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Global, regional, and national burden of asthma from 1990 to 2021: A systematic analysis of the global burden of disease study 2021 1990年至2021年全球、区域和国家哮喘负担:2021年全球疾病负担研究的系统分析
Pub Date : 2025-03-01 DOI: 10.1016/j.pccm.2025.02.005
Zhenyu Mao , Xiaoyan Zhu , Pengdou Zheng , Lingling Wang , Fengqin Zhang , Lixiang Chen , Ling Zhou , Wei Liu , Huiguo Liu
<div><h3>Background</h3><div>Asthma is a prevalent non-communicable disease that affects individuals of all ages and has emerged as a significant global public health concern. This study aims to conduct a comprehensive assessment of the burden of asthma worldwide, as well as at regional and national levels, utilizing the Global Burden of Diseases (GBD) 2021 database for the years 1990 to 2021.</div></div><div><h3>Methods</h3><div>This study utilized the GBD 2021 database to report the prevalent cases and incident cases of asthma, alongside age-standardized prevalence rates (ASPR), age-standardized incidence rate (ASIR), the number of disability-adjusted life years (DALYs), age-standardized DALY rates (ASDR), the number of deaths, and age-standardized mortality rates (ASMR) at global, regional, and national levels for the year 2021. Additionally, it computed the estimated annual percentage change (EAPC) for these asthma burden indicators from 1990 to 2021. This study further analyzed the levels of the above indicators in different gender and age groups, and investigated the association between asthma ASDR/ASMR levels and socio-demographic index (SDI). It also provided an analysis of the contribution of four risk factors to the overall asthma burden.</div></div><div><h3>Results</h3><div>From 1990 to 2021, the global EAPC for asthma ASIR was −1.04 (95 % confidence interval [CI]:−1.18 to −0.89), the EAPC for ASPR was −1.59 (95 % CI:−1.74 to −1.43), the EAPC for ASDR was −1.91 (95 % CI:−1.98 to −1.84), and the EAPC for ASMR was −2.03 (95 % CI:−2.09 to −1.98). In 2021, the prevalent cases of asthma remained alarmingly high at 260.48 million (95 % UI: 227.21 million to 297.97 million). Developed countries, exemplified by the United States, exhibited elevated asthma ASPR. However, the burden of asthma-related mortality and DALYs predominantly afflicted low- and middle-income nations. In China, there has been a significant decline in ASIR, ASPR, ASDR and ASMR for asthma. In most age groups, the burden of asthma among women was markedly higher than that among men, particularly evident in prevalence and DALYs. Children and the elderly bore a heavier burden of asthma. In 2021, ASDR and ASMR levels varied across countries, generally exhibiting a negative correlation with SDI levels. A high body-mass index continued to be a primary risk factor for asthma on a global scale. Decomposition analysis reveals that population growth plays a significant role in exacerbating the burden of asthma-related deaths and DALYs.</div></div><div><h3>Conclusions</h3><div>From 1990 to 2021, the burden of asthma as measured by age-standardized rate (ASR) has shown a declining trend. However, the overall burden of asthma remains significantly high. Moreover, there is a notable inequality in the burden of asthma across different regions and populations worldwide. This highlights the urgent need for countries to prioritize asthma management and control strategies to address these dis
哮喘是一种流行的非传染性疾病,影响所有年龄段的个体,并已成为一个重大的全球公共卫生问题。本研究旨在利用全球疾病负担(GBD) 2021数据库,对1990年至2021年的全球哮喘负担以及区域和国家层面进行全面评估。方法:本研究利用GBD 2021数据库报告2021年全球、地区和国家各级哮喘的流行病例和发病率,以及年龄标准化患病率(ASPR)、年龄标准化发病率(ASIR)、残疾调整生命年(DALYs)、年龄标准化DALY率(ASDR)、死亡人数和年龄标准化死亡率(ASMR)。此外,它还计算了这些哮喘负担指标从1990年到2021年的估计年百分比变化(EAPC)。本研究进一步分析上述指标在不同性别和年龄组的水平,探讨哮喘ASDR/ASMR水平与社会人口指数(SDI)的关系。它还提供了四种风险因素对总体哮喘负担的贡献分析。结果从1990年到2021年,哮喘ASIR的全球EAPC为- 1.04(95% %置信区间[CI]: - 1.18至- 0.89),ASPR的EAPC为- 1.59(95% % CI: - 1.74至- 1.43),ASDR的EAPC为- 1.91(95% % CI: - 1.98至- 1.84),ASMR的EAPC为- 2.03(95% % CI: - 2.09至- 1.98)。2021年,哮喘流行病例仍然高得惊人,达2.6048亿例(95 % UI: 2.2721亿至2.7997亿)。以美国为代表的发达国家,哮喘的ASPR升高。然而,与哮喘有关的死亡率和残疾调整生命年的负担主要影响着低收入和中等收入国家。在中国,哮喘的ASIR、ASPR、ASDR和ASMR有明显下降。在大多数年龄组中,妇女的哮喘负担明显高于男子,这在患病率和残疾调整生命年方面尤为明显。儿童和老年人患哮喘的负担更重。2021年,各国的ASDR和ASMR水平各不相同,总体上与SDI水平呈负相关。在全球范围内,高体重指数仍然是哮喘的主要危险因素。分解分析表明,人口增长在加剧哮喘相关死亡和残疾调整生命年负担方面起着重要作用。结论从1990年到2021年,以年龄标准化率(ASR)衡量的哮喘负担呈下降趋势。然而,哮喘的总体负担仍然很高。此外,全世界不同地区和不同人群的哮喘负担存在显著不平等。这突出表明各国迫切需要优先考虑哮喘管理和控制战略,以解决这些差异并改善受影响个体的健康结果。
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引用次数: 0
Clinical management of checkpoint inhibitor pneumonitis: Focus, challenges, and future directions 检查点抑制剂肺炎的临床管理:焦点、挑战和未来方向
