Immunosuppressive agents and interstitial lung disease: what are the risks?

Meyer, Keith C.

doi:10.1586/17476348.2014.880054

Cited by 9 publications

(17 citation statements)

References 12 publications

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“…With pulmonary fibrosis as the common end stage, increasing data support the importance of dysregulated wound-healing mechanisms for both entities 2 30. Furthermore, in contrast to previous assumptions regarding the non-inflammatory pathogenesis of IPF,5 31 lately, the potential pathogenic role of immune cells in the development and progression of IPF has been re-evaluated 32 33. Thus, a molecular-based rather than a clinical/histological-driven classification as the basis for substratification of patients with ILD might open novel perspectives.…”

Section: Discussionmentioning

confidence: 99%

Visualisation of interstitial lung disease by molecular imaging of integrin αvβ3 and somatostatin receptor 2

Schniering

Benešová²,

Brunner

et al. 2018

Ann Rheum Dis

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ObjectiveTo evaluate integrin αvβ3 (alpha-v-beta-3)-targeted and somatostatin receptor 2 (SSTR2)-targeted nuclear imaging for the visualisation of interstitial lung disease (ILD).MethodsThe pulmonary expression of integrin αvβ3 and SSTR2 was analysed in patients with different forms of ILD as well as in bleomycin (BLM)-treated mice and respective controls using immunohistochemistry. Single photon emission CT/CT (SPECT/CT) was performed on days 3, 7 and 14 after BLM instillation using the integrin αvβ3-targeting 177Lu-DOTA-RGD and the SSTR2-targeting 177Lu-DOTA-NOC radiotracer. The specific pulmonary accumulation of the radiotracers over time was assessed by in vivo and ex vivo SPECT/CT scans and by biodistribution studies.ResultsExpression of integrin αvβ3 and SSTR2 was substantially increased in human ILD regardless of the subtype. Similarly, in lungs of BLM-challenged mice, but not of controls, both imaging targets were stage-specifically overexpressed. While integrin αvβ3 was most abundantly upregulated on day 7, the inflammatory stage of BLM-induced lung fibrosis, SSTR2 expression peaked on day 14, the established fibrotic stage. In agreement with the findings on tissue level, targeted nuclear imaging using SPECT/CT specifically detected both imaging targets ex vivo and in vivo, and thus visualised different stages of experimental ILD.ConclusionOur preclinical proof-of-concept study suggests that specific visualisation of molecular processes in ILD by targeted nuclear imaging is feasible. If transferred into clinics, where imaging is considered an integral part of patients’ management, the additional information derived from specific imaging tools could represent a first step towards precision medicine in ILD.

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Section: Discussionmentioning

confidence: 99%

Visualisation of interstitial lung disease by molecular imaging of integrin αvβ3 and somatostatin receptor 2

Schniering

Benešová²,

Brunner

et al. 2018

Ann Rheum Dis

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“…Screening for latent TB infection (LTBI) and hepatitis B is the most well recognized, while hepatitis C, human immunodeficiency virus (HIV) and strongyloides infection should be considered on an individual patient basis. 67,89,90 Latent TB infection…”

Section: Special Considerationsmentioning

confidence: 99%

Diagnosis and management of connective tissue disease‐associated interstitial lung disease in Australia and New Zealand: A position statement from the Thoracic Society of Australia and New Zealand*

et al. 2020

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Pulmonary complications in CTD are common and can involve the interstitium, airways, pleura and pulmonary vasculature. ILD can occur in all CTD (CTD-ILD), and may vary from limited, non-progressive lung involvement, to fulminant, life-threatening disease. Given the potential for major adverse outcomes in CTD-ILD, accurate diagnosis, assessment and careful consideration of therapeutic intervention are a priority. Limited data are available to guide management decisions in CTD-ILD. Autoimmunemediated pulmonary inflammation is considered a key pathobiological pathway in these disorders, and immunosuppressive therapy is generally regarded the cornerstone of treatment for severe and/or progressive CTD-ILD. However, the natural history of CTD-ILD in individual patients can be difficult to predict, and deciding who to treat, when and with what agent can be challenging. Establishing realistic therapeutic goals from both the patient and clinician perspective requires considerable expertise. The document aims to provide a framework for clinicians to aid in the assessment and management of ILD in the major CTD. A suggested approach to diagnosis and monitoring of CTD-ILD and, where available, evidence-based, diseasespecific approaches to treatment have been provided.

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“…The two most frequent ILDs seen in clinical practice are idiopathic pulmonary fibrosis (IPF) and sarcoidosis; however, there are well over 100 other types of ILD that have been discovered based on clinical presentation, radiographic features, and histopathologic investigation [ 1 ]. Some types of ILD may remain stable or even spontaneously improve, while others may deteriorate over time, but may respond to immunosuppression [ 2 ]. Clinicians must determine whether to treat a patient with an immunosuppressive agent after reaching a confident diagnosis and evaluating patients’ clinical comorbidities [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Bacterial Infections Associated with Immunosuppressive Agents Commonly Used in Patients with Interstitial Lung Diseases

Chaaban

Sadikot

2023

Pathogens

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There are about 200 different types of interstitial lung disease (ILD), and a crucial initial step in the assessment of a patient with suspected ILD is achieving an appropriate diagnosis. Some ILDs respond to immunosuppressive agents, while immunosuppression can be detrimental in others, hence treatment is based on the most confident diagnosis with consideration of a patient’s risk factors. Immunosuppressive medications have the potential to result in substantial, and perhaps life-threatening, bacterial infections to a patient. However, data on the risk of bacterial infections from immunosuppressive treatment specifically in patients with interstitial lung disease is lacking. We hereby review the immunosuppressive treatments used in ILD patients excluding sarcoidosis, highlight their risk of bacterial infections, and discuss the potential mechanisms that contribute to the increased risk of infections.

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Immunosuppressive agents and interstitial lung disease: what are the risks?

Cited by 9 publications

References 12 publications

Visualisation of interstitial lung disease by molecular imaging of integrin αvβ3 and somatostatin receptor 2

Visualisation of interstitial lung disease by molecular imaging of integrin αvβ3 and somatostatin receptor 2

Diagnosis and management of connective tissue disease‐associated interstitial lung disease in Australia and New Zealand: A position statement from the Thoracic Society of Australia and New Zealand*

Bacterial Infections Associated with Immunosuppressive Agents Commonly Used in Patients with Interstitial Lung Diseases

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