Variations of Inflammatory Mediators and α₁-Antitrypsin Levels after Lung Volume Reduction Surgery for Emphysema

Abstract

LVRS significantly reduced circulating inflammatory mediators and increased antiprotease levels over respiratory rehabilitation, also improving respiratory function and nutritional status. Correlations of inflammatory mediators and antiprotease levels with RV and, partly, with body composition suggest that elimination of inflammatory emphysematous tissue may explain clinical improvements after surgery.

Weight Gain after Lung Reduction Surgery Is Related to Improved Lung Function and Ventilatory Efficiency

“…There was also a profound decrease in respiratory muscle oxygen consumption by 44.1%, which correlated well with decreases in RV after surgery. Another study of 28 LVRS patients found significant reductions in serum levels of TNF-a, IL-6, and IL-8 after surgery, which again correlated with reductions in RV (11). Similarly, in 33 LVRS patients, the reduction in RV correlated with increases in serum ghrelin (an appetite-stimulating hormone), decreases in serum leptin (a fat-burning hormone and appetite suppressant), and increases in fat-free mass (6).…”

“…Lung volume reduction surgery (LVRS) has been shown to decrease mortality in select patients with advanced emphysema (10) and may improve systemic inflammation and nutritional status (6,11). In whom LVRS will cause weight gain and the mechanisms responsible are currently not well characterized.…”

Atelectasis and survival after bronchoscopic lung volume reduction for COPD

“…Dynamic hyperinflation has been shown to be associated with reductions in daily physical activity [28], which is itself associated with accelerated disease progression [29] and increased comorbidity [30]. Interestingly, a reduction in systemic inflammation following LVRS was observed by MINEO et al [31]; the authors suggested that this is because of the removal of diseased lung, but an alternative hypothesis is that a reduced work of breathing leads to a reduction in sympathetic activation [32] and reduced cardiac compromise from hyperinflation [33]. This would be an interesting hypothesis to test in subsequent studies with BLVR approaches.…”

Hypoxia and muscle maintenance regulation

“…Mineo et al [61] showed improvements in muscle mass that were maintained for at least 5 years following LVRS and were associated with improved outcomes. Interestingly, they also reported a decrease in plasmatic inflammatory markers, such as TNF-a, IL-6 and IL-8, 1 year after surgery [62 ], pointing towards the pre-existence of hypoxia-induced systemic inflammation. After lung transplantation, thus despite correction of hypoxemia, only partial restoration of muscle OXPHEN has been reported, suggesting a long-lasting signature of chronic hypoxia that could partially be reversed by rehabilitation [63][64][65].…”