GRADS Cooperative Research Project: JHU Clinical Center

描述（由申请人提供）： 结节病和α-1抗胰蛋白酶缺乏症是不常见的，研究不足的疾病，缺乏安全，有效的治疗方法。结节病是一种多系统肉芽肿性疾病，超过90%的受影响个体涉及肺部，并可能导致终末期肺纤维化和死亡。在美国，发病率为每10万人中约10-40人，结节病是一个重要的健康问题和健康差异问题。结节病的病理特征是非干酪化性肉芽肿和疾病部位的极化Th 1免疫。缓解期和慢性进展性疾病在器官受累、严重程度和临床病程方面存在巨大的临床异质性。除了受影响组织的活检外，没有结节病的诊断测试，也没有临床上有用的生物标志物用于风险分层，预后或治疗反应。该研究的目的是通过对系统表型受试者进行基因组学和微生物组学分析，确定分子异常及其与疾病特征的关系，并阐明致病机制和确定疾病的预测因子。拟定的目标1研究将对新诊断的结节病患者进行系统性表型分析，并为研究范围内的基因组和微生物组学分析提供肺、血液和组织样本。将建立研究范围内的方案，以评价结节病中对候选病原微生物抗原的抗原特异性免疫应答，并将这些动态指标与临床表型和基因组/微生物组学分析相关联。提出的目标2研究将通过将血液、肺和组织中的SAA水平与临床表型和基因组/微生物组学分析相关联，评估SAA对结节病中血液和肺细胞的促炎和促纤维化作用，并确定介导这些效应的受体途径。这些研究可能建立特定临床表型、微生物病因学和常见致病机制之间的联系，为结节病的新治疗方法提供框架。

DESCRIPTION (provided by applicant): Sarcoidosis and Alpha-1 Antitrypsin Deficiency are uncommon, understudied diseases that lack safe, effective treatments. Sarcoidosis is a multisystem granulomatous disorder that involves the lungs in over 90% of affected individuals and may cause end-stage pulmonary fibrosis and death. With an incidence of ~10-40 per 100,000 people in the U.S., sarcoidosis represents a significant health problem and health disparity concern. The pathologic hallmarks of sarcoidosis are non-caseating granulomas and polarized Th1 immunity at sites of disease. There is tremendous clinical heterogeneity with respect to organ involvement, severity and clinical course with both remitting and chronic progressive disease. There are no diagnostic tests for sarcoidosis except for biopsy of affected tissues, and no clinically useful biomarkers for risk stratification, prognosis or response to treatment. The goals of the study are to identify molecular abnormalities and their relationship to disease characteristics by employing genomics and microbiomics analyses of systematically phenotyped subjects, and to elucidate pathogenic mechanisms and identify predictors of disease. Proposed Aim 1 studies will systematically phenotype newly diagnosed sarcoidosis patients and provide lung, blood and tissue samples for study wide genomic and microbiomic analyses. Study-wide protocols will be established to evaluate the antigen specific immune responses to candidate pathogenic microbial antigens in sarcoidosis and correlate these dynamic measures with clinical phenotype and genomic/microbiomic analyses. Proposed Aim 2 studies will explore the hypothesis that serum amyloid A, an acute phase reactant and amyloid precursor protein, is a central mediator of chronic inflammation and fibrosis by correlating SAA levels in blood, lung and tissues with clinical phenotype and genomic/microbiomic analyses, assessing the proinflammatory and profibrotic cytokine-inducing effects of SAA on blood and lung cells in sarcoidosis, and identifying the receptor pathways that mediate these effects. These studies may establish links between specific clinical phenotypes, microbial etiologies, and common pathogenic mechanisms to provide a framework for new therapeutic approaches to sarcoidosis.