Pub Date : 2025-03-01 DOI: 10.1016/j.pccm.2024.12.001
Yan Xu, Ruxuan Chen, Ruili Pan, Xiaoxing Gao, Hui Huang, Mengzhao Wang
Immune checkpoint inhibitors (ICIs) have revolutionized the treatment landscape for various malignancies by demonstrating exceptional antitumor effects and significant improvement in patient survival. Despite their overt therapeutic advantages, ICIs also induce immune-related adverse events (irAEs). Of these, checkpoint inhibitor pneumonitis (CIP) represents a prominent manifestation of pulmonary toxicity following ICI therapy, with incidence rates ranging from 2.7 % to 20.0 %. Notably, a substantial proportion of CIP cases show severe manifestations, often leading to life-threatening complications, which emphasizes its clinical significance. Understanding the risk factors and potential pathogenetic mechanisms of CIP, combined with vigilant monitoring during immunotherapy, is pivotal for early detection and management of this condition. Proactive strategies for the timely identification, accurate diagnosis, and effective management of CIP are essential to optimize patient outcomes. However, several challenges persist in CIP management, including management of severe and refractory cases, determining the timing of ICI rechallenge after CIP, management of long-term chronic CIP, and mitigating secondary infections. In order to manage this potentially life-threatening irAE effectively, it is urgent to establish multi-disciplinary treatment (MDT) management, precision CIP management, and practical surveillance systems for CIP monitoring, diagnosis, and management and to call for prospective multi-center clinical trials.
免疫检查点抑制剂(ICIs)通过表现出卓越的抗肿瘤作用和显著提高患者生存率,彻底改变了各种恶性肿瘤的治疗前景。尽管具有明显的治疗优势,但ICIs也会诱导免疫相关不良事件(irAEs)。其中,检查点抑制剂肺炎(CIP)是ICI治疗后肺毒性的突出表现,发病率从2.7 %到20.0 %不等。值得注意的是,相当比例的CIP病例表现严重,往往导致危及生命的并发症,这强调了其临床意义。了解CIP的危险因素和潜在的发病机制,并结合免疫治疗期间的警惕监测,对这种疾病的早期发现和管理至关重要。及时识别、准确诊断和有效管理CIP的积极策略对于优化患者预后至关重要。然而,CIP管理仍然存在一些挑战,包括严重和难治性病例的管理,CIP后ICI再挑战的确定时间,长期慢性CIP的管理,以及减轻继发感染。为了有效地管理这一可能危及生命的irAE,迫切需要建立多学科治疗(MDT)管理、精确CIP管理和实用的CIP监测、诊断和管理监测系统,并呼吁开展前瞻性的多中心临床试验。
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引用次数: 0
Erratum regarding previously published articles 关于以前发表的文章的勘误
Pub Date : 2025-03-01 DOI: 10.1016/j.pccm.2024.09.001
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引用次数: 0
Advances in idiopathic pulmonary fibrosis diagnosis and treatment 特发性肺纤维化的诊断和治疗进展
Pub Date : 2025-03-01 DOI: 10.1016/j.pccm.2025.02.001
Hongli Liu , Jiaxi Shen , Chao He
Significant advances have been made in diagnosing and treating idiopathic pulmonary fibrosis (IPF) in the last decade. The incidence and prevalence of IPF are increasing, and morbidity and mortality remain high despite the two Food and Drug Administration (FDA)-approved medications, pirfenidone and nintedanib. Hence, there is an urgent need to develop new diagnostic tools and effective therapeutics to improve early, accurate diagnosis of IPF and halt or reverse the progression of fibrosis with a better safety profile. New diagnostic tools such as transbronchial cryobiopsy and genomic classifier require less tissue and generally have good safety profiles, and they have been increasingly utilized in clinical practice. Advances in artificial intelligence-aided diagnostic software are promising, but challenges remain. Both pirfenidone and nintedanib focus on growth factor-activated pathways to inhibit fibroblast activation. Novel therapies targeting different pathways and cell types (immune and epithelial cells) are being investigated. Biomarker-based personalized medicine approaches are also in clinical trials. This review aims to summarize recent diagnostic and therapeutic development in IPF.
在过去的十年中,特发性肺纤维化(IPF)的诊断和治疗取得了重大进展。IPF的发病率和流行率正在增加,尽管有两种美国食品和药物管理局(FDA)批准的药物吡非尼酮和尼达尼布,发病率和死亡率仍然很高。因此,迫切需要开发新的诊断工具和有效的治疗方法,以提高IPF的早期、准确诊断,并以更好的安全性阻止或逆转纤维化的进展。新的诊断工具,如经支气管冷冻活检和基因组分类器需要较少的组织,通常具有良好的安全性,并且在临床实践中越来越多地使用。人工智能辅助诊断软件的进步前景光明,但挑战依然存在。吡非尼酮和尼达尼布都通过生长因子激活途径抑制成纤维细胞的激活。针对不同途径和细胞类型(免疫细胞和上皮细胞)的新疗法正在研究中。基于生物标志物的个性化医疗方法也在临床试验中。本文综述了近年来IPF的诊断和治疗进展。
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引用次数: 0
Parkin deficiency aggravates inflammation-induced acute lung injury by promoting necroptosis in alveolar type II cells 帕金缺乏通过促进肺泡II型细胞坏死而加重炎症诱导的急性肺损伤。
Pub Date : 2024-12-01 DOI: 10.1016/j.pccm.2024.11.004
Meiyu Quan , Qiang Guo , Xihua Yan , Chenhua Yu , Linglong Yang , Yuting Zhang , Jiaqi Li , Qiongxia Weng , Bin Liu , Quan Li , Li Dong , Junjie Chen , Zhenkun Lou , Xuru Jin , Chengshui Chen , Jin-San Zhang

