Mucus clears from the trachea in a helix: a new twist to understanding airway diseases.

IF 9 1区 医学 Q1 RESPIRATORY SYSTEM Thorax Pub Date : 2024-06-14 DOI:10.1136/thorax-2023-221052
David Abelson, James Di Michiel, Clayton Frater, Mark Pearson, Robert Russo, Martin Wechselberger, Alice Cottee, Lucy Morgan
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Abstract

Background: Mucociliary clearance (MCC) is critical to lung health and is impaired in many diseases. The path of MCC may have an important impact on clearance but has never been rigorously studied. The objective of this study is to assess the three-dimensional path of human tracheal MCC in disease and health.

Methods: Tracheal MCC was imaged in 12 ex-smokers, 3 non-smokers (1 opportunistically imaged during acute influenza and repeated after recovery) and 5 individuals with primary ciliary dyskinesia (PCD). Radiolabelled macroaggregated albumin droplets were injected into the trachea via the cricothyroid membrane. Droplet movement was tracked via scintigraphy, the path of movement mapped and helical and axial models of tracheal MCC were compared.

Measurements and main results: In 5/5 participants with PCD and 1 healthy participant with acute influenza, radiolabelled albumin coated the trachea and did not move. In all others (15/15), mucus coalesced into globules. Globule movement was negligible in 3 ex-smokers, but in all others (12/15) ascended the trachea in a helical path. Median cephalad tracheal MCC was 2.7 mm/min ex-smokers vs 8.4 mm/min non-smokers (p=0.02) and correlated strongly to helical angle (r=0.92 (p=0.00002); median 18o ex-smokers, 47o non-smokers (p=0.036)), but not to actual speed on helical path (r=0.26 (p=0.46); median 13.6 mm/min ex-smokers vs 13.9 mm/min non-smokers (p=1.0)).

Conclusion: For the first time, we show that human tracheal MCC is helical, and impairment in ex-smokers is often caused by flattened helical transit, not slower movement. Our methodology provides a simple method to map tracheal MCC and speed in vivo.

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粘液以螺旋状从气管中清除:了解气道疾病的新转折。
背景:黏膜纤毛清除(MCC)对肺部健康至关重要,在许多疾病中都会受损。MCC 的路径可能对清除有重要影响,但从未进行过严格研究。本研究的目的是评估人体气管 MCC 在疾病和健康状态下的三维路径:方法:对 12 名戒烟者、3 名非吸烟者(其中 1 人在急性流感期间进行了机会性成像,并在康复后进行了重复成像)和 5 名原发性睫状肌运动障碍(PCD)患者的气管 MCC 进行了成像。放射性标记的大聚合白蛋白液滴经环甲膜注入气管。通过闪烁扫描跟踪液滴运动,绘制运动路径图,并比较气管 MCC 的螺旋模型和轴向模型:在 5/5 名患有 PCD 的参与者和 1 名患有急性流感的健康参与者中,放射性标记的白蛋白覆盖了气管且没有移动。在其他所有参与者(15/15)中,粘液凝聚成球。3 名戒烟者的球状物移动可以忽略不计,但其他所有戒烟者(12/15)的球状物都以螺旋路径上升到气管。头侧气管 MCC 中位数为 2.7 毫米/分钟(戒烟者)和 8.4 毫米/分钟(非吸烟者)(p=0.02),与螺旋角密切相关(r=0.92(p=0.00002);前吸烟者的中位数为18o,非吸烟者为47o(p=0.036)),但与螺旋路径上的实际速度无关(r=0.26(p=0.46);前吸烟者的中位数为13.6毫米/分钟,非吸烟者为13.9毫米/分钟(p=1.0)):我们首次证明了人类气管 MCC 是螺旋形的,戒烟者的功能障碍通常是由扁平的螺旋运动而不是运动减慢造成的。我们的方法提供了一种绘制气管 MCC 和体内速度图的简单方法。
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来源期刊
Thorax
Thorax 医学-呼吸系统
CiteScore
16.10
自引率
2.00%
发文量
197
审稿时长
1 months
期刊介绍: Thorax stands as one of the premier respiratory medicine journals globally, featuring clinical and experimental research articles spanning respiratory medicine, pediatrics, immunology, pharmacology, pathology, and surgery. The journal's mission is to publish noteworthy advancements in scientific understanding that are poised to influence clinical practice significantly. This encompasses articles delving into basic and translational mechanisms applicable to clinical material, covering areas such as cell and molecular biology, genetics, epidemiology, and immunology.
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