Image-enhanced bronchoscopic evaluation of bronchial mucosal microvasculature in COPD

Abstract

BackgroundBronchial vascular remodeling is an underresearched component of airway remodeling in COPD. Image-enhanced bronchoscopy may offer a less invasive method for studying bronchial microvasculature in COPD.ObjectivesTo evaluate endobronchial mucosal vasculature and changes in COPD by image-enhanced i-scan3 bronchoscopy and correlate them pathologically by analyzing bronchial mucosal biopsies.MethodsThis case–control study analyzed 29 COPD patients (41.4% Global initiative for chronic Obstructive Lung Disease B [GOLD B] and 58.6% GOLD D) and ten healthy controls admitted at Alexandria Main University Hospital, Egypt. Combined high-definition white light bronchoscopy (HD WLB) with i-scan3 was used to evaluate endobronchial mucosal microvasculature. The vascularity was graded according to the level of mucosal red discoloration (ie, endobronchial erythema) from decreased discoloration to normal, mild, moderate, and severe increased red discoloration (G−1, G0, G+1, G+2, and G+3, respectively) and scored by three bronchoscopists independently. Bronchial mucosal biopsies were taken for microvascular density counting using anti-CD34 antibody as angiogenesis marker.ResultsDifferent grades of endobronchial erythema were observed across/within COPD patients using combined HD WLB + i-scan3, with significant agreement among scorers (P=0.031; median score of G+1 [G−1–G+2]) being higher in GOLD D (P=0.001). Endobronchial erythema significantly correlated with COPD duration, exacerbation frequency, and body mass index (P<0.05). Angiogenesis was significantly decreased among COPD patients versus controls (10.6 [8–13.3] vs 14 [11–17.1]; P=0.02). Mucosal surface changes (including edema, atrophy, and nodules) were better visualized by the combined HD WLB + i-scan3 rather than HD WLB alone.ConclusionCombined HD WLB + i-scan3 seems to be valuable in evaluating mucosal microvasculature and surface changes in COPD, which may represent vasodilatation rather than angiogenesis.

Chronic obstructive pulmonary disease candidate gene prioritization based on metabolic networks and functional information

“…The promoter polymorphism of the gene coding for the enzyme has been shown to be associated with the severity and prognosis of COPD patients [ 35 ]. Fathy et al found that “angiogenesis” was significantly decreased among COPD patients compared with controls after evaluating angiogenesis by counting microvessels highlighted using anti-CD34 antibody as a measure of microvascular density [ 36 ]. Busch et al found five differentially methylated CpG probes significantly associated with COPD among African-Americans.…”

Candidate gene prioritization for chronic obstructive pulmonary disease using expression information in protein–protein interaction networks

“…“Angiogenesis” was observed to be significantly decreased among COPD patients versus controls. This suggested the possibility of blunted “angiogenesis” in COPD patients, who showed impaired training-induced blood pressure adaptation related to a change in muscle capillarizatio [ 34 , 35 ]. Hepatocyte growth factor was involved in the pathogenesis of various lung diseases as it was significantly higher in COPD patients compared to control patients.…”

Aging Airways: between Normal and Disease. A Multidimensional Diagnostic Approach by Combining Clinical, Functional, and Imaging Data

“…Bronchoscopy allows also the study of wall changes and endobronchial mucosal vasculature in COPD patients [41]. Bronchoscopy-related procedures, such as endobronchial ultrasounds and transbronchial needle aspiration, are also safe and effective, even though they are invasive and might not be well tolerated by the elderly [42].…”

“…Bronchoscopy can provide additional information to clinical and imaging data in the study of the airways also in elderly subjects, as it can be performed safely and effectively in this subset of population, with only one report of a greater incidence of adverse reactions in patients 80 years or older [ 40 ]. Bronchoscopy allows also the study of wall changes and endobronchial mucosal vasculature in COPD patients [ 41 ]. Bronchoscopy-related procedures, such as endobronchial ultrasounds and transbronchial needle aspiration, are also safe and effective, even though they are invasive and might not be well tolerated by the elderly [ 42 ].…”