The Epidemiology, Etiology, Clinical Features, and Natural History of Emphysema

Kemp, Samuel V.; Polkey, Michael I.; Shah, Pallav L.

doi:10.1016/j.thorsurg.2009.03.003

Cited by 46 publications

(31 citation statements)

References 48 publications

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“…Emphysema is one of the major pathological manifestations of COPD, chronic obstructive pulmonary disease, which causes high and still-increasing morbidity and mortality in the United States and worldwide [1]. Closely associated with chronic cigarette smoking, this disease develops moderate-to-severe shortness of breath (dyspnea), resulting in physical and functional disability and eventually death, due to the progressive destruction and loss of the alveolar septa and the abnormal airspace enlargement in the lung [2,3].…”

Section: Introductionmentioning

confidence: 99%

Novel low molecular weight lignins as potential anti-emphysema agents: In vitro triple inhibitory activity against elastase, oxidation and inflammation

Saluja

Thakkar

et al. 2013

Pulmonary Pharmacology & Therapeutics

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No molecule has been found to be effective against emphysema to date primarily because of its complex pathogenesis that involves elastolysis, oxidation and inflammation. We here describe novel unsulfated or sulfated low molecular weight lignins (LMWLs) chemo-enzymatically prepared from 4-hydroxycinnamic acids monomers, as the first potent triple-action inhibitors of neutrophil elastase, oxidation and inflammation. The inhibitory potencies of three different cinnamic acid-based LMWLs were determined in vitro using chromogenic substrate hydrolysis assays, radical scavenging and lung cellular oxidative biomarker reduced glutathione (rGSH) assays, and lung cellular inflammatory biomarker NFκB and IL-8 assays, respectively. Each LWML uniquely displayed triple-action inhibition, among which CDSO3, a sulfated caffeic acid-based LMWL, was most potent. The half-maximal anti-human neutrophil elastase (HNE) potency of CDSO3 was 0.43 μM. This high potency arose from lignin-like oligomerization, which was further potentiated by 6.6-fold due to sulfation. Mechanistically, this elastase inhibition was of mixed-type, time-dependent and more selective to positively charged elastases. The half-maximal anti-oxidative potency of CDSO3 was 3.52 μM, 4.8-fold potentiated from that of the monomer, caffeic acid (CA). In contrast, the half-maximal inhibitory potency to TNFα-induced inflammation was 5–10 μM, despite no activity with the monomer. More intriguingly, this anti-inflammatory activity was essentially identical with different stimuli, okadaic acid and hydrogen peroxide (H2O2), which implied that CDSO3 acts directly on inflammatory cascades within the cells. Overall, oligomerization and sulfation produced or significantly potentiated the activity, in comparison to the monomer. Thus, sulfated and unsulfated LMWLs are novel non-peptidic 2.8–4.1 kDa macromolecules that exhibit for the first time potent triple inhibitory activity against elastase, oxidation and inflammation, the three major pathogenic mechanisms known to cause emphysema.

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Section: Introductionmentioning

confidence: 99%

Novel low molecular weight lignins as potential anti-emphysema agents: In vitro triple inhibitory activity against elastase, oxidation and inflammation

Saluja

Thakkar

et al. 2013

Pulmonary Pharmacology & Therapeutics

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“…Emphysema is characterized by a destructive process of the lung parenchyma resulting in permanent enlargement of air spaces distal to the terminal bronchioles. It is caused by cigarette smoking and associated with inhalation of smoke and dust [4]. This condition is also one of the main types of Chronic Obstructive Pulmonary Disease (COPD) as classified by the Global Initiative of Chronic Obstructive Lung Disease [5] (GOLD).…”

Section: Introductionmentioning

confidence: 99%

Aging and pulmonary emphysema: Current issues

Morsch¹,

Mansour²,

Silva³

2017

Geriatr Med Care

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This review aims to describe emphysema and age-related factors that might influence on its development. In addition, available treatments for this lung disease will be presented. The older adult population has been increasing as well as life expectancy. This demographic change is accompanied by an epidemiological transition, represented by a high incidence of chronic diseases, such as pulmonary emphysema. Emphysema is a devastating illness characterized by the destruction of alveoli walls. Symptoms may vary depending on the severity of the disease, but most patients report having dyspnea and difficulty in exhaling air, due to reduced compliance of the lungs and airway obstruction. The fundamental cause of emphysema is still unknown. It is understood that there is a relationship between cell inflammatory responses to toxic substances, such as tobacco as well as an imbalance between proteases and antiproteases. However, it has been suggested that age can play a key role in the development of this disease, especially because of cell senescence. Even though treatments are available to reduce emphysema symptoms, and specific therapies aiming to regenerate lungs are being tested, more research about this disease is crucial to find its fundamental cause and clarify the role of age on its development. Avoiding environment factors such as tobacco smoking and exposure to pollutants can help to prevent this disease. The aim of this paper is to discuss emphysema, available treatments as well as research conducted about promising interventions for the future. Additionally, the paper aims to discuss how age can contribute to its development.

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“…Treatment can slow its progression, but it cannot be cured. The emphysema subgroup is characterized by progressive alveolar damage and loss of alveolar structure, particularly alveolar tetherings [2]. The net effect is reduced surface area for gas exchange but also pressure-dependent airway collapse.…”

Section: Introductionmentioning

confidence: 99%

Endoscopic Lung Volume Reduction: An Expert Panel Recommendation

et al. 2016

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Chronic obstructive pulmonary disease (COPD) is a progressive condition comprising a constellation of disorders from chronic bronchitis, airflow obstruction through to emphysema. The global burden of COPD is estimated at more than 6% of the population. The standard of care is based on a combination of smoking cessation, immunization, pharmacological treatments and pulmonary rehabilitation. However, the more advanced stages of COPD are challenging to manage. In this situation, our current standards of care do not adequately control patient symptoms nor halt the progressive decline. For the emphysema phenotype, lung volume reduction surgery has shown a beneficial effect in selected patients but is counterbalanced by the morbidity experienced by some patients. Bronchoscopic volume reduction technologies have been developed to improve the clinical situation of emphysema patients. This expert statement provides broad guidance regarding patient selection and the current position of the available techniques for patients with advanced emphysema.

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The Epidemiology, Etiology, Clinical Features, and Natural History of Emphysema

Cited by 46 publications

References 48 publications

Novel low molecular weight lignins as potential anti-emphysema agents: In vitro triple inhibitory activity against elastase, oxidation and inflammation

Novel low molecular weight lignins as potential anti-emphysema agents: In vitro triple inhibitory activity against elastase, oxidation and inflammation

Aging and pulmonary emphysema: Current issues

Endoscopic Lung Volume Reduction: An Expert Panel Recommendation

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