Impact of Anti-fibrotic Medications on Post-COVID-19 Pulmonary Fibrosis: A Systematic Review and Meta-analysis.

OBJECTIVES: The impact of anti-fibrotic medications on pulmonary fibrosis caused by COVID-19 remains inconclusive and lacks systematic investigation. This study assessed the efficacy of anti-fibrotic drugs in addressing post-COVID-19 lung fibrosis. METHODS: We searched PubMed, Web of Science, Embase, and the Cochrane Library until June 15, 2024. The meta-analysis was performed using Review Manager. Heterogeneity was evaluated utilizing I2 statistic, and publication bias was assessed via funnel plots. RESULTS: The study (CRD42024552847) included 7 trials with 496 participants. No significant differences were observed in chest CT score (SMD= -0.60, 95% CI: -1.33 to 0.12, P= 0.10), length of hospital stay (MD= -1.34, 95% CI: -4.39 to 1.70, P= 0.39), and mortality (OR= 0.91, 95% CI: 0.50 to 1.64, P= 0.75) between anti-fibrosis and standard treatment groups. Notable improvements in pulmonary function were observed with anti-fibrotic drugs, as indicated by FEV1%pred (MD= 23.95, 95% CI: 12.24 to 35.67, P< 0.0001) and FEV1/FVC (MD= 18.17, 95% CI: 11.96 to 24.38, P< 0.00001). CONCLUSIONS: Anti-fibrotic medications may help reduce fibrotic lesions and improve pulmonary function in post-COVID-19 pulmonary fibrosis, but their practical use is currently based more on theory than on solid medical evidence. Currently, in clinical practice, the use of anti-fibrotic drugs in these patients primarily relies on empirical treatment. Further clinical studies are imperative to bolster its credibility for future applications.

Characterization of beta subunit variants of recombinant human chorionic gonadotrophin.

Human chorionic gonadotropin (hCG), an endogenous glycoprotein hormone, has been widely used for the treatment of infertility and corpus luteum defect in women. The biological specificity of hCG is essentially determined by its beta (ß-) subunit, whereas the alpha (α-) subunit is a common subunit shared among the gonadotropin family. In development of a therapeutic recombinant hCG, the purity analysis showed that the beta (ß-) subunit has two variants, ß1 and ß2. Structural characterization using a combination of analytical techniques has demonstrated that ß1-subunit is derived from non-glycosylation at Asn 13, whereas ß2-subunit is a normal species with complete N-glycosylation at both Asn 13 and Asn 30. In vivo Bioactivity evaluation of the r-hCG fractions with various ratios of ß1-and ß2-subunits showed that incomplete glycosylation at Asn 13 potentially reduced the biological activity of r-hCG to promote uterus growth. Although hCG has a long history of medicinal use, this is the first report to identify the structural difference of hCG ß-subunit variants, as well as to preliminary establish the structure-activity relationship of this variation. The obtained results also suggest the importance of variant characterization and necessary quality control of product variants during the development of recombinant protein therapeutics.

IL-1ß promotes IL-17A production of ILC3s to aggravate neutrophilic airway inflammation in mice.

