenchyma and small airways disease are associated with COPD severity and progression. Respir Res 2024; 25:106. [PMID: 38419014 PMCID: PMC10903150 DOI: 10.1186/s12931-024-02729-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 02/13/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Small airways disease (SAD) is a major cause of airflow obstruction in COPD patients and has been identified as a precursor to emphysema. Although the amount of SAD in the lungs can be quantified using our Parametric Response Mapping (PRM) approach, the full breadth of this readout as a measure of emphysema and COPD progression has yet to be explored. We evaluated topological features of PRM-derived normal parenchyma and SAD as surrogates of emphysema and predictors of spirometric decline. METHODS PRM metrics of normal lung (PRMNorm) and functional SAD (PRMfSAD) were generated from CT scans collected as part of the COPDGene study (n = 8956). Volume density (V) and Euler-Poincaré Characteristic (χ) image maps, measures of the extent and coalescence of pocket formations (i.e., topologies), respectively, were determined for both PRMNorm and PRMfSAD. Association with COPD severity, emphysema, and spirometric measures were assessed via multivariable regression models. Readouts were evaluated as inputs for predicting FEV1 decline using a machine learning model. RESULTS Multivariable cross-sectional analysis of COPD subjects showed that V and χ measures for PRMfSAD and PRMNorm were independently associated with the amount of emphysema. Readouts χfSAD (β of 0.106, p < 0.001) and VfSAD (β of 0.065, p = 0.004) were also independently associated with FEV1% predicted. The machine learning model using PRM topologies as inputs predicted FEV1 decline over five years with an AUC of 0.69. CONCLUSIONS We demonstrated that V and χ of fSAD and Norm have independent value when associated with lung function and emphysema. In addition, we demonstrated that these readouts are predictive of spirometric decline when used as inputs in a ML model. Our topological PRM approach using PRMfSAD and PRMNorm may show promise as an early indicator of emphysema onset and COPD progression.
Collapse
Affiliation(s)
- Alexander J Bell
- Department of Radiology, University of Michigan, 109 Zina Pitcher Place BSRB A506, Ann Arbor, MI, 48109-2200, USA
| | - Ravi Pal
- Department of Radiology, University of Michigan, 109 Zina Pitcher Place BSRB A506, Ann Arbor, MI, 48109-2200, USA
| | - Wassim W Labaki
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Benjamin A Hoff
- Department of Radiology, University of Michigan, 109 Zina Pitcher Place BSRB A506, Ann Arbor, MI, 48109-2200, USA
| | - Jennifer M Wang
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Susan Murray
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Ella A Kazerooni
- Department of Radiology, University of Michigan, 109 Zina Pitcher Place BSRB A506, Ann Arbor, MI, 48109-2200, USA
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Stefanie Galban
- Department of Radiology, University of Michigan, 109 Zina Pitcher Place BSRB A506, Ann Arbor, MI, 48109-2200, USA
| | - David A Lynch
- Department of Radiology, National Jewish Health, Denver, CO, USA
| | | | | | | | - MeiLan K Han
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Sundaresh Ram
- Department of Radiology, University of Michigan, 109 Zina Pitcher Place BSRB A506, Ann Arbor, MI, 48109-2200, USA.
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA.
| | - Craig J Galban
- Department of Radiology, University of Michigan, 109 Zina Pitcher Place BSRB A506, Ann Arbor, MI, 48109-2200, USA.
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA.
| |
Collapse
|
5
|
Wade RC, Ling SX, Helgeson ES, Voelker H, Labaki WW, Meza D, O’Corragain O, So JY, Criner GJ, Han MK, Kalhan R, Reed RM, Dransfield MT, Wells JM. Associations Between Coronary Artery Calcium Score and Exacerbation Risk in BLOCK-COPD. Chronic Obstr Pulm Dis 2024; 11:101-105. [PMID: 37963303 PMCID: PMC10913922 DOI: 10.15326/jcopdf.2023.0423] [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] [Subscribe] [Scholar Register] [Accepted: 11/01/2023] [Indexed: 11/16/2023]
Abstract
Introduction In 2019, the Beta-Blockers for the Prevention of Acute Exacerbations of Chronic Obstructive Pulmonary Disease study (BLOCK-COPD) evaluated the effect of metoprolol on exacerbation risk and mortality in a COPD population without indications for beta-blocker use. We hypothesized that an imaging metric of coronary artery disease (CAD), the coronary artery calcium (CAC) score, would predict exacerbation risk and identify a differential response to metoprolol treatment. Methods The study population includes participants in the BLOCK-COPD study from multiple study sites. Participants underwent clinically indicated thoracic computed tomography (CT) scans ± 12 months from enrollment. The Weston scoring system quantified CAC. Adjusted Cox proportional hazards models evaluated for associations between CAC and time to exacerbation. Results Data is included for 109 participants. The mean CAC score was 5.1±3.7, and 92 participants (84%) had CAC scores greater than 0. Over a median (interquartile range) follow-up time of 350 (280 to 352) days, there were 61 mild exacerbations and 19 severe/very severe exacerbations. No associations were found between exacerbations of any severity and CAC>0 or total CAC. Associations were observed between total CAC and CAC>0 in the left circumflex (LCx) and time to exacerbation of any severity (adjusted hazard ratio [aHR]=1.39, confidence interval [CI]: 1.08-1.79, p=0.01) and (aHR=1.96, 95% CI: 1.04-3.70, p=0.04), respectively. Conclusions CAD is a prevalent comorbidity in COPD accounting for significant mortality. Our study confirms the high prevalence of CAD using the CAC score; however, we did not discover an association between CAC and exacerbation risk. We did find novel associations between CAC in the LCx and exacerbation risk which warrant further investigation in larger cohorts.
Collapse
Affiliation(s)
- R. Chad Wade
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
- Lung Health Center, University of Alabama at Birmingham, Birmingham, Alabama, United States
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
- Acute Care Service, Birmingham VA Medical Center, Birmingham, Alabama, United States
| | - Sharon X. Ling
- Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota, United States
- †Deceased
| | - Erika S. Helgeson
- Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota, United States
| | - Helen Voelker
- Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota, United States
| | - Wassim W. Labaki
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan, United States
| | - Daniel Meza
- Division of Pulmonary and Critical Care Medicine, Northwestern University, Chicago, Illinois, United States
| | - Oisin O’Corragain
- Department of Thoracic Medicine and Surgery, Temple University, Philadelphia, Pennsylvania, United States
| | - Jennifer Y. So
- Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, Maryland, United States
| | - Gerard J. Criner
- Department of Thoracic Medicine and Surgery, Temple University, Philadelphia, Pennsylvania, United States
| | - MeiLan K. Han
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan, United States
| | - Ravi Kalhan
- Division of Pulmonary and Critical Care Medicine, Northwestern University, Chicago, Illinois, United States
| | - Robert M. Reed
- Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, Maryland, United States
| | - Mark T. Dransfield
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
- Lung Health Center, University of Alabama at Birmingham, Birmingham, Alabama, United States
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
- Acute Care Service, Birmingham VA Medical Center, Birmingham, Alabama, United States
| | - J. Michael Wells
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
- Lung Health Center, University of Alabama at Birmingham, Birmingham, Alabama, United States
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
- Acute Care Service, Birmingham VA Medical Center, Birmingham, Alabama, United States
| |
Collapse
|
6
|
Jimenez JV, Ackrivo J, Hsu JY, Wilson MW, Labaki WW, Hansen-Flaschen J, Hyzy RC, Choi PJ. Lowering P CO2 With Noninvasive Ventilation Is Associated With Improved Survival in Chronic Hypercapnic Respiratory Failure. Respir Care 2023; 68:1613-1622. [PMID: 37137711 PMCID: PMC10676248 DOI: 10.4187/respcare.10813] [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: 12/15/2022] [Accepted: 05/01/2023] [Indexed: 05/05/2023]
Abstract
BACKGROUND Chronic hypercapnic respiratory failure is associated with high mortality. Although previous work has demonstrated a mortality improvement with high-intensity noninvasive ventilation in COPD, it is unclear whether a PCO2 reduction strategy is associated with improved outcomes in other populations of chronic hypercapnia. METHODS The objective of this study was to investigate the association between PCO2 reduction (by using transcutaneous PCO2 as an estimate for PaCO2 and survival in a broad population of individuals treated with noninvasive ventilation for chronic hypercapnia. We hypothesized that reductions in PCO2 would be associated with improved survival. Therefore, we performed a cohort study of all the subjects evaluated from February 2012 to January 2021 for noninvasive ventilation initiation and/or optimization due to chronic hypercapnia at a home ventilation clinic in an academic center. We used multivariable Cox proportional hazard models with time-varying coefficients and PCO2 as a time-varying covariate to test the association between PCO2 and all-cause mortality and when adjusting for known cofounders. RESULTS The mean ± SD age of 337 subjects was 57 ± 16 years, 37% women, and 85% white. In a univariate analysis, survival probability increased with reductions in PCO2 to < 50 mm Hg after 90 d, and these remained significant after adjusting for age, sex, race, body mass index, diagnosis, Charlson comorbidity index, and baseline PCO2 . In the multivariable analysis, the subjects who had a PaCO2 < 50 mm Hg had a reduced mortality risk of 94% between 90 and 179 d (hazard ratio [HR] 0.06, 95% CI 0.01-0.50), 69% between 180 and 364 d (HR 0.31, 95% CI 0.12-0.79), and 73% for 365-730 d (HR 0.27, 95% CI 0.13-0.56). CONCLUSIONS Reduction in PCO2 from baseline for subjects with chronic hypercapnia treated with noninvasive ventilation was associated with improved survival. Management strategies should target the greatest attainable reductions in PCO2 .
Collapse
Affiliation(s)
- Jose Victor Jimenez
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan. Dr Jimenez is affiliated with the Department of Internal Medicine, Yale New Haven Hospital, New Haven, Connecticut
| | - Jason Ackrivo
- Pulmonary, Allergy, and Critical Care Division, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jesse Y Hsu
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mathew W Wilson
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan. Dr Jimenez is affiliated with the Department of Internal Medicine, Yale New Haven Hospital, New Haven, Connecticut
| | - Wassim W Labaki
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan. Dr Jimenez is affiliated with the Department of Internal Medicine, Yale New Haven Hospital, New Haven, Connecticut
| | - John Hansen-Flaschen
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan. Dr Jimenez is affiliated with the Department of Internal Medicine, Yale New Haven Hospital, New Haven, Connecticut
| | - Robert C Hyzy
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan. Dr Jimenez is affiliated with the Department of Internal Medicine, Yale New Haven Hospital, New Haven, Connecticut
| | - Philip J Choi
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan. Dr Jimenez is affiliated with the Department of Internal Medicine, Yale New Haven Hospital, New Haven, Connecticut.
| |
Collapse
|
7
|
Bell AJ, Pal R, Labaki WW, Hoff BA, Wang JM, Murray S, Kazerooni EA, Galban S, Lynch DA, Humphries SM, Martinez FJ, Hatt CR, Han MK, Ram S, Galban CJ. Quantitative CT of Normal Lung Parenchyma and Small Airways Disease Topologies are Associated With COPD Severity and Progression. medRxiv 2023:2023.05.26.23290532. [PMID: 37333382 PMCID: PMC10274970 DOI: 10.1101/2023.05.26.23290532] [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] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
Objectives Small airways disease (SAD) is a major cause of airflow obstruction in COPD patients, and has been identified as a precursor to emphysema. Although the amount of SAD in the lungs can be quantified using our Parametric Response Mapping (PRM) approach, the full breadth of this readout as a measure of emphysema and COPD progression has yet to be explored. We evaluated topological features of PRM-derived normal parenchyma and SAD as surrogates of emphysema and predictors of spirometric decline. Materials and Methods PRM metrics of normal lung (PRMNorm) and functional SAD (PRMfSAD) were generated from CT scans collected as part of the COPDGene study (n=8956). Volume density (V) and Euler-Poincaré Characteristic (χ) image maps, measures of the extent and coalescence of pocket formations (i.e., topologies), respectively, were determined for both PRMNorm and PRMfSAD. Association with COPD severity, emphysema, and spirometric measures were assessed via multivariable regression models. Readouts were evaluated as inputs for predicting FEV1 decline using a machine learning model. Results Multivariable cross-sectional analysis of COPD subjects showed that V and χ measures for PRMfSAD and PRMNorm were independently associated with the amount of emphysema. Readouts χfSAD (β of 0.106, p<0.001) and VfSAD (β of 0.065, p=0.004) were also independently associated with FEV1% predicted. The machine learning model using PRM topologies as inputs predicted FEV1 decline over five years with an AUC of 0.69. Conclusions We demonstrated that V and χ of fSAD and Norm have independent value when associated with lung function and emphysema. In addition, we demonstrated that these readouts are predictive of spirometric decline when used as inputs in a ML model. Our topological PRM approach using PRMfSAD and PRMNorm may show promise as an early indicator of emphysema onset and COPD progression.
Collapse
Affiliation(s)
- Alexander J. Bell
- Department of Radiology, University of Michigan, Ann Arbor, MI, United States
| | - Ravi Pal
- Department of Radiology, University of Michigan, Ann Arbor, MI, United States
| | - Wassim W. Labaki
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Benjamin A. Hoff
- Department of Radiology, University of Michigan, Ann Arbor, MI, United States
| | - Jennifer M. Wang
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Susan Murray
- School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Ella A. Kazerooni
- Department of Radiology, University of Michigan, Ann Arbor, MI, United States
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Stefanie Galban
- Department of Radiology, University of Michigan, Ann Arbor, MI, United States
| | - David A. Lynch
- Department of Radiology, National Jewish Health, Denver, CO, United States
| | | | | | | | - MeiLan K. Han
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Sundaresh Ram
- Department of Radiology, University of Michigan, Ann Arbor, MI, United States
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, United States
| | - Craig J. Galban
- Department of Radiology, University of Michigan, Ann Arbor, MI, United States
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, United States
| |
Collapse
|
8
|
Choi B, San José Estépar R, Godbole S, Curtis JL, Wang JM, San José Estépar R, Rosas IO, Mayers JR, Hobbs BD, Hersh CP, Ash SY, Han MK, Bowler RP, Stringer KA, Washko GR, Labaki WW. Plasma metabolomics and quantitative interstitial abnormalities in ever-smokers. Respir Res 2023; 24:265. [PMID: 37925418 PMCID: PMC10625195 DOI: 10.1186/s12931-023-02576-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 10/23/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Quantitative interstitial abnormalities (QIA) are an automated computed tomography (CT) finding of early parenchymal lung disease, associated with worse lung function, reduced exercise capacity, increased respiratory symptoms, and death. The metabolomic perturbations associated with QIA are not well known. We sought to identify plasma metabolites associated with QIA in smokers. We also sought to identify shared and differentiating metabolomics features between QIA and emphysema, another smoking-related advanced radiographic abnormality. METHODS In 928 former and current smokers in the Genetic Epidemiology of COPD cohort, we measured QIA and emphysema using an automated local density histogram method and generated metabolite profiles from plasma samples using liquid chromatography-mass spectrometry (Metabolon). We assessed the associations between metabolite levels and QIA using multivariable linear regression models adjusted for age, sex, body mass index, smoking status, pack-years, and inhaled corticosteroid use, at a Benjamini-Hochberg False Discovery Rate p-value of ≤ 0.05. Using multinomial regression models adjusted for these covariates, we assessed the associations between metabolite levels and the following CT phenotypes: QIA-predominant, emphysema-predominant, combined-predominant, and neither- predominant. Pathway enrichment analyses were performed using MetaboAnalyst. RESULTS We found 85 metabolites significantly associated with QIA, with overrepresentation of the nicotinate and nicotinamide, histidine, starch and sucrose, pyrimidine, phosphatidylcholine, lysophospholipid, and sphingomyelin pathways. These included metabolites involved in inflammation and immune response, extracellular matrix remodeling, surfactant, and muscle cachexia. There were 75 metabolites significantly different between QIA-predominant and emphysema-predominant phenotypes, with overrepresentation of the phosphatidylethanolamine, nicotinate and nicotinamide, aminoacyl-tRNA, arginine, proline, alanine, aspartate, and glutamate pathways. CONCLUSIONS Metabolomic correlates may lend insight to the biologic perturbations and pathways that underlie clinically meaningful quantitative CT measurements like QIA in smokers.
Collapse
Affiliation(s)
- Bina Choi
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, Pulmonary-PBB-CA-3, Boston, MA, 02115, USA.
- Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA, USA.
| | - Raúl San José Estépar
- Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA, USA
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Suneeta Godbole
- Anschutz Medical Campus, Department of Biostatistics and Informatics, University of Colorado, Aurora, CO, USA
| | - Jeffrey L Curtis
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Medical Service, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Jennifer M Wang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Rubén San José Estépar
- Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA, USA
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Jared R Mayers
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, Pulmonary-PBB-CA-3, Boston, MA, 02115, USA
| | - Brian D Hobbs
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, Pulmonary-PBB-CA-3, Boston, MA, 02115, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Craig P Hersh
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, Pulmonary-PBB-CA-3, Boston, MA, 02115, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Samuel Y Ash
- Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA, USA
- Department of Critical Care, South Shore Hospital, South Weymouth, MA, USA
| | - MeiLan K Han
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Russell P Bowler
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, National Jewish Health, Denver, CO, USA
| | - Kathleen A Stringer
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor, MI, USA
| | - George R Washko
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, Pulmonary-PBB-CA-3, Boston, MA, 02115, USA
- Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA, USA
| | - Wassim W Labaki
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
9
|
Wendt CH, Bowler RP, Demorest C, Hastie A, Labaki WW, Chen M, Carmella SG, Hecht SS. Levels of Urinary Mercapturic Acids of Acrolein, Methacrolein, Crotonaldehyde, and Methyl Vinyl Ketone in Relationship to Chronic Obstructive Pulmonary Disease in Cigarette Smokers of the Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS). Chem Res Toxicol 2023. [PMID: 37725788 DOI: 10.1021/acs.chemrestox.3c00197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
Cigarette smoking is an established cause of chronic obstructive pulmonary disease (COPD). Numerous studies implicate acrolein, which occurs in relatively high concentrations in cigarette smoke and reacts readily with proteins, as one causative factor for COPD in smokers. Far less is known about the possible roles in COPD of the related α,β-unsaturated carbonyl compounds of cigarette smoke crotonaldehyde, methacrolein, and methyl vinyl ketone. In the study reported here, we analyzed mercapturic acids of these α,β-unsaturated compounds in the urine of 413 confirmed cigarette smokers in the Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS)─202 with COPD and 211 without COPD. The mercapturic acids analyzed were 3-hydroxypropyl mercapturic acid (3-HPMA) from acrolein, 3-hydroxy-1-methylpropyl mercapturic acid (HMPMA-1) from crotonaldehyde, 3-hydroxy-2-methylpropyl mercapturic acid (HMPMA-2) from methacrolein, and 3-hydroxy-3-methylpropyl mercapturic acid (HMPMA-3) from methyl vinyl ketone. In models adjusting for age, sex, race, pack years of tobacco use, and BMI, all four mercapturic acids were increased in individuals with COPD but not significantly. Stratified by the GOLD status, there were increased levels of the metabolites associated with GOLD 3-4 compared to that with GOLD 0, with the methacrolein metabolite HMPMA-2 reaching statistical significance (adjusted odds ratio 1.23 [95% CI: 1.00-1.53]). These results highlight the possible role of methacrolein, which has previously received little attention in this regard, as a causative factor in COPD in cigarette smokers.
