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2.
Biotechnol Bioeng ; 118(6): 2168-2183, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33629351

RESUMO

At the end of 2019, respiratory coronavirus diseases 2019 (COVID-19) appeared and spread rapidly in the world. Besides several mutations, the outcome of this pandemic was the death up to 15% of hospitalized patients. Mesenchymal stromal cell therapy as a therapeutic strategy seemed successful in treatment of several diseases. Not only mesenchymal stromal cells of several tissues, but also their secreted extracellular vesicles and even secretome indicated beneficial therapeutic function. All of these three options were studied for treatment of COVID-19 as well as those respiratory diseases that have similar symptom. Fortunately, most of the outcomes were promising and optimistic. In this paper, we review in-vivo and clinical studies which have been used different sources of mesenchymal stromal cell, secreted extracellular vesicles, and secretome to improve and treat symptoms of COVID-19 and similar lung diseases.


Assuntos
/terapia , Vesículas Extracelulares/transplante , Transplante de Células-Tronco Mesenquimais , Animais , Humanos , Pneumopatias/terapia , Células-Tronco Mesenquimais
3.
Am J Ther ; 28(2): e217-e223, 2021 Feb 03.
Artigo em Inglês | MEDLINE | ID: mdl-33590991

RESUMO

BACKGROUND: The current coronavirus disease 2019 (COVID-19) pandemic has caused a significant strain on medical resources throughout the world. A major shift to telemedicine and mobile health technologies has now taken on an immediate urgency. Newly developed devices designed for home use have facilitated remote monitoring of various physiologic parameters relevant to pulmonary diseases. These devices have also enabled home-based pulmonary rehabilitation programs. In addition, telemedicine and home care services have been leveraged to rapidly develop acute care hospital-at-home programs for the treatment of mild-to-moderate COVID-19 illness. AREAS OF UNCERTAINTY: The benefit of remote monitoring technologies on patient outcomes has not been established in robust trials. Furthermore, the use of these devices, which can increase the burden of care, has not been integrated into current clinical workflows and electronic medical records. Finally, reimbursement for these telemedicine and remote monitoring services is variable. DATA SOURCES: Literature review. THERAPEUTIC ADVANCES: Advances in digital technology have improved remote monitoring of physiologic parameters relevant to pulmonary medicine. In addition, telemedicine services for the provision of pulmonary rehabilitation and novel hospital-at-home programs have been developed. These new home-based programs have been adapted for COVID-19 and may also be relevant for the management of acute and chronic pulmonary diseases after the pandemic. CONCLUSION: Digital remote monitoring of physiologic parameters relevant to pulmonary medicine and novel hospital-at-home programs are feasible and may improve care for patients with acute and chronic respiratory-related disorders.


Assuntos
Pneumopatias , Telemedicina , Tecnologia Biomédica/tendências , /terapia , Humanos , Pneumopatias/diagnóstico , Pneumopatias/reabilitação , Pneumopatias/terapia , Pneumologia/tendências , Telemedicina/métodos , Telemedicina/organização & administração
4.
BMC Palliat Care ; 20(1): 8, 2021 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-33422058

RESUMO

BACKGROUND: Palliative care improves the quality of lives of patients and families affected by advanced illnesses through the prevention and relief of suffering. While palliative care is well established in developed countries, it is inadequate or non-existent in most developing countries. Palliative care is an emerging concept in Bhutan, a tiny Himalayan Kingdom. A small community palliative care service is available in the national referral hospital with three dedicated inpatient palliative care beds. This study explored the needs for palliative care among patients diagnosed with advanced illnesses and is a component of a larger project aimed to inform a suitable palliative care model for the country. METHODS: This is a cross-sectional descriptive study. A survey, using a structured questionnaire including the EORTC QLQ-C30, was carried out among patients with advanced illness in hospitals, primary care units and communities across the country. Purposeful and snowball sampling strategies were used to recruit study participants. RESULTS: Seventy (76%), out of 93 eligible patients, agreed to participate in the survey. Participants reported low to moderate scores on physical, role, emotional, cognitive and social functioning, a moderate score for the global health/ quality of life scale and moderately high (worse) scores in symptoms including fatigue, pain, insomnia, loss of appetite and the financial impact from the disease. CONCLUSIONS: The symptom burden experienced by patients affected by advanced illnesses demonstrates the need for palliative care in Bhutan. These findings will help inform the development of a public health-focused palliative care model, modified to the Bhutanese context, as recommended by the World Health Organization.


