TY - THES A1 - Bucher, Hannes T1 - Pre-clinical modeling of viral- and bacterial-induced exacerbations of chronic obstructive pulmonary disease T1 - Prä-klinische Modellierung von viral und bakteriell induzierten Exazerbationen von Chronisch Obstruktiver Lungenerkrankung N2 - Chronic Obstructive Pulmonary Disease (COPD) exacerbations are a considerable reason for increased morbidity and mortality in patients. Infections with influenza virus (H1N1), respiratory syncytial virus (RSV) or nontypeable Haemophilus influenzae (NTHi) are important triggers of exacerbations. To date, no treatments are available which can stop the progression of COPD. Novel approaches are urgently needed. Pre-clinical models of the disease are crucial for the development of novel therapeutic options. In order to establish pre-clinical models which mimic aspects of human COPD exacerbations, mice were exposed to cigarette smoke (CS) and additionally infected with H1N1, RSV and/or NTHi. Clinically relevant treatments such as the corticosteroids Fluticasone propionate and Dexamethasone, the phosphodiesterase-4 (PDE-4) inhibitor Roflumilast and the long-acting muscarinic receptor antagonist Tiotropium were tested in the established models. Furthermore, a novel treatment approach using antibodies (Abs) directed against IL-1α, IL-1β or IL-1R1 was examined in the established CS/H1N1 model. Levels of IFN-γ, IL-1β, IL-2, IL-6, KC, TNF-α, RANTES, IL-17, MCP-1, MIP 1α and MIP-1β were measured in lung homogenate. Numbers of total cells, neutrophils and macrophages were assessed in bronchoalveolar lavage (BAL) fluid. Hematoxylin- and eosin- (H&E-) stained lung slices were analyzed to detect pathological changes. Quantitative polymerase-chain-reaction (qPCR) was used to investigate gene expression of ICAM-1 and MUC5 A/C. The viral/bacterial load was investigated in lung homogenate or BAL fluid. In addition to the in vivo studies, the effects of the above mentioned treatments were investigated in vitro in H1N1, RSV or NTHi-infected (primary) human bronchial epithelial cells using submerged or air-liquid-interface (ALI) cell culture systems. Four pre-clinical models (CS/H1N1, CS/RSV, CS/NTHi, CS/H1N1/NTHi) were established depicting clinically relevant aspects of COPD exacerbations such as increased inflammatory cells and cytokines in the airways and impaired lung function. In the CS/H1N1 model, Tiotropium improved lung function and was superior in reducing inflammation in comparison to Fluticasone or Roflumilast. Moreover, Fluticasone increased the loss of body-weight, levels of IL-6, KC and TNF-α and worsened lung function. In CS/RSV-exposed mice Tiotropium but not Fluticasone or Roflumilast treatment reduced neutrophil numbers and IL-6 and TNF α levels in the lung. The viral load of H1N1 and RSV was significantly elevated in CS/virus-exposed mice and NCI-H292 cells after Fluticasone and Dexamethasone treatment. The results from these studies demonstrate that Tiotropium has anti-inflammatory effects on CS/virus-induced inflammation and might help to explain the observed reduction of exacerbation rates in Tiotropium-treated COPD patients. Furthermore, the findings from this work indicate that treatment with Fluticasone or Dexamethasone might not be beneficial to reduce inflammation in the airways of COPD patients and supports clinical studies that link treatment with corticosteroids to an increased risk for pneumonia. Testing of anti-IL-1α, anti-IL-1β or anti-IL-1R1 Abs in the CS/H1N1 model suggests that, in line with clinical data, antagonization of IL-1β is not sufficient to reduce pulmonary inflammation and indicates a predominant role of IL-1α in CS/virus-induced airway inflammation. In line with the in vivo findings, anti-IL-1α but not anti-IL-1β Abs reduced levels of TNF-α and IL-6 in H1N1-infected primary human bronchial epithelial ALI cell culture. Blocking the IL-1R1 provided significant inhibitory effects on inflammatory cells in vivo but was inferior compared to inhibiting both its soluble ligands IL-1α and IL-1β. Concomitant usage of Abs against IL-1α/IL-1β revealed strong effects and reduced total cells, neutrophils and macrophages. Additionally, levels of KC, IL-6, TNF-α, MCP-1, MIP-1α and MIP-1β were significantly reduced and ICAM-1 mRNA expression was attenuated. These results suggest that combined inhibition of IL-1α/IL-1β might be beneficial to reduce inflammation and exacerbations in COPD patients. Moreover, combined targeting of both IL-1α/IL-1β