IL-17A-producing group 3 innate lymphoid cells (ILC3s) have been found to participate in the development of various phenotypes of asthma, however, little is known about how ILC3s mediate neutrophilic airway inflammation. Elevated IL-1ß has been reported in neutrophilic asthma (NA) and IL-1ß receptor is highly expressed on lung ILC3s. Therefore, we hypothesize that IL-1ß aggravates neutrophilic airway inflammation via provoking IL-17A-producing ILC3s. We sought to determine the pathological roles of the IL-1ß-ILC3-IL-17A axis in neutrophilic airway inflammation. Lung ILC subsets were measured in eosinophilic asthma (ovalbumin [OVA]/Alum) and NA (OVA/lipopolysaccharides [LPS]) murine models. Rag2-/- (lacking adaptive immunity), RORc-/- (lacking transcription factor RORγt), Rag2-/- RORc-/- (lacking adaptive immunity and ILC3s), and ILCs depletion mice were used to verify the roles of ILC3s in neutrophilic airway inflammation by measurement of CXCL-1, IL-17A, IL-22 and neutrophil counts in bronchoalveolar lavage fluid (BALF), detection of Muc5ac in lung tissues, and quantification of IL-17A-producing ILC3s after treatment of anti-IL-17A or recombinant IL-1ß (rIL-1ß) and its monoclonal antibody. NLRP3, Caspase 1 and their induction of IL-1ß were detected in lung tissues of OVA/LPS-induced mice. The OVA/LPS model was characterized by an enrichment of airway neutrophilia, lung RORγt+ ILC3s and Th17 cytokines (IL-17A and IL-22) and neutrophilic chemokine C-X-C motif (chemokine) ligand 1 (CXCL-1), compared to the phenotypic features of airway eosinophilia, GATA3+ ILC2s and type-2 cytokines in OVA/Alum model. The concentration of CXCL-1 and neutrophil counts in BALF were decreased by anti-IL-17A. RORγt deficiency led to a decrease in IL-17A and CXCL-1 levels and neutrophil counts in BALF. ILC depletion in Rag2-/- mice ameliorated OVA/LPS-induced IL-17A, IL-22, CXCL-1 and airway neutrophil counts. IL-17A-producing ILCs and BALF neutrophil counts were significantly lower in Rag2-/- RORc-/- mice than those in Rag2-/- mice. IL-1ß was highly expressed in BALF and bronchial epithelial cells (BECs) in OVA/LPS model, and administration of rIL-1ß substantially aggravated airway inflammation and promoted upregulation of RORγt+ and IL-17A-producing lung ILC3s, which were reversed by anti-IL-1ß. NLRP3 and Caspase 1 expressions were enhanced by OVA/LPS, and their inhibitors abolished the OVA/LPS-induced IL-1ß in BECs. ILC3s play a pathogenic role in the pathogenesis of NA, which is triggered by IL-1ß via promoting IL-17A production of lung ILC3s.

Re-evaluation of the diagnostic value of fractional exhaled nitric oxide & its impact in patients with asthma.

BACKGROUND & OBJECTIVES: The diagnostic value of fractional exhaled nitric oxide (FeNO) in patients with asthma remains controversial. This study was aimed to re-evaluate the diagnostic value of FeNO in specific groups with asthma and identify potential factors associated with FeNO. METHODS: FeNO measurement and bronchial provocation test (BPT) or bronchodilator test (BDT) were performed in patients with suggestive symptoms for asthma. Correlation analysis was performed, and receiver-operating characteristic (ROC) curves and area under the curve (AUC) were calculated to evaluate the accuracy of FeNO in diagnosis. RESULTS: A total of 265 (66.3%) patients with asthma were identified in 400 individuals suspected to have asthma from October 2014 to June 2015. Positive correlations of gender (r=0.138, P=0.005), atopy (r=0.598, P <0.001) and rhinitis (r=0.485, P <0.001) but negative correlations of age (r=-0.220, P <0.001) and the cumulative methacholine dosage with a 20 per cent decrease in forced expiratory volume in one second (r=-0.197, P <0.001) with FeNO were found. AUC of FeNO in whole population and patients with atopy and rhinitis was 0.728 [95% confidence interval (CI) 0.675-0.781, P <0.001] and 0.752 (95% CI 0.640-0.865, P <0.001), while the cut-offs were 23.5 and 44.5 parts per billion (ppb), respectively, rendering sensitivities, specificities, positive predictive value and negative predictive value of 79.9, 54.7, 77.9, 58.1 and 78.7, 67.9, 89.2 and 48.7 per cent, respectively. The cut-off of FeNO with specificity of 90 per cent (FeNO90) for all patients and a sub-group of patients with atopy and rhinitis was 59.5 and 90.5 ppb, respectively, while FeNO90decreased by 12 ppb with every 10 years. INTERPRETATION & CONCLUSIONS: : Our findings show that the diagnostic value of FeNO varies in different groups of patients with asthma, thus, the cut-off point should be adjusted in different asthmatic sub-populations. A cut-off point of FeNO with a specificity >90 per cent could decrease the false-positive rate.

[Quality control of human chorionic gonadotrophin subunit dissociation].

Human chorionic gonadotrophin (hCG), a glycohormone widely used in treatment of infertility, is a heterodimer composed of an alpha- and a beta-subunit. The heterodimer could be dissociated during production and storage with an impact on its bioactivity. A CE-SDS method for quantitative analysis of hCG subunit dissociation was established in this study by optimization of a variety of method conditions including sample preparation buffer compositions, incubation temperature, separation voltage, and capillary temperature. This method was validated for good sensitivity, linearity, precision, and accuracy for both α- and ß-subunit. CE-SDS also showed much better precision and accuracy than SDS-PAGE. The method was successfully used in both recombinant hCG (r-hCG) produced by cell culture and hCG (u-hCG) derived from urine. The CE-SDS method was used in the study of hCG development and stability. Therefore, it is an useful tool for the quality control of hCG.

