Lymphocytic inflammation in childhood bronchiolitis obliterans

Mauad, Thaís; Schadewijk, Annemarie van; Schrumpf, Jasmijn A.; Hack, C. Erik; Fernezlian, Sandra; Garippo, A. L.; Ejzenberg, Bernardo; Hiemstra, Pieter S.; Rabe, Klaus F.; Dolhnikoff, Marisa

doi:10.1002/ppul.20064

Cited by 35 publications

(24 citation statements)

References 27 publications

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“…However, we have been careful to process the autopsy material with adequate fixation and timing in order to avoid loss of antigenicity. Using immunohistochemistry we have previously published adequate results in autopsy and biopsy material [45]. In cases of UIP and NSIP, the basement membrane perimeter was higher than in controls and CB groups.…”

Section: Discussionmentioning

confidence: 85%

Small Airway Remodeling in Idiopathic Interstitial Pneumonias: A Pathological Study

Mello¹,

Carvalho²,

Kairalla³

et al. 2009

Respiration

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Background: Few studies have addressed small airway (SA) histopathological changes and their possible role in the remodeling process in idiopathic interstitial pneumonias. Objectives: To study morphological, morphometrical and immunohistochemical features of SA in idiopathic pulmonary fibrosis (usual interstitial pneumonia, UIP) and nonspecific interstitial pneumonia (NSIP). Methods: We analyzed SA pathology in lung biopsies from 29 patients with UIP and 8 with NSIP. Biopsies were compared with lung tissue from 13 patients with constrictive bronchiolitis (CB) as positive controls and 10 normal autopsied control lungs. We semi-quantitatively analyzed SA structure, inflammation, architectural features and the bronchiolar epithelial immunohistochemical expression of TGF-β, MMP-2, 7, 9, and their tissue inhibitors (TIMP-1, 2). Results: Compared to controls, patients with UIP, NSIP and CB presented increased bronchiolar inflammation, peribronchiolar inflammation and fibrosis and decreased luminal areas. UIP patients had thicker walls due to an increase in most airway compartments. NSIP patients presented increased epithelial areas, whereas patients with CB had larger inner wall areas. All of the groups studied presented increased bronchiolar expression of MMP-7 and MMP-9, compared to the controls. Conclusion: We conclude that SAs are pathologically altered and may take part in the lung-remodeling process in idiopathic interstitial pneumonias.

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Section: Discussionmentioning

confidence: 85%

Small Airway Remodeling in Idiopathic Interstitial Pneumonias: A Pathological Study

Mello¹,

Carvalho²,

Kairalla³

et al. 2009

Respiration

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“…38 In line with these findings, we did observe high numbers of granzyme B positive cells in lung tissue from children with childhood bronchiolitis obliterans, a disease that is thought to result from acute viral bronchiolitis. 39 In vitro studies may provide additional information by examining more extensively the possible lack of cytotoxicity of CD8+ T lymphocytes in COPD.…”

Section: Discussionmentioning

confidence: 99%

Relation between duration of smoking cessation and bronchial inflammation in COPD

Lapperre

Postma

Gosman

et al. 2005

Respiratory Medicine: COPD Update

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Background: Chronic obstructive pulmonary disease (COPD) is associated with airway inflammation. Although smoking cessation improves symptoms and the decline in lung function in COPD, it is unknown whether bronchial inflammation in patients with established COPD varies with the duration of smoking cessation. Methods: 114 patients (99 men) with COPD of mean (SD) age 62 (8) years, a median (IQR) smoking history of 42 (31-55) pack years, no inhaled or oral corticosteroids, all current or ex-smokers (n = 42, quit .1 month, median cessation duration 3.5 years), post-bronchodilator FEV 1 63 (9)% predicted, and FEV 1 /IVC 48 (9)% were studied cross sectionally. The numbers of subepithelial T lymphocytes (CD3, CD4, CD8), neutrophils, macrophages, eosinophils, mast cells, and plasma cells were measured in bronchial biopsy specimens (median (IQR)/0.1 mm 2 ) using fully automated image analysis. Results: Ex-smokers with COPD had higher CD3+, CD4+, and plasma cell numbers than current smokers with COPD (149 (88-225) v 108 (61-164), p = 0.036; 58 (32-90) v 40 (25-66), p = 0.023; and 9.0 (5.5-20) v 7.5 (3.1-14), p = 0.044, respectively), but no difference in other inflammatory cells. Short term ex-smokers (,3.5 years) had higher CD4+ and CD8+ cell numbers than current smokers (p = 0.017, p = 0.023; respectively). Conversely, long term ex-smokers (quit >3.5 years) had lower CD8+ cell numbers than short term ex-smokers (p = 0.009), lower CD8/CD3 ratios than both current smokers and short-term ex-smokers (p = 0.012, p = 0.003; respectively), and higher plasma cell numbers than current smokers (p = 0.003). Conclusions: With longer duration of smoking cessation, CD8 cell numbers decrease and plasma cell numbers increase. This indicates that bronchial T lymphocyte and plasma cell counts, but not other inflammatory cells, are related to duration of smoking cessation in patients with COPD.