Background

Necroptosis is a form of programmed cell death resulting in tissue inflammation due to the release of intracellular contents. Its role and regulatory mechanism in the context of acute lung injury (ALI) are unclear. Parkin (Prkn), an E3 ubiquitin ligase, has recently been implicated in the regulation of necroptosis. In this study, we aimed to investigate the role and mechanism of Parkin in the process of ALI.

Methods

Lipopolysaccharides (LPS)-induced mouse ALI model was utilized, and the pathological changes in lung tissues were characterized. To elucidate the roles of Parkin and necroptosis in this context, mixed lineage kinase domain-like (Mlkl) knockout mice, Prkn conditional knockout mice, and the necroptosis inhibitor were employed. Additionally, alveolar type 2 (AT2) cell-specific Parkin deletion and lineage-tracing mice were introduced to explore the specific roles and mechanisms of Parkin in AT2 cells.

Results

A dose-dependent increase in Parkin expression in mouse lung tissues following LPS administration was observed, correlating with a shift from epithelial apoptosis to necroptosis. Notably, depletion of MLKL significantly mitigated the pathological changes associated with ALI, particularly the inflammatory response. Conversely, the deletion of Parkin exacerbated the injury pathology, significantly enhancing necroptosis, particularly in AT2 cells. This led to increased inflammation and post-LPS fibrosis. However, treatment with GSK872, a necroptosis inhibitor, substantially mitigated the phenotype induced by Parkin deletion. Importantly, Parkin deletion impaired the proliferation and differentiation of AT2 cells into AT1 cells.