might be more efficient compared to inhibition of the IL-1R1. As in the CS/virus models, corticosteroid treatment failed to reduce inflammatory cells in the CS/NTHi and CS/H1N1/NTHi models, increased the loss of body-weight and the bacterial load. Furthermore, Roflumilast administration had no significant effects on cell counts or cytokines. However, it improved compliance in the CS/NTHi model. Treatment with Azithromycin reduced the bacterial load in the CS/NTHi model and reduced numbers of total cells, neutrophils, macrophages and levels of KC and TNF-α in the CS/H1N1/NTHi model. In conclusion, the established CS/H1N1, CS/RSV, CS/NTHi, CS/H1N1/NTHi models depict clinically relevant aspects of human COPD exacerbations in mice and provide the opportunity to investigate underlying disease mechanisms and to test novel therapies. N2 - Exazerbationen von Chronisch Obstruktiver Lungenerkrankung (COPD) sind ein bedeutender Grund für erhöhte Morbidität und Mortalität von Patienten. Infektionen mit Influenza Virus (H1N1), Respiratory Syncytial Virus (RSV) oder nontypeable Haemophilus influenzae (NTHi) gelten als wichtige Auslöser von Exazerbationen. Bis heute gibt es keine Therapien, welche die Progression von COPD verhindern können. Neue Therapieansätze werden daher dringend benötigt. Prä-klinische Modelle spielen bei der Entwicklung neuer Therapien eine entscheidende Rolle. Um Aspekte einer humanen COPD-Exazerbation abzubilden, wurden Mäuse Zigarettenrauch (CS) ausgesetzt und zusätzlich mit H1N1, RSV und/oder NTHi infiziert. Klinisch relevante Behandlungen, z.B. die Kortikosteroide Fluticasonpropionat und Dexamethason, der Phosphodiesterase 4 (PDE-4) Inhibitor Roflumilast und der muskarinische Rezeptorantagonist Tiotropium, wurden in den etablierten Modellen getestet. Zudem wurde ein neuer therapeutischer Ansatz untersucht bei dem IL-1α, IL-1β neutralisierende bzw. IL-1R1 blockierende Antikörper (Ak) zum Einsatz kamen. Die Mengen von IFN-γ, IL-1β, IL 2, IL-6, KC, TNF-α, RANTES, IL-17, MCP-1, MIP-1α und MIP-1β wurden im Lungenhomogenat gemessen. Die Gesamtzellzahl und die Anzahl von Neutrophilen und Makrophagen wurden in bronchoalveolärer Lavage (BAL) Flüssigkeit bestimmt. Hematoxylin- und Eosin- (H&E-) gefärbte Lungenschnitte wurden analysiert, um pathologische Veränderungen zu detektieren. Quantitative Polymerase-Kettenreaktion (qPCR) wurde genutzt, um die Genexpression von ICAM-1 und MUC5 A/C zu untersuchen. Die Virus /Bakterienlast wurde in BAL Flüssigkeit oder Lungenhomogenat gemessen. Darüber hinaus wurden die Effekte der oben genannten Behandlungen in vitro in H1N1, RSV oder NTHi infizierten (primären) humanen bronchialen Epithelzellen in „submerged“ oder „air-liquid-interface (ALI)“ Zellkultur-Systemen untersucht. Vier prä-klinische Modelle (CS/H1N1, CS/RSV, CS/NTHi, CS/H1N1/NTHi) wurden etabliert, die relevante Aspekte einer Exazerbation, wie beispielsweise den Einstrom inflammatorischer Zellen, erhöhte Zytokinlevel oder verminderte Lungenfunktion abbilden. Im CS/H1N1-Modell verbesserte Tiotropium die Lungenfunktion und zeigte stärker anti-entzündliche Effekte als Fluticason oder Roflumilast. Zudem verstärkte Fluticason den Gewichtsverlust, erhöhte die Level von IL-6 und TNF-α und verschlechterte die Lungenfunktion. Im CS/RSV-Modell reduzierte Tiotropium, aber nicht Fluticason oder Roflumilast die Zahl der Neutrophilen sowie IL-6 und TNF-α Mengen. Die Menge von H1N1 und RSV war in den CS/Virus-Modellen sowie in NCI-H292 Zellen nach Fluticason- oder Dexamethason-Behandlung signifikant erhöht. Die Ergebnisse dieser Studien demonstrieren anti-inflammatorische Effekte von Tiotropium auf CS/Virus-induzierte Entzündung und könnten helfen, reduzierte Exazerbationshäufigkeiten in mit Tiotropium behandelten Patienten zu erklären. Zudem könnten die Resultate dieser Arbeit darauf hindeuten, dass die Behandlung mit Kortikosteroiden nicht geeignet ist, um Entzündung in COPD-Patienten zu reduzieren, und könnten dabei helfen, das in klinischen Studien festgestellte erhöhte Risiko von Pneumonien bei Behandlung mit Kortikosteroiden zu erklären. Im Einklang mit klinischen Daten deutet die Testung von anti-IL-1α, anti-IL-1β oder anti IL-1R1 Ak im CS/H1N1-Modell darauf hin, dass die Neutralisation von IL-1β nicht ausreicht, um die Entzündung in der Lunge zu reduzieren, und impliziert eine prädominierende Rolle von IL-1α in CS/H1N1-induzierter Atemwegsentzündung. Konform mit den in vivo Ergebnissen, reduzierten anti-IL-1α, aber nicht