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BAL neutrophilia in azithromycin-treated lung transplant recipients: Clinical significance.
- Source :
-
Transplant immunology [Transpl Immunol] 2015 Sep; Vol. 33 (1), pp. 37-44. Date of Electronic Publication: 2015 Jul 11. - Publication Year :
- 2015
-
Abstract
- Background: Azithromycin decreases airway neutrophilia and can prevent chronic lung allograft dysfunction (CLAD) after lung transplantation (LTx). It also can be used to treat lymphocytic bronchiolitis, as it decreases the submucosal infiltrating IL-17 positive lymphocytes. Some patients, while receiving azithromycin, (re)develop increased airway neutrophilia, which we hypothesize to result in worse outcome and to be regulated by an IL-17-independent mechanism.<br />Methods: LTx recipients, transplanted between 2001 and 2012, were investigated and categorized in a study group of patients with increased broncho-alveolar lavage (BAL) neutrophilia (≥15%) and a matched control group with low BAL neutrophilia (<15%), both groups while already being on azithromycin treatment. CLAD-free and overall survival were compared between groups. Cell differentials and 33 proteins in BAL were analyzed to identify underlying mechanisms.<br />Results: The study group (n=72) demonstrated a significantly lower CLAD-free (p=0.015) and overall survival (p=0.041) compared to the control group (n=37). Absolute BAL neutrophils and eosinophils were increased in the study group, which was paralleled by elevated inflammatory cytokines (IL-1β/IL-1Ra, IL-4 and IL-6) and chemokines (CXCL8/IL-8, CCL2/MCP-1, CCL3/MIP-1α, CCL4/MIP-1β, CCL11/eotaxin) concentrations compared to the control group (all p<0.05).<br />Conclusion: Patients with elevated airway neutrophilia despite azithromycin, experience worse CLAD-free and overall survival. In these patients, IL-1β might play a central role giving rise to neutrophils, eosinophils, macrophages and B-cells. This provides an opportunity to further investigate the modulation of this pathway.<br /> (Copyright © 2015 Elsevier B.V. All rights reserved.)
- Subjects :
- Disease-Free Survival
Female
Humans
Male
Middle Aged
Survival Rate
Azithromycin administration & dosage
Bronchoalveolar Lavage Fluid immunology
Cytokines immunology
Leukocyte Disorders drug therapy
Leukocyte Disorders immunology
Leukocyte Disorders mortality
Leukocyte Disorders pathology
Lung Diseases drug therapy
Lung Diseases immunology
Lung Diseases mortality
Lung Diseases pathology
Lung Transplantation
Subjects
Details
- Language :
- English
- ISSN :
- 1878-5492
- Volume :
- 33
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Transplant immunology
- Publication Type :
- Academic Journal
- Accession number :
- 26168736
- Full Text :
- https://doi.org/10.1016/j.trim.2015.07.001