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“…Essa lesão leva à necrose do epitélio bronquiolar e do infiltrado inflamatório peribronquial, intraepitelial e intersticial 30 .…”

Section: Patogeniaunclassified

“…Um estudo que objetivou determinar o perfil linfohistiocítico em fragmentos de tecido de biopsia pulmonar de pacientes com BOPI demonstrou que as células CD3+T foram as mais frequentemente encontradas, com a predominância do subtipo de células CD8+T. As células CD8 podem levar as células do epitélio alveolar a produzir citocinas, o que contribui para a intensificação do processo inflamatório e para a perpetuação da lesão pulmonar 30 .…”

Section: Patogeniaunclassified

Post-infectious bronchiolitis obliterans in children

Champs

Lasmar²,

Camargos³

et al. 2011

J Pediatr (Rio J)

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Objective: To review publications about the main features of postinfectious bronchiolitis obliterans and its history, etiology, epidemiology, risk factors, pathogenesis, histological findings, clinical presentation, complementary tests, diagnostic criteria, differential diagnosis, treatment and prognosis.Sources: Non-systematic review of MEDLINE and LILACS databases and selection of 66 most relevant studies. Summary of the findings:In the post-infectious bronchiolitis obliterans there is an insult to respiratory epithelial cells, and its clinical severity is associated with the degree of lesion and inflammation. Diagnosis is made according to clinical signs and symptoms, by exclusion of main differential diagnoses and with the aid of complementary tests. High resolution CT, particularly images obtained during inspiration and expiration, provide information for the evaluation of the small airways. Pulmonary function tests show fixed airway obstructions and marked decrease of FEF 25-75% . Treatment has not been definitely established, and corticoids have been administered as pulse therapy or by inhalation of high doses of steroids. However, data about its efficacy are scarce in the literature. Long-term prognosis is variable, and there might be either clinical improvement or deterioration into respiratory insufficiency and death.Conclusion: Post-infectious bronchiolitis obliterans is a disease with a high morbidity rate; it should be treated by a multidisciplinary team, and patients should be followed up for a long period of time.J Pediatr (Rio J). 2011;87(3):187-198: Bronchiolitis obliterans, diagnosis, spirometry, CT, child. ResumoObjetivo: Revisar os trabalhos publicados sobre os principais aspectos da bronquiolite obliterante pós-infecciosa, relacionados com sua história, etiologia, epidemiologia, fatores de risco, patogenia, alterações histológicas, manifestações clínicas, exames complementares, critérios diagnósticos, diagnóstico diferencial, tratamento e prognóstico. Fonte dos dados:Realizou-se uma revisão não sistemática nas bases de dados MEDLINE e LILACS, selecionando-se 66 referências mais relevantes. Síntese dos dados:Na bronquiolite obliterante pós-infecciosa ocorre lesão do epitélio respiratório, e a gravidade clínica está relacionada aos diferentes graus de lesão e ao processo inflamatório. O diagnóstico baseia-se no quadro clínico, na exclusão dos principais diagnósticos diferenciais e no auxílio dos exames complementares. A tomografia computadorizada de alta resolução, principalmente com imagens em inspiração e expiração, possibilta a avaliação das pequenas vias aéreas. As provas de função pulmonar caracterizam-se por padrão obstrutivo fixo com redução acentuada do FEF 25-75% . O tratamento não está bem estabelecido, e o uso de corticoides tem sido preconizado em forma de pulsoterapia ou por via inalatória em elevadas doses, no entanto, os dados da literatura a respeito de sua eficácia ainda são escassos. O prognóstico a longo prazo é variável, podendo haver melhora clínica ou evolução par...

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Lymphocytic inflammation in childhood bronchiolitis obliterans

Cited by 35 publications

References 27 publications

Small Airway Remodeling in Idiopathic Interstitial Pneumonias: A Pathological Study

Small Airway Remodeling in Idiopathic Interstitial Pneumonias: A Pathological Study

Relation between duration of smoking cessation and bronchial inflammation in COPD

Post-infectious bronchiolitis obliterans in children

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