anti-IL-1β Ak, TNF-α und IL-6 in H1N1-infizierter primärer humaner bronchialer epithelialer ALI-Zellkultur. Die Blockade von IL-1R1 zeigte in vivo signifikante inhibitorische Effekte auf inflammatorische Zellen, die verglichen mit der Neutralisation seiner löslichen Liganden IL-1α/IL-1β allerdings unterlegen waren. Die kombinierte Neutralisation von IL-1α/IL-1β war sehr effektiv und reduzierte die Gesamtzellzahl sowie die Zahl der Neutrophilen und Makrophagen in der Lunge. Zusätzlich wurden die Level von KC, IL-6, TNF-α, MCP-1, MIP-1α und MIP-1β signifikant reduziert. Diese Ergebnisse deuten darauf hin, dass kombinierte Inhibition von IL-1α/IL-1β geeignet sein könnte, um Entzündung und Exazerbationen in COPD-Patienten zu reduzieren. Zudem könnte IL-1α/IL-1β-Neutralisation effektiver sein als IL-1R1-Blockade. Wie in den CS/Virus-Modellen wurden inflammatorische Zellen durch Kortikosteroid-Behandlung im CS/NTHi- und CS/H1N1/NTHi-Modell nicht reduziert, verstärkten zudem den Gewichtsverlust und erhöhten die Bakterienmenge. Roflumilast zeigte keine Effekte auf Zellzahlen und Zytokine. Allerdings verbesserte die Behandlung damit die Compliance im CS/NTHi-Modell. Die Behandlung mit Azithromycin reduzierte die Bakterienmenge im CS/NTHi-Modell und reduzierte die Gesamtzellzahl und Anzahl von Neutrophilen und Makrophagen, sowie die Level von KC und TNF-α im CS/H1N1/NTHi-Modell. Zusammenfassend bilden die etablierten CS/H1N1-, CS/RSV-, CS/NTHi-, CS/H1N1/NTHi-Modelle klinisch relevante Aspekte von humanen COPD-Exazerbationen ab und ermöglichen die Erforschung von Krankheitsmechanismen und neuen Therapieansätze. KW - Obstruktive Ventilationsstörung KW - COPD KW - Exacerbation KW - Tiotropium KW - Influenza KW - NTHi KW - Preclinical KW - Model KW - Treatment KW - Exazerbation KW - Maus Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-144368 ER - TY - JOUR A1 - Alma, Harma A1 - de Jong, Corina A1 - Jelusic, Danijel A1 - Wittmann, Michael A1 - Schuler, Michael A1 - Flokstra-de Blok, Bertine A1 - Kocks, Janwillem A1 - Schultz, Konrad A1 - van der Molen, Thys T1 - Health status instruments for patients with COPD in pulmonary rehabilitation: defining a minimal clinically important difference JF - npj Primary Care Respiration Medicine N2 - The minimal clinically important difference (MCID) defines to what extent change on a health status instrument is clinically relevant, which aids scientists and physicians in measuring therapy effects. This is the first study that aimed to establish the MCID of the Clinical chronic obstructive pulmonary disease (COPD) Questionnaire (CCQ), the COPD Assessment Test (CAT) and the St George’s Respiratory Questionnaire (SGRQ) in the same pulmonary rehabilitation population using multiple approaches. In total, 451 COPD patients participated in a 3-week Pulmonary Rehabilitation (PR) programme (58 years, 65% male, 43 pack-years, GOLD stage II/III/IV 50/39/11%). Techniques used to assess the MCID were anchor-based approaches, including patient-referencing, criterion-referencing and questionnaire-referencing, and the distribution-based methods standard error of measurement (SEM), 1.96SEM and half standard deviation (0.5s.d.). Patient- and criterion-referencing led to MCID estimates of 0.56 and 0.62 (CCQ); 3.12 and 2.96 (CAT); and 8.40 and 9.28 (SGRQ). Questionnaire-referencing suggested MCID ranges of 0.28–0.61 (CCQ), 1.46–3.08 (CAT) and 6.86–9.47 (SGRQ). The SEM, 1.96SEM and 0.5s.d. were 0.29, 0.56 and 0.46 (CCQ); 3.28, 6.43 and 2.80 (CAT); 5.20, 10.19 and 6.06 (SGRQ). Pooled estimates were 0.52 (CCQ), 3.29 (CAT) and 7.91 (SGRQ) for improvement. MCID estimates differed depending on the method used. Pooled estimates suggest clinically relevant improvements needing to exceed 0.40 on the CCQ, 3.00 on the CAT and 7.00 on the SGRQ for moderate to very severe COPD patients. The MCIDs of the CAT and SGRQ in the literature might be too low, leading to overestimation of treatment effects for patients with COPD. KW - COPD KW - rehabilitation KW - health status instruments Y1 - 2016 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-166327 VL - 26 IS - 16041 ER - TY - JOUR A1 - Karnati, Srikanth A1 - Seimetz, Michael A1 - Kleefeldt, Florian A1 - Sonawane, Avinash A1 - Madhusudhan, Thati A1 - Bachhuka, Akash A1 - Kosanovic, Djuro A1 - Weissmann, Norbert A1 - Krüger, Karsten A1 - Ergün, Süleyman T1 - Chronic Obstructive Pulmonary Disease and the Cardiovascular System: Vascular Repair and Regeneration as a Therapeutic