Collapse
Affiliation(s)
- Chris H Wendt
- University of Minnesota, Minneapolis, Minnesota 55455, United States
- Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota 55417, United States
| | | | - Connor Demorest
- University of Minnesota, Minneapolis, Minnesota 55455, United States
| | - Annette Hastie
- Wake Forest University School of Medicine, Winston Salem, North Carolina 27101-4135, United States
| | - Wassim W Labaki
- University of Michigan, Ann Arbor, Michigan 48109-1382, United States
| | - Menglan Chen
- University of Minnesota, Minneapolis, Minnesota 55455, United States
| | - Steven G Carmella
- University of Minnesota, Minneapolis, Minnesota 55455, United States
| | - Stephen S Hecht
- University of Minnesota, Minneapolis, Minnesota 55455, United States
| |
Collapse
|
10
|
Labaki WW, Gu T, Murray S, Curtis JL, Wells JM, Bhatt SP, Bon J, Diaz AA, Hersh CP, Wan ES, Kim V, Beaty TH, Hokanson JE, Bowler RP, Arenberg DA, Kazerooni EA, Martinez FJ, Silverman EK, Crapo JD, Make BJ, Regan EA, Han MK. Causes of and Clinical Features Associated with Death in Tobacco Cigarette Users by Lung Function Impairment. Am J Respir Crit Care Med 2023; 208:451-460. [PMID: 37159910 PMCID: PMC10449063 DOI: 10.1164/rccm.202210-1887oc] [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: 10/10/2022] [Accepted: 05/08/2023] [Indexed: 05/11/2023] Open
Abstract
Rationale: Cigarette smoking contributes to the risk of death through different mechanisms. Objectives: To determine how causes of and clinical features associated with death vary in tobacco cigarette users by lung function impairment. Methods: We stratified current and former tobacco cigarette users enrolled in Genetic Epidemiology of Chronic Obstructive Pulmonary Disease (COPDGene) into normal spirometry, PRISm (Preserved Ratio Impaired Spirometry), Global Initiative for Chronic Obstructive Lung Disease (GOLD) 1-2 COPD, and GOLD 3-4 COPD. Deaths were identified via longitudinal follow-up and Social Security Death Index search. Causes of death were adjudicated after a review of death certificates, medical records, and next-of-kin interviews. We tested associations between baseline clinical variables and all-cause mortality using multivariable Cox proportional hazards models. Measurements and Main Results: Over a 10.1-year median follow-up, 2,200 deaths occurred among 10,132 participants (age 59.5 ± 9.0 yr; 46.6% women). Death from cardiovascular disease was most frequent in PRISm (31% of deaths). Lung cancer deaths were most frequent in GOLD 1-2 (18% of deaths vs. 9-11% in other groups). Respiratory deaths outpaced competing causes of death in GOLD 3-4, particularly when BODE index ⩾7. St. George's Respiratory Questionnaire score ⩾25 was associated with higher mortality in all groups: Hazard ratio (HR), 1.48 (1.20-1.84) normal spirometry; HR, 1.40 (1.05-1.87) PRISm; HR, 1.80 (1.49-2.17) GOLD 1-2; HR, 1.65 (1.26-2.17) GOLD 3-4. History of respiratory exacerbations was associated with higher mortality in GOLD 1-2 and GOLD 3-4, quantitative emphysema in GOLD 1-2, and airway wall thickness in PRISm and GOLD 3-4. Conclusions: Leading causes of death vary by lung function impairment in tobacco cigarette users. Worse respiratory-related quality of life is associated with all-cause mortality regardless of lung function.
Collapse
Affiliation(s)
| | - Tian Gu
- Department of Biostatistics, T.H. Chan School of Public Health
| | | | - Jeffrey L. Curtis
- Division of Pulmonary and Critical Care Medicine
- Medical Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - J. Michael Wells
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Surya P. Bhatt
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jessica Bon
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- Medical Service, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | | | - Craig P. Hersh
- Division of Pulmonary and Critical Care Medicine, and
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Emily S. Wan
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Harvard University, Boston, Massachusetts
- Veterans Affairs Boston Healthcare System, Boston, Massachusetts
| | - Victor Kim
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Terri H. Beaty
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - John E. Hokanson
- Department of Epidemiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | | | | | - Ella A. Kazerooni
- Division of Pulmonary and Critical Care Medicine
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Fernando J. Martinez
- Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical College, New York, New York
| | - Edwin K. Silverman
- Division of Pulmonary and Critical Care Medicine, and
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - James D. Crapo
- Division of Pulmonary, Critical Care and Sleep Medicine and
| | - Barry J. Make
- Division of Pulmonary, Critical Care and Sleep Medicine and
| | | | | |
Collapse
|
11
|
Arjomandi M, Zeng S, Chen J, Bhatt SP, Abtin F, Barjaktarevic I, Barr RG, Bleecker ER, Buhr RG, Criner GJ, Comellas AP, Couper DJ, Curtis JL, Dransfield MT, Fortis S, Han MK, Hansel NN, Hoffman EA, Hokanson JE, Kaner RJ, Kanner RE, Krishnan JA, Labaki WW, Lynch DA, Ortega VE, Peters SP, Woodruff PG, Cooper CB, Bowler RP, Paine III R, Rennard SI, Tashkin DP. Changes in Lung Volumes with Spirometric Disease Progression in COPD. Chronic Obstr Pulm Dis 2023; 10:270-285. [PMID: 37199719 PMCID: PMC10484496 DOI: 10.15326/jcopdf.2022.0363] [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] [Subscribe] [Scholar Register] [Accepted: 05/12/2023] [Indexed: 05/19/2023]
Abstract
Background Abnormal lung volumes representing air trapping identify the subset of smokers with preserved spirometry who develop spirometric chronic obstructive pulmonary disease (COPD) and adverse outcomes. However, how lung volumes evolve in early COPD as airflow obstruction develops remains unclear. Methods To establish how lung volumes change with the development of spirometric COPD, we examined lung volumes from the pulmonary function data (seated posture) available in the U.S. Department of Veterans Affairs electronic health records (n=71,356) and lung volumes measured by computed tomography (supine posture) available from the COPD Genetic Epidemiology (COPDGene®) study (n=7969) and the SubPopulations and InterMediate Outcome Measures In COPD Study (SPIROMICS) (n=2552) cohorts, and studied their cross-sectional distributions and longitudinal changes across the airflow obstruction spectrum. Patients with preserved ratio-impaired spirometry (PRISm) were excluded from this analysis. Results Lung volumes from all 3 cohorts showed similar patterns of distributions and longitudinal changes with worsening airflow obstruction. The distributions for total lung capacity (TLC), vital capacity (VC), and inspiratory capacity (IC) and their patterns of change were nonlinear and included different phases. When stratified by airflow obstruction using Global initiative for chronic Obstructive Lung Disease (GOLD) stages, patients with GOLD 1 (mild) COPD had larger lung volumes (TLC, VC, IC) compared to patients with GOLD 0 (smokers with preserved spirometry) or GOLD 2 (moderate) disease. In longitudinal follow-up of baseline GOLD 0 patients who progressed to spirometric COPD, those with an initially higher TLC and VC developed mild obstruction (GOLD 1) while those with an initially lower TLC and VC developed moderate obstruction (GOLD 2). Conclusions In COPD, TLC, and VC have biphasic distributions, change in nonlinear fashions as obstruction worsens, and could differentiate those GOLD 0 patients at risk for more rapid spirometric disease progression.
Collapse
Affiliation(s)
- Mehrdad Arjomandi
- San Francisco Veterans Affairs Healthcare System, San Francisco, California, United States
- Department of Medicine, University of California, San Francisco, California, United States
| | - Siyang Zeng
- San Francisco Veterans Affairs Healthcare System, San Francisco, California, United States
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington, United States
| | - Jianhong Chen
- San Francisco Veterans Affairs Healthcare System, San Francisco, California, United States
- Department of Medicine, University of California, San Francisco, California, United States
| | - Surya P. Bhatt
- University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Fereidoun Abtin
- Department of Medicine, University of California, Los Angeles, California, United States
| | - Igor Barjaktarevic
- Department of Medicine, University of California, Los Angeles, California, United States
| | - R. Graham Barr
- Columbia-Presbyterian Medical Center, New York, New York, United States
| | - Eugene R. Bleecker
- University of Arizona, College of Medicine, Tucson, Arizona, United States
| | - Russell G. Buhr
- Department of Medicine, University of California, Los Angeles, California, United States
| | | | | | - David J. Couper
- University of North Carolina, Chapel Hill, North Carolina, United States
| | - Jeffrey L. Curtis
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States
- Medical Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, United States
| | | | | | - MeiLan K. Han
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States
| | - Nadia N. Hansel
- Department of Medicine, Johns Hopkins University, Baltimore, United States
| | | | - John E. Hokanson
- Department of Epidemiology, School of Public Health, University of Colorado, United States
| | - Robert J. Kaner
- Weill Cornell Medical Center, New York, New York, United States
| | | | | | - Wassim W. Labaki
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States
| | - David A. Lynch
- Department of Radiology, National Jewish Health Systems, Denver, Colorado, United States
| | | | - Stephen P. Peters
- Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
| | - Prescott G. Woodruff
- Department of Medicine, University of California, San Francisco, California, United States
| | - Christopher B. Cooper
- Department of Medicine, University of California, Los Angeles, California, United States
| | - Russell P. Bowler
- Department of Medicine, National Jewish Health Systems, Denver, Colorado, United States
| | - Robert Paine III
- University of Utah, Salt Lake City, Utah, United States
- Department of Medicine, National Jewish Health Systems, Denver, Colorado, United States
| | | | - Donald P. Tashkin
- Columbia-Presbyterian Medical Center, New York, New York, United States
| | - the COPDGene and SPIROMICS Investigators.
- San Francisco Veterans Affairs Healthcare System, San Francisco, California, United States
- Department of Medicine, University of California, San Francisco, California, United States
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington, United States
- University of Alabama at Birmingham, Birmingham, Alabama, United States
- Department of Medicine, University of California, Los Angeles, California, United States
- Columbia-Presbyterian Medical Center, New York, New York, United States
- University of Arizona, College of Medicine, Tucson, Arizona, United States
- Temple University, Philadelphia, Pennsylvania, United States
- University of Iowa, Iowa City, Iowa, United States
- University of North Carolina, Chapel Hill, North Carolina, United States
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States
- Medical Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, United States
- Department of Medicine, Johns Hopkins University, Baltimore, United States
- Department of Epidemiology, School of Public Health, University of Colorado, United States
- Weill Cornell Medical Center, New York, New York, United States
- University of Utah, Salt Lake City, Utah, United States
- University of Illinois at Chicago, Chicago, Illinois, United States
- Department of Radiology, National Jewish Health Systems, Denver, Colorado, United States
- Mayo Clinic, Scottsdale, Arizona, United States
- Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
- Department of Medicine, National Jewish Health Systems, Denver, Colorado, United States
- University of Nebraska Medical Center, Omaha, Nebraska, United States
| |
Collapse
|
12
|
DiLillo KM, Norman KC, Freeman CM, Christenson SA, Alexis NE, Anderson WH, Barjaktarevic IZ, Barr RG, Comellas AP, Bleecker ER, Boucher RC, Couper DJ, Criner GJ, Doerschuk CM, Wells JM, Han MK, Hoffman EA, Hansel NN, Hastie AT, Kaner RJ, Krishnan JA, Labaki WW, Martinez FJ, Meyers DA, O'Neal WK, Ortega VE, Paine R, Peters SP, Woodruff PG, Cooper CB, Bowler RP, Curtis JL, Arnold KB. A blood and bronchoalveolar lavage protein signature of rapid FEV 1 decline in smoking-associated COPD. Sci Rep 2023; 13:8228. [PMID: 37217548 PMCID: PMC10203309 DOI: 10.1038/s41598-023-32216-0] [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: 08/31/2022] [Accepted: 03/24/2023] [Indexed: 05/24/2023] Open
Abstract
Accelerated progression of chronic obstructive pulmonary disease (COPD) is associated with increased risks of hospitalization and death. Prognostic insights into mechanisms and markers of progression could facilitate development of disease-modifying therapies. Although individual biomarkers exhibit some predictive value, performance is modest and their univariate nature limits network-level insights. To overcome these limitations and gain insights into early pathways associated with rapid progression, we measured 1305 peripheral blood and 48 bronchoalveolar lavage proteins in individuals with COPD [n = 45, mean initial forced expiratory volume in one second (FEV1) 75.6 ± 17.4% predicted]. We applied a data-driven analysis pipeline, which enabled identification of protein signatures that predicted individuals at-risk for accelerated lung function decline (FEV1 decline ≥ 70 mL/year) ~ 6 years later, with high accuracy. Progression signatures suggested that early dysregulation in elements of the complement cascade is associated with accelerated decline. Our results propose potential biomarkers and early aberrant signaling mechanisms driving rapid progression in COPD.
Collapse
Affiliation(s)
- Katarina M DiLillo
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Katy C Norman
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Christine M Freeman
- Research Service, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Division of Pulmonary & Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA
- Graduate Program in Immunology, University of Michigan, Ann Arbor, MI, USA
| | - Stephanie A Christenson
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Neil E Alexis
- Center for Environmental Medicine, Asthma, and Lung Biology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Wayne H Anderson
- Marsico Lung Institute/Pulmonary and Critical Care Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Igor Z Barjaktarevic
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - R Graham Barr
- Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Alejandro P Comellas
- Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa, Iowa City, IA, USA
| | - Eugene R Bleecker
- Division of Genetics, Genomics and Precision Medicine, University of Arizona Health Sciences, Tucson, AZ, USA
| | - Richard C Boucher
- Marsico Lung Institute/Cystic Fibrosis Research Center, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - David J Couper
- Collaborative Studies Coordinating Center, Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Gerard J Criner
- Department of Thoracic Medicine and Surgery, Temple University, Philadelphia, PA, USA
| | - Claire M Doerschuk
- Marsico Lung Institute/Cystic Fibrosis Research Center, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - J Michael Wells
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - MeiLan K Han
- Division of Pulmonary & Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Eric A Hoffman
- Department of Radiology, University of Iowa, Iowa City, IA, USA
| | - Nadia N Hansel
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Annette T Hastie
- Department of Internal Medicine, Wake Forest School of Medicine, Atrium Health, Wake Forest Baptist, Winston Salem, NC, USA
| | - Robert J Kaner
- Department of Medicine, Weill Cornell Medical Center, New York, NY, USA
| | - Jerry A Krishnan
- Division of Pulmonary, Critical Care, Sleep and Allergy, University of Illinois at Chicago, Chicago, IL, USA
| | - Wassim W Labaki
- Division of Pulmonary & Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA
| | | | - Deborah A Meyers
- Division of Genetics, Genomics and Precision Medicine, University of Arizona Health Sciences, Tucson, AZ, USA
| | - Wanda K O'Neal
- Marsico Lung Institute/Cystic Fibrosis Research Center, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Victor E Ortega
- Department of Internal Medicine, Division of Respiratory Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | - Robert Paine
- Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah, Salt Lake City, UT, USA
| | - Stephen P Peters
- Department of Internal Medicine, Wake Forest School of Medicine, Atrium Health, Wake Forest Baptist, Winston Salem, NC, USA
| | - Prescott G Woodruff
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Christopher B Cooper
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Russell P Bowler
- Division of Pulmonary and Critical Care, National Jewish Health, Denver, CO, USA
| | - Jeffrey L Curtis
- Division of Pulmonary & Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA
- Graduate Program in Immunology, University of Michigan, Ann Arbor, MI, USA
- Medical Service, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Kelly B Arnold
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA.
| |
Collapse
|
13
|
Wang JM, Labaki WW, Murray S, Martinez FJ, Curtis JL, Hoffman EA, Ram S, Bell AJ, Galban CJ, Han MK, Hatt C. Machine learning for screening of at-risk, mild and moderate COPD patients at risk of FEV 1 decline: results from COPDGene and SPIROMICS. Front Physiol 2023; 14:1144192. [PMID: 37153221 PMCID: PMC10161244 DOI: 10.3389/fphys.2023.1144192] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 04/03/2023] [Indexed: 05/09/2023] Open
Abstract
Purpose: The purpose of this study was to train and validate machine learning models for predicting rapid decline of forced expiratory volume in 1 s (FEV1) in individuals with a smoking history at-risk-for chronic obstructive pulmonary disease (COPD), Global Initiative for Chronic Obstructive Lung Disease (GOLD 0), or with mild-to-moderate (GOLD 1-2) COPD. We trained multiple models to predict rapid FEV1 decline using demographic, clinical and radiologic biomarker data. Training and internal validation data were obtained from the COPDGene study and prediction models were validated against the SPIROMICS cohort. Methods: We used GOLD 0-2 participants (n = 3,821) from COPDGene (60.0 ± 8.8 years, 49.9% male) for variable selection and model training. Accelerated lung function decline was defined as a mean drop in FEV1% predicted of > 1.5%/year at 5-year follow-up. We built logistic regression models predicting accelerated decline based on 22 chest CT imaging biomarker, pulmonary function, symptom, and demographic features. Models were validated using n = 885 SPIROMICS subjects (63.6 ± 8.6 years, 47.8% male). Results: The most important variables for predicting FEV1 decline in GOLD 0 participants were bronchodilator responsiveness (BDR), post bronchodilator FEV1% predicted (FEV1.pp.post), and CT-derived expiratory lung volume; among GOLD 1 and 2 subjects, they were BDR, age, and PRMlower lobes fSAD. In the validation cohort, GOLD 0 and GOLD 1-2 full variable models had significant predictive performance with AUCs of 0.620 ± 0.081 (p = 0.041) and 0.640 ± 0.059 (p < 0.001). Subjects with higher model-derived risk scores had significantly greater odds of FEV1 decline than those with lower scores. Conclusion: Predicting FEV1 decline in at-risk patients remains challenging but a combination of clinical, physiologic and imaging variables provided the best performance across two COPD cohorts.
