Differences in Treatment Response in Bronchial Epithelial Cells from Idiopathic Pulmonary Fibrosis (IPF) Patients: A First Step towards Personalized Medicine?

Abstract

Idiopathic pulmonary fibrosis (IPF) has a detrimental prognosis despite antifibrotic therapies to which individual responses vary. IPF pathology is associated with oxidative stress, inflammation and increased activation of SRC family kinases (SFK). This pilot study evaluates individual responses to pirfenidone, nintedanib and SFK inhibitor saracatinib, markers of redox homeostasis, fibrosis and inflammation, in IPF-derived human bronchial epithelial (HBE) cells. Differentiated HBE cells from patients with and without IPF were analyzed for potential alterations in redox and profibrotic genes and pro-inflammatory cytokine secretion. Additionally, the effects of pirfenidone, nintedanib and saracatinib on these markers were determined. HBE cells were differentiated into a bronchial epithelium containing ciliated epithelial, basal, goblet and club cells. NOX4 expression was increased in IPF-derived HBE cells but differed on an individual level. In patients with higher NOX4 expression, pirfenidone induced antioxidant gene expression. All drugs significantly decreased NOX4 expression. IL-6 (p = 0.09) and IL-8 secretion (p = 0.014) were increased in IPF-derived HBE cells and significantly reduced by saracatinib. Finally, saracatinib significantly decreased TGF-β gene expression. Our results indicate that treatment responsiveness varies between IPF patients in relation to their oxidative and inflammatory status. Interestingly, saracatinib tends to be more effective in IPF than standard antifibrotic drugs.

Advances in common in vitro cellular models of pulmonary fibrosis

“…Through the release of cytokines and growth factors, bronchial epithelial cells stimulate cell differentiation and modify matrix deposition, chemotaxis and activation, thus augmenting lung host defense mechanisms. 24,25 Currently, models using bronchial epithelial cells, including primary cells and immortalized cell lines, are commonly used to establish pathological models of PF. Primary cells encompass human primary bronchial epithelial cells and mouse primary bronchial epithelial cells, while immortalized cell lines consist of the human bronchial epithelial-like cell line (16HBE) and the human bronchial epithelial cell line (BEAS-2B) (Table 2).…”

“…Besides, in PF, there is a presence of cells expressing markers characteristic of proximal airway epithelial cells within the distal lung, notably goblet cells, basal cells and ciliated cells. Through the release of cytokines and growth factors, bronchial epithelial cells stimulate cell differentiation and modify matrix deposition, chemotaxis and activation, thus augmenting lung host defense mechanisms 24,25 . Currently, models using bronchial epithelial cells, including primary cells and immortalized cell lines, are commonly used to establish pathological models of PF.…”