Target JF - Frontiers in Cardiovascular Medicine N2 - Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide and encompasses chronic bronchitis and emphysema. It has been shown that vascular wall remodeling and pulmonary hypertension (PH) can occur not only in patients with COPD but also in smokers with normal lung function, suggesting a causal role for vascular alterations in the development of emphysema. Mechanistically, abnormalities in the vasculature, such as inflammation, endothelial dysfunction, imbalances in cellular apoptosis/proliferation, and increased oxidative/nitrosative stress promote development of PH, cor pulmonale, and most probably pulmonary emphysema. Hypoxemia in the pulmonary chamber modulates the activation of key transcription factors and signaling cascades, which propagates inflammation and infiltration of neutrophils, resulting in vascular remodeling. Endothelial progenitor cells have angiogenesis capabilities, resulting in transdifferentiation of the smooth muscle cells via aberrant activation of several cytokines, growth factors, and chemokines. The vascular endothelium influences the balance between vaso-constriction and -dilation in the heart. Targeting key players affecting the vasculature might help in the development of new treatment strategies for both PH and COPD. The present review aims to summarize current knowledge about vascular alterations and production of reactive oxygen species in COPD. The present review emphasizes on the importance of the vasculature for the usually parenchyma-focused view of the pathobiology of COPD. KW - COPD KW - emphysema KW - pulmonary hypertension KW - hypoxia KW - oxidative stress Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-235631 SN - 2297-055X VL - 8 ER - TY - JOUR A1 - Vollmer, Andreas A1 - Vollmer, Michael A1 - Lang, Gernot A1 - Straub, Anton A1 - Shavlokhova, Veronika A1 - Kübler, Alexander A1 - Gubik, Sebastian A1 - Brands, Roman A1 - Hartmann, Stefan A1 - Saravi, Babak T1 - Associations between periodontitis and COPD: An artificial intelligence-based analysis of NHANES III JF - Journal of Clinical Medicine N2 - A number of cross-sectional epidemiological studies suggest that poor oral health is associated with respiratory diseases. However, the number of cases within the studies was limited, and the studies had different measurement conditions. By analyzing data from the National Health and Nutrition Examination Survey III (NHANES III), this study aimed to investigate possible associations between chronic obstructive pulmonary disease (COPD) and periodontitis in the general population. COPD was diagnosed in cases where FEV (1)/FVC ratio was below 70% (non-COPD versus COPD; binary classification task). We used unsupervised learning utilizing k-means clustering to identify clusters in the data. COPD classes were predicted with logistic regression, a random forest classifier, a stochastic gradient descent (SGD) classifier, k-nearest neighbors, a decision tree classifier, Gaussian naive Bayes (GaussianNB), support vector machines (SVM), a custom-made convolutional neural network (CNN), a multilayer perceptron artificial neural network (MLP), and a radial basis function neural network (RBNN) in Python. We calculated the accuracy of the prediction and the area under the curve (AUC). The most important predictors were determined using feature importance analysis. Results: Overall, 15,868 participants and 19 feature variables were included. Based on k-means clustering, the data were separated into two clusters that identified two risk characteristic groups of patients. The algorithms reached AUCs between 0.608 (DTC) and 0.953% (CNN) for the classification of COPD classes. Feature importance analysis of deep learning algorithms indicated that age and mean attachment loss were the most important features in predicting COPD. Conclusions: Data analysis of a large population showed that machine learning and deep learning algorithms could predict COPD cases based on demographics and oral health feature variables. This study indicates that periodontitis might be an important predictor of COPD. Further prospective studies examining the association between periodontitis and COPD are warranted to validate the present results. KW - COPD KW - periodontitis KW - bone loss KW - machine learning KW - prediction KW - artificial intelligence KW - model KW - gingivitis Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-312713 SN - 2077-0383 VL - 11 IS - 23 ER -