Collapse
Affiliation(s)
- Jennifer M. Wang
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Wassim W. Labaki
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Susan Murray
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | | | - Jeffrey L. Curtis
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, United States
- Medical Service, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States
| | - Eric A. Hoffman
- Department of Radiology, University of Iowa, Iowa City, IA, United States
| | - Sundaresh Ram
- Department of Radiology, University of Michigan, Ann Arbor, MI, United States
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, United States
| | - Alexander J. Bell
- Department of Radiology, University of Michigan, Ann Arbor, MI, United States
| | - Craig J. Galban
- Department of Radiology, University of Michigan, Ann Arbor, MI, United States
| | - MeiLan K. Han
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Charles Hatt
- Department of Radiology, University of Michigan, Ann Arbor, MI, United States
- Imbio Inc., Minneapolis, MN, United States
| |
Collapse
|
14
|
Jimenez JV, Munroe E, Weirauch AJ, Fiorino K, Culter CA, Nelson K, Labaki WW, Choi PJ, Co I, Standiford TJ, Prescott HC, Hyzy RC. Electric impedance tomography-guided PEEP titration reduces mechanical power in ARDS: a randomized crossover pilot trial. Crit Care 2023; 27:21. [PMID: 36650593 PMCID: PMC9843117 DOI: 10.1186/s13054-023-04315-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 01/11/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND In patients with acute respiratory distress syndrome undergoing mechanical ventilation, positive end-expiratory pressure (PEEP) can lead to recruitment or overdistension. Current strategies utilized for PEEP titration do not permit the distinction. Electric impedance tomography (EIT) detects and quantifies the presence of both collapse and overdistension. We investigated whether using EIT-guided PEEP titration leads to decreased mechanical power compared to high-PEEP/FiO2 tables. METHODS A single-center, randomized crossover pilot trial comparing EIT-guided PEEP selection versus PEEP selection using the High-PEEP/FiO2 table in patients with moderate-severe acute respiratory distress syndrome. The primary outcome was the change in mechanical power after each PEEP selection strategy. Secondary outcomes included changes in the 4 × driving pressure + respiratory rate (4 ΔP, + RR index) index, driving pressure, plateau pressure, PaO2/FiO2 ratio, and static compliance. RESULTS EIT was consistently associated with a decrease in mechanical power compared to PEEP/FiO2 tables (mean difference - 4.36 J/min, 95% CI - 6.7, - 1.95, p = 0.002) and led to lower values in the 4ΔP + RR index (- 11.42 J/min, 95% CI - 19.01, - 3.82, p = 0.007) mainly driven by a decrease in the elastic-dynamic power (- 1.61 J/min, - 2.99, - 0.22, p = 0.027). The elastic-static and resistive powers were unchanged. Similarly, EIT led to a statistically significant change in set PEEP (- 2 cmH2O, p = 0.046), driving pressure, (- 2.92 cmH2O, p = 0.003), peak pressure (- 6.25 cmH2O, p = 0.003), plateau pressure (- 4.53 cmH2O, p = 0.006), and static respiratory system compliance (+ 7.93 ml/cmH2O, p = 0.008). CONCLUSIONS In patients with moderate-severe acute respiratory distress syndrome, EIT-guided PEEP titration reduces mechanical power mainly through a reduction in elastic-dynamic power. Trial registration This trial was prospectively registered on Clinicaltrials.gov (NCT03793842) on January 4th, 2019.
Collapse
Affiliation(s)
- Jose Victor Jimenez
- grid.214458.e0000000086837370Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, 1500 E Medical Center Dr. Floor 3 Reception C, Ann Arbor, MI 48109 USA
| | - Elizabeth Munroe
- grid.214458.e0000000086837370Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, 1500 E Medical Center Dr. Floor 3 Reception C, Ann Arbor, MI 48109 USA
| | - Andrew J. Weirauch
- grid.214458.e0000000086837370UH/CVC Department of Respiratory Care, University of Michigan, Ann Arbor, MI USA
| | - Kelly Fiorino
- grid.214458.e0000000086837370UH/CVC Department of Respiratory Care, University of Michigan, Ann Arbor, MI USA
| | - Christopher A. Culter
- grid.214458.e0000000086837370UH/CVC Department of Respiratory Care, University of Michigan, Ann Arbor, MI USA
| | - Kristine Nelson
- grid.214458.e0000000086837370Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, 1500 E Medical Center Dr. Floor 3 Reception C, Ann Arbor, MI 48109 USA
| | - Wassim W. Labaki
- grid.214458.e0000000086837370Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, 1500 E Medical Center Dr. Floor 3 Reception C, Ann Arbor, MI 48109 USA
| | - Philip J. Choi
- grid.214458.e0000000086837370Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, 1500 E Medical Center Dr. Floor 3 Reception C, Ann Arbor, MI 48109 USA ,grid.214458.e0000000086837370UH/CVC Department of Respiratory Care, University of Michigan, Ann Arbor, MI USA
| | - Ivan Co
- grid.214458.e0000000086837370Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, 1500 E Medical Center Dr. Floor 3 Reception C, Ann Arbor, MI 48109 USA
| | - Theodore J. Standiford
- grid.214458.e0000000086837370Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, 1500 E Medical Center Dr. Floor 3 Reception C, Ann Arbor, MI 48109 USA
| | - Hallie C. Prescott
- grid.214458.e0000000086837370Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, 1500 E Medical Center Dr. Floor 3 Reception C, Ann Arbor, MI 48109 USA ,grid.497654.d0000 0000 8603 8958VA Center for Clinical Management Research, Ann Arbor, MI USA
| | - Robert C. Hyzy
- grid.214458.e0000000086837370Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, 1500 E Medical Center Dr. Floor 3 Reception C, Ann Arbor, MI 48109 USA
| |
Collapse
|
15
|
Esther CR, O'Neal WK, Anderson WH, Kesimer M, Ceppe A, Doerschuk CM, Alexis NE, Hastie AT, Barr RG, Bowler RP, Wells JM, Oelsner EC, Comellas AP, Tesfaigzi Y, Kim V, Paulin LM, Cooper CB, Han MK, Huang YJ, Labaki WW, Curtis JL, Boucher RC. Identification of Sputum Biomarkers Predictive of Pulmonary Exacerbations in COPD. Chest 2022; 161:1239-1249. [PMID: 34801592 PMCID: PMC9131049 DOI: 10.1016/j.chest.2021.10.049] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [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: 06/10/2021] [Revised: 10/15/2021] [Accepted: 10/29/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Improved understanding of the pathways associated with airway pathophysiologic features in COPD will identify new predictive biomarkers and novel therapeutic targets. RESEARCH QUESTION Which physiologic pathways are altered in the airways of patients with COPD and will predict exacerbations? STUDY DESIGN AND METHODS We applied a mass spectrometric panel of metabolomic biomarkers related to mucus hydration and inflammation to sputa from the multicenter Subpopulations and Intermediate Outcome Measures in COPD Study. Biomarkers elevated in sputa from patients with COPD were evaluated for relationships to measures of COPD disease severity and their ability to predict future exacerbations. RESULTS Sputum supernatants from 980 patients were analyzed: 77 healthy nonsmokers, 341 smokers with preserved spirometry, and 562 patients with COPD (178 with Global Initiative on Chronic Obstructive Lung Disease [GOLD] stage 1 disease, 303 with GOLD stage 2 disease, and 81 with GOLD stage 3 disease) were analyzed. Biomarkers from multiple pathways were elevated in COPD and correlated with sputum neutrophil counts. Among the most significant analytes (false discovery rate, 0.1) were sialic acid, hypoxanthine, xanthine, methylthioadenosine, adenine, and glutathione. Sialic acid and hypoxanthine were associated strongly with measures of disease severity, and elevation of these biomarkers was associated with shorter time to exacerbation and improved prediction models of future exacerbations. INTERPRETATION Biomarker evaluation implicated pathways involved in mucus hydration, adenosine metabolism, methionine salvage, and oxidative stress in COPD airway pathophysiologic characteristics. Therapies that target these pathways may be of benefit in COPD, and a simple model adding sputum-soluble phase biomarkers improves prediction of pulmonary exacerbations. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT01969344; URL: www. CLINICALTRIALS gov.
Collapse
Affiliation(s)
- Charles R Esther
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC.
| | - Wanda K O'Neal
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Wayne H Anderson
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Mehmet Kesimer
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Agathe Ceppe
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Claire M Doerschuk
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Neil E Alexis
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Annette T Hastie
- Department of Internal Medicine, School of Medicine, Wake Forest University, Winston-Salem, NC
| | - R Graham Barr
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY
| | | | - J Michael Wells
- Lung Health Center, Division of Pulmonary Allergy and Critical Care, University of Alabama at Birmingham, Birmingham, AL
| | - Elizabeth C Oelsner
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY
| | - Alejandro P Comellas
- Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa, Iowa City, IA
| | - Yohannes Tesfaigzi
- Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Victor Kim
- Pulmonary and Critical Care Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Laura M Paulin
- Department of Medicine and Epidemiology, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine, Hanover, NH
| | - Christopher B Cooper
- Department of Medicine and Physiology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - MeiLan K Han
- Division of Pulmonary and Critical Care Medicine, University of Michigan Ann Arbor, Ann Arbor, MI
| | - Yvonne J Huang
- Division of Pulmonary and Critical Care Medicine, University of Michigan Ann Arbor, Ann Arbor, MI
| | - Wassim W Labaki
- Division of Pulmonary and Critical Care Medicine, University of Michigan Ann Arbor, Ann Arbor, MI
| | - Jeffrey L Curtis
- Division of Pulmonary and Critical Care Medicine, University of Michigan Ann Arbor, Ann Arbor, MI; Medicine Service, VA Ann Arbor Healthcare System, Ann Arbor, MI
| | - Richard C Boucher
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC
| |
Collapse
|
16
|
Wang JM, Ram S, Labaki WW, Han MK, Galbán CJ. CT-Based Commercial Software Applications: Improving Patient Care Through Accurate COPD Subtyping. Int J Chron Obstruct Pulmon Dis 2022; 17:919-930. [PMID: 35502294 PMCID: PMC9056100 DOI: 10.2147/copd.s334592] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 04/03/2022] [Indexed: 12/14/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is heterogenous in its clinical manifestations and disease progression. Patients often have disease courses that are difficult to predict with readily available data, such as lung function testing. The ability to better classify COPD into well-defined groups will allow researchers and clinicians to tailor novel therapies, monitor their effects, and improve patient-centered outcomes. Different modalities of assessing these COPD phenotypes are actively being studied, and an area of great promise includes the use of quantitative computed tomography (QCT) techniques focused on key features such as airway anatomy, lung density, and vascular morphology. Over the last few decades, companies around the world have commercialized automated CT software packages that have proven immensely useful in these endeavors. This article reviews the key features of several commercial platforms, including the technologies they are based on, the metrics they can generate, and their clinical correlations and applications. While such tools are increasingly being used in research and clinical settings, they have yet to be consistently adopted for diagnostic work-up and treatment planning, and their full potential remains to be explored.
Collapse
Affiliation(s)
- Jennifer M Wang
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Sundaresh Ram
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Wassim W Labaki
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA
| | - MeiLan K Han
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Craig J Galbán
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA,Correspondence: Craig J Galbán, Department of Radiology, University of Michigan, BSRB, Room A506, 109 Zina Pitcher Place, Ann Arbor, MI, 48109-2200, USA, Tel +1 734-764-8726, Fax +1 734-615-1599, Email
| |
Collapse
|
17
|
Godbole S, Labaki WW, Pratte KA, Hill A, Moll M, Hastie AT, Peters SP, Gregory A, Ortega VE, DeMeo D, Cho MH, Bhatt SP, Wells JM, Barjaktarevic I, Stringer KA, Comellas A, O’Neal W, Kechris K, Bowler RP. A Metabolomic Severity Score for Airflow Obstruction and Emphysema. Metabolites 2022; 12:metabo12050368. [PMID: 35629872 PMCID: PMC9143560 DOI: 10.3390/metabo12050368] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 04/07/2022] [Indexed: 01/21/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a disease with marked metabolic disturbance. Previous studies have shown the association between single metabolites and lung function for COPD, but whether a combination of metabolites could predict phenotype is unknown. We developed metabolomic severity scores using plasma metabolomics from the Metabolon platform from two US cohorts of ever-smokers: the Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS) (n = 648; training/testing cohort; 72% non-Hispanic, white; average age 63 years) and the COPDGene Study (n = 1120; validation cohort; 92% non-Hispanic, white; average age 67 years). Separate adaptive LASSO (adaLASSO) models were used to model forced expiratory volume at one second (FEV1) and MESA-adjusted lung density using 762 metabolites common between studies. Metabolite coefficients selected by the adaLASSO procedure were used to create a metabolomic severity score (metSS) for each outcome. A total of 132 metabolites were selected to create a metSS for FEV1. The metSS-only models explained 64.8% and 31.7% of the variability in FEV1 in the training and validation cohorts, respectively. For MESA-adjusted lung density, 129 metabolites were selected, and metSS-only models explained 59.0% of the variability in the training cohort and 17.4% in the validation cohort. Regression models including both clinical covariates and the metSS explained more variability than either the clinical covariate or metSS-only models (53.4% vs. 46.4% and 31.6%) in the validation dataset. The metabolomic pathways for arginine biosynthesis; aminoacyl-tRNA biosynthesis; and glycine, serine, and threonine pathway were enriched by adaLASSO metabolites for FEV1. This is the first demonstration of a respiratory metabolomic severity score, which shows how a metSS can add explanation of variance to clinical predictors of FEV1 and MESA-adjusted lung density. The advantage of a comprehensive metSS is that it explains more disease than individual metabolites and can account for substantial collinearity among classes of metabolites. Future studies should be performed to determine whether metSSs are similar in younger, and more racially and ethnically diverse populations as well as whether a metabolomic severity score can predict disease development in individuals who do not yet have COPD.
Collapse
Affiliation(s)
- Suneeta Godbole
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA;
- Correspondence:
| | - Wassim W. Labaki
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI 48109, USA; (W.W.L.); (K.A.S.)
| | - Katherine A. Pratte
- Division of Medicine, National Jewish Health, Denver, CO 80206, USA; (K.A.P.); (A.H.); (R.P.B.)
| | - Andrew Hill
- Division of Medicine, National Jewish Health, Denver, CO 80206, USA; (K.A.P.); (A.H.); (R.P.B.)
| | - Matthew Moll
- Channing Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA; (M.M.); (D.D.); (M.H.C.)
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA;
| | - Annette T. Hastie
- Section on Pulmonary, Critical Care, Allergy & Immunology, Internal Medicine, Wake Forest School of Medicine, Winston Salem, NC 27157, USA;
| | - Stephen P. Peters
- Section on Pulmonary, Critical Care, Allergy & Immunology, Internal Medicine, Atrium Health Wake Forest Baptist, Winston Salem, NC 20157, USA;
| | - Andrew Gregory
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA;
| | - Victor E. Ortega
- Division of Respiratory Medicine, Department of Internal Medicine, Center for Individualized Medicine, Mayo Clinic, Scottsdale, AZ 85259, USA;
| | - Dawn DeMeo
- Channing Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA; (M.M.); (D.D.); (M.H.C.)
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA;
| | - Michael H. Cho
- Channing Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA; (M.M.); (D.D.); (M.H.C.)
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA;
| | - Surya P. Bhatt
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA;
| | - J. Michael Wells
- UAB Lung Health Center, Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA;
| | - Igor Barjaktarevic
- Division of Pulmonary and Critical Care, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA;
| | - Kathleen A. Stringer
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI 48109, USA; (W.W.L.); (K.A.S.)
- Department of Clinical Pharmacy and the NMR Metabolomics Laboratory, College of Pharmacy, University of Michigan, Ann Arbor, MI 48109, USA
| | - Alejandro Comellas
- Division of Pulmonary and Critical Care, University of Iowa, Iowa City, IA 52242, USA;
| | - Wanda O’Neal
- Marsico Lung Institute, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Katerina Kechris
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA;
| | - Russell P. Bowler
- Division of Medicine, National Jewish Health, Denver, CO 80206, USA; (K.A.P.); (A.H.); (R.P.B.)
| |
Collapse
|
18
|
Abstract
PURPOSE OF REVIEW Risk assessment tools are essential in COPD care to help clinicians identify patients at higher risk of accelerated lung function decline, respiratory exacerbations, hospitalizations, and death. RECENT FINDINGS Conventional methods of assessing risk have focused on spirometry, patient-reported symptoms, functional status, and a combination of these tools in composite indices. More recently, qualitatively and quantitatively assessed chest imaging findings, such as emphysema, large and small airways disease, and pulmonary vascular abnormalities have been associated with poor long-term outcomes in COPD patients. Although several blood and sputum biomarkers have been investigated for risk assessment in COPD, most still warrant further validation. Finally, novel remote digital monitoring technologies may be valuable to predict exacerbations but their large-scale performance, ease of implementation, and cost effectiveness remain to be determined. SUMMARY Given the complex heterogeneity of COPD, any single metric is unlikely to fully capture the risk of poor long-term outcomes. Therefore, clinicians should review all available clinical data, including spirometry, symptom severity, functional status, chest imaging, and bloodwork, to guide personalized preventive care of COPD patients. The potential of machine learning tools and remote monitoring technologies to refine COPD risk assessment is promising but remains largely untapped pending further investigation.
Collapse
Affiliation(s)
- Jennifer M Wang
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | | | | |
Collapse
|
19
|
Wang JM, Han MK, Labaki WW. Understanding lung health beliefs in low-resource settings. The Lancet Global Health 2022; 10:e6-e7. [DOI: 10.1016/s2214-109x(21)00511-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 10/21/2021] [Indexed: 10/19/2022] Open
|
20
|
Lakshman Kumar P, Wilson AC, Rocco A, Cho MH, Wan E, Hobbs BD, Washko GR, Ortega VE, Christenson SA, Li X, Wells JM, Bhatt SP, DeMeo DL, Lutz SM, Rossiter H, Casaburi R, Rennard SI, Lomas DA, Labaki WW, Tal‐Singer R, Bowler RP, Hersh CP, Tiwari HK, Dransfield M, Thalacker‐Mercer A, Meyers DA, Silverman EK, McDonald MN. Genetic variation in genes regulating skeletal muscle regeneration and tissue remodelling associated with weight loss in chronic obstructive pulmonary disease. J Cachexia Sarcopenia Muscle 2021; 12:1803-1817. [PMID: 34523824 PMCID: PMC8718068 DOI: 10.1002/jcsm.12782] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 06/08/2021] [Accepted: 08/04/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is the third leading cause of death globally. COPD patients with cachexia or weight loss have increased risk of death independent of body mass index (BMI) and lung function. We tested the hypothesis genetic variation is associated with weight loss in COPD using a genome-wide association study approach. METHODS Participants with COPD (N = 4308) from three studies (COPDGene, ECLIPSE, and SPIROMICS) were analysed. Discovery analyses were performed in COPDGene with replication in SPIROMICS and ECLIPSE. In COPDGene, weight loss was defined as self-reported unintentional weight loss > 5% in the past year or low BMI (BMI < 20 kg/m2 ). In ECLIPSE and SPIROMICS, weight loss was calculated using available longitudinal visits. Stratified analyses were performed among African American (AA) and Non-Hispanic White (NHW) participants with COPD. Single variant and gene-based analyses were performed adjusting for confounders. Fine mapping was performed using a Bayesian approach integrating genetic association results with linkage disequilibrium and functional annotation. Significant gene networks were identified by integrating genetic regions associated with weight loss with skeletal muscle protein-protein interaction (PPI) data. RESULTS At the single variant level, only the rs35368512 variant, intergenic to GRXCR1 and LINC02383, was associated with weight loss (odds ratio = 3.6, 95% confidence interval = 2.3-5.6, P = 3.2 × 10-8 ) among AA COPD participants in COPDGene. At the gene level in COPDGene, EFNA2 and BAIAP2 were significantly associated with weight loss in AA and NHW COPD participants, respectively. The EFNA2 association replicated among AA from SPIROMICS (P = 0.0014), whereas the BAIAP2 association replicated in NHW from ECLIPSE (P = 0.025). The EFNA2 gene encodes the membrane-bound protein ephrin-A2 involved in the regulation of developmental processes and adult tissue homeostasis such as skeletal muscle. The BAIAP2 gene encodes the insulin-responsive protein of mass 53 kD (IRSp53), a negative regulator of myogenic differentiation. Integration of the gene-based findings participants with PPI data revealed networks of genes involved in pathways such as Rho and synapse signalling. CONCLUSIONS The EFNA2 and BAIAP2 genes were significantly associated with weight loss in COPD participants. Collectively, the integrative network analyses indicated genetic variation associated with weight loss in COPD may influence skeletal muscle regeneration and tissue remodelling.
