High Nrf2 expression in alveolar type I pneumocytes is associated with low recurrences in primary spontaneous pneumothorax

Abstract

Recurrent primary spontaneous pneumothorax (PSP) is a troublesome problem and a major concern for the patients. This study examined whether nuclear factor erythroid 2-related factor 2 (Nrf2) expression in alveolar type I pneumocytes was associated with the clinical manifestations of PSP patients including disease recurrence. Eighty-eight PSP patients who were managed with needlescopic video-assisted thoracoscopic surgery (NVATS) were included in this study. Immunohistochemistry (IHC) was assessed to determine Nrf2 expression in resected lung tissues and the results were correlated with clinicopathological characteristics by the chi-square or the Fisher's exact test. The prognostic value of Nrf2 for overall recurrence was evaluated by univariate and multivariable Cox regression model. The expression of Nrf2 was observed in type I pneumocytes of lung tissues from PSP patients by IHC. We found that low Nrf2 expression in PSP patients, especially in young (age ≤ 20, p = 0.033) and body mass index (BMI) ≥18 kg/m (p = 0.019) groups, was significantly correlated with PSP recurrence. In the univariate and multivariate analyses, high Nrf2 expression was a significant protective factor for overall recurrence in PSP patients (univariate: p = 0.026; multivariate: p = 0.004). The expression level of Nrf2 in alveolar type I pneumocytes was a potential factor involved in PSP recurrence. Our findings suggest that elevated Nrf2 expression in PSP patients may be a promising way for reducing PSP recurrence.

Aetiology of Primary Spontaneous Pneumothorax

“…Alongside the overexpression of the potentially damaging MMPs, propensity for the lung tissue to become more porous may be due to the absence of other "protective" factors. Nuclear factor erythroid 2-related factor 2 (Nrf2) is a regulator of redox homeostasis and inflammatory response which may have a cytoprotective role in detoxification and chemoprevention [26]. The lung tissue of same patient group as above found higher Nrf2 expression (in alveolar type I pneumocytes) in patients without previous recurrence, suggesting a possible protective effect [26].…”

A randomized study on the effect of sequential acupoint stimulation on pulmonary function of patients with spontaneous pneumothorax during VATS perioperative period

“…SP is one of the most common diseases in clinical practice, and is also the most common emergency in thoracic surgery. [15] Surgical treatment remains one of the main treatment methods. In the present study, in addition to strictly mastering basic nursing skills and paying attention to individualized nursing and treatment, the investigators took the unique theories and concepts of traditional Chinese medicine into account, and adopted the self-created nursing method for pulmonary function recovery during the perioperative period.…”

Pneumothorax—Time for New Guidelines?

“…It is believed to play a cytoprotective role in detoxification and chemoprevention. 15 High Nrf2 expression was seen in those patients without previous recurrence, suggesting a protective effect. 15…”