Conclusions

These findings underscore the multifaceted role of Parkin in the progression of lung injury, inflammation, and fibrosis through the regulation of AT2 cell necroptosis. Therefore, Parkin may hold potential as a therapeutic target for managing lung injury and fibrosis.
背景:坏死性上睑下垂是一种程序性细胞死亡的形式,由于细胞内内容物的释放导致组织炎症。其在急性肺损伤(ALI)中的作用和调控机制尚不清楚。Parkin (Prkn)是一种E3泛素连接酶,最近被认为与坏死性坏死的调节有关。在本研究中,我们旨在探讨Parkin在ALI过程中的作用和机制。方法:采用脂多糖(LPS)诱导的小鼠ALI模型,观察肺组织病理变化。为了阐明Parkin和坏死性上睑下垂在这种情况下的作用,我们使用了混合谱系激酶结构域样(Mlkl)敲除小鼠、Prkn条件敲除小鼠和坏死性上睑下垂抑制剂。此外,引入肺泡2型(AT2)细胞特异性Parkin缺失和谱系追踪小鼠,探讨Parkin在AT2细胞中的具体作用和机制。结果:小鼠肺组织中Parkin表达在LPS作用下呈剂量依赖性增加,与上皮细胞凋亡向坏死下垂的转变有关。值得注意的是,MLKL的消耗显著减轻了与ALI相关的病理变化,特别是炎症反应。相反,Parkin基因的缺失加重了损伤病理,显著增强了坏死下垂,尤其是在AT2细胞中。这导致炎症增加和lps后纤维化。然而,用GSK872(一种坏死性下垂抑制剂)治疗可以显著减轻Parkin缺失引起的表型。重要的是,Parkin缺失损害了AT2细胞向AT1细胞的增殖和分化。结论:这些发现强调了Parkin通过调节AT2细胞坏死在肺损伤、炎症和纤维化进展中的多方面作用。因此,帕金可能作为治疗肺损伤和纤维化的潜在治疗靶点。
{"title":"Parkin deficiency aggravates inflammation-induced acute lung injury by promoting necroptosis in alveolar type II cells","authors":"Meiyu Quan ,&nbsp;Qiang Guo ,&nbsp;Xihua Yan ,&nbsp;Chenhua Yu ,&nbsp;Linglong Yang ,&nbsp;Yuting Zhang ,&nbsp;Jiaqi Li ,&nbsp;Qiongxia Weng ,&nbsp;Bin Liu ,&nbsp;Quan Li ,&nbsp;Li Dong ,&nbsp;Junjie Chen ,&nbsp;Zhenkun Lou ,&nbsp;Xuru Jin ,&nbsp;Chengshui Chen ,&nbsp;Jin-San Zhang","doi":"10.1016/j.pccm.2024.11.004","DOIUrl":"10.1016/j.pccm.2024.11.004","url":null,"abstract":"<div><h3>Background</h3><div>Necroptosis is a form of programmed cell death resulting in tissue inflammation due to the release of intracellular contents. Its role and regulatory mechanism in the context of acute lung injury (ALI) are unclear. Parkin (Prkn), an E3 ubiquitin ligase, has recently been implicated in the regulation of necroptosis. In this study, we aimed to investigate the role and mechanism of Parkin in the process of ALI.</div></div><div><h3>Methods</h3><div>Lipopolysaccharides (LPS)-induced mouse ALI model was utilized, and the pathological changes in lung tissues were characterized. To elucidate the roles of Parkin and necroptosis in this context, mixed lineage kinase domain-like (<em>Mlkl</em>) knockout mice, <em>Prkn</em> conditional knockout mice, and the necroptosis inhibitor were employed. Additionally, alveolar type 2 (AT2) cell-specific Parkin deletion and lineage-tracing mice were introduced to explore the specific roles and mechanisms of Parkin in AT2 cells.</div></div><div><h3>Results</h3><div>A dose-dependent increase in Parkin expression in mouse lung tissues following LPS administration was observed, correlating with a shift from epithelial apoptosis to necroptosis. Notably, depletion of MLKL significantly mitigated the pathological changes associated with ALI, particularly the inflammatory response. Conversely, the deletion of Parkin exacerbated the injury pathology, significantly enhancing necroptosis, particularly in AT2 cells. This led to increased inflammation and post-LPS fibrosis. However, treatment with GSK872, a necroptosis inhibitor, substantially mitigated the phenotype induced by Parkin deletion. Importantly, Parkin deletion impaired the proliferation and differentiation of AT2 cells into AT1 cells.</div></div><div><h3>Conclusions</h3><div>These findings underscore the multifaceted role of Parkin in the progression of lung injury, inflammation, and fibrosis through the regulation of AT2 cell necroptosis. Therefore, Parkin may hold potential as a therapeutic target for managing lung injury and fibrosis.</div></div>","PeriodicalId":72583,"journal":{"name":"Chinese medical journal pulmonary and critical care medicine","volume":"2 4","pages":"Pages 265-278"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11742354/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Role of GLCCI1 in inhibiting PI3K-induced NLRP3 inflammasome activation in asthma GLCCI1在抑制pi3k诱导的哮喘NLRP3炎性体激活中的作用。
Pub Date : 2024-12-01 DOI: 10.1016/j.pccm.2024.11.007
Yingyu Zhang , Yuanyuan Jiang , Daimo Zhang , Xinyue Hu , Shuanglinzi Deng , Xiaozhao Li , Juntao Feng

