Prediction of exacerbation frequency of AECOPD based on next-generation sequencing and its relationship with imbalance of lung and gut microbiota: a protocol of a prospective cohort study

Abstract

IntroductionPatients with frequent acute exacerbation phenotype chronic obstructive pulmonary disease (AECOPD) have a higher hospitalisation rate than infrequent exacerbation, the disease progresses quickly and treatment is more difficult. At present, it is impossible to predict patients with COPD with frequent acute exacerbation phenotypes. The composition of the lower respiratory tract flora and the intestinal flora is closely related to AECOPD, but the specific association mechanism between them is not very clear. This study used metagenomic next-generation sequencing (mNGS) technology to explore the microbial characteristics of the intestinal tract and airways of patients with COPD, and analyse the correlation between the sequencing results and inflammatory factors, immune factors and nutritional factors.Methods and analysisThis will be a prospective cohort study. We intend to recruit 152 patients with stable COPD. In the baseline, we will detect the participants’ induced sputum and faecal flora through mNGS, and changes in blood immune levels, and the patient’s condition is evaluated. Every 2 months, we will check the number of acute exacerbation through the phone range. After 12 months, we will check again the changes in the blood immune level, evaluate the patient’s condition and count the number of episodes.Ethics and disseminationThis study has been approved by the ethics committee of Guangdong Provincial Hospital of Traditional Chinese Medicine (approval number ZF2019-219-03). The results of the study will be published in peer-reviewed journals.Trial registration numberClinicalTrials.gov Registry (ChiCTR2000032870).

The role of gut-lung axis in COPD: Pathogenesis, immune response, and prospective treatment

“…Studies have shown associations between gut dysbiosis and changes in lung microbiota composition, as well as the impact of lung microbiota disruptions on gut health [ 10 ]. In the stool of patients with stable COPD, the level of beneficial bacteria significantly decreased, such as bifidobacteria and lactobacilli [ 11 ]. Analysis of gut microbiota in COPD patients with different GOLD grades also revealed some correlations between severity and microbiota pattern: in COPD with GOLD 1, the abundance of Bacteroides was higher, and the abundances of Tyzzerella 4 and Microbacterium spp.…”

MRI-assessed diaphragmatic function can predict frequent acute exacerbation of COPD: a prospective observational study based on telehealth-based monitoring system

“…In the management of COPD, some researchers have argued that remote monitoring may be a promising alternative or an adjunct to traditional health care services [ 22 ]. In recent years, many studies have established risk factors prediction models for acute exacerbation in COPD patients through different monitoring methods, including electronic medical records [ 23 ], questionnaire diary records [ 24 ], or telephone follow-up [ 25 ]. Nonetheless, it is not always possible to monitor all exacerbations in terms of frequency, severity, and likely causes.…”

Microbiome Alteration in Lung Tissues of Tuberculosis Patients Revealed by Metagenomic Next-Generation Sequencing and Immune-Related Transcriptional Profile Identified by Transcriptome Sequencing

“…6 In the patients with acute exacerbation phenotype chronic obstructive pulmonary disease, mNGS was employed to explore the lung and gut microbiota, and it is expected that the clarified intestinal microenvironment of patients will benefit the drug development. 7 Advances in transcriptome sequencing technology (RNAseq) are broadening our vision of host responses to Mtb infection. Cai et al performed single-cell transcriptomics of blood and proved a depletion of natural killer cell subset in TB patients, which could be relieved after anti-TB treatment.…”

“…A study performing mNGS for 92 acute respiratory failure patients revealed the pathogens and the airway microbiome, thereby identifying patients with lower respiratory tract infections . In the patients with acute exacerbation phenotype chronic obstructive pulmonary disease, mNGS was employed to explore the lung and gut microbiota, and it is expected that the clarified intestinal microenvironment of patients will benefit the drug development …”