Mucus plugs in patients with asthma linked to eosinophilia and airflow obstruction.

Autor:	Dunican EM; Division of Pulmonary and Critical Care Medicine, Department of Medicine and Cardiovascular Research Institute, and., Elicker BM; Department of Radiology and Biomedical Imaging, UCSF, San Francisco, California, USA., Gierada DS; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA., Nagle SK; Department of Medical Physics and Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA., Schiebler ML; Department of Medical Physics and Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA., Newell JD; Division of Cardiovascular and Pulmonary Imaging, Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA., Raymond WW; Division of Pulmonary and Critical Care Medicine, Department of Medicine and Cardiovascular Research Institute, and., Lachowicz-Scroggins ME; Division of Pulmonary and Critical Care Medicine, Department of Medicine and Cardiovascular Research Institute, and., Di Maio S; Division of Pulmonary and Critical Care Medicine, Department of Medicine and Cardiovascular Research Institute, and., Hoffman EA; Division of Cardiovascular and Pulmonary Imaging, Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA., Castro M; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University, St. Louis, Missouri, USA., Fain SB; Department of Medical Physics and Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA., Jarjour NN; Allergy, Pulmonary and Critical Care Medicine Division, University of Wisconsin School of Medicine, Madison, Wisconsin, USA., Israel E; Pulmonary and Critical Care Medicine Division, Brigham and Women's Hospital, Boston, Massachusetts, USA., Levy BD; Pulmonary and Critical Care Medicine Division, Brigham and Women's Hospital, Boston, Massachusetts, USA., Erzurum SC; Department of Pathobiology, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio., Wenzel SE; Pulmonary, Allergy and Critical Care Medicine Division, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA., Meyers DA; Center for Genomics and Personalized Medicine Research, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA., Bleecker ER; Center for Genomics and Personalized Medicine Research, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA., Phillips BR; Division of Biostatistics and Bioinformatics, Department of Public Health Sciences, Penn State University, Hershey, Pennsylvania, USA., Mauger DT; Division of Biostatistics and Bioinformatics, Department of Public Health Sciences, Penn State University, Hershey, Pennsylvania, USA., Gordon ED; Division of Pulmonary and Critical Care Medicine, Department of Medicine and Cardiovascular Research Institute, and., Woodruff PG; Division of Pulmonary and Critical Care Medicine, Department of Medicine and Cardiovascular Research Institute, and., Peters MC; Division of Pulmonary and Critical Care Medicine, Department of Medicine and Cardiovascular Research Institute, and., Fahy JV; Division of Pulmonary and Critical Care Medicine, Department of Medicine and Cardiovascular Research Institute, and.
Jazyk:	angličtina
Zdroj:	The Journal of clinical investigation [J Clin Invest] 2018 Mar 01; Vol. 128 (3), pp. 997-1009. Date of Electronic Publication: 2018 Feb 05.
DOI:	10.1172/JCI95693
Abstrakt:	Background: The link between mucus plugs and airflow obstruction has not been established in chronic severe asthma, and the role of eosinophils and their products in mucus plug formation is unknown. Methods: In clinical studies, we developed and applied a bronchopulmonary segment-based scoring system to quantify mucus plugs on multidetector computed tomography (MDCT) lung scans from 146 subjects with asthma and 22 controls, and analyzed relationships among mucus plug scores, forced expiratory volume in 1 second (FEV1), and airway eosinophils. Additionally, we used airway mucus gel models to explore whether oxidants generated by eosinophil peroxidase (EPO) oxidize cysteine thiol groups to promote mucus plug formation. Results: Mucus plugs occurred in at least 1 of 20 lung segments in 58% of subjects with asthma and in only 4.5% of controls, and the plugs in subjects with asthma persisted in the same segment for years. A high mucus score (plugs in ≥ 4 segments) occurred in 67% of subjects with asthma with FEV1 of less than 60% of predicted volume, 19% with FEV1 of 60%-80%, and 6% with FEV1 greater than 80% (P < 0.001) and was associated with marked increases in sputum eosinophils and EPO. EPO catalyzed oxidation of thiocyanate and bromide by H2O2 to generate oxidants that crosslink cysteine thiol groups and stiffen thiolated hydrogels. Conclusion: Mucus plugs are a plausible mechanism of chronic airflow obstruction in severe asthma, and EPO-generated oxidants may mediate mucus plug formation. We propose an approach for quantifying airway mucus plugging using MDCT lung scans and suggest that treating mucus plugs may improve airflow in chronic severe asthma. Trial Registration: Clinicaltrials.gov NCT01718197, NCT01606826, NCT01750411, NCT01761058, NCT01761630, NCT01759186, NCT01716494, and NCT01760915. Funding: NIH grants P01 HL107201, R01 HL080414, U10 HL109146, U10 HL109164, U10 HL109172, U10 HL109086, U10 HL109250, U10 HL109168, U10 HL109257, U10 HL109152, and P01 HL107202 and National Center for Advancing Translational Sciences grants UL1TR0000427, UL1TR000448, and KL2TR000428.
Databáze:	MEDLINE
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