Hershey Medical Center Hershey Medical Center Geisinger Health System Geisinger Health System Univ of Penn Univ of Penn Temple University Temple University University of Pittsburgh UPMC Simmons Center
PA-IPF Registry home  

The Daniel and Joan Beren
Pennsylvania Idiopathic Pulmonary Fibrosis
State Registry

A project of the University of Pittsburgh, University of Pennsylvania, Penn State Milton S. Hershey Medical Center, Temple University, Geisinger Medical System

PA-IPF Hotline  1-866-922-4IPF (4473)


JOURNALS & CITATIONS

Am J Respir Crit Care Med
Eur Respir J
N Engl J Med
PLoS ONE
Proc Am Thorac Soc
Proc Natl Acad Sci USA
Respir Med

Physician Resources

PLoS ONE


PLoS ONE. 2007 May 30;2(5):e482

Accelerated variant of idiopathic pulmonary fibrosis: clinical behavior and gene expression pattern

Selman M, Carrillo G, Estrada A, Mejia M, Becerril C, Cisnercos J, Gaxiola M, Perez-Padilla R, Navarro C, Richards T, Dauber J, King TE, Jr., Pardo A, Kaminski N

Abstract

Background: Idiopathic pulmonary fibrosis (IPF) is characterized by the insidious onset of dyspnea or cough. However, a subset of patients has a short duration of symptoms with rapid progression to end-stage disease. In this study, we evaluated clinical and molecular features of “rapid” and “slow” progressors with IPF.

Methods and Findings: 26 patients with <6 months of symptoms before first presentation [rapid progressors] and 88 patients with >24 months of symptoms [slow progressors] were studied. Survival was analyzed by the Kaplan-Meyer method and proportional hazard's model. Lung microarrays and tissue proteins were measured in a subset of patients. No differences were found in age, physiologic impairment and bronchoalveolar lavage (BAL) cellular profile. There were more males (OR = 6.5; CI:1.4-29.5; p = 0.006) and smokers (OR = 3.04; CI:1.1-8.3; p = 0.04) in the rapid progressors group. Survival from the beginning of symptoms was significantly reduced in rapid progressors (HR = 9.0; CI:4.48-18.3; p<0.0001) and there was a tendency for decreased survival from the time of diagnosis (HR = 1.5; CI:0.81-2.87; p = 0.18). We identified 437 differentially expressed genes. Lungs of rapid progressors overexpressed genes involved in morphogenesis, oxidative stress, migration/proliferation, and genes from fibroblasts/smooth muscle cells. Upregulation of two of these genes, adenosine-2B receptor and prominin-1/CD133, was validated by immunohistochemistry and were expressed by alveolar epithelial cells. BAL from rapid progressors showed a >2-fold increase of active matrix metalloproteinase-9, and induced a higher fibroblast migration compared with slow progressors and controls [238±98% versus 123±29% (p<0.05) and 30±17% (p<0.01)].

Conclusions/Significance: A subgroup of IPF patients, predominantly smoking males, display an accelerated clinical course and have a gene expression pattern that is different from those with slower progression and longer survival. These findings highlight the variability in the progression of IPF, and may explain, in part, the difficulty in obtaining significant and reproducible results in studies of therapeutic interventions in patients with IPF.