Collapse
Affiliation(s)
- Preeti Lakshman Kumar
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of MedicineUniversity of Alabama at BirminghamBirminghamALUSA
| | - Ava C. Wilson
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of MedicineUniversity of Alabama at BirminghamBirminghamALUSA
- Department of EpidemiologyUniversity of Alabama at BirminghamBirminghamALUSA
| | - Alison Rocco
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of MedicineUniversity of Alabama at BirminghamBirminghamALUSA
- Department of EpidemiologyUniversity of Alabama at BirminghamBirminghamALUSA
| | - Michael H. Cho
- Channing Division of Network MedicineBrigham and Women's HospitalBostonMAUSA
- Division of Pulmonary and Critical Care MedicineBrigham and Women's HospitalBostonMAUSA
| | - Emily Wan
- Channing Division of Network MedicineBrigham and Women's HospitalBostonMAUSA
- Veterans Affairs Boston Health Care System, Jamaica PlainBostonMAUSA
| | - Brian D. Hobbs
- Channing Division of Network MedicineBrigham and Women's HospitalBostonMAUSA
- Division of Pulmonary and Critical Care MedicineBrigham and Women's HospitalBostonMAUSA
| | - George R. Washko
- Division of Pulmonary and Critical Care MedicineBrigham and Women's HospitalBostonMAUSA
| | - Victor E. Ortega
- Department of Internal Medicine, Section on Pulmonary, Critical Care, Allergy and Immunologic DiseasesWake Forest School of MedicineWinston‐SalemNCUSA
| | - Stephanie A. Christenson
- Division of Pulmonary, Critical Care, Allergy, & Sleep Medicine, Department of MedicineUniversity of California San FranciscoSan FranciscoCAUSA
| | - Xingnan Li
- Department of MedicineUniversity of Arizona College of MedicineTucsonAZUSA
| | - J. Michael Wells
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of MedicineUniversity of Alabama at BirminghamBirminghamALUSA
| | - Surya P. Bhatt
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of MedicineUniversity of Alabama at BirminghamBirminghamALUSA
| | - Dawn L. DeMeo
- Channing Division of Network MedicineBrigham and Women's HospitalBostonMAUSA
- Division of Pulmonary and Critical Care MedicineBrigham and Women's HospitalBostonMAUSA
| | - Sharon M. Lutz
- Department of Population MedicineHarvard Medical SchoolBostonMAUSA
| | - Harry Rossiter
- Rehabilitation Clinical Trials CenterLos Angeles Biomedical Research Institute at Harbor Harbor‐UCLA Medical CenterTorranceCAUSA
| | - Richard Casaburi
- Rehabilitation Clinical Trials CenterLos Angeles Biomedical Research Institute at Harbor Harbor‐UCLA Medical CenterTorranceCAUSA
| | | | | | - Wassim W. Labaki
- Division of Pulmonary and Critical Care MedicineUniversity of MichiganAnn ArborMIUSA
| | | | - Russel P. Bowler
- Department of Medicine, Division of Pulmonary, Critical Care & Sleep MedicineNational Jewish HealthDenverCOUSA
| | - Craig P. Hersh
- Channing Division of Network MedicineBrigham and Women's HospitalBostonMAUSA
- Division of Pulmonary and Critical Care MedicineBrigham and Women's HospitalBostonMAUSA
| | - Hemant K. Tiwari
- Department of BiostatisticsUniversity of Alabama at BirminghamBirminghamALUSA
| | - Mark Dransfield
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of MedicineUniversity of Alabama at BirminghamBirminghamALUSA
| | - Anna Thalacker‐Mercer
- Department of Cell Development and Integrative BiologyUniversity of Alabama at BirminghamBirminghamALUSA
| | - Deborah A. Meyers
- Department of MedicineUniversity of Arizona College of MedicineTucsonAZUSA
| | - Edwin K. Silverman
- Channing Division of Network MedicineBrigham and Women's HospitalBostonMAUSA
- Division of Pulmonary and Critical Care MedicineBrigham and Women's HospitalBostonMAUSA
| | - Merry‐Lynn N. McDonald
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of MedicineUniversity of Alabama at BirminghamBirminghamALUSA
- Department of EpidemiologyUniversity of Alabama at BirminghamBirminghamALUSA
- Department of GeneticsUniversity of Alabama at BirminghamBirminghamALUSA
| | | |
Collapse
|
21
|
Mason SE, Moreta-Martinez R, Labaki WW, Strand MJ, Regan EA, Bon J, San Jose Estepar R, Casaburi R, McDonald ML, Rossiter HB, Make B, Dransfield MT, Han MK, Young K, Curtis JL, Stringer K, Kinney G, Hokanson JE, San Jose Estepar R, Washko GR. Longitudinal association between muscle loss and mortality in ever-smokers. Chest 2021; 161:960-970. [PMID: 34785234 DOI: 10.1016/j.chest.2021.10.047] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 09/25/2021] [Accepted: 10/23/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Body composition measures, specifically low weight or reduced muscle mass, are associated with mortality in chronic obstructive pulmonary disease (COPD), but the effect of longitudinal body composition changes is undefined. RESEARCH QUESTION Is the longitudinal loss of fat-free mass (FFM) associated with increased mortality including in those with initially normal or elevated body composition metrics? STUDY DESIGN AND METHODS Participants with complete data for at least one visit in the COPDGene (n=9,268) and ECLIPSE studies (1,760) were included and followed for 12 and 8 years, respectively. Pectoralis muscle area (PMA) was derived from thoracic CT scans and used as a proxy for FFM. A longitudinal mixed sub-model for PMA and a Cox proportional hazards sub-model for survival were fitted on a joint distribution using a shared random intercept parameter and Markov chain Monte Carlo parameter estimation. RESULTS Both cohorts demonstrated a left shifted distribution of baseline FFM, not reflected in BMI, and an increase in all-cause mortality risk associated with longitudinal loss of PMA. For each one cm2 PMA loss, mortality increased 3.1% (95% CI 2.4, 3.7, p<0.001) in COPDGene, and 2.4% (95% CI 0.9, 4.0, p<0.001) in ECLIPSE. Increased mortality risk was independent of enrollment values for BMI and disease severity (BODE index quartiles) and was significant even in participants with initially greater than average PMA. INTERPRETATION Longitudinal loss of PMA is associated with increased all-cause mortality, regardless of BMI or initial muscle mass. Consideration of novel screening tests and further research into mechanisms contributing to muscle decline may improve risk stratification and identify novel therapeutic targets in ever-smokers.
Collapse
Affiliation(s)
- Stefanie E Mason
- Department of Medicine, Division of Pulmonary and Critical Care, Brigham and Women's Hospital, Boston MA.
| | | | - Wassim W Labaki
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor MI
| | - Matthew J Strand
- Division of Biostatistics and Bioinformatics, National Jewish Health, Denver CO
| | - Elizabeth A Regan
- Department of Medicine, Division of Rheumatology, National Jewish Health, Denver CO
| | - Jessica Bon
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care, Pittsburgh PA; VA Pittsburgh Healthcare System, Pittsburgh, PA
| | | | - Richard Casaburi
- Rehabilitation Clinical Trials Center, Division of Pulmonary and Critical Care Physiology and Medicine, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance CA
| | - Merry-Lynn McDonald
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care, University of Alabama at Birmingham, Birmingham AL
| | - Harry B Rossiter
- Rehabilitation Clinical Trials Center, Division of Pulmonary and Critical Care Physiology and Medicine, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance CA
| | - Barry Make
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, National Jewish Health, Denver CO
| | - Mark T Dransfield
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care, University of Alabama at Birmingham, Birmingham AL
| | - MeiLan K Han
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor MI
| | - Kendra Young
- Department of Epidemiology, Colorado School of Public Health, Aurora CO
| | - Jeffrey L Curtis
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor MI; Medical Service, VA Ann Arbor Healthcare System, Ann Arbor, MI
| | - Kathleen Stringer
- Department of Clinical Sciences, University of Michigan College of Pharmacy, Ann Arbor, MI
| | - Greg Kinney
- Department of Epidemiology, Colorado School of Public Health, Aurora CO
| | - John E Hokanson
- Department of Epidemiology, Colorado School of Public Health, Aurora CO
| | | | - George R Washko
- Department of Medicine, Division of Pulmonary and Critical Care, Brigham and Women's Hospital, Boston MA
| | | |
Collapse
|
22
|
Burkes RM, Couper DJ, Barjaktarevic IZ, Cooper CB, Labaki WW, Han MK, Woodruff PG, Lazarus SC, Parekh TM, Paine, III R, Comellas AP, Bowler RP, Loehr LR, Putcha N, Wise RA, Brown TT, Drummond MB. Age-Dependent Associations Between 25-Hydroxy Vitamin D Levels and COPD Symptoms: Analysis of SPIROMICS. Chronic Obstr Pulm Dis 2021; 8:277-291. [PMID: 33829714 PMCID: PMC8237982 DOI: 10.15326/jcopdf.2020.0180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/31/2021] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Age and vitamin D levels may affect symptom burden in chronic obstructive pulmonary disease (COPD). We used the Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS) to determine independent associations between vitamin D levels and COPD symptoms in different age strata. METHODS Serum 25-hydroxy (OH)-vitamin D levels were modeled continuously and categorically (<20 ng/ml versus ≥20 ng/ml). Stratifying by age group (middle-age: 40-64 years old and older: >65 years old), multivariable modeling was performed to identify relationships between 25-OH-vitamin D levels and the COPD Assessment Test (CAT), the modified Medical Research Council score (mMRC), the St George's Respiratory Questionnaire (SGRQ) total and subdomain scores, the Veterans' Specific Activity Questionnaire, and the 6-minute walk test distance. RESULTS InIn the middle-aged group, each 5 ng/ml higher 25-OH-vitamin D level was independently associated with more favorable CAT score (-0.35 [-0.67 to -0.03], P=0.03), total SGRQ (-0.91 [-1.65 to -0.17]; P=0.02), and the SGRQ subdomains (Symptoms:-1.07 [-1.96 to -0.18], P=0.02; Impact: -0.77 [-1.53 to -0.003], P=0.049; Activity: -1.07 [-1.96 to -0.18], P=0.02). These associations persisted after the addition of comorbidity score, reported vitamin D supplementation, outdoor time, or season of blood draw to models. No associations were observed between 25-OH-vitamin D levels and symptom scores in the older age group. DISCUSSION When controlled for clinically relevant covariates, higher 25-OH-vitamin D levels are associated with more favorable respiratory-specific symptoms and quality-of-life assessments in middle-age but not older COPD individuals. Study of the role of vitamin D supplementation in the symptom burden of younger COPD patients is needed.
Collapse
Affiliation(s)
- Robert M. Burkes
- Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States
| | - David J. Couper
- Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States
| | - Igor Z. Barjaktarevic
- Division of Pulmonary, Critical Care, and Sleep Medicine, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California, United States
| | - Christopher B. Cooper
- Departments of Medicine and Physiology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California, United States
| | - Wassim W. Labaki
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan, United States
| | - Meilan K. Han
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan, United States
| | - Prescott G. Woodruff
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, University of California-San Francisco, San Francisco, California, United States
| | - Stephen C. Lazarus
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, University of California-San Francisco, San Francisco, California, United States
| | - Trisha M. Parekh
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, University of Alabama-Birmingham, Birmingham, Alabama, United States
| | - Robert Paine, III
- Division of Pulmonary Medicine, University of Utah, Salt Lake City, Utah, United States
| | - Alejandro P. Comellas
- Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa, Iowa City, Iowa, United States
| | - Russell P. Bowler
- Division of Pulmonary, Critical Care, and Sleep Medicine, National Jewish Hospital, Denver, Colorado, United States
| | - Laura R. Loehr
- Division of General Medicine and Clinical Epidemiology, University of North Carolina, Chapel Hill, North Carolina, United States
| | - Nirupama Putcha
- Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore, Maryland, United States
| | - Robert A. Wise
- Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore, Maryland, United States
| | - Todd T. Brown
- Division of Endocrinology and Metabolism, Johns Hopkins University, Baltimore, Maryland, United States
| | - M. Bradley Drummond
- Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States
| |
Collapse
|
23
|
Zhang WZ, Hoffman KL, Schiffer KT, Oromendia C, Rice MC, Barjaktarevic I, Peters SP, Putcha N, Bowler RP, Wells JM, Couper DJ, Labaki WW, Curtis JL, Han MK, Paine R, Woodruff PG, Criner GJ, Hansel NN, Diaz I, Ballman KV, Nakahira K, Choi ME, Martinez FJ, Choi AMK, Cloonan SM. Association of plasma mitochondrial DNA with COPD severity and progression in the SPIROMICS cohort. Respir Res 2021; 22:126. [PMID: 33902556 PMCID: PMC8074408 DOI: 10.1186/s12931-021-01707-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 01/27/2021] [Accepted: 04/06/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND There is a lack of mechanism-driven, clinically relevant biomarkers in chronic obstructive pulmonary disease (COPD). Mitochondrial dysfunction, a proposed disease mechanism in COPD, is associated with the release of mitochondrial DNA (mtDNA), but plasma cell-free mtDNA has not been previously examined prospectively for associations with clinical COPD measures. METHODS P-mtDNA, defined as copy number of mitochondrially-encoded NADH dehydrogenase-1 (MT-ND1) gene, was measured by real-time quantitative PCR in 700 plasma samples from participants enrolled in the Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS) cohort. Associations between p-mtDNA and clinical disease parameters were examined, adjusting for age, sex, smoking status, and for informative loss to follow-up. RESULTS P-mtDNA levels were higher in participants with mild or moderate COPD, compared to smokers without airflow obstruction, and to participants with severe COPD. Baseline increased p-mtDNA levels were associated with better CAT scores in female smokers without airflow obstruction and female participants with mild or moderate COPD on 1-year follow-up, but worse 6MWD in females with severe COPD. Higher p-mtDNA levels were associated with better 6MWD in male participants with severe COPD. These associations were no longer significant after adjusting for informative loss to follow-up. CONCLUSION In this study, p-mtDNA levels associated with baseline COPD status but not future changes in clinical COPD measures after accounting for informative loss to follow-up. To better characterize mitochondrial dysfunction as a potential COPD endotype, these results should be confirmed and validated in future studies. TRIAL REGISTRATION ClinicalTrials.gov NCT01969344 (SPIROMICS).
Collapse
Affiliation(s)
- William Z Zhang
- Division of Pulmonary and Critical Care Medicine, Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medicine, New York, NY, USA
- Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA
| | - Katherine L Hoffman
- Department of Population Health Science, Division of Biostatistics and Epidemiology, Weill Cornell Medicine, New York, NY, USA
| | - Kristen T Schiffer
- Division of Pulmonary and Critical Care Medicine, Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Clara Oromendia
- Department of Population Health Science, Division of Biostatistics and Epidemiology, Weill Cornell Medicine, New York, NY, USA
| | - Michelle C Rice
- Division of Nephrology and Hypertension, Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Igor Barjaktarevic
- Division of Pulmonary and Critical Care Medicine, University of California Los Angeles Medical Center, Los Angeles, CA, USA
| | - Stephen P Peters
- Pulmonary, Critical Care, Allergy, and Immunologic Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Nirupama Putcha
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Russell P Bowler
- Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, CO, USA
| | | | - David J Couper
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Wassim W Labaki
- Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, Ann Arbor, MI, USA
| | - Jeffrey L Curtis
- Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, Ann Arbor, MI, USA
| | - Meilan K Han
- Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, Ann Arbor, MI, USA
| | - Robert Paine
- Section of Pulmonary and Critical Care Medicine, Salt Lake City Department of Veterans Affairs Medical Center, Salt Lake City, UT, USA
| | | | - Gerard J Criner
- Department of Pulmonary & Critical Care Medicine, Temple University, Philadelphia, PA, USA
| | - Nadia N Hansel
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ivan Diaz
- Department of Population Health Science, Division of Biostatistics and Epidemiology, Weill Cornell Medicine, New York, NY, USA
| | - Karla V Ballman
- Department of Population Health Science, Division of Biostatistics and Epidemiology, Weill Cornell Medicine, New York, NY, USA
| | - Kiichi Nakahira
- Division of Pulmonary and Critical Care Medicine, Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Mary E Choi
- Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA
- Division of Nephrology and Hypertension, Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Fernando J Martinez
- Division of Pulmonary and Critical Care Medicine, Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medicine, New York, NY, USA
- Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA
| | - Augustine M K Choi
- Division of Pulmonary and Critical Care Medicine, Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medicine, New York, NY, USA
- Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA
| | - Suzanne M Cloonan
- Division of Pulmonary and Critical Care Medicine, Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medicine, New York, NY, USA.
- School of Medicine, Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland and Tallaght University Hospital, Dublin, Ireland.
- Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medicine, New York, USA.
| |
Collapse
|
24
|
Gillenwater LA, Kechris KJ, Pratte KA, Reisdorph N, Petrache I, Labaki WW, O’Neal W, Krishnan JA, Ortega VE, DeMeo DL, Bowler RP. Metabolomic Profiling Reveals Sex Specific Associations with Chronic Obstructive Pulmonary Disease and Emphysema. Metabolites 2021; 11:161. [PMID: 33799786 PMCID: PMC7999201 DOI: 10.3390/metabo11030161] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 01/26/2021] [Revised: 02/25/2021] [Accepted: 03/08/2021] [Indexed: 12/12/2022] Open
Abstract
Susceptibility and progression of lung disease, as well as response to treatment, often differ by sex, yet the metabolic mechanisms driving these sex-specific differences are still poorly understood. Women with chronic obstructive pulmonary disease (COPD) have less emphysema and more small airway disease on average than men, though these differences become less pronounced with more severe airflow limitation. While small studies of targeted metabolites have identified compounds differing by sex and COPD status, the sex-specific effect of COPD on systemic metabolism has yet to be interrogated. Significant sex differences were observed in 9 of the 11 modules identified in COPDGene. Sex-specific associations by COPD status and emphysema were observed in 3 modules for each phenotype. Sex stratified individual metabolite associations with COPD demonstrated male-specific associations in sphingomyelins and female-specific associations in acyl carnitines and phosphatidylethanolamines. There was high preservation of module assignments in SPIROMICS (SubPopulations and InteRmediate Outcome Measures In COPD Study) and similar female-specific shift in acyl carnitines. Several COPD associated metabolites differed by sex. Acyl carnitines and sphingomyelins demonstrate sex-specific abundances and may represent important metabolic signatures of sex differences in COPD. Accurately characterizing the sex-specific molecular differences in COPD is vital for personalized diagnostics and therapeutics.
Collapse
Affiliation(s)
- Lucas A. Gillenwater
- Computational Bioscience Program, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA;
| | - Katerina J. Kechris
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA;
| | - Katherine A. Pratte
- Division of Medicine, National Jewish Health, Denver, CO 80206, USA; (K.A.P.); (I.P.); (R.P.B.)
| | - Nichole Reisdorph
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA;
| | - Irina Petrache
- Division of Medicine, National Jewish Health, Denver, CO 80206, USA; (K.A.P.); (I.P.); (R.P.B.)
- School of Medicine, University of Colorado, Aurora, CO 80045, USA
| | - Wassim W. Labaki
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI 48109, USA;
| | - Wanda O’Neal
- Cystic Fibrosis/Pulmonary Research and Treatment Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Jerry A. Krishnan
- Breathe Chicago Center, University of Illinois at Chicago, Chicago, IL 60608, USA;
| | - Victor E. Ortega
- Center for Precision Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA;
| | - Dawn L. DeMeo
- Channing Division of Network Medicine, and Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Russell P. Bowler
- Division of Medicine, National Jewish Health, Denver, CO 80206, USA; (K.A.P.); (I.P.); (R.P.B.)
