Effect of bronchial thermoplasty on structural changes and inflammatory mediators in the airways of subjects with severe asthma
Effect of bronchial thermoplasty on structural changes and inflammatory mediators in the airways of subjects with severe asthma
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DOI：
10.1016/j.rmed.2019.03.005
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发表时间：
2019-04-01
影响因子：
4.3
通讯作者：
Hamid, Qutayba
中科院分区：
文献类型：
--
作者：
Ichikawa, Tomohiro;Panariti, Alice;Hamid, Qutayba
背景：支气管热成形术（BT）是一种用于治疗严重难治性哮喘的新技术。在支气管镜检查期间向气道壁提供放射性物质以减少气道重塑。几项临床研究报告了BT后受试者症状的改善。然而，BT如何影响气道结构和炎症介质在airways.Methods：在这项研究中招募了14名严重哮喘患者根据ATS严重哮喘定义的标准。研究受试者在基线和初始BT治疗后6周的支气管镜检查过程中进行支气管活检。用α-平滑肌肌动蛋白（α-SMA）、蛋白基因产物（PGP）9.5（一种特异性神经标记物）、血管性血友病因子（vWF）、白细胞介素-17 A（IL-17 A）和转化生长因子-β 1（TGF-β 1）的抗体对获得的样本进行染色。基线和BT后的血管数量无显著差异。此外，BT不影响气道中IL-17 A和TGF-β 1的产生。α-SMA和PGP9.5表达的变化与肺功能的改善无显著相关性。结论：和临床意义：本研究表明，BT降低气道平滑肌质量和气道神经支配，而不影响血管和炎症介质的产生在严重哮喘患者的气道。
Background: Bronchial thermoplasty (BT) is a novel technique used in the treatment of subjects with severe refractory asthma. Radiofrequency is provided to airway walls during bronchoscopy in order to reduce airway remodeling. Several clinical studies have reported an improvement in subjects' symptoms following BT. However, how BT affects the airway architectures and inflammatory mediators in the airways has not been yet fully elucidated.Methods: Fourteen subjects with severe asthma were recruited in this study according to the criteria of ATS severe asthma definition. The study subjects undertook bronchial biopsy during the bronchoscopy procedure at baseline and 6 weeks after the initial BT treatment. The obtained samples were stained with antibodies for alpha-smooth muscle actin (alpha-SMA); protein gene product (PGP) 9.5, a specific nerve marker; von Willebrand factor (vWF), a marker for blood vessels; interleukin-17A (IL-17A) and transforming growth factor-beta 1 (TGF-beta 1).Results: The expression of alpha-SMA and PGP9.5 were significantly reduced post-BT. There was no significant difference in the number of blood vessels between baseline and post-BT. In addition, BT did not affect the production of IL-17A and TGF-beta 1 in the airways. The changes in the expression of alpha-SMA and PGP9.5 had no significant correlation with the improvement of pulmonary function.Conclusion: and Clinical Relevance: This study suggests that BT reduces airway smooth muscle mass and the airway innervation without affecting vasculature and the production of inflammatory mediators in the airways of subjects with severe asthma.