Assuntos
Infecções por HIV/fisiopatologia , Determinação de Necessidades de Cuidados de Saúde , Neoplasias/fisiopatologia , Cuidados Paliativos , Qualidade de Vida , Insuficiência Renal Crônica/fisiopatologia , Tuberculose Resistente a Múltiplos Medicamentos/fisiopatologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Pessoal Técnico de Saúde , Butão , Cognição , Feminino , Infecções por HIV/psicologia , Infecções por HIV/terapia , Humanos , Hepatopatias Alcoólicas/fisiopatologia , Hepatopatias Alcoólicas/psicologia , Hepatopatias Alcoólicas/terapia , Pneumopatias/fisiopatologia , Pneumopatias/psicologia , Pneumopatias/terapia , Masculino , Pessoa de Meia-Idade , Neoplasias/psicologia , Neoplasias/terapia , Enfermeiras e Enfermeiros , Médicos , Insuficiência Renal Crônica/psicologia , Insuficiência Renal Crônica/terapia , Traumatismos da Medula Espinal/fisiopatologia , Traumatismos da Medula Espinal/psicologia , Traumatismos da Medula Espinal/terapia , Doente Terminal , Tuberculose Resistente a Múltiplos Medicamentos/psicologia , Tuberculose Resistente a Múltiplos Medicamentos/terapia , Adulto Jovem
5.
J Paediatr Child Health ; 57(1): 15-18, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33404128

RESUMO

Nontuberculous mycobacteria (NTM) are ubiquitous organisms in our surrounding environment. Four distinct clinical syndromes associated with NTM infection have been described: skin and soft tissue disease, lymphadenitis, disseminated disease and pulmonary disease. In children, lymphadenitis is the most common NTM clinical entity, particularly affecting those aged 1-5 years who have no known risk factors for disease. Optimal management of NTM lymphadenitis is not entirely clear, although surgical intervention is likely a definitive therapy. Disseminated NTM disease is uncommon and only seen in the setting of immunocompromise. In previously well children, this presentation should always lead to consideration of an underlying immune defect, such as Mendelian susceptibility to mycobacterial disease. Identification of the underlying cause enables more targeted therapy and better prognostic understanding. Pulmonary NTM disease is fundamentally different to the other clinical syndromes, presenting in different hosts, who have different comorbidities, and follow a different clinical course.


Assuntos
Pneumopatias , Infecções por Mycobacterium não Tuberculosas , Criança , Pré-Escolar , Humanos , Lactente , Pneumopatias/diagnóstico , Pneumopatias/etiologia , Pneumopatias/terapia , Infecções por Mycobacterium não Tuberculosas/diagnóstico , Infecções por Mycobacterium não Tuberculosas/tratamento farmacológico , Infecções por Mycobacterium não Tuberculosas/epidemiologia , Micobactérias não Tuberculosas , Prognóstico , Fatores de Risco
7.
Monaldi Arch Chest Dis ; 91(1)2021 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-33501822

RESUMO

COVID 19 pandemic has brought about a sea change in health care practices across the globe. All specialities have changed their way of working during the pandemic. In this study, we evaluated the impact of COVID-19 on the practice of interventional pulmonology at our centre. All interventional pulmonology procedures done during the three months after implementation of lockdown were evaluated retrospectively for patient demographics, clinical diagnosis, indication for procedure and diagnostic accuracy. The changes in practices, additional human resources requirement, the additional cost per procedure and impact on resident training were also assessed. Procedures done during the month of January 2020 were used as controls for comparison. Twenty-two flexible bronchoscopies (75.8%), four semirigid thoracoscopies (13.7%) and three EBUS-TBNAs (10.3%) were carried out during three month lockdown period as compared to 174 during January 2020. Twenty-three of the procedures were for the diagnostic indication (79%), and six were therapeutic (20.6%). The diagnostic yield in suspected neoplasm was 100% while for suspected infections was 58.3%. The percentage of independent procedures being done by residents reduced from 45.4% to 0%. The workforce required per procedure increased from 0.75 to 4-8, and the additional cost per procedure came out to be 135 USD. To conclude, COVID 19 has impacted the interventional pulmonology services in various ways and brought about a need to reorganize the services, while also thinking of innovative ideas to reduce cost without compromising patient safety.


