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Genomic impact of cigarette smoke, with application to three smoking-related diseases.

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There is considerable evidence that inhaled toxicants such as cigarette smoke can cause both irreversible changes to the genetic material (DNA mutations) and putatively reversible changes to the epigenetic landscape (changes in the DNA methylation and chromatin modification state).

The diseases that are believed to involve genetic and epigenetic perturbations include lung cancer, chronic obstructive pulmonary disease (COPD), and cardiovascular disease (CVD), all of which are strongly linked epidemiologically to cigarette smoking.

In this review, we highlight the significance of genomics and epigenomics in these major smoking-related diseases. We also summarize the in vitro and in vivo findings on the specific perturbations that smoke and its constituent compounds can inflict upon the genome, particularly on the pulmonary system. Finally, we review state-of-the-art genomics and new techniques such as high-throughput sequencing and genome-wide chromatin assays, rapidly evolving techniques which have allowed epigenetic changes to be characterized at the genome level. These techniques have the potential to significantly improve our understanding of the specific mechanisms by which exposure to environmental chemicals causes disease.

Such mechanistic knowledge provides a variety of opportunities for enhanced product safety assessment and the discovery of novel therapeutic interventions.

Association of Matrix Metalloproteinase-1 Polymorphisms with Risk of COPD and Lung Cancer and Survival in Lung Cancer.

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BACKGROUND: The primary risk factor for chronic obstructive pulmonary disease (COPD) and non-small cell lung cancer (NSCLC) is cigarette smoking but shared susceptibility factors, such as variations in the matrix metalloproteinase-1 (MMP1) gene, may also underlie both diseases.

MATERIALS AND METHODS: Cases with prevalent COPD (n=167), incident NSCLC (n=242), or prevalent COPD plus incident NSCLC (n=128) were compared to disease-free controls (n=338) to assess six MMP1 polymorphisms. The association between these polymorphisms and survival in NSCLC was also evaluated.

RESULTS: Rs11292517 among African-Americans [odds ratio (OR)=5.48, 95% confidence interval (CI)=1.17-25.72] and rs2071230 among Caucasians (OR=2.51, 95% CI=1.09-5.77) appeared to be associated with NSCLC risk in the presence of COPD. Rs470558 appeared to be associated with survival in NSCLC among African-Americans (hazard ratio=3.94; 95%CI=1.14-13.63). No associations remained after adjusting for multiple comparisons.

CONCLUSION: Polymorphisms in MMP1 were not consistently associated with prevalent COPD or incident NSCLC nor with survival in NSCLC.

Endogenous lung regeneration: Potential and limitations.

The exploration of the endogenous regenerative potential of the diseased adult human lung represents an innovative and exciting task. In this pulmonary perspective, we discuss three major components essential for endogenous lung repair and regeneration: epithelial progenitor populations, developmental signaling pathways that regulate their reparative and regenerative potential, as well as the surrounding extracellular matrix in the human diseased lung.

Over the past years, several distinct epithelial progenitor populations have been discovered within the lung, all of which most likely respond to different injuries by varying degrees. It has become evident that several progenitor populations are mutually involved in maintenance and repair, which is highly regulated by developmental pathways, such as Wnt or Notch signaling. Third, endogenous progenitor cells and developmental signaling pathways act in close spatio-temporal synergy with the extracellular matrix. These three components define and refine the highly dynamic microenviroment of the lung, which is altered in a disease-specific fashion in several chronic lung diseases.

The search for the right mixture to induce efficient and controlled repair and regeneration of the diseased lung is ongoing and will open completely novel avenues for the treatment of patients with chronic lung disease.

Diagnostic value of exhaled carbon monoxide as an early marker of exacerbation in children with chronic lung diseases.

Chronic airways infection and inflammation are leading causes of morbidity and mortality in chronic lung diseases (CLD). Pulmonary exacerbations are major causes of morbidity in CLD. Exhaled carbon monoxide (eCO) is a product of endogenous metabolic processes whose presence in exhaled breath is considered an index of inflammatory processes.

Objective. To evaluate carbon monoxide (eCO) as inflammatory marker for early detection of acute exacerbation in CLD.

Methods. Case control study included 40 children with CLD (twenty in exacerbation, group I and twenty in quiescent period, group II) recruited from the Chest Clinic, Children's Hospital, Ain Shams University. Twenty apparently healthy children were included as controls (group III).

Results. Patients' mean age was 9.98 ± 3.29 years: 24 (60%) males and 16 (40%) females. The mean eCO level among patients during exacerbation was 5.35 ± 1.35 (ppm) compared to 2.65 ± 0.49 (ppm) in quiescent stage and 1.30 ± 0.47 (ppm) in controls. eCO cutoff value discriminating cases and control was 1.5 (ppm) (sensitivity; 100% and specificity 70%) and cutoff value discriminating group I from group II was 3 (ppm) (sensitivity: 100% and specificity: 100%).

Conclusion. Exhaled CO can be considered a noninvasive early marker of acute exacerbation of CLD.

Pulmonary embolism: risk assessment and management.

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Pulmonary embolism: risk assessment and management.

Eur Heart J. 2012 Sep 13;

Authors: Konstantinides S, Goldhaber SZ

Abstract
Acute pulmonary embolism (PE) poses a significant burden on health and survival. Its severity ranges from asymptomatic, incidentally discovered subsegmental thrombi to massive, pressor-dependent PE complicated by cardiogenic shock and multisystem organ failure. Rapid and accurate risk stratification is therefore of paramount importance to ensure the highest quality of care. This article critically reviews currently available and emerging tools for risk-stratifying acute PE, and particularly for distinguishing between elevated (intermediate) and low risk among normotensive patients. We focus on the potential value of risk assessment strategies for optimizing severity-adjusted management. Apart from reviewing the current evidence on advanced early therapy of acute PE (thrombolysis, surgery, catheter interventions, vena cava filters), we discuss recent advances in oral anticoagulation with vitamin K antagonists, and with new direct inhibitors of factor Xa and thrombin, which may contribute to profound changes in the treatment and secondary prophylaxis of venous thrombo-embolism in the near future.

PMID: 22961946 [PubMed - as supplied by publisher]

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