Background

Glucocorticoid-induced transcript 1 (GLCCI1) has been reported to be associated with the efficiency of inhaled glucocorticoids in patients with asthma. This study aimed to investigate the role of GLCCI1 in the regulation of nucleotide-binding oligomerization domain (NOD)-like receptor (NLR) family pyrin domain-containing 3 (NLRP3) by the phosphatidylinositol 3-kinase (PI3K) pathway in the pathogenesis of allergic asthma.

Methods

The expression levels of genes encoding GLCCI1, NLRP3 inflammasome components, and PI3K pathway-related indicators were detected in cells isolated from induced sputum from patients with asthma and healthy controls. Next, we induced asthma in wild-type C57BL/6 mice and Glcci1 knockout (Glcci1-/-) mice by injecting them with ovalbumin (OVA) and treated the asthmatic mice with a PI3K pathway inhibitor (LY294002) or left them untreated. We also performed adoptive transfer of macrophages into the mice and assessed lung inflammation, as well as GLCCI1, PI3K pathway component, and NLRP3 inflammasome component expression levels. Finally, primary bone marrow-derived macrophages (BMDMs) from wild-type and Glcci1-/- mice were treated with OVA, either in the presence or absence of LY294002 and the NLRP3 inhibitor (MCC950), to validate our findings.

Results

The mRNA level of Glcci1 in induced sputum cells from asthmatic patients was lower compared to that of healthy controls. Additionally, Glcci1 mRNA expression correlated negatively with NLRP3 inflammasome indicators and the PI3K pathway components, as well as with IL-1β expression in induced sputum macrophages. In vivo, Glcci1-/- asthmatic mice showed elevated levels of airway inflammation and NLRP3 inflammasome activation compared to wild-type asthmatic mice. Surprisingly, the efficacy of LY294002 in reducing lung tissue inflammation and NLRP3 inflammasome activity in wild-type asthmatic mice was attenuated by Glcci1 knockout. LY294002 enhanced GLCCI1 levels in macrophages within the lung tissue of wild-type asthmatic mice. Moreover, LY294002 did not inhibit lung inflammation in wild-type asthmatic mice depleted of macrophages that had received adoptive transfer of Glcci1-/- BMDMs. In vitro experiments further illustrated that LY294002 suppressed NLRP3 activation by upregulating GLCCI1 expression in BMDMs. The introduction of MCC950 led to a marked decrease in NLRP3 and apoptosis-associated speck-like protein containing a caspase recruitment domain (ASC) protein levels, but did not affect the expression levels of GLCCI1 or the phospho-protein kinase B (p-AKT)/AKT ratio.