Assuntos
Broncoscopia , Assistência à Saúde , Controle de Infecções , Pneumopatias , Broncoscopia/métodos , Broncoscopia/estatística & dados numéricos , /prevenção & controle , Assistência à Saúde/organização & administração , Assistência à Saúde/tendências , Técnicas de Diagnóstico do Sistema Respiratório/estatística & dados numéricos , Feminino , Humanos , Índia/epidemiologia , Controle de Infecções/instrumentação , Controle de Infecções/métodos , Pneumopatias/diagnóstico , Pneumopatias/epidemiologia , Pneumopatias/terapia , Masculino , Pessoa de Meia-Idade , Inovação Organizacional , Estudos Retrospectivos , Centros de Atenção Terciária/estatística & dados numéricos
8.
Sr Care Pharm ; 36(2): 97-103, 2021 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-33509333

RESUMO

OBJECTIVE: To describe the case of an 88-yearold male with rheumatoid arthritis who developed pulmonary manifestations. Treatment for his RA previously included various biologics, while at the time of pulmonary consultation included meloxicam, methotrexate, and abatacept. Following chest scans, bronchoscopy, needle biopsy, pulmonary function testing, and a thoracentesis, the diagnosis of pleural effusion and nodules associated with rheumatoid arthritis was determined. The patient was recommended to follow-up with the pulmonologist but was lost to follow-up because of nonpulmonary and nonrheumatoid arthritis complications.
SETTINGS: Ambulatory clinic pharmacy practice, Community pharmacy, Consultant pharmacy practice.
PRACTICE CONSIDERATIONS: Drugs used to treat rheumatoid arthritis may produce pulmonary toxicity similar to what is seen with the disease itself. Drug therapy may require modification if identified as an offending agent causing pulmonary manifestations. If fibrosing interstitial lung disease develops, the addition of nintedanib may need to be considered.
CONCLUSION: In order for pharmacists to better assist providers and patients and improve therapeutic outcomes, it is important for pharmacists to understand that pulmonary manifestations are common in patients having rheumatoid arthritis as well as with drugs used to treat rheumatoid arthritis.


Assuntos
Artrite Reumatoide/complicações , Pneumopatias/etiologia , Doenças Pleurais/etiologia , Derrame Pleural/diagnóstico , Abatacepte/efeitos adversos , Abatacepte/uso terapêutico , Idoso de 80 Anos ou mais , Antirreumáticos/efeitos adversos , Artrite Reumatoide/tratamento farmacológico , Artrite Reumatoide/etiologia , Biópsia , Broncoscopia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Feminino , Humanos , Pulmão/diagnóstico por imagem , Pneumopatias/terapia , Masculino , Metotrexato/efeitos adversos , Doenças Pleurais/terapia , Toracentese
9.
J Card Surg ; 36(2): 743-747, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33350513

RESUMO

Granulomatosis with polyangiitis (GPA, also known as Wegener's granulomatosis) is a type of systematic vasculitis that primarily involves the lung and kidney. Diffuse alveolar hemorrhage (DAH) and associated acute respiratory failure are uncommon but devastating complications of GPA. Experience in using extracorporeal membrane oxygenation (ECMO) to manage DAH caused by GPA is limited. We report two GPA patients with DAH that were successfully managed using ECMO support. Examining 13 cases identified in the literature and two of our own, we observed that most patients experienced rapid deterioration in respiratory function in conjunction with a precedent respiratory infection. All 15 patients received veno-venous ECMO support. The median duration of ECMO support was 11 days (interquartile range: 7.5-20.75 days). Bleeding was the most common complication, seen in four (26.7%) cases. All patients were successfully weaned off ECMO after a median length of hospital stay of 42 days (interquartile range: 30-78 days). We demonstrated that the use of ECMO is a reasonable and effective support option in the management of GPA patients with DAH. The risk of bleeding is high but maybe reduced using a lower anticoagulation goal.