- School of Medicine, University of Colorado, Aurora, CO 80045, USA
| |
Collapse
|
25
|
Mason SE, Moreta-Martinez R, Labaki WW, Strand M, Baraghoshi D, Regan EA, Bon J, San Jose Estepar R, Casaburi R, McDonald MLN, Rossiter H, Make BJ, Dransfield MT, Han MK, Young KA, Kinney G, Hokanson JE, San Jose Estepar R, Washko GR. Respiratory exacerbations are associated with muscle loss in current and former smokers. Thorax 2021; 76:554-560. [PMID: 33574123 DOI: 10.1136/thoraxjnl-2020-215999] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/30/2020] [Accepted: 12/21/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Muscle wasting is a recognised extra-pulmonary complication in chronic obstructive pulmonary disease and has been associated with increased risk of death. Acute respiratory exacerbations are associated with reduction of muscle function, but there is a paucity of data on their long-term effect. This study explores the relationship between acute respiratory exacerbations and long-term muscle loss using serial measurements of CT derived pectoralis muscle area (PMA). DESIGN AND SETTING Participants were included from two prospective, longitudinal, observational, multicentre cohorts of ever-smokers with at least 10 pack-year history. PARTICIPANTS The primary analysis included 1332 (of 2501) participants from Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) and 4384 (of 10 198) participants from Genetic Epidemiology of COPD (COPDGene) who had complete data from their baseline and follow-up visits. INTERVENTIONS PMA was measured on chest CT scans at two timepoints. Self-reported exacerbation data were collected from participants in both studies through the use of periodic longitudinal surveys. MAIN OUTCOME MEASURES Age-related and excess muscle loss over time. RESULTS Age, sex, race and body mass index were associated with baseline PMA. Participants experienced age-related decline at the upper end of reported normal ranges. In ECLIPSE, the exacerbation rate over time was associated with an excess muscle area loss of 1.3% (95% CI 0.6 to 1.9, p<0.001) over 3 years and in COPDGene with an excess muscle area loss of 2.1% (95% CI 1.2 to 2.8, p<0.001) over 5 years. Excess muscle area decline was absent in 273 individuals who participated in pulmonary rehabilitation. CONCLUSIONS Exacerbations are associated with accelerated skeletal muscle loss. Each annual exacerbation was associated with the equivalent of 6 months of age-expected decline in muscle mass. Ameliorating exacerbation-associated muscle loss represents an important therapeutic target.
Collapse
Affiliation(s)
- Stefanie Elizabeth Mason
- Division of Pulmonary and Critical Care, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - Wassim W Labaki
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Matthew Strand
- Division of Biostatistics and Bioinformatics, National Jewish Health, Denver, Colorado, USA
| | - David Baraghoshi
- Division of Biostatistics and Bioinformatics, National Jewish Health, Denver, Colorado, USA
| | - Elizabeth A Regan
- Division of Rheumatology, National Jewish Health, Denver, Colorado, USA
| | - Jessica Bon
- Division of Pulmonary, Allergy and Critical Care, UPMC, Pittsburgh, Pennsylvania, USA
| | | | - Richard Casaburi
- Division of Respiratory and Critical Care Physiology and Medicine, Los Angeles Biomedical Research Institute, Torrance, California, USA
| | - Merry-Lynn N McDonald
- Division of Pulmonary, Allergy, and Critical Care, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Harry Rossiter
- Division of Respiratory and Critical Care Physiology and Medicine, Los Angeles Biomedical Research Institute, Torrance, California, USA
| | - Barry J Make
- Division of Pulmonary, Critical Care, and Sleep Medicine, National Jewish Health, Denver, Colorado, USA
| | - Mark T Dransfield
- Division of Pulmonary, Allergy, and Critical Care, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - MeiLan K Han
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Kendra A Young
- Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado, USA
| | - Greg Kinney
- Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado, USA
| | - John E Hokanson
- Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado, USA
| | | | - George R Washko
- Division of Pulmonary and Critical Care, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | | |
Collapse
|
26
|
Fortis S, Comellas AP, Bhatt SP, Hoffman EA, Han MK, Bhakta NR, Paine R, Ronish B, Kanner RE, Dransfield M, Hoesterey D, Buhr RG, Barr RG, Dolezal B, Ortega VE, Drummond MB, Arjomandi M, Kaner RJ, Kim V, Curtis JL, Bowler RP, Martinez F, Labaki WW, Cooper CB, O'Neal WK, Criner G, Hansel NN, Krishnan JA, Woodruff P, Couper D, Tashkin D, Barjaktarevic I. Ratio of FEV 1/Slow Vital Capacity of < 0.7 Is Associated With Clinical, Functional, and Radiologic Features of Obstructive Lung Disease in Smokers With Preserved Lung Function. Chest 2021; 160:94-103. [PMID: 33539837 DOI: 10.1016/j.chest.2021.01.067] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 12/27/2020] [Accepted: 01/04/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Mild expiratory flow limitation may not be recognized using traditional spirometric criteria based on the ratio of FEV1/FVC. RESEARCH QUESTION Does slow vital capacity (SVC) instead of FVC increase the sensitivity of spirometry to identify patients with early or mild obstructive lung disease? STUDY DESIGN AND METHODS We included 854 current and former smokers from the Subpopulations and Intermediate Outcome Measures in COPD Study cohort with a postbronchodilator FEV1/FVC ≥ 0.7 and FEV1 % predicted of ≥ 80% at enrollment. We compared baseline characteristics, chest CT scan features, exacerbations, and progression to COPD (postbronchodilator FEV1/FVC, < 0.7) during the follow-up period between 734 participants with postbronchodilator FEV1/SVC of ≥ 0.7 and 120 with postbronchodilator FEV1/SVC < 0.7 at the enrollment. We performed multivariate linear and logistic regression models and negative binomial and interval-censored proportion hazards regression models adjusted for demographics and smoking exposure to examine the association of FEV1/SVC < 0.7 with those characteristics and outcomes. RESULTS Participants with FEV1/SVC < 0.7 were older and had lower FEV1 and more emphysema than those with FEV1/SVC ≥ 0.7. In adjusted analysis, individuals with postbronchodilator FEV1/SVC < 0.7 showed a greater percentage of emphysema by 0.45% (95% CI, 0.09%-0.82%), percentage of gas trapping by 2.52% (95% CI, 0.59%-4.44%), and percentage of functional small airways disease based on parametric response mapping by 2.78% (95% CI, 0.72%-4.83%) at baseline than those with FEV1/SVC ≥ 0.7. During a median follow-up time of 1,500 days, an FEV1/SVC < 0.7 was not associated with total exacerbations (incident rate ratio [IRR], 1.61; 95% CI, 0.97-2.64), but was associated with severe exacerbations (IRR, 2.60; 95% CI, 1.04-4.89). An FEV1/SVC < 0.7 was associated with progression to COPD during a 3-year follow-up even after adjustment for demographics and smoking exposure (hazard ratio, 3.93; 95% CI, 2.71-5.72). We found similar results when we examined the association of prebronchodilator FEV1/SVC < 0.7 or FEV1/SVC less than the lower limit of normal with chest CT scan features and progression to COPD. INTERPRETATION Low FEV1 to SVC in current and former smokers with normal spirometry results can identify individuals with CT scan features of COPD who are at risk for severe exacerbations and is associated with progression to COPD in the future. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT01969344T4; URL: www.clinicaltrials.gov.
Collapse
Affiliation(s)
- Spyridon Fortis
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, IA.
| | - Alejandro P Comellas
- Department of Internal Medicine, Division of Pulmonary, Critical Care and Occupation Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA
| | - Surya P Bhatt
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Eric A Hoffman
- Departments of Radiology, Biomedical Engineering and Medicine, University of Iowa, Iowa City, IA
| | - MeiLan K Han
- Department of Medicine, University of Michigan, Ann Arbor, MI
| | - Nirav R Bhakta
- Department of Medicine, University of California, San Francisco, CA
| | - Robert Paine
- Department of Pulmonary Medicine, University of Utah, Salt Lake City, UT
| | - Bonnie Ronish
- Department of Pulmonary Medicine, University of Utah, Salt Lake City, UT
| | - Richard E Kanner
- Department of Pulmonary Medicine, University of Utah, Salt Lake City, UT
| | - Mark Dransfield
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL; Division of Pulmonary and Critical Care Medicine, Birmingham VA Medical Center, Birmingham, AL
| | - Daniel Hoesterey
- Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at the University of California, Los Angeles, CA
| | - Russell G Buhr
- Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at the University of California, Los Angeles, CA; Department of Medicine, Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, CA
| | - R Graham Barr
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY
| | - Brett Dolezal
- Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at the University of California, Los Angeles, CA
| | - Victor E Ortega
- Department of Internal Medicine, Section on Pulmonary, Critical Care, Allergy, and Immunologic Diseases, Wake Forest School of Medicine, Winston-Salem, NC
| | - M Bradley Drummond
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Mehrdad Arjomandi
- Department of Medicine, University of California, San Francisco, CA; San Francisco Veterans Affairs Healthcare System, San Francisco, CA
| | - Robert J Kaner
- Departments of Medicine and Genetic Medicine, Weill Cornell Medicine, New York, NY
| | - Victor Kim
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Jeffrey L Curtis
- Department of Medicine, University of Michigan, Ann Arbor, MI; Medicine Service, VA Ann Arbor Healthcare System, Ann Arbor, MI
| | - Russell P Bowler
- Department of Medicine, National Jewish Medical and Research Center, Denver, CO
| | - Fernando Martinez
- Departments of Medicine and Genetic Medicine, Weill Cornell Medicine, New York, NY
| | - Wassim W Labaki
- Department of Medicine, University of Michigan, Ann Arbor, MI
| | - Christopher B Cooper
- Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at the University of California, Los Angeles, CA; Department of Physiology, David Geffen School of Medicine, University of California, Los Angeles, CA; Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - Wanda K O'Neal
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Gerald Criner
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Nadia N Hansel
- Department of Physiology, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Jerry A Krishnan
- Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois at Chicago, Chicago, IL
| | | | - David Couper
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | - Donald Tashkin
- Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at the University of California, Los Angeles, CA
| | - Igor Barjaktarevic
- Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at the University of California, Los Angeles, CA
| |
Collapse
|
27
|
Abstract
Chronic obstructive pulmonary disease (COPD) is a common respiratory disorder with significant morbidity and mortality. Despite its prevalence, COPD is underdiagnosed, and many patients do not receive a diagnosis until the disease is clinically advanced. Recent basic science and clinical research have focused on the early physiologic and pathobiologic changes in COPD with the hopes of improving diagnosis, providing targets for disease-modifying therapy, and identifying patients most likely to benefit from early intervention. Available treatments for COPD have grown substantially in the past 20 years with the introduction of new oral and inhaled medications as well as novel surgical and bronchoscopic procedures. This article summarizes some of the recent advances in our understanding of disease pathogenesis and treatment paradigms.
Collapse
Affiliation(s)
- Michael C Ferrera
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan 48109, USA; , ,
| | - Wassim W Labaki
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan 48109, USA; , ,
| | - MeiLan K Han
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan 48109, USA; , ,
| |
Collapse
|
28
|
Gillenwater LA, Pratte KA, Hobbs BD, Cho MH, Zhuang Y, Halper-Stromberg E, Cruickshank-Quinn C, Reisdorph N, Petrache I, Labaki WW, O'Neal WK, Ortega VE, Jones DP, Uppal K, Jacobson S, Michelotti G, Wendt CH, Kechris KJ, Bowler RP. Plasma Metabolomic Signatures of Chronic Obstructive Pulmonary Disease and the Impact of Genetic Variants on Phenotype-Driven Modules. Netw Syst Med 2020; 3:159-181. [PMID: 33987620 PMCID: PMC8109053 DOI: 10.1089/nsm.2020.0009] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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] [Accepted: 10/05/2020] [Indexed: 02/07/2023] Open
Abstract
Background: Small studies have recently suggested that there are specific plasma metabolic signatures in chronic obstructive pulmonary disease (COPD), but there have been no large comprehensive study of metabolomic signatures in COPD that also integrate genetic variants. Materials and Methods: Fresh frozen plasma from 957 non-Hispanic white subjects in COPDGene was used to quantify 995 metabolites with Metabolon's global metabolomics platform. Metabolite associations with five COPD phenotypes (chronic bronchitis, exacerbation frequency, percent emphysema, post-bronchodilator forced expiratory volume at one second [FEV1]/forced vital capacity [FVC], and FEV1 percent predicted) were assessed. A metabolome-wide association study was performed to find genetic associations with metabolite levels. Significantly associated single-nucleotide polymorphisms were tested for replication with independent metabolomic platforms and independent cohorts. COPD phenotype-driven modules were identified in network analysis integrated with genetic associations to assess gene-metabolite-phenotype interactions. Results: Of metabolites tested, 147 (14.8%) were significantly associated with at least 1 COPD phenotype. Associations with airflow obstruction were enriched for diacylglycerols and branched chain amino acids. Genetic associations were observed with 109 (11%) metabolites, 72 (66%) of which replicated in an independent cohort. For 20 metabolites, more than 20% of variance was explained by genetics. A sparse network of COPD phenotype-driven modules was identified, often containing metabolites missed in previous testing. Of the 26 COPD phenotype-driven modules, 6 contained metabolites with significant met-QTLs, although little module variance was explained by genetics. Conclusion: A dysregulation of systemic metabolism was predominantly found in COPD phenotypes characterized by airflow obstruction, where we identified robust heritable effects on individual metabolite abundances. However, network analysis, which increased the statistical power to detect associations missed previously in classic regression analyses, revealed that the genetic influence on COPD phenotype-driven metabolomic modules was modest when compared with clinical and environmental factors.
Collapse
Affiliation(s)
| | | | - Brian D. Hobbs
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Michael H. Cho
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Yonghua Zhuang
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | | | | | - Nichole Reisdorph
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Irina Petrache
- National Jewish Health, Denver, Colorado, USA
- School of Medicine, University of Colorado, Aurora, Colorado, USA
| | - Wassim W. Labaki
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Wanda K. O'Neal
- Lung Institute/Cystic Fibrosis Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Victor E. Ortega
- Department of Internal Medicine, Center for Precision Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Dean P. Jones
- Clinical Biomarkers Laboratory, Division of Pulmonary, Allergy, and Critical Care Medicine, Emory School of Medicine, Atlanta, Georgia, USA
| | - Karan Uppal
- Clinical Biomarkers Laboratory, Division of Pulmonary, Allergy, and Critical Care Medicine, Emory School of Medicine, Atlanta, Georgia, USA
| | | | | | - Christine H. Wendt
- Department of Medicine, University of Minnesota and the VAMC, Minneapolis, Minnesota, USA
| | - Katerina J. Kechris
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Russell P. Bowler
- National Jewish Health, Denver, Colorado, USA
- School of Medicine, University of Colorado, Aurora, Colorado, USA
| |
Collapse
|
29
|
Abstract
Chronic obstructive pulmonary disease (COPD) is characterized by persistent respiratory symptoms and progressive airflow obstruction. Tobacco smoking is the leading cause but not the only one. A postbronchodilator FEV1-FVC ratio less than 0.70 is required for a diagnosis of COPD. Inhaler therapy is the backbone of treatment and should be complemented by a multifaceted management strategy that includes counseling and pharmacotherapy for smoking cessation, pulmonary rehabilitation, treatment of comorbidities, administration of influenza and pneumococcal immunizations, and prescription of long-term oxygen therapy in hypoxemic patients.
Collapse
|
30
|
|
31
|
Raffield LM, Dang H, Pratte KA, Jacobson S, Gillenwater L, Ampleford E, Barjaktarevic I, Basta P, Clish CB, Comellas AP, Cornell E, Curtis JL, Doerschuk C, Durda P, Emson C, Freeman C, Guo X, Hastie AT, Hawkins GA, Herrera J, Johnson WC, Labaki WW, Liu Y, Masters B, Miller M, Ortega VE, Papanicolaou G, Peters S, Taylor KD, Rich SS, Rotter JI, Auer P, Reiner AP, Tracy RP, Ngo D, Gerszten RE, O’Neal WK, Bowler RP. Comparison of Proteomic Assessment Methods in Multiple Cohort Studies. Proteomics 2020; 20:e1900278. [PMID: 32386347 PMCID: PMC7425176 DOI: 10.1002/pmic.201900278] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 04/30/2020] [Indexed: 11/09/2022]
Abstract
Novel proteomics platforms, such as the aptamer-based SOMAscan platform, can quantify large numbers of proteins efficiently and cost-effectively and are rapidly growing in popularity. However, comparisons to conventional immunoassays remain underexplored, leaving investigators unsure when cross-assay comparisons are appropriate. The correlation of results from immunoassays with relative protein quantification is explored by SOMAscan. For 63 proteins assessed in two chronic obstructive pulmonary disease (COPD) cohorts, subpopulations and intermediate outcome measures in COPD Study (SPIROMICS), and COPDGene, using myriad rules based medicine multiplex immunoassays and SOMAscan, Spearman correlation coefficients range from -0.13 to 0.97, with a median correlation coefficient of ≈0.5 and consistent results across cohorts. A similar range is observed for immunoassays in the population-based Multi-Ethnic Study of Atherosclerosis and for other assays in COPDGene and SPIROMICS. Comparisons of relative quantification from the antibody-based Olink platform and SOMAscan in a small cohort of myocardial infarction patients also show a wide correlation range. Finally, cis pQTL data, mass spectrometry aptamer confirmation, and other publicly available data are integrated to assess relationships with observed correlations. Correlation between proteomics assays shows a wide range and should be carefully considered when comparing and meta-analyzing proteomics data across assays and studies.
