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2014 ; 9
(ä): 533-42
Nephropedia Template TP
gab.com Text
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Twit Text #
English Wikipedia
A randomized controlled trial of inhaled corticosteroids (ICS) on markers of
epithelial-mesenchymal transition (EMT) in large airway samples in COPD: an
exploratory proof of concept study
#MMPMID24920891
Sohal SS
; Soltani A
; Reid D
; Ward C
; Wills KE
; Muller HK
; Walters EH
Int J Chron Obstruct Pulmon Dis
2014[]; 9
(ä): 533-42
PMID24920891
show ga
BACKGROUND: We recently reported that epithelial-mesenchymal transition (EMT) is
active in the airways in chronic obstructive pulmonary disease (COPD), suggesting
presence of an active profibrotic and promalignant stroma. With no data available
on potential treatment effects, we undertook a blinded analysis of inhaled
corticosteroids (ICS) effects versus placebo on EMT markers in previously
obtained endobronchial biopsies in COPD patients, as a "proof of concept" study.
METHODS: Assessment of the effects of inhaled fluticasone propionate (FP; 500 ?g
twice daily for 6 months) versus placebo in 34 COPD patients (23 on fluticasone
propionate and eleven on placebo). The end points were epidermal growth factor
receptor (EGFR; marker of epithelial activation) and the biomarkers of EMT:
reticular basement membrane (Rbm) fragmentation ("hallmark" structural marker),
matrix metalloproteinase-9 (MMP-9) cell expression, and S100A4 expression in
basal epithelial and Rbm cells (mesenchymal transition markers). RESULTS:
Epithelial activation, "clefts/fragmentation" in the Rbm, and changes in the
other biomarkers all regressed on ICS, at or close to conventional levels of
statistical significance. From these data, we have been able to nominate primary
and secondary end points and develop power calculations that would be applicable
to a definitive prospective study. CONCLUSION: Although only a pilot "proof of
concept" study, this trial provided strong suggestive support for an anti-EMT
effect of ICS in COPD airways. A larger and fully powered prospective study is
now indicated as this issue is likely to be extremely important. Such studies may
clarify the links between ICS use and better clinical outcomes and protection
against lung cancer in COPD.