Assuntos
Oxigenação por Membrana Extracorpórea , Granulomatose com Poliangiite , Pneumopatias , Granulomatose com Poliangiite/complicações , Granulomatose com Poliangiite/terapia , Hemorragia/etiologia , Hemorragia/terapia , Humanos , Pneumopatias/etiologia , Pneumopatias/terapia
10.
Pediatr Clin North Am ; 68(1): 103-130, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33228927

RESUMO

Immune deficiencies may alter normal lung function and protective mechanisms, resulting in a myriad of pulmonary manifestations. Primary immunodeficiencies involve multiple branches of the immune system, and defects may predispose to recurrent upper and lower respiratory infections by common pathogens; opportunistic infections; and autoimmune, inflammatory, and malignant processes that may result in interstitial pneumonias. Secondary immunodeficiencies may result from neoplasms or their treatment, organ transplant and immunosuppression, and from autoimmune diseases and their treatments. Primary and secondary immunodeficiencies and their pulmonary manifestations may be difficult to diagnose and treat. A multidisciplinary approach to evaluation is essential.


Assuntos
Síndromes de Imunodeficiência/complicações , Pneumopatias/etiologia , Pneumopatias/imunologia , Criança , Humanos , Imunidade Humoral , Imunidade Inata , Síndromes de Imunodeficiência/diagnóstico , Síndromes de Imunodeficiência/terapia , Imunossupressores/efeitos adversos , Pneumopatias/diagnóstico , Pneumopatias/terapia , Transplante de Órgãos/efeitos adversos
11.
Pediatr Clin North Am ; 68(1): 131-145, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33228928

RESUMO

Respiratory complications comprise a large proportion of the burden of mortality and morbidity in children with human immunodeficiency virus (HIV). HIV-associated lower respiratory tract infection (LRTI) has declined in incidence with early diagnosis and use of antiretroviral therapy (ART) but is widespread in areas with limited access to ART. HIV-exposed uninfected infants have a higher risk of LRTI early in life than unexposed infants. Pulmonary tuberculosis (PTB) presenting as acute or chronic disease is common in highly TB endemic areas. Chronic lung disease is common; preceding LRTI, PTB or late initiation of ART are risk factors.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/virologia , Infecções por HIV/complicações , Pneumopatias/virologia , Infecções Oportunistas Relacionadas com a AIDS/terapia , Fármacos Anti-HIV/efeitos adversos , Criança , Infecções por HIV/tratamento farmacológico , Humanos , Hospedeiro Imunocomprometido , Pneumopatias/terapia
12.
Pediatr Clin North Am ; 68(1): 147-166, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33228929

RESUMO

Children with rheumatic disease have rare pulmonary manifestations that may cause significant morbidity and mortality. These children are often clinically asymptomatic until disease has significantly progressed, so they should be screened for pulmonary involvement. There has been recent recognition of a high mortality-related lung disease in systemic-onset juvenile idiopathic arthritis; risk factors include onset of juvenile idiopathic arthritis less than 2 years of age, history of macrophage activation syndrome, presence of trisomy 21, and history of anaphylactic reaction to biologic therapy. Early recognition and treatment of lung disease in children with rheumatic diseases may improve outcomes.


Assuntos
Pneumopatias/etiologia , Doenças Reumáticas/complicações , Criança , Humanos , Pneumopatias/diagnóstico , Pneumopatias/terapia , Testes de Função Respiratória , Doenças Reumáticas/diagnóstico , Doenças Reumáticas/terapia
13.
Pediatr Clin North Am ; 68(1): 167-176, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33228930

RESUMO

Vasculitides are defined according to the vessel size involved, and they tend to affect certain organ systems. Pulmonary involvement is rare in the common childhood vasculitides, such as Kawasaki disease, IgA vasculitis (Henoch Schonlein purpura). On the other hand, lung involvement is common in a rare pediatric vasculitis, granulomatosis with polyangiitis (GPA) (Wegener granulomatosis), where respiratory system findings are common. A criterion in the Ankara 2008 classification criteria for GPA is the presence of nodules, cavities, or fixed infiltrates. The adult data suggest that rituximab may be an alternative to cyclophosphamide in induction treatment.


Assuntos
Pneumopatias/etiologia , Vasculite Sistêmica/complicações , Criança , Humanos , Pneumopatias/diagnóstico , Pneumopatias/terapia , Circulação Pulmonar , Vasculite Sistêmica/diagnóstico , Vasculite Sistêmica/terapia
14.
Pediatr Clin North Am ; 68(1): 177-191, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33228931

RESUMO

Respiration is an event of oxygen consumption and carbon dioxide production. Respiratory failure is common in pediatric neuromuscular diseases and the main cause of morbidity and mortality. It is a consequence of lung failure, ventilatory pump failure, or their combination. Lung failure often is due to chronic aspiration either from above or from below. It may lead to end-stage lung disease. Ventilatory pump failure is caused by increased respiratory load and progressive respiratory muscles weakness. This article reviews the normal function of the respiratory pump, general pathophysiology issues, abnormalities in the more common neuromuscular conditions and noninvasive interventions.