Collapse
Affiliation(s)
- Laura M. Raffield
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Hong Dang
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Katherine A. Pratte
- Division of Pulmonary Medicine, Department of Medicine, National Jewish Health (NJH), Denver, CO
| | - Sean Jacobson
- Division of Pulmonary Medicine, Department of Medicine, National Jewish Health (NJH), Denver, CO
| | - Lucas Gillenwater
- Division of Pulmonary Medicine, Department of Medicine, National Jewish Health (NJH), Denver, CO
| | - Elizabeth Ampleford
- Department of Internal Medicine, Section for Pulmonary, Critical Care, Allergy & Immunology, School of Medicine, Wake Forest University, Winston-Salem, NC
| | - Igor Barjaktarevic
- UCLA Division of Pulmonary and Critical Care, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA
| | - Patricia Basta
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Clary B. Clish
- Metabolomics Platform, Broad Institute of MIT and Harvard, Cambridge, MA
| | | | - Elaine Cornell
- Department of Pathology & Laboratory Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT
| | - Jeffrey L. Curtis
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI
- VA Ann Arbor Healthcare System, Ann Arbor, MI
| | - Claire Doerschuk
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Peter Durda
- Department of Pathology & Laboratory Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT
| | - Claire Emson
- Translational Science and Experimental Medicine, Research and Early Development, Respiratory & Immunology, BioPharmaceuticals R&D, AstraZenenca, Gaithersburg, MD
| | - Christine Freeman
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI
- VA Ann Arbor Healthcare System, Ann Arbor, MI
| | - Xiuqing Guo
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA
| | - Annette T. Hastie
- Department of Internal Medicine, Section for Pulmonary, Critical Care, Allergy & Immunology, School of Medicine, Wake Forest University, Winston-Salem, NC
| | - Gregory A. Hawkins
- Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, NC
| | | | - W. Craig Johnson
- Department of Biostatistics, University of Washington, Seattle, WA
| | - Wassim W. Labaki
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI
| | - Yongmei Liu
- Department of Epidemiology & Prevention, Wake Forest School of Medicine, Winston-Salem, NC
| | | | | | - Victor E. Ortega
- Department of Internal Medicine, Section for Pulmonary, Critical Care, Allergy & Immunology, School of Medicine, Wake Forest University, Winston-Salem, NC
| | - George Papanicolaou
- Epidemiology Branch, Division of Cardiovascular Sciences, National Heart, Lung and Blood Institute, Bethesda, MD
| | - Stephen Peters
- Department of Internal Medicine, Section for Pulmonary, Critical Care, Allergy & Immunology, School of Medicine, Wake Forest University, Winston-Salem, NC
| | - Kent D. Taylor
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA
| | - Stephen S. Rich
- Center for Public Health Genomics, University of Virginia, Charlottesville, VA
| | - Jerome I. Rotter
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA
| | - Paul Auer
- Zilber School of Public Health, University of Wisconsin Milwaukee, Milwaukee, WI
| | - Alex P. Reiner
- Fred Hutchinson Cancer Research Center, Seattle, WA
- Department of Epidemiology, University of Washington, Seattle, WA
| | - Russell P. Tracy
- Department of Pathology & Laboratory Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT
- Department of Biochemistry, Larner College of Medicine at the University of Vermont, Burlington, VT
| | - Debby Ngo
- Division of Pulmonary, Sleep and Critical Care Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Robert E. Gerszten
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Wanda Kay O’Neal
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Russell P. Bowler
- Division of Pulmonary Medicine, Department of Medicine, National Jewish Health (NJH), Denver, CO
| | | |
Collapse
|
32
|
Affiliation(s)
- Wassim W Labaki
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - MeiLan K Han
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI 48109, USA.
| |
Collapse
|
33
|
Galiatsatos P, Woo H, Paulin LM, Kind A, Putcha N, Gassett AJ, Cooper CB, Dransfield MT, Parekh TM, Oates GR, Barr RG, Comellas AP, Han MK, Peters SP, Krishnan JA, Labaki WW, McCormack MC, Kaufman JD, Hansel NN. The Association Between Neighborhood Socioeconomic Disadvantage and Chronic Obstructive Pulmonary Disease. Int J Chron Obstruct Pulmon Dis 2020; 15:981-993. [PMID: 32440110 PMCID: PMC7211318 DOI: 10.2147/copd.s238933] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 04/20/2020] [Indexed: 01/10/2023] Open
Abstract
Rationale Individual socioeconomic status has been shown to influence the outcomes of patients with chronic obstructive pulmonary disease (COPD). However, contextual factors may also play a role. The objective of this study is to evaluate the association between neighborhood socioeconomic disadvantage measured by the area deprivation index (ADI) and COPD-related outcomes. Methods Residential addresses of SubPopulations and InteRmediate Outcome Measures in COPD Study (SPIROMICS) subjects with COPD (FEV1/FVC <0.70) at baseline were geocoded and linked to their respective ADI national ranking score at the census block group level. The associations between the ADI and COPD-related outcomes were evaluated by examining the contrast between participants living in the most-disadvantaged (top quintile) to the least-disadvantaged (bottom quintile) neighborhood. Regression models included adjustment for individual-level demographics, socioeconomic variables (personal income, education), exposures (smoking status, packs per year, occupational exposures), clinical characteristics (FEV1% predicted, body mass index) and neighborhood rural status. Results A total of 1800 participants were included in the analysis. Participants residing in the most-disadvantaged neighborhoods had 56% higher rate of COPD exacerbation (P<0.001), 98% higher rate of severe COPD exacerbation (P=0.001), a 1.6 point higher CAT score (P<0.001), 3.1 points higher SGRQ (P<0.001), and 24.6 meters less six-minute walk distance (P=0.008) compared with participants who resided in the least disadvantaged neighborhoods. Conclusion Participants with COPD who reside in more-disadvantaged neighborhoods had worse COPD outcomes compared to those residing in less-disadvantaged neighborhoods. Neighborhood effects were independent of individual-level socioeconomic factors, suggesting that contextual factors could be used to inform intervention strategies targeting high-risk persons with COPD.
Collapse
Affiliation(s)
- Panagis Galiatsatos
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Han Woo
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Laura M Paulin
- Pulmonary and Critical Care, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - Amy Kind
- University of Wisconsin School of Medicine and Public Health, Department of Medicine Health Services and Care Research Program and Division of Geriatrics, Madison, WI, USA.,Geriatric Research Education and Clinical Center, Wm. S. Middleton Veterans Hospital, Madison, WI, USA
| | - Nirupama Putcha
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Christopher B Cooper
- Department of Medicine, University of California Los Angeles School of Medicine, Los Angeles, CA, USA
| | - Mark T Dransfield
- Department of Medicine, University of Alabama Birmingham and Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA
| | - Trisha M Parekh
- Department of Medicine, University of Alabama Birmingham and Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA
| | - Gabriela R Oates
- Department of Medicine, University of Alabama Birmingham, Birmingham, AL, USA
| | - R Graham Barr
- Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
| | | | - Meilan K Han
- Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Stephen P Peters
- Department of Medicine, Wake Forest University Health Sciences, Winston-Salem, NC, USA
| | - Jerry A Krishnan
- Department of Medicine, University of Illinois, Chicago, IL, USA
| | - Wassim W Labaki
- Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Meredith C McCormack
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Joel D Kaufman
- Office of the Dean, University of Washington School of Public Health, Seattle, WA, USA
| | - Nadia N Hansel
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
34
|
Burkes RM, Ceppe AS, Doerschuk CM, Couper D, Hoffman EA, Comellas AP, Barr RG, Krishnan JA, Cooper C, Labaki WW, Ortega VE, Wells JM, Criner GJ, Woodruff PG, Bowler RP, Pirozzi CS, Hansel NN, Wise RA, Brown TT, Drummond MB. Associations Among 25-Hydroxyvitamin D Levels, Lung Function, and Exacerbation Outcomes in COPD: An Analysis of the SPIROMICS Cohort. Chest 2020; 157:856-865. [PMID: 31958447 PMCID: PMC7118244 DOI: 10.1016/j.chest.2019.11.047] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 11/25/2019] [Accepted: 11/30/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The relationship between 25-hydroxyvitamin D (25-OH-vitamin D) and COPD outcomes remains unclear. Using the Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS), we determined associations among baseline 25-OH-vitamin D and cross-sectional and longitudinal lung function and COPD exacerbations. METHODS Serum 25-OH-vitamin D level was measured in stored samples from 1,609 SPIROMICS participants with COPD. 25-OH-vitamin D levels were modeled continuously and dichotomized as deficient (< 20 ng/mL) vs not deficient (≥ 20 ng/mL). Outcomes of interest included % predicted FEV1 (current and 1-year longitudinal decline) and COPD exacerbations (separately any and severe, occurring in prior year and first year of follow-up). RESULTS Vitamin D deficiency was present in 21% of the cohort and was more prevalent in the younger, active smokers, and blacks. Vitamin D deficiency was independently associated with lower % predicted FEV1 (by 4.11%) at enrollment (95% CI, -6.90% to -1.34% predicted FEV1; P = .004), 1.27% predicted greater rate of FEV1 decline after 1 year (95% CI, -2.32% to -0.22% predicted/y; P = .02), and higher odds of any COPD exacerbation in the prior year (OR, 1.32; 95% CI, 1.00-1.74; P = .049). Each 10-ng/mL decrease in 25-OH-vitamin D was associated with lower baseline lung function (-1.04% predicted; 95% CI, -1.96% to -0.12% predicted; P = .03) and increased odds of any exacerbation in the year before enrollment (OR, 1.11; 95% CI, 1.01-1.22; P = .04). CONCLUSIONS Vitamin D deficiency is associated with worse cross-sectional and longitudinal lung function and increased odds of prior COPD exacerbations. These findings identify 25-OH-vitamin D levels as a potentially useful marker of adverse COPD-related outcomes.
Collapse
Affiliation(s)
- Robert M Burkes
- Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC.
| | - Agathe S Ceppe
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Claire M Doerschuk
- Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC; Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - David Couper
- University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC
| | - Eric A Hoffman
- Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Alejandro P Comellas
- Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa Carver College of Medicine, Iowa City, IA
| | - R Graham Barr
- Department of Epidemiology, Columbia University, New York, NY
| | - Jerry A Krishnan
- Division of Pulmonary, Critical Care, Sleep, and Allergy Medicine, University of Illinois at Chicago, Chicago, IL
| | - Christopher Cooper
- Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA
| | - Wassim W Labaki
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI
| | - Victor E Ortega
- Section of Pulmonary, Critical Care, Allergy, and Immunologic Disease, Wake Forest University, Winston-Salem, NC
| | - J Michael Wells
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Gerard J Criner
- Division of Thoracic Medicine and Surgery, Temple University, Philadelphia, PA
| | - Prescott G Woodruff
- Division of Pulmonary Critical Care, Allergy, and Sleep Medicine, University of California, San Francisco, San Francisco, CA
| | - Russell P Bowler
- Division of Pulmonary, Critical Care, and Sleep Medicine, National Jewish Health, Denver, CO
| | - Cheryl S Pirozzi
- Division of Pulmonary and Critical Care Medicine, University of Utah, Salt Lake City, UT
| | - Nadia N Hansel
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD
| | - Robert A Wise
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD
| | - Todd T Brown
- Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University, Baltimore, MD
| | - M Bradley Drummond
- Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC; Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC
| |
Collapse
|
35
|
Zhang WZ, Rice MC, Hoffman KL, Oromendia C, Barjaktarevic IZ, Wells JM, Hastie AT, Labaki WW, Cooper CB, Comellas AP, Criner GJ, Krishnan JA, Paine R, Hansel NN, Bowler RP, Barr RG, Peters SP, Woodruff PG, Curtis JL, Han MK, Ballman KV, Martinez FJ, Choi AM, Nakahira K, Cloonan SM, Choi ME. Association of urine mitochondrial DNA with clinical measures of COPD in the SPIROMICS cohort. JCI Insight 2020; 5:133984. [PMID: 31895696 DOI: 10.1172/jci.insight.133984] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [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] [Accepted: 12/26/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUNDMitochondrial dysfunction, a proposed mechanism of chronic obstructive pulmonary disease (COPD) pathogenesis, is associated with the leakage of mitochondrial DNA (mtDNA), which may be detected extracellularly in various bodily fluids. Despite evidence for the increased prevalence of chronic kidney disease in COPD subjects and for mitochondrial dysfunction in the kidneys of murine COPD models, whether urine mtDNA (u-mtDNA) associates with measures of disease severity in COPD is unknown.METHODSCell-free u-mtDNA, defined as copy number of mitochondrially encoded NADH dehydrogenase-1 (MTND1) gene, was measured by quantitative PCR and normalized to urine creatinine in cell-free urine samples from participants in the Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS) cohort. Urine albumin/creatinine ratios (UACR) were measured in the same samples. Associations between u-mtDNA, UACR, and clinical disease parameters - including FEV1 % predicted, clinical measures of exercise tolerance, respiratory symptom burden, and chest CT measures of lung structure - were examined.RESULTSU-mtDNA and UACR levels were measured in never smokers (n = 64), smokers without airflow obstruction (n = 109), participants with mild/moderate COPD (n = 142), and participants with severe COPD (n = 168). U-mtDNA was associated with increased respiratory symptom burden, especially among smokers without COPD. Significant sex differences in u-mtDNA levels were observed, with females having higher u-mtDNA levels across all study subgroups. U-mtDNA associated with worse spirometry and CT emphysema in males only and with worse respiratory symptoms in females only. Similar associations were not found with UACR.CONCLUSIONU-mtDNA levels may help to identify distinct clinical phenotypes and underlying pathobiological differences in males versus females with COPD.TRIAL REGISTRATIONThis study has been registered at ClinicalTrials.gov ( NCT01969344).FUNDINGUS NIH, National Heart, Lung and Blood Institute, supplemented by contributions made through the Foundation for the NIH and the COPD Foundation from AstraZeneca/MedImmune, Bayer, Bellerophon Therapeutics, Boehringer-Ingelheim Pharmaceuticals Inc., Chiesi Farmaceutici S.p.A., Forest Research Institute Inc., GlaxoSmithKline, Grifols Therapeutics Inc., Ikaria Inc., Novartis Pharmaceuticals Corporation, Nycomed GmbH, ProterixBio, Regeneron Pharmaceuticals Inc., Sanofi, Sunovion, Takeda Pharmaceutical Company, and Theravance Biopharma and Mylan.
Collapse
Affiliation(s)
- William Z Zhang
- Division of Pulmonary and Critical Care Medicine, Joan and Sanford I. Weill Department of Medicine, New York, New York, USA.,New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA
| | - Michelle C Rice
- Division of Nephrology and Hypertension, Joan and Sanford I. Weill Department of Medicine, and
| | - Katherine L Hoffman
- Department of Healthcare Policy and Research, Division of Biostatistics and Epidemiology, Weill Cornell Medicine, New York, New York, USA
| | - Clara Oromendia
- Department of Healthcare Policy and Research, Division of Biostatistics and Epidemiology, Weill Cornell Medicine, New York, New York, USA
| | - Igor Z Barjaktarevic
- Division of Pulmonary and Critical Care Medicine, UCLA Medical Center, Los Angeles, California, USA
| | - J Michael Wells
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Annette T Hastie
- Pulmonary, Critical Care, Allergy, and Immunologic Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Wassim W Labaki
- Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Christopher B Cooper
- Division of Pulmonary and Critical Care Medicine, UCLA Medical Center, Los Angeles, California, USA
| | - Alejandro P Comellas
- Division of Pulmonary and Critical Care, University of Iowa, Iowa City, Iowa, USA
| | - Gerard J Criner
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Jerry A Krishnan
- Division of Pulmonary, Critical Care, Sleep and Allergy, University of Illinois College of Medicine, Chicago, Illinois, USA
| | - Robert Paine
- Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Nadia N Hansel
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Russell P Bowler
- Division of Pulmonary, Critical Care Medicine, National Jewish Health, Denver, Colorado, USA
| | - R Graham Barr
- Columbia University Medical Center, New York, New York, USA
| | - Stephen P Peters
- Pulmonary, Critical Care, Allergy, and Immunologic Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Prescott G Woodruff
- Division of Pulmonary and Critical Care Medicine, UCSF, School of Medicine, San Francisco, California, USA
| | - Jeffrey L Curtis
- Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, Ann Arbor, Michigan, USA.,Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Meilan K Han
- Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Karla V Ballman
- Department of Healthcare Policy and Research, Division of Biostatistics and Epidemiology, Weill Cornell Medicine, New York, New York, USA
| | - Fernando J Martinez
- Division of Pulmonary and Critical Care Medicine, Joan and Sanford I. Weill Department of Medicine, New York, New York, USA.,New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA
| | - Augustine Mk Choi
- Division of Pulmonary and Critical Care Medicine, Joan and Sanford I. Weill Department of Medicine, New York, New York, USA.,New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA
| | - Kiichi Nakahira
- Division of Pulmonary and Critical Care Medicine, Joan and Sanford I. Weill Department of Medicine, New York, New York, USA
| | - Suzanne M Cloonan
- Division of Pulmonary and Critical Care Medicine, Joan and Sanford I. Weill Department of Medicine, New York, New York, USA
| | - Mary E Choi
- New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA.,Division of Nephrology and Hypertension, Joan and Sanford I. Weill Department of Medicine, and
| | | |
Collapse
|
36
|
LaFon DC, Bhatt SP, Labaki WW, Rahaghi FN, Moll M, Bowler RP, Regan EA, Make BJ, Crapo JD, San Jose Estepar R, Diaz AA, Silverman EK, Han MK, Hobbs B, Cho MH, Washko GR, Dransfield MT, Wells JM. Pulmonary artery enlargement and mortality risk in moderate to severe COPD: results from COPDGene. Eur Respir J 2020; 55:13993003.01812-2019. [PMID: 31772001 DOI: 10.1183/13993003.01812-2019] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 10/23/2019] [Indexed: 11/05/2022]
Affiliation(s)
- David C LaFon
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, USA .,UAB Lung Health Center, Birmingham, AL, USA
| | - Surya P Bhatt
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, USA.,UAB Lung Health Center, Birmingham, AL, USA.,UAB Lung Imaging Core, Birmingham, AL, USA
| | - Wassim W Labaki
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Farbod N Rahaghi
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Matthew Moll
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Russ P Bowler
- Division of Pulmonary and Critical Care Medicine, National Jewish Health, Denver, CO, USA
| | - Elizabeth A Regan
- Division of Rheumatology, Dept of Medicine, National Jewish Health, Denver, CO, USA
| | - Barry J Make
- Division of Pulmonary and Critical Care Medicine, National Jewish Health, Denver, CO, USA
| | - James D Crapo
- Division of Pulmonary and Critical Care Medicine, National Jewish Health, Denver, CO, USA
| | - Raul San Jose Estepar
- Applied Chest Imaging Laboratory, Dept of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Alejandro A Diaz
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Edwin K Silverman
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - MeiLan K Han
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Brian Hobbs
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael H Cho
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - George R Washko
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Mark T Dransfield
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, USA.,UAB Lung Health Center, Birmingham, AL, USA.,Birmingham VA Medical Center, Birmingham, AL, USA
| | - J Michael Wells
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, USA.,UAB Lung Health Center, Birmingham, AL, USA.,Birmingham VA Medical Center, Birmingham, AL, USA
| | | |
Collapse
|
37
|
Burkes RM, Ceppe AS, Couper DJ, Comellas AP, Wells JM, Peters SP, Criner GJ, Kanner RE, Paine R, Christenson SA, Cooper CB, Barjaktarevic IZ, Krishnan JA, Labaki WW, Han MK, Curtis JL, Hansel NN, Wise RA, Drummond MB. Plasma Cathelicidin is Independently Associated with Reduced Lung Function in COPD: Analysis of the Subpopulations and Intermediate Outcome Measures in COPD Study Cohort. Chronic Obstr Pulm Dis 2020; 7:370-381. [PMID: 33108110 DOI: 10.15326/jcopdf.7.4.2020.0142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Ratrionale The antimicrobial peptide cathelicidin, also known in humans as LL-37, is a defensin secreted by immune and airway epithelial cells. Deficiencies in this peptide may contribute to adverse pulmonary outcomes in chronic obstructive pulmonary disease (COPD). Objectives Using clinical and biological samples from the SubPopulations and InteRmediate Outcome Measures In COPD Study (SPIROMICS), we assessed the associations of plasma cathelicidin levels with cross-sectional and longitudinal COPD outcomes. Methods A total of 1609 SPIROMICS participants with COPD and available plasma samples were analyzed. Cathelicidin was modeled dichotomously (lowest quartile [< 50 ng/ml] versus highest 75% [≥ 50 ng/ml]) and continuously per 10 ng/ml. Fixed-effect multilevel regression analyses were used to assess associations between cathelicidin and cross-sectional as well as longitudinal lung function. The associations between cathelicidin and participant-reported retrospective and prospective COPD exacerbations were assessed via logistic regression. Measurements and Main Results Cathelicidin < 50 ng/ml (N=383) was associated with female sex, black race, and lower body mass index (BMI).At baseline,cathelicidin < 50 ng/ml was independently associated with 3.55% lower % predicted forced expiratory volume in 1 second (FEV1)(95% confidence interval [CI] -6.22% to -0.88% predicted; p=0.01), while every 10 ng/ml lower cathelicidin was independently associated with 0.65% lower % predicted FEV1 (95% CI -1.01% to -0.28% predicted; p< 0.001). No independent associations with longitudinal lung function decline or participant-reported COPD exacerbations were observed. Conclusions Reduced cathelicidin is associated with lower lung function at baseline. Plasma cathelicidin may potentially identify COPD patients at increased risk for more severe lung disease.