Conclusions

GLCCI1 deficiency promotes asthma inflammation through PI3K-induced NLRP3 inflammasome activation.
背景:据报道,糖皮质激素诱导转录物1 (GLCCI1)与哮喘患者吸入糖皮质激素的效率有关。本研究旨在探讨GLCCI1在磷脂酰肌醇3-激酶(PI3K)通路调控核苷酸结合寡聚结构域(NOD)样受体(NLR)家族pyrin domain-containing 3 (NLRP3)在过敏性哮喘发病中的作用。方法:检测哮喘患者和健康对照的诱导痰细胞中编码GLCCI1、NLRP3炎性小体成分及PI3K通路相关指标基因的表达水平。接下来,我们通过给野生型C57BL/6小鼠和Glcci1敲除(Glcci1 -/-)小鼠注射卵清蛋白(OVA)诱导哮喘,并用PI3K途径抑制剂(LY294002)治疗或不治疗哮喘小鼠。我们还将巨噬细胞过继转移到小鼠体内,并评估肺部炎症,以及GLCCI1、PI3K通路成分和NLRP3炎症小体成分的表达水平。最后,在LY294002和NLRP3抑制剂(MCC950)存在或不存在的情况下,用OVA处理野生型和Glcci1 -/-小鼠的原代骨髓源性巨噬细胞(bmdm),以验证我们的发现。结果:哮喘患者诱导痰细胞中Glcci1 mRNA表达水平明显低于正常对照组。此外,在诱导的痰巨噬细胞中,glcci1mrna的表达与NLRP3炎性体指标和PI3K通路成分以及IL-1β表达呈负相关。在体内,与野生型哮喘小鼠相比,Glcci1 -/-哮喘小鼠的气道炎症和NLRP3炎性体激活水平升高。令人惊讶的是,LY294002在野生型哮喘小鼠中减轻肺组织炎症和NLRP3炎性体活性的作用被Glcci1敲除后减弱。LY294002增强野生型哮喘小鼠肺组织巨噬细胞GLCCI1水平。此外,LY294002不能抑制巨噬细胞缺失的野生型哮喘小鼠的肺部炎症,这些巨噬细胞接受了Glcci1 -/- BMDMs过继转移。体外实验进一步证明LY294002通过上调GLCCI1在bmms中的表达抑制NLRP3的激活。MCC950的引入导致NLRP3和含有caspase募集域(ASC)蛋白的凋亡相关斑点样蛋白水平显著降低,但不影响GLCCI1的表达水平或磷酸化蛋白激酶B (p-AKT)/AKT比值。结论:GLCCI1缺乏通过pi3k诱导的NLRP3炎性体激活促进哮喘炎症。
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引用次数: 0
When prenatal infection meets postnatal hyperoxia: Better models for bronchopulmonary dysplasia and its therapeutic approaches 当产前感染遇到产后高氧:支气管肺发育不良的更好模型及其治疗方法。
Pub Date : 2024-12-01 DOI: 10.1016/j.pccm.2024.11.002
Ying Dong , Annika Leidner , Manuela Marega , Stefano Rivetti , Saverio Bellusci
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引用次数: 0
Integrating tobacco control into China's health management: Strategies for healthier China 将控烟纳入中国健康管理:健康中国战略
Pub Date : 2024-12-01 DOI: 10.1016/j.pccm.2024.08.005
Dan Xiao , Chen Wang
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引用次数: 0
Neoadjuvant immunotherapy for non-small cell lung cancer: Opportunities and challenges 非小细胞肺癌的新辅助免疫治疗:机遇与挑战。
Pub Date : 2024-12-01 DOI: 10.1016/j.pccm.2024.11.003
Junjie Hu , Jing Zhang , Shiyue Wan , Peng Zhang
Immune checkpoint inhibitors (ICIs) have transformed the treatment landscape for resectable non-small cell lung cancer. Numerous trials have explored the use of ICIs, either as monotherapy or in combination with other therapies, in the neoadjuvant setting for stage I–III non-small cell lung cancer. Most trials have demonstrated neoadjuvant immunotherapy to be safe and to have remarkable efficacy, with a high pathological response rate and significantly improved event-free survival. This review summarizes the findings of Phase I–III clinical trials investigating various neoadjuvant regimens, including ICI monotherapy, ICI therapy combined with chemotherapy, ICI plus anti-angiogenic therapy, dual ICI therapy, and ICI therapy in combination with radiotherapy or chemoradiotherapy. We discuss the benefits and outcomes associated with each approach. Despite the results being promising, several unresolved issues remain, including identification of reliable biomarkers, the appropriate duration of therapy, the optimal treatment regimen for tumors with high programmed cell death ligand 1 (PD-L1) expression, the false-negative pathological complete response rate, and the role of digital pathology in assessing the response to treatment. Resistance to immunotherapy, in particular, remains a significant barrier to