Assuntos
Pneumopatias/etiologia , Doenças Neuromusculares/complicações , Criança , Humanos , Pneumopatias/diagnóstico , Pneumopatias/terapia , Doenças Neuromusculares/diagnóstico , Doenças Neuromusculares/terapia , Respiração Artificial
15.
Pediatr Clin North Am ; 68(1): 209-222, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33228933

RESUMO

The causes of kidney disease in pediatric patients are evenly divided between congenital abnormalities of the kidney and urinary tract and acquired disorders. Nearly 10% to 15% of adults in the United States have chronic kidney disease (CKD); there are no comparable data in children. Regardless of patient age, CKD is a systemic problem that affects every organ system, including the lung. We review the tests used to diagnose and evaluate kidney disease and the main clinical syndromes that are likely to be encountered to aid the pulmonology consultant who is asked to evaluate patients with kidney disease.


Assuntos
Nefropatias/complicações , Pneumopatias/etiologia , Criança , Humanos , Nefropatias/diagnóstico , Nefropatias/terapia , Pneumopatias/diagnóstico , Pneumopatias/terapia , Terapia de Substituição Renal , Anormalidades Urogenitais/complicações
16.
Pediatr Clin North Am ; 68(1): 41-60, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33228942

RESUMO

Pulmonary manifestations of gastrointestinal (GI) diseases are often subtle, and underlying disease may precede overt symptoms. A high index of suspicion and a low threshold for consultation with a pediatric pulmonologist is warranted in common GI conditions. This article outlines the pulmonary manifestations of different GI, pancreatic, and liver diseases in children, including gastroesophageal reflux disease, inflammatory bowel disease, pancreatitis, alpha1-antitrypsin deficiency, nonalcoholic fatty liver disease, and complications of chronic liver disease (hepatopulmonary syndrome and portopulmonary hypertension).


Assuntos
Gastroenteropatias/complicações , Hepatopatias/complicações , Pneumopatias/etiologia , Pancreatopatias/complicações , Criança , Ecocardiografia , Gastroenteropatias/diagnóstico , Gastroenteropatias/terapia , Humanos , Hepatopatias/diagnóstico , Hepatopatias/terapia , Pneumopatias/diagnóstico , Pneumopatias/terapia , Pancreatopatias/diagnóstico , Pancreatopatias/terapia , Testes de Função Respiratória
17.
Pediatr Clin North Am ; 68(1): 61-80, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33228943

RESUMO

Pulmonary complications are common in children with hematologic or oncologic diseases, and many experience long-term effects even after the primary disease has been cured. This article reviews pulmonary complications in children with cancer, after hematopoietic stem cell transplant, and caused by sickle cell disease and discusses their management.


Assuntos
Doenças Hematológicas/complicações , Doenças Hematológicas/terapia , Pneumopatias/etiologia , Neoplasias/complicações , Neoplasias/terapia , Criança , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Humanos , Hospedeiro Imunocomprometido , Pneumopatias/diagnóstico , Pneumopatias/terapia
18.
Pediatr Clin North Am ; 68(1): 81-102, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33228944

RESUMO

Advances in technology, methodology, and deep phenotyping are increasingly driving the understanding of the pathologic basis of disease. Improvements in patient identification and treatment are impacting survival. This is true in endocrinology and inborn errors of metabolism, where disease-modifying therapies are developing. Inherent to this evolution is the increasing awareness of the respiratory manifestations of these rare diseases. This review updates clinicians, stratifying diseases spirometerically; pulmonary hypertension and diseases with a predisposition to recurrent pulmonary infection are discussed. This division is artificial; many diseases have multiple pathologic effects on respiration. This review does not cover the impact of obesity.