Collapse
Affiliation(s)
- Robert M Burkes
- Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina, Chapel Hill
| | - Agathe S Ceppe
- Marsico Lung Institute, University of North Carolina, Chapel Hill
| | - David J Couper
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill
| | - Alejandro P Comellas
- Division of Pulmonary, Critical Care, and Occupational Medicine, Carver College of Medicine, University of Iowa, Iowa City
| | - J Michael Wells
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama, Birmingham
| | - Stephen P Peters
- Section of Pulmonary, Critical Care, Allergy, and Immunologic Disease, Wake Forest University, Winston-Salem, North Carolina
| | - Gerard J Criner
- Division of Thoracic Medicine and Surgery, Temple University, Philadelphia, Pennsylvania
| | - Richard E Kanner
- Division of Respiratory, Critical Care and Occupational Pulmonary Medicine, Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City
| | - Robert Paine
- Division of Respiratory, Critical Care and Occupational Pulmonary Medicine, Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City
| | - Stephanie A Christenson
- Division of Pulmonary Critical Care, Allergy, and Sleep Medicine, University of California, San Francisco
| | - Christopher B Cooper
- Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | - Igor Z Barjaktarevic
- Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | - Jerry A Krishnan
- Division of Pulmonary, Critical Care, Sleep, and Allergy Medicine, University of Illinois, Chicago
| | - Wassim W Labaki
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor
| | - MeiLan K Han
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor
| | - Jeffrey L Curtis
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor.,Medicine Service, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Nadia N Hansel
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University Baltimore, Maryland
| | - Robert A Wise
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University Baltimore, Maryland
| | - M Bradley Drummond
- Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina, Chapel Hill.,Marsico Lung Institute, University of North Carolina, Chapel Hill
| | | |
Collapse
|
38
|
Criner RN, Hatt CR, Galbán CJ, Kazerooni EA, Lynch DA, McCormack MC, Casaburi R, MacIntyre NR, Make BJ, Martinez FJ, Labaki WW, Curtis JL, Han MLK. Relationship between diffusion capacity and small airway abnormality in COPDGene. Respir Res 2019; 20:269. [PMID: 31791337 PMCID: PMC6889734 DOI: 10.1186/s12931-019-1237-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 11/08/2019] [Indexed: 12/26/2022] Open
Abstract
Abstract Impaired single breath carbon monoxide diffusing capacity (DLCO) is associated with emphysema. Small airways disease (SAD) may be a precursor lesion to emphysema, but the relationship between SAD and DLCO is undescribed. We hypothesized that in mild COPD, functional SAD (fSAD) defined by computed tomography (CT) and Parametric Response Mapping methodology would correlate with impaired DLCO. Using data from ever-smokers in the COPDGene cohort, we established that fSAD correlated significantly with lower DLCO among both non-obstructed and GOLD 1–2 subjects. The relationship between DLCO with CT-defined emphysema was present in all GOLD stages, but most prominent in severe disease. Trial registration NCT00608764. Registry: COPDGene. Registered 06 February 2008, retrospectively registered.
Collapse
Affiliation(s)
- Rachel N Criner
- Division of Pulmonary, Allergy and Critical Care, University of Pennsylvania, 839 West Gates Building, Philadelphia, PA, 19104, USA.
| | - Charles R Hatt
- Imbio, LLC, Minneapolis, MN, USA.,Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Craig J Galbán
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Ella A Kazerooni
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - David A Lynch
- Department of Radiology, National Jewish Health, Denver, CO, USA
| | - Meredith C McCormack
- Division of Pulmonary & Critical Care Medicine, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Richard Casaburi
- Rehabilitation Clinical Trials Center, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Neil R MacIntyre
- Division of Pulmonary, Allergy and Critical Care Medicine, Duke University, Durham, NC, USA
| | - Barry J Make
- Division of Pulmonary, Critical Care, and Sleep Medicine, National Jewish, Denver, CO, USA
| | - Fernando J Martinez
- Division of Pulmonary & Critical Care Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Wassim W Labaki
- Division of Pulmonary & Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Jeffrey L Curtis
- Division of Pulmonary & Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA.,VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Mei Lan K Han
- Division of Pulmonary & Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
39
|
Affiliation(s)
- Wassim W Labaki
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - MeiLan K Han
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan, USA
| |
Collapse
|
40
|
Diao W, Labaki WW, Han MK, Yeomans L, Sun Y, Smiley Z, Kim JH, McHugh C, Xiang P, Shen N, Sun X, Guo C, Lu M, Standiford TJ, He B, Stringer KA. Disruption of histidine and energy homeostasis in chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2019; 14:2015-2025. [PMID: 31564849 PMCID: PMC6732562 DOI: 10.2147/copd.s210598] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 08/01/2019] [Indexed: 01/01/2023] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is a systemic condition that is too complex to be assessed by lung function alone. Metabolomics has the potential to help understand the mechanistic underpinnings that contribute to COPD pathogenesis. Since blood metabolomics may be affected by sex and body mass index (BMI), the aim of this study was to determine the metabolomic variability in male smokers with and without COPD who have a narrow BMI range. Methods We compared the quantitative proton nuclear magnetic resonance acquired serum metabolomics of a male Chinese Han population of non-smokers without COPD, and smokers with and without COPD. We also assessed the impact of smoking status on metabolite concentrations and the associations between metabolite concentrations and inflammatory markers such as serum interleukin-6 and histamine, and blood cell differential (%). Metabolomics data were log-transformed and auto-scaled for parametric statistical analysis. Mean normalized metabolite concentration values and continuous demographic variables were compared by Student’s t-test with Welch correction or ANOVA with post-hoc Tukey’s test, as applicable; t-test p-values for metabolomics data were corrected for false discovery rate (FDR). A Pearson association matrix was built to evaluate the relationship between metabolite concentrations, clinical parameters and markers of inflammation. Results Twenty-eight metabolites were identified and quantified. Creatine, glycine, histidine, and threonine concentrations were reduced in COPD patients compared to non-COPD smokers (FDR ≤15%). Concentrations of these metabolites were inversely correlated with interleukin-6 levels. COPD patients had overall dampening of metabolite concentrations including energy-related metabolic pathways such as creatine metabolism. They also had higher histamine levels and percent basophils compared to smokers without COPD. Conclusion COPD is associated with alterations in the serum metabolome, including a disruption in the histidine-histamine and creatine metabolic pathways. These findings support the use of metabolomics to understand the pathogenic mechanisms involved in COPD. Trial registrationwww.clinicaltrials.gov, NCT03310177.
Collapse
Affiliation(s)
- Wenqi Diao
- Department of Respiratory Medicine, Peking University Third Hospital, Beijing, People's Republic of China
| | - Wassim W Labaki
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, School of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - MeiLan K Han
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, School of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Larisa Yeomans
- Biochemical Nuclear Magnetic Resonance Core, College of Pharmacy, University of Michigan, Ann Arbor, MI, USA
| | - Yihan Sun
- NMR Metabolomics Laboratory, Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor, MI, USA
| | - Zyad Smiley
- NMR Metabolomics Laboratory, Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor, MI, USA
| | - Jae Hyun Kim
- Biochemical Nuclear Magnetic Resonance Core, College of Pharmacy, University of Michigan, Ann Arbor, MI, USA
| | - Cora McHugh
- NMR Metabolomics Laboratory, Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor, MI, USA
| | - Pingchao Xiang
- Department of Respiratory and Critical Care Medicine, Shou-Gang Hospital Affiliated to Peking University, Beijing, People's Republic of China
| | - Ning Shen
- Department of Respiratory Medicine, Peking University Third Hospital, Beijing 100191, People's Republic of China
| | - Xiaoyan Sun
- Department of Respiratory Medicine, Peking University Third Hospital, Beijing 100191, People's Republic of China
| | - Chenxia Guo
- Department of Respiratory Medicine, Peking University Third Hospital, Beijing 100191, People's Republic of China
| | - Ming Lu
- Department of Respiratory Medicine, Peking University Third Hospital, Beijing 100191, People's Republic of China
| | - Theodore J Standiford
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, School of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Bei He
- Department of Respiratory Medicine, Peking University Health Sciences Center, Third Hospital, Beijing, People's Republic of China
| | - Kathleen A Stringer
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, School of Medicine, University of Michigan, Ann Arbor, MI, USA.,NMR Metabolomics Laboratory, Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
41
|
Vasilescu DM, Martinez FJ, Marchetti N, Galbán CJ, Hatt C, Meldrum CA, Dass C, Tanabe N, Reddy RM, Lagstein A, Ross BD, Labaki WW, Murray S, Meng X, Curtis JL, Hackett TL, Kazerooni EA, Criner GJ, Hogg JC, Han MK. Noninvasive Imaging Biomarker Identifies Small Airway Damage in Severe Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2019; 200:575-581. [PMID: 30794432 PMCID: PMC6727153 DOI: 10.1164/rccm.201811-2083oc] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [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: 11/05/2018] [Accepted: 02/21/2019] [Indexed: 02/02/2023] Open
Abstract
Rationale: Evidence suggests damage to small airways is a key pathologic lesion in chronic obstructive pulmonary disease (COPD). Computed tomography densitometry has been demonstrated to identify emphysema, but no such studies have been performed linking an imaging metric to small airway abnormality.Objectives: To correlate ex vivo parametric response mapping (PRM) analysis to in vivo lung tissue measurements of patients with severe COPD treated by lung transplantation and control subjects.Methods: Resected lungs were inflated, frozen, and systematically sampled, generating 33 COPD (n = 11 subjects) and 22 control tissue samples (n = 3 subjects) for micro-computed tomography analysis of terminal bronchioles (TBs; last generation of conducting airways) and emphysema.Measurements and Main Results: PRM analysis was conducted to differentiate functional small airways disease (PRMfSAD) from emphysema (PRMEmph). In COPD lungs, TB numbers were reduced (P = 0.01); surviving TBs had increased wall area percentage (P < 0.001), decreased circularity (P < 0.001), reduced cross-sectional luminal area (P < 0.001), and greater airway obstruction (P = 0.008). COPD lungs had increased airspace size (P < 0.001) and decreased alveolar surface area (P < 0.001). Regression analyses demonstrated unique correlations between PRMfSAD and TBs, with decreased circularity (P < 0.001), decreased luminal area (P < 0.001), and complete obstruction (P = 0.008). PRMEmph correlated with increased airspace size (P < 0.001), decreased alveolar surface area (P = 0.003), and fewer alveolar attachments per TB (P = 0.01).Conclusions: PRMfSAD identifies areas of lung tissue with TB loss, luminal narrowing, and obstruction. This is the first confirmation that an imaging biomarker can identify terminal bronchial pathology in established COPD and provides a noninvasive imaging methodology to identify small airway damage in COPD.
Collapse
Affiliation(s)
| | | | - Nathaniel Marchetti
- Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | | | - Charles Hatt
- University of Michigan, Ann Arbor, Michigan
- Imbio, Minneapolis, Minnesota
| | | | - Chandra Dass
- Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | | | | | | | | | | | | | - Xia Meng
- University of British Columbia, Vancouver, British Columbia, Canada
- Weill Cornell Medical College, New York, New York
- Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
- University of Michigan, Ann Arbor, Michigan
- Imbio, Minneapolis, Minnesota
- Kyoto University, Kyoto, Japan; and
- VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Jeffrey L. Curtis
- University of Michigan, Ann Arbor, Michigan
- VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | | | | | - Gerard J. Criner
- Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - James C. Hogg
- University of British Columbia, Vancouver, British Columbia, Canada
| | | |
Collapse
|
42
|
Washko GR, Nardelli P, Ash SY, Vegas Sanchez-Ferrero G, Rahaghi FN, Come CE, Dransfield MT, Kalhan R, Han MK, Bhatt SP, Wells JM, Aaron CP, Diaz AA, Ross JC, Cuttica MJ, Labaki WW, Querejeta Roca G, Shah AM, Young K, Kinney GL, Hokanson JE, Agustí A. Arterial Vascular Pruning, Right Ventricular Size, and Clinical Outcomes in Chronic Obstructive Pulmonary Disease. A Longitudinal Observational Study. Am J Respir Crit Care Med 2019; 200:454-461. [PMID: 30758975 PMCID: PMC6701031 DOI: 10.1164/rccm.201811-2063oc] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [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: 11/01/2018] [Accepted: 02/08/2019] [Indexed: 01/05/2023] Open
Abstract
Rationale: Cor pulmonale (right ventricular [RV] dilation) and cor pulmonale parvus (RV shrinkage) are both described in chronic obstructive pulmonary disease (COPD). The identification of emphysema as a shared risk factor suggests that additional disease characterization is needed to understand these widely divergent cardiac processes.Objectives: To explore the relationship between computed tomography measures of emphysema and distal pulmonary arterial morphology with RV volume, and their association with exercise capacity and mortality in ever-smokers with COPD enrolled in the COPDGene Study.Methods: Epicardial (myocardium and chamber) RV volume (RVEV), distal pulmonary arterial blood vessel volume (arterial BV5: vessels <5 mm2 in cross-section), and objective measures of emphysema were extracted from 3,506 COPDGene computed tomography scans. Multivariable linear and Cox regression models and the log-rank test were used to explore the association between emphysema, arterial BV5, and RVEV with exercise capacity (6-min-walk distance) and all-cause mortality.Measurements and Main Results: The RVEV was approximately 10% smaller in Global Initiative for Chronic Obstructive Lung Disease stage 4 versus stage 1 COPD (P < 0.0001). In multivariable modeling, a 10-ml decrease in arterial BV5 (pruning) was associated with a 1-ml increase in RVEV. For a given amount of emphysema, relative preservation of the arterial BV5 was associated with a smaller RVEV. An increased RVEV was associated with reduced 6-minute-walk distance and in those with arterial pruning an increased mortality.Conclusions: Pulmonary arterial pruning is associated with clinically significant increases in RV volume in smokers with COPD and is related to exercise capacity and mortality in COPD.Clinical trial registered with www.clinicaltrials.gov (NCT00608764).
Collapse
Affiliation(s)
| | | | - Samuel Y. Ash
- Division of Pulmonary and Critical Care, Department of Medicine
| | | | | | - Carolyn E. Come
- Division of Pulmonary and Critical Care, Department of Medicine
| | - Mark T. Dransfield
- Lung Health Center, University of Alabama at Birmingham, Birmingham, Alabama
| | - Ravi Kalhan
- Asthma and COPD Program, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - MeiLan K. Han
- Division of Pulmonary and Critical Care Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Surya P. Bhatt
- Lung Health Center, University of Alabama at Birmingham, Birmingham, Alabama
| | - J. Michael Wells
- Lung Health Center, University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | - James C. Ross
- Applied Chest Imaging Laboratory, Department of Radiology
| | - Michael J. Cuttica
- Asthma and COPD Program, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Wassim W. Labaki
- Division of Pulmonary and Critical Care Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | | | - Amil M. Shah
- Division of Cardiovascular, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Kendra Young
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado; and
| | - Gregory L. Kinney
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado; and
| | - John E. Hokanson
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado; and
| | | | - for the COPDGene Investigators
- Division of Pulmonary and Critical Care, Department of Medicine
- Applied Chest Imaging Laboratory, Department of Radiology
- Department of Anesthesia, and
- Division of Cardiovascular, Brigham and Women’s Hospital, Boston, Massachusetts
- Lung Health Center, University of Alabama at Birmingham, Birmingham, Alabama
- Asthma and COPD Program, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Division of Pulmonary and Critical Care Medicine, University of Michigan Medical School, Ann Arbor, Michigan
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado; and
- Hospital Clinic Barcelona, Barcelona, Spain
| |
Collapse
|
43
|
Halper-Stromberg E, Gillenwater L, Cruickshank-Quinn C, O'Neal WK, Reisdorph N, Petrache I, Zhuang Y, Labaki WW, Curtis JL, Wells J, Rennard S, Pratte KA, Woodruff P, Stringer KA, Kechris K, Bowler RP. Bronchoalveolar Lavage Fluid from COPD Patients Reveals More Compounds Associated with Disease than Matched Plasma. Metabolites 2019; 9:metabo9080157. [PMID: 31349744 PMCID: PMC6724137 DOI: 10.3390/metabo9080157] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 07/12/2019] [Accepted: 07/18/2019] [Indexed: 12/22/2022] Open
Abstract
Smoking causes chronic obstructive pulmonary disease (COPD). Though recent studies identified a COPD metabolomic signature in blood, no large studies examine the metabolome in bronchoalveolar lavage (BAL) fluid, a more direct representation of lung cell metabolism. We performed untargeted liquid chromatography-mass spectrometry (LC-MS) on BAL and matched plasma from 115 subjects from the SPIROMICS cohort. Regression was performed with COPD phenotypes as the outcome and metabolites as the predictor, adjusted for clinical covariates and false discovery rate. Weighted gene co-expression network analysis (WGCNA) grouped metabolites into modules which were then associated with phenotypes. K-means clustering grouped similar subjects. We detected 7939 and 10,561 compounds in BAL and paired plasma samples, respectively. FEV1/FVC (Forced Expiratory Volume in One Second/Forced Vital Capacity) ratio, emphysema, FEV1 % predicted, and COPD exacerbations associated with 1230, 792, eight, and one BAL compounds, respectively. Only two plasma compounds associated with a COPD phenotype (emphysema). Three BAL co-expression modules associated with FEV1/FVC and emphysema. K-means BAL metabolomic signature clustering identified two groups, one with more airway obstruction (34% of subjects, median FEV1/FVC 0.67), one with less (66% of subjects, median FEV1/FVC 0.77; p < 2 × 10-4). Associations between metabolites and COPD phenotypes are more robustly represented in BAL compared to plasma.
Collapse
Affiliation(s)
- Eitan Halper-Stromberg
- School of Medicine, University of Colorado, Aurora, CO 80045, USA
- Pathology Department, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Lucas Gillenwater
- Department of Medicine, National Jewish Health, Denver, CO 80206, USA
| | | | - Wanda Kay O'Neal
- Department of Marsico, Lung Institute/Cystic Fibrosis Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Nichole Reisdorph
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Irina Petrache
- School of Medicine, University of Colorado, Aurora, CO 80045, USA
- Department of Medicine, National Jewish Health, Denver, CO 80206, USA
| | - Yonghua Zhuang
- Department of Biostatistics, Colorado School of Public Health, Aurora, CO 80045, USA
| | - Wassim W Labaki
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Jeffrey L Curtis
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - James Wells
- Division of Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Stephen Rennard
- BioPharmaceuticals R&D, AstraZeneca, Cambridge CB4 0XR, UK
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68588, USA
| | | | - Prescott Woodruff
- Department of Medicine, UCSF Pulmonary, Critical Care, Allergy and Sleep Medicine, University of California, San Francisco, CA 94143, USA
| | - Kathleen A Stringer
- Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor, MI 48109, USA
| | - Katerina Kechris
- Department of Biostatistics, Colorado School of Public Health, Aurora, CO 80045, USA.
| | - Russell P Bowler
- School of Medicine, University of Colorado, Aurora, CO 80045, USA.