effective use of ICIs. Given the critical influence of the tumor microenvironment (TME) on the response to treatment, we examine the characteristics of the TME in both responsive and resistant tumors as well as the dynamic changes that occur in the TME in response to neoadjuvant immunotherapy. We also summarize the mechanisms underlying T cell responses following neoadjuvant immunotherapy and provide a perspective on strategies to enhance the understanding of tumor heterogeneity, therapy-driven TME remodeling, and overcoming resistance to therapy. Finally, we propose future directions for advancements in personalized neoadjuvant immunotherapy.
免疫检查点抑制剂(ICIs)已经改变了可切除非小细胞肺癌的治疗前景。许多试验已经探索了在I-III期非小细胞肺癌的新辅助治疗中使用ICIs,无论是作为单一疗法还是与其他疗法联合使用。大多数试验表明,新辅助免疫治疗是安全的,疗效显著,病理反应率高,无事件生存率显著提高。本文综述了研究各种新辅助治疗方案的I-III期临床试验的结果,包括ICI单药治疗、ICI联合化疗、ICI加抗血管生成治疗、双重ICI治疗、ICI联合放疗或放化疗。我们将讨论与每种方法相关的好处和结果。尽管结果很有希望,但仍存在一些未解决的问题,包括确定可靠的生物标志物,适当的治疗时间,高程序性细胞死亡配体1 (PD-L1)表达的肿瘤的最佳治疗方案,假阴性病理完全缓解率,以及数字病理学在评估治疗反应中的作用。特别是对免疫疗法的耐药性,仍然是有效使用免疫球蛋白的一个重大障碍。鉴于肿瘤微环境(TME)对治疗反应的关键影响,我们研究了反应性和耐药肿瘤中TME的特征,以及新辅助免疫治疗后TME发生的动态变化。我们还总结了新辅助免疫治疗后T细胞反应的机制,并提供了增强对肿瘤异质性、治疗驱动的TME重塑和克服治疗耐药性的策略的观点。最后,我们提出了个性化新辅助免疫治疗的未来发展方向。
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引用次数: 0
Lung-resident lymphocytes and their roles in respiratory infections and chronic respiratory diseases 肺驻留淋巴细胞及其在呼吸道感染和慢性呼吸道疾病中的作用。
Pub Date : 2024-12-01 DOI: 10.1016/j.pccm.2024.11.006
Arka Sen Chaudhuri , Jie Sun
Recent scientific breakthroughs have blurred traditional boundaries between innate and adaptive immunity, revealing a sophisticated network of tissue-resident cells that deliver immediate, localized immune responses. These lymphocytes not only provide rapid frontline defense but also present a paradoxical role in the pathogenesis of respiratory diseases such as asthma, chronic obstructive pulmonary disease, pulmonary fibrosis, and the long-term tissue consequences of viral infections including severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). This review traverses the intricate landscape of lung-resident lymphocytes, delving into their origins, diverse functions, and their dualistic impact on pulmonary health. We dissect their interactions with the microenvironment and the regulatory mechanisms guiding their activity, with an emphasis on their contribution to both immune protection and immunopathology. This review aims to elucidate the complex narrative of these cells, enhancing our understanding of the development of precise therapeutic strategies to combat acute and chronic pulmonary diseases. Through this exploration, the review aspires to shed light on the potential of harnessing lung-resident lymphocytes for the treatment of respiratory conditions.
最近的科学突破模糊了固有免疫和适应性免疫之间的传统界限,揭示了一个复杂的组织驻留细胞网络,可以提供即时的局部免疫反应。这些淋巴细胞不仅提供快速的一线防御,而且在哮喘、慢性阻塞性肺疾病、肺纤维化等呼吸系统疾病的发病机制以及包括严重急性呼吸综合征冠状病毒-2 (SARS-CoV-2)在内的病毒感染的长期组织后果中发挥着矛盾的作用。本文回顾了肺驻留淋巴细胞的复杂景观,深入研究了它们的起源、不同的功能以及它们对肺部健康的双重影响。我们剖析了它们与微环境的相互作用以及指导它们活动的调节机制,重点是它们对免疫保护和免疫病理学的贡献。本综述旨在阐明这些细胞的复杂叙事,增强我们对发展精确治疗策略以对抗急性和慢性肺部疾病的理解。通过这一探索,本综述希望揭示利用肺驻留淋巴细胞治疗呼吸系统疾病的潜力。
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Chinese medical journal pulmonary and critical care medicine
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