ABSTRACT
BACKGROUND: Traditionally, clinical research has focused on individual fibrotic diseases or fibrosis in a particular organ. However, it is possible for people to have multiple fibrotic diseases. While multi-organ fibrosis may suggest shared pathogenic mechanisms, yet there is no consensus on what constitutes a fibrotic disease and therefore fibrotic multimorbidity. AIM: A Delphi study was performed to reach consensus on which diseases may be described as fibrotic. METHODS: Participants were asked to rate a list of diseases, sub-grouped according to eight body regions, as 'fibrotic manifestation always present', 'can develop fibrotic manifestations', 'associated with fibrotic manifestations' or 'not fibrotic nor associated'. Classifications of 'fibrotic manifestation always present' and 'can develop fibrotic manifestations' were merged and termed 'fibrotic'. Clinical consensus was defined according to the interquartile range, having met a minimum number of responses. Clinical agreement was used for classification where diseases did not meet the minimum number of responses (required for consensus measure), were only classified if there was 100% consensus on disease classification. RESULTS: After consulting experts, searching the literature and coding dictionaries, a total of 323 non-overlapping diseases which might be considered fibrotic were identified; 92 clinical specialists responded to the first round of the survey. Over three survey rounds, 240 diseases were categorized as fibrotic via clinical consensus and 25 additional diseases through clinical agreement. CONCLUSION: Using a robust methodology, an extensive list of diseases was classified. The findings lay the foundations for studies estimating the burden of fibrotic multimorbidity, as well as investigating shared mechanisms and therapies.
Subject(s)
Multimorbidity , Humans , Delphi Technique , Consensus , Fibrosis , Surveys and QuestionnairesABSTRACT
We describe the case of a 71-year-old man with idiopathic pulmonary fibrosis (usual interstitial pneumonia (UIP) pattern) diagnosed on clinical, radiological and lung function criteria, in accordance with the American Thoracic Society/European Respiratory Society consensus criteria (2000), who had been in close proximity to three atmospheric nuclear bomb blasts during military service in 1957. He does not have clubbing and clinically and radiologically his lung disease is stable. He also has bladder carcinoma and carotid arteriosclerosis, both recognised consequences of radiation injury. This is the first reported case of UIP in a nuclear test veteran. Awareness of this potential association is important given the current attempts of the British Nuclear Test Veterans Association to gain compensation for claimed injuries.
Subject(s)
Idiopathic Pulmonary Fibrosis/etiology , Nuclear Weapons , Radiation Injuries/complications , Veterans , Aged , Australia , Diagnosis, Differential , Humans , Idiopathic Pulmonary Fibrosis/diagnosis , Idiopathic Pulmonary Fibrosis/diagnostic imaging , Lung/diagnostic imaging , Lung/radiation effects , Male , Radiation Injuries/etiology , Tomography, X-Ray ComputedABSTRACT
The molecular basis of alpha(1)-antitrypsin deficiency is reviewed and is shown to be due to the accumulation of mutant protein as ordered polymers within the endoplasmic reticulum of hepatocytes. The current goals are to determine the cellular response to polymeric alpha(1)-antitrypsin and to develop therapeutic strategies to block polymerisation in vivo.
Subject(s)
Liver Diseases/metabolism , Lung Diseases/metabolism , alpha 1-Antitrypsin Deficiency/metabolism , alpha 1-Antitrypsin/chemistry , Humans , Mutation , Polymers/chemistry , alpha 1-Antitrypsin Deficiency/geneticsABSTRACT
alpha1-Antitrypsin (alpha1-AT) is the most abundant circulating proteinase inhibitor. The Z variant results in profound plasma deficiency as the mutant polymerizes within hepatocytes. The retained polymers are associated with cirrhosis, and the lack of circulating protein predisposes to early onset emphysema. We have investigated the role of the naturally occurring solute trimethylamine N-oxide (TMAO) in modulating the polymerization of normal M and disease-associated Z alpha1-AT. TMAO stabilized both M and Z alpha1-AT in an active conformation against heat-induced polymerization. Spectroscopic analysis demonstrated that this was due to inhibition of the conversion of the native state to a polymerogenic intermediate. However, TMAO did not aid the refolding of denatured alpha1-AT to a native conformation; instead, it enhanced polymerization. These data show that TMAO can be used to control the conformational transitions of folded alpha1-AT but that it is ineffective in promoting folding of the polypeptide chain within the secretory pathway.
Subject(s)
Methylamines/pharmacology , alpha 1-Antitrypsin Deficiency/drug therapy , alpha 1-Antitrypsin/drug effects , Homozygote , Humans , Protein Conformation/drug effects , Protein Denaturation/drug effects , Protein Folding , alpha 1-Antitrypsin Deficiency/geneticsABSTRACT
The effect of lithium ions on agonist-stimulated inositol polyphosphate production was investigated in slices of rat cerebral cortex. LiCl potentiated the formation of inositol monophosphate and inositol bisphosphate following stimulation with a variety of agonists including carbachol (1 mM), noradrenaline (NA, 300 ?M), 5-hydroxytryptamine (5-HT, 100 ?M) and quisqualic acid (Quis, 100 ?M), the EC(50) for these effects was in the range 0.5-5 mM. The production of inositol trisphosphate and inositol tetrakisphosphate following NA, 5-HT or Quis stimulation was not significantly affected by LiCl, though there was a delayed but striking inhibition of both the inositol 1,4,5-trisphosphate and, particularly, inositol tetrakisphosphate responses to carbachol, which was even greater in buffer containing elevated (20 mM) KCl. The possible mechanisms underlying this effect of LiCl are discussed in relation to previously observed effects of this ion on phosphoinositide metabolism.