Assuntos
Doenças do Sistema Endócrino/complicações , Pneumopatias/etiologia , Doenças Metabólicas/complicações , Criança , Doenças do Sistema Endócrino/diagnóstico , Doenças do Sistema Endócrino/terapia , Humanos , Pneumopatias/diagnóstico , Pneumopatias/terapia , Doenças Metabólicas/diagnóstico , Doenças Metabólicas/terapia , Fenótipo
19.
Sci Rep ; 10(1): 22042, 2020 12 16.
Artigo em Inglês | MEDLINE | ID: mdl-33328527

RESUMO

The objective of this study was to evaluate a novel microstream method by comparison with PaCO2 and the more standard mainstream capnometer in intubated pediatric patients. We hypothesized that the novel microstream method would superior compared to the traditional mainstream method in predicting PaCO2. This was a prospective single-center comparative study. The study was carried out on 174 subjects with a total of 1338 values for each method. Data were collected prospectively from mainstream and microstream capnometer simultaneously and compared with PaCO2 results. Although both mainstream PetCO2 (mainPetCO2) and microstream PetCO2 (microPetCO2) were moderately correlated (r = 0.63 and r = 0.68, respectively) with PaCO2 values, mainPetCO2 was in better agreement with PaCO2 in all subjects (bias ± precision values of 3.8 ± 8.9 and 7.3 ± 8.2 mmHg, respectively). In those with severe pulmonary disease, the mainPetCO2 and microPetCO2 methods were highly correlated with PaCO2 (r = 0.80 and r = 0.81, respectively); however, the biases of both methods increased (14.8 ± 9.1 mmHg and 16.2 ± 9.0 mmHg, respectively). In cases with increased physiologic dead space ventilation, the agreement levels of mainPetCO2 and microPetCO2 methods became distorted (bias ± precision values of 20.9 ± 11.2 and 25.0 ± 11.8 mm Hg, respectively) even though mainPetCO2 and microPetCO2 were highly correlated (r = 0.78 and r = 0.78, respectively). It was found that the novel microstream capnometer method for PetCO2 measurements provided no superiority to the traditional mainstream method. Both capnometer methods may be useful in predicting the trend of PaCO2 due to significant correlations with the gold standard measurement in cases with severe pulmonary disease or increased physiological dead space -despite reduced accuracy.


Assuntos
Capnografia , Dióxido de Carbono/sangue , Pneumopatias/sangue , Pneumopatias/terapia , Respiração Artificial , Monitorização Transcutânea dos Gases Sanguíneos , Criança , Pré-Escolar , Estado Terminal , Feminino , Humanos , Lactente , Masculino , Estudos Prospectivos
20.
Isr Med Assoc J ; 22(12): 736-740, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33381943

RESUMO

BACKGROUND: Chronic lung diseases, especially emphysema and pulmonary fibrosis, are the third leading cause of mortality worldwide. Their treatment includes symptom alleviation, slowing of the disease progression, and ultimately organ transplant. Regenerative medicine represents an attractive alternative. OBJECTIVES: To develop a dual approach to lung therapy by engineering a platform dedicated to both remodeling pulmonary architecture (bronchoscopic lung volume reduction) and regeneration of lost respiratory tissue (scaffold). METHODS: The authors developed a hydrogel scaffold based on the natural polymers gelatin and alginate. The unique physical properties allow its injection through long catheters that pass through the working channel of a bronchoscope. The scaffold might reach the diseased area; thus, serving a dual purpose: remodeling the lung architecture as a lung volume reduction material and developing a platform for tissue regeneration to allow for cell or organoid implant. RESULTS: The authors' novel hydrogel scaffold can be injected through long catheters, exhibiting the physical and mechanical properties necessary for the dual treatment objectives. Its biocompatibility was analyzed on human fibroblasts and mouse mesenchymal cells. Cells injected with the scaffold through long narrow catheters exhibited at least 70% viability up to 7 days. CONCLUSIONS: The catheter-injectable gelatin-alginate hydrogel represents a new concept, which combines tissue engineering with minimal invasive procedure. It is an inexpensive and convenient to use alternative to other types of suggested scaffolds for lung tissue engineering. This novel concept may be used for additional clinical applications in regenerative medicine.


Assuntos
Hidrogéis/uso terapêutico , Pneumopatias/terapia , Engenharia Tecidual/métodos , Tecidos Suporte , Alginatos , Animais , Materiais Biocompatíveis/administração & dosagem , Materiais Biocompatíveis/uso terapêutico , Cateteres , Fibroblastos , Gelatina , Humanos , Hidrogéis/administração & dosagem , Injeções , Pulmão , Camundongos
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