A morphologic study of the airway structure abnormalities in patients with asthma by high-resolution computed tomography.

BACKGROUND: Airway structure changes, termed as airway remodeling, are common in asthma patients due to chronic inflammation, which can be assessed by high-resolution computed tomography (HRCT). Considering the controversial conclusions in the correlation of morphologic abnormalities with clinical feature and outcome, we aimed to further specify and evaluate the structural abnormalities of Chinese asthmatics by HRCT. METHODS: From August 2012 to February 2015, outpatients with asthma were recruited consecutively in the Asthma Center of West China Hospital, Sichuan University. Standard HRCT and pulmonary function test (PFT) were performed to collect information of bronchial wall thickening, bronchial dilatation, mucus impaction, emphysema, mosaic perfusion, atelectasis, and spirometric parameters. We reported the incidence of each structural abnormality in HRCT and compared it among different asthmatic severities. RESULTS: A total of 123 asthmatics were enrolled, among which 84 (68.3%) were female and 39 (31.7%) were male. At least one structural abnormality was detected by HRCT in 85.4% asthmatics, and the incidence of bronchial wall thickening, bronchial dilatation, mucus impaction, emphysema, mosaic perfusion, and atelectasis was 57.7%, 51.2%, 22%, 24.4%, 5.7% and 1.6%, respectively. The incidences of bronchial wall thickening, bronchial dilation and emphysema were significantly increased by asthma severity (P<0.05), while incidences of mucus impaction (26/27, 96.30%), mosaic perfusion (6/7, 85.71%) and atelectasis (2/2, 100%) were mainly found in severe asthma. We found a longer asthma history (28.13±18.55 years, P<0.001, P=0.003), older age (51.30±10.70 years, P=0.022, P=0.006) and lower predicted percentage of forced expiratory volume in one second (FEV1%) (41.97±15.19, P<0.001, P<0.001) and ratio of forced expiratory volume to forced vital capacity (FEV1/FVC) (48.01±9.55, P<0.001, P<0.001) in patients with severe bronchial dilation compared with those in none and mild bronchial dilation. A negative correlation was also found between the extent of bronchial dilation and FEV1% as well as FEV1/FVC (r=-0.359, P=0.004; r=-0.266, P=0.035, respectively). CONCLUSIONS: The incidences of structural abnormalities detected by HRCT are fairly high in Chinese asthma populations, especially the bronchial wall thickening and bronchial dilation, which are significantly increased in severe asthma, and are potential risk factors of pulmonary function decline in asthmatics.

Risk Factors Associated with Irreversible Airway Obstruction in Asthma: A Systematic Review and Meta-Analysis.

Irreversible airway obstruction (IAO) is a subtype of asthma and relates to poorer prognosis in some asthma patients. However, the prevalence and risk factors for IAO are unknown. A systematic review regarding controlled clinical studies (cohort, case-control studies) on IAO asthma in adult and/or children affected by asthma/early wheeze was performed. Eighteen papers were identified in this study. It was reported that the incidence of IAO at random effects or fixed effects in severe asthma and nonsevere asthma was 0.54 (95% CI: 0.45-0.62) and 0.16 (95% CI: 0.12-0.20), respectively. In IAO asthma, the pooled odds ratio (OR) related to smoking exposure was 2.22 (95% CI: 1.82-2.73), the OR for male, smoking, and fractional exhaled nitric oxide (FENO) was 2.22 (95% CI: 1.82-2.7), 1.79 (95% CI: 1.46-2.19), and 2.16 (95% CI: 1.05-4.43), respectively, suggesting these factors increase the risk of IAO. However, a decreased OR in IAO asthma was observed due to rhinitis (OR = 0.31, 95% CI: 0.24-0.40), atopy (OR = 0.584, 95% CI: 0.466-0.732), and atopic dermatitis (OR = 0.60, 95% CI: 0.42-0.85), indicating these factors are associated with reduced risk of IAO. IAO in asthma is associated with gender, smoking, FENO, rhinitis, atopy, and atopic dermatitis.