- Department of Medicine, National Jewish Health, Denver, CO 80206, USA.
| |
Collapse
|
44
|
Labaki WW, Kimmig LM, Mutlu GM, Han MK, Bhatt SP. Update in Chronic Obstructive Pulmonary Disease 2018. Am J Respir Crit Care Med 2019; 199:1462-1470. [PMID: 30958976 PMCID: PMC6835078 DOI: 10.1164/rccm.201902-0374up] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 04/04/2019] [Indexed: 12/21/2022] Open
Affiliation(s)
- Wassim W. Labaki
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan
| | - Lucas M. Kimmig
- Section of Pulmonary and Critical Care Medicine, The University of Chicago, Chicago, Illinois; and
| | - Gökhan M. Mutlu
- Section of Pulmonary and Critical Care Medicine, The University of Chicago, Chicago, Illinois; and
| | - MeiLan K. Han
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan
| | - Surya P. Bhatt
- Division of Pulmonary, Allergy, and Critical Care Medicine, The University of Alabama at Birmingham, Birmingham, Alabama
| |
Collapse
|
45
|
Affiliation(s)
- Wassim W Labaki
- 1 Division of Pulmonary and Critical Care Medicine University of Michigan Ann Arbor, Michigan
| | - MeiLan K Han
- 1 Division of Pulmonary and Critical Care Medicine University of Michigan Ann Arbor, Michigan
| |
Collapse
|
46
|
Labaki WW, Gu T, Murray S, Hatt CR, Galbán CJ, Ross BD, Martinez CH, Curtis JL, Hoffman EA, Pompe E, Lynch DA, Kazerooni EA, Martinez FJ, Han MK. Reprint of: Voxel-Wise Longitudinal Parametric Response Mapping Analysis of Chest Computed Tomography in Smokers. Acad Radiol 2019; 26:306-312. [PMID: 30792137 DOI: 10.1016/j.acra.2019.02.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 11/30/2017] [Revised: 05/01/2018] [Accepted: 05/19/2018] [Indexed: 11/17/2022]
Abstract
RATIONALE AND OBJECTIVES Chronic obstructive pulmonary disease is a heterogeneous disease characterized by small airway abnormality and emphysema. We hypothesized that a voxel-wise computed tomography analytic approach would identify patterns of disease progression in smokers. MATERIALS AND METHODS We analyzed 725 smokers in spirometric GOLD stages 0-4 with two chest CTs 5 years apart. Baseline inspiration, follow-up inspiration and follow-up expiration images were spatially registered to baseline expiration so that each voxel had correspondences across all time points and respiratory phases. Voxel-wise Parametric Response Mapping (PRM) was then generated for the baseline and follow-up scans. PRM classifies lung as normal, functional small airway disease (PRMfSAD), and emphysema (PRMEMPH). RESULTS Subjects with low baseline PRMfSAD and PRMEMPH predominantly had an increase in PRMfSAD on follow-up; those with higher baseline PRMfSAD and PRMEMPH mostly had increases in PRMEMPH. For GOLD 0 participants (n = 419), mean 5-year increases in PRMfSAD and PRMEMPH were 0.3% for both; for GOLD 1-4 participants (n = 306), they were 0.6% and 1.6%, respectively. Eighty GOLD 0 subjects (19.1%) had overall radiologic progression (30.0% to PRMfSAD, 52.5% to PRMEMPH, and 17.5% to both); 153 GOLD 1-4 subjects (50.0%) experienced progression (17.6% to PRMfSAD, 48.4% to PRMEMPH, and 34.0% to both). In a multivariable model, both baseline PRMfSAD and PRMEMPH were associated with development of PRMEMPH on follow-up, although this relationship was diminished at higher levels of baseline PRMEMPH. CONCLUSION A voxel-wise longitudinal PRM analytic approach can identify patterns of disease progression in smokers with and without chronic obstructive pulmonary disease.
Collapse
Affiliation(s)
- Wassim W Labaki
- Division of Pulmonary and Critical Care Medicine, University of Michigan, 3916 Taubman Center, 1500 E Medical Center Drive, Ann Arbor, MI
| | - Tian Gu
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Susan Murray
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | | | - Craig J Galbán
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Brian D Ross
- Imbio LLC, Minneapolis, Minnesota; Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Carlos H Martinez
- Division of Pulmonary and Critical Care Medicine, University of Michigan, 3916 Taubman Center, 1500 E Medical Center Drive, Ann Arbor, MI
| | - Jeffrey L Curtis
- Division of Pulmonary and Critical Care Medicine, University of Michigan, 3916 Taubman Center, 1500 E Medical Center Drive, Ann Arbor, MI; Medical Service, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Eric A Hoffman
- Department of Radiology, University of Iowa, Iowa City, Iowa
| | - Esther Pompe
- Department of Respiratory Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - David A Lynch
- Department of Radiology, National Jewish Health, Denver, Colorado
| | - Ella A Kazerooni
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Fernando J Martinez
- Division of Pulmonary and Critical Care Medicine, University of Michigan, 3916 Taubman Center, 1500 E Medical Center Drive, Ann Arbor, MI; Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical College, New York, New York
| | - MeiLan K Han
- Division of Pulmonary and Critical Care Medicine, University of Michigan, 3916 Taubman Center, 1500 E Medical Center Drive, Ann Arbor, MI.
| |
Collapse
|
47
|
Labaki WW, Gu T, Murray S, Hatt CR, Galbán CJ, Ross BD, Martinez CH, Curtis JL, Hoffman EA, Pompe E, Lynch DA, Kazerooni EA, Martinez FJ, Han MK. Voxel-Wise Longitudinal Parametric Response Mapping Analysis of Chest Computed Tomography in Smokers. Acad Radiol 2019; 26:217-223. [PMID: 30055897 DOI: 10.1016/j.acra.2018.05.024] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 05/01/2018] [Accepted: 05/19/2018] [Indexed: 12/31/2022]
Abstract
RATIONALE AND OBJECTIVES Chronic obstructive pulmonary disease is a heterogeneous disease characterized by small airway abnormality and emphysema. We hypothesized that a voxel-wise computed tomography analytic approach would identify patterns of disease progression in smokers. MATERIALS AND METHODS We analyzed 725 smokers in spirometric GOLD stages 0-4 with two chest CTs 5 years apart. Baseline inspiration, follow-up inspiration and follow-up expiration images were spatially registered to baseline expiration so that each voxel had correspondences across all time points and respiratory phases. Voxel-wise Parametric Response Mapping (PRM) was then generated for the baseline and follow-up scans. PRM classifies lung as normal, functional small airway disease (PRMfSAD), and emphysema (PRMEMPH). RESULTS Subjects with low baseline PRMfSAD and PRMEMPH predominantly had an increase in PRMfSAD on follow-up; those with higher baseline PRMfSAD and PRMEMPH mostly had increases in PRMEMPH. For GOLD 0 participants (n = 419), mean 5-year increases in PRMfSAD and PRMEMPH were 0.3% for both; for GOLD 1-4 participants (n = 306), they were 0.6% and 1.6%, respectively. Eighty GOLD 0 subjects (19.1%) had overall radiologic progression (30.0% to PRMfSAD, 52.5% to PRMEMPH, and 17.5% to both); 153 GOLD 1-4 subjects (50.0%) experienced progression (17.6% to PRMfSAD, 48.4% to PRMEMPH, and 34.0% to both). In a multivariable model, both baseline PRMfSAD and PRMEMPH were associated with development of PRMEMPH on follow-up, although this relationship was diminished at higher levels of baseline PRMEMPH. CONCLUSION A voxel-wise longitudinal PRM analytic approach can identify patterns of disease progression in smokers with and without chronic obstructive pulmonary disease.
Collapse
|
48
|
Criner RN, Labaki WW, Regan EA, Bon JM, Soler X, Bhatt SP, Murray S, Hokanson JE, Silverman EK, Crapo JD, Curtis JL, Martinez FJ, Make BJ, Han MK, Martinez CH. Mortality and Exacerbations by Global Initiative for Chronic Obstructive Lung Disease Groups ABCD: 2011 Versus 2017 in the COPDGene® Cohort. Chronic Obstr Pulm Dis 2019; 6:64-73. [PMID: 30775425 DOI: 10.15326/jcopdf.6.1.2018.0130] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background: The Global initiative for chronic Obstructive Lung Disease (GOLD) ABCD groupings were recently modified. The GOLD 2011 guidelines defined increased risk as forced expiratory volume in 1 second (FEV1) < 50% predicted or ≥ 2 outpatient or ≥ 1 hospitalized exacerbation in the prior year, whereas the GOLD 2017 guidelines use only exacerbation history. We compared mortality and exacerbation rates in the Genetic Epidemiology of COPD Study cohort (COPDGene®) by 2011 (exacerbation history/FEV1 and dyspnea) versus 2017 (exacerbations and dyspnea) classifications. Methods: Using data from COPDGene®, we tested associations of ABCD groups with all-cause mortality (Cox models, adjusted for age, sex, race and comorbidities) and longitudinal exacerbations (zero-inflated Poisson models). Results: In 4469 individuals (mean age 63.1 years, 44% female), individual distributions in 2011 versus 2017 systems were: A, 32.0% versus 37.0%; B, 17.6% versus 36.3%; C, 9.4% versus 4.4%; D, 41.0% versus 22.3%; (observed agreement 76% [expected 27.8%], Kappa 0.67, p<0.001). Individuals in group D-2011 had 1.1 ± 1.6 exacerbations/year (mean ± standard deviation [SD]) versus 1.4 ± 1.8 for D-2017 (median follow-up 3.7 years). Using group A as reference, for both systems, mortality (median follow-up 6.8 years) was highest in group D (D-2011, [hazard ratio] HR 5.2 [95% confidence interval (CI) 4.2, 6.4]; D-2017, HR 5.5 [4.5, 6.8]), lowest for group C (HR 1.9 [1.4, 2.6] versus HR 1.9 [1.3, 2.8]) and intermediate for group B (HR 2.6 [2.0, 3.4] versus HR 3.4 [2.8, 4.1]). GOLD 2011 had better mortality discrimination (area under the curve [AUC] 0.68) than GOLD 2017 (AUC 0.66, p<0.001 for comparison) but similar exacerbation rate prediction. Conclusions: Relative to the GOLD 2011 consensus statement, discriminate predictive power of the 2017 ABCD classification is similar for exacerbations but lower for survival.
Collapse
Affiliation(s)
- Rachel N Criner
- Department of Internal Medicine, University of Michigan, Ann Arbor
| | - Wassim W Labaki
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor
| | - Elizabeth A Regan
- Division of Pulmonary Medicine, National Jewish Health, Denver, Colorado
| | - Jessica M Bon
- Division of Pulmonary and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Xavier Soler
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California, San Diego
| | - Surya P Bhatt
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama, Birmingham
| | - Susan Murray
- School of Public Health, University of Michigan, Ann Arbor
| | | | - Edwin K Silverman
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - James D Crapo
- Division of Pulmonary Medicine, National Jewish Health, Denver, Colorado
| | - Jeffrey L Curtis
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor.,Veterans' Administration Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Fernando J Martinez
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor
| | - Barry J Make
- Division of Pulmonary Medicine, National Jewish Health, Denver, Colorado
| | - MeiLan K Han
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor
| | - Carlos H Martinez
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor
| | | |
Collapse
|
49
|
Fawzy A, Putcha N, Aaron CP, Bowler RP, Comellas AP, Cooper CB, Dransfield MT, Han MK, Hoffman EA, Kanner RE, Krishnan JA, Labaki WW, Paine R, Paulin LM, Peters SP, Wise R, Barr RG, Hansel NN. Aspirin Use and Respiratory Morbidity in COPD: A Propensity Score-Matched Analysis in Subpopulations and Intermediate Outcome Measures in COPD Study. Chest 2018; 155:519-527. [PMID: 30593776 DOI: 10.1016/j.chest.2018.11.028] [Citation(s) in RCA: 21] [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: 07/24/2018] [Revised: 11/05/2018] [Accepted: 11/19/2018] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Aspirin use in COPD has been associated with reduced all-cause mortality in meta-regression analysis with few equivocal studies. However, the effect of aspirin on COPD morbidity is unknown. METHODS Self-reported daily aspirin use was obtained at baseline from SPIROMICS participants with COPD (FEV1/FVC < 70%). Acute exacerbations of COPD (AECOPD) were prospectively ascertained through quarterly structured telephone questionnaires up to 3 years and categorized as moderate (symptoms treated with antibiotics or oral corticosteroids) or severe (requiring ED visit or hospitalization). Aspirin users were matched one-to-one with nonusers, based on propensity score. The association of aspirin use with total, moderate, and severe AECOPD was investigated using zero-inflated negative binomial models. Linear or logistic regression was used to investigate the association with baseline respiratory symptoms, quality of life, and exercise tolerance. RESULTS Among 1,698 participants, 45% reported daily aspirin use at baseline. Propensity score matching resulted in 503 participant pairs. Aspirin users had a lower incidence rate of total AECOPD (adjusted incidence rate ratio [IRR], 0.78; 95% CI, 0.65-0.94), with similar effect for moderate but not severe AECOPD (IRR, 0.86; 95% CI, 0.63-1.18). Aspirin use was associated with lower total St. George's Respiratory Questionnaire score (β, -2.2; 95% CI, -4.1 to -0.4), reduced odds of moderate-severe dyspnea (modified Medical Research Council questionnaire score ≥ 2; adjusted odds ratio, 0.69; 95% CI, 0.51-0.93), and COPD Assessment Test score (β, -1.1; 95% CI, -1.9 to -0.2) but not 6-min walk distance (β, 0.7 m; 95% CI, -14.3 to 15.6). CONCLUSIONS Daily aspirin use is associated with reduced rate of COPD exacerbations, less dyspnea, and better quality of life. Randomized clinical trials of aspirin use in COPD are warranted to account for unmeasured and residual confounding. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT01969344; URL: www.clinicaltrials.gov.
Collapse
Affiliation(s)
- Ashraf Fawzy
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - Nirupama Putcha
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - Carrie P Aaron
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY
| | - Russell P Bowler
- Department of Medicine, National Jewish Medical and Research Center, Denver, CO
| | - Alejandro P Comellas
- Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa College of Medicine, Iowa City, IA
| | - Christopher B Cooper
- Department of Medicine and Department of Physiology, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Mark T Dransfield
- Lung Health Center and Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - MeiLan K Han
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI
| | - Eric A Hoffman
- Department of Radiology, University of Iowa, Iowa City, IA
| | - Richard E Kanner
- Division of Respiratory, Critical Care and Occupational Medicine, University of Utah Health Sciences Center, Salt Lake City, UT
| | - Jerry A Krishnan
- Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois at Chicago, Chicago, IL
| | - Wassim W Labaki
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI
| | - Robert Paine
- Division of Respiratory, Critical Care and Occupational Medicine, University of Utah Health Sciences Center, Salt Lake City, UT
| | - Laura M Paulin
- Department of Medicine, Dartmouth-Hitchcock Medical Center /Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Stephen P Peters
- Section on Pulmonary, Critical Care, Allergy and Immunologic Diseases, Wake Forest University, Winston-Salem, NC
| | - Robert Wise
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - R Graham Barr
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY
| | - Nadia N Hansel
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD.
| | | |
Collapse
|
50
|
Bhatt SP, Nath HP, Kim YI, Ramachandran R, Watts JR, Terry NLJ, Sonavane S, Deshmane SP, Woodruff PG, Oelsner EC, Bodduluri S, Han MK, Labaki WW, Michael Wells J, Martinez FJ, Barr RG, Dransfield MT. Centrilobular emphysema and coronary artery calcification: mediation analysis in the SPIROMICS cohort. Respir Res 2018; 19:257. [PMID: 30563576 PMCID: PMC6299495 DOI: 10.1186/s12931-018-0946-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 11/20/2018] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is associated with a two-to-five fold increase in the risk of coronary artery disease independent of shared risk factors. This association is hypothesized to be mediated by systemic inflammation but this link has not been established. METHODS We included 300 participants enrolled in the SPIROMICS cohort, 75 each of lifetime non-smokers, smokers without airflow obstruction, mild-moderate COPD, and severe-very severe COPD. We quantified emphysema and airway disease on computed tomography, characterized visual emphysema subtypes (centrilobular and paraseptal) and airway disease, and used the Weston visual score to quantify coronary artery calcification (CAC). We used the Sobel test to determine whether markers of systemic inflammation mediated a link between spirometric and radiographic features of COPD and CAC. RESULTS FEV1/FVC but not quantitative emphysema or airway wall thickening was associated with CAC (p = 0.036), after adjustment for demographics, diabetes mellitus, hypertension, statin use, and CT scanner type. To explain this discordance, we examined visual subtypes of emphysema and airway disease, and found that centrilobular emphysema but not paraseptal emphysema or bronchial thickening was independently associated with CAC (p = 0.019). MMP3, VCAM1, CXCL5 and CXCL9 mediated 8, 8, 7 and 16% of the association between FEV1/FVC and CAC, respectively. Similar biomarkers partially mediated the association between centrilobular emphysema and CAC. CONCLUSIONS The association between airflow obstruction and coronary calcification is driven primarily by the centrilobular subtype of emphysema, and is linked through bioactive molecules implicated in the pathogenesis of atherosclerosis. TRIAL REGISTRATION ClinicalTrials.gov: Identifier: NCT01969344 .
Collapse
Affiliation(s)
- Surya P Bhatt
- Division of Pulmonary, Allergy and Critical Care Medicine and Lung Health Center, University of Alabama at Birmingham, THT 422, 1720, 2nd Avenue South, Birmingham, AL, 35294, USA.
- UAB Lung Imaging Core, University of Alabama at Birmingham, Birmingham, AL, 35294, USA.
| | - Hrudaya P Nath
- UAB Lung Imaging Core, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Young-Il Kim
- Division of Pulmonary, Allergy and Critical Care Medicine and Lung Health Center, University of Alabama at Birmingham, THT 422, 1720, 2nd Avenue South, Birmingham, AL, 35294, USA
- Department of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Rekha Ramachandran
- Department of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Jubal R Watts
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Nina L J Terry
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Sushil Sonavane
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Swati P Deshmane
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Prescott G Woodruff
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, University California San Francisco, San Francisco, CA, 94143, USA
| | - Elizabeth C Oelsner
- Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Medical Center, New York, NY, 10032, USA
| | - Sandeep Bodduluri
- Division of Pulmonary, Allergy and Critical Care Medicine and Lung Health Center, University of Alabama at Birmingham, THT 422, 1720, 2nd Avenue South, Birmingham, AL, 35294, USA
- UAB Lung Imaging Core, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - MeiLan K Han
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Wassim W Labaki
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, 48109, USA
| | - J Michael Wells
- Division of Pulmonary, Allergy and Critical Care Medicine and Lung Health Center, University of Alabama at Birmingham, THT 422, 1720, 2nd Avenue South, Birmingham, AL, 35294, USA
- UAB Lung Imaging Core, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
- Birmingham Veterans Affairs Hospital, Birmingham, AL, 35294, USA
| | - Fernando J Martinez
- Division of Pulmonary and Critical Care Medicine, Weill Cornell School of Medicine, New York, NY, 10065, USA
| | - R Graham Barr
- Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Medical Center, New York, NY, 10032, USA
| | - Mark T Dransfield
- Division of Pulmonary, Allergy and Critical Care Medicine and Lung Health Center, University of Alabama at Birmingham, THT 422, 1720, 2nd Avenue South, Birmingham, AL, 35294, USA
- UAB Lung Imaging Core, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
- Birmingham Veterans Affairs Hospital, Birmingham, AL, 35294, USA
| |
Collapse
|