Trauma and Spirituality

In a world which is beset with suffering and trauma, in which we encounter in the course of our lives many tramatized women, children, and men, in which many of us have also been abused and have had to deal ourselves with the after effects of trauma, it is imperative that we know something about the nature of trauma and familiarize ourselves with the helpful insights of neuroscience

What patients with pulmonary fibrosis and their partners think

Pulmonary fibrosis greatly impacts patients and their partners. Unmet needs of patients are increasingly acknowledged; the needs of partners often remain unnoticed. Little is known about the best way to educate patients and partners. We investigated pulmonary fibrosis patients’ and partners’ perspectives and preferences in care, and the differences in these between the Netherlands and Germany. Additionally, we evaluated whether interactive interviewing could be a novel education method in this population. Patients and partners were interviewed during pulmonary fibrosis patient information meetings. In the Netherlands, voting boxes were used and results were projected directly. In Germany, questionnaires were used. In the Netherlands, 278 patients and partners participated; in Germany, 51. Many participants experienced anxiety. Almost all experienced misunderstanding, because people do not know what pulmonary fibrosis is. All expressed a need for information, psychological support and care for partners. Use of the interactive voting system was found to be pleasant (70%) and informative (94%). This study improves the knowledge of care needs of patients with pulmonary fibrosis and their partners. There were no major differences between the Netherlands and Germany. Interactive interviewing could be an attractive method to acquire insights into the needs and preferences of patients and partners, while providing them with information at the same time

Evidence for local dendritic cell activation in pulmonary sarcoidosis

<p>Abstract</p> <p>Background</p> <p>Sarcoidosis is a granulomatous disease characterized by a seemingly exaggerated immune response against a difficult to discern antigen. Dendritic cells (DCs) are pivotal antigen presenting cells thought to play an important role in the pathogenesis. Paradoxically, decreased DC immune reactivity was reported in blood samples from pulmonary sarcoidosis patients. However, functional data on lung DCs in sarcoidosis are lacking. We hypothesized that at the site of disease DCs are mature, immunocompetent and involved in granuloma formation.</p> <p>Methods</p> <p>We analyzed myeloid DCs (mDCs) and plasmacytoid DCs (pDCs) in broncho-alveolar lavage (BAL) and blood from newly diagnosed, untreated pulmonary sarcoidosis patients and healthy controls using 9-color flowcytometry. DCs, isolated from BAL using flowcytometric sorting (mDCs) or cultured from monocytes (mo-DCs), were functionally assessed in a mixed leukocyte reaction with naïve allogeneic CD4+ T cells. Using Immunohistochemistry, location and activation status of CD11c⁺DCs was assessed in mucosal airway biopsies.</p> <p>Results</p> <p>mDCs in BAL, but not in blood, from sarcoidosis patients were increased in number when compared with mDCs from healthy controls. mDCs purified from BAL of sarcoidosis patients induced T cell proliferation and differentiation and did not show diminished immune reactivity. Mo-DCs from patients induced increased TNFα release in co-cultures with naïve allogeneic CD4⁺T cells. Finally, immunohistochemical analyses revealed increased numbers of mature CD86⁺DCs in granuloma-containing airway mucosal biopsies from sarcoidosis patients.</p> <p>Conclusion</p> <p>Taken together, these finding implicate increased local DC activation in granuloma formation or maintenance in pulmonary sarcoidosis.</p

Design of RESOLVE Lung, a multinational Phase 2, randomized, placebo-controlled trial of the anti-GM-CSF monoclonal antibody namilumab in patients with chronic pulmonary sarcoidosis

Background: Pulmonary sarcoidosis is a rare inflammatory disease associated with morbidity and mortality. In light of limited treatment options, oral corticosteroids (OCS), off-label immunosuppressive therapies (IST) and tumor necrosis factor alpha inhibitors are standard of care. However, due to tolerability concerns with long-term use of OCS and IST, novel treatment options are needed. Namilumab is a potent, investigational granulocyte macrophage colony-stimulating factor humanized monoclonal antibody, that can potentially downregulate the granulomatous response, with favorable tolerability observed across clinical studies. Study design: In this double-blind, 26-week, placebo-controlled trial, with an optional 28-week, open-label extension, approximately 100 patients will be randomized in a 1:1 ratio to receive 150 mg namilumab or placebo via subcutaneous injection. Eligible patients have active, chronic pulmonary sarcoidosis (CPS; assessed by clinical and radiologic parameters) poorly regulated by OCS and/or ISTs or failed or intolerant to treatment. At randomization, ISTs will be stopped and OCS tapered. Objective: The objective of this trial is to evaluate the efficacy and safety of namilumab in patients with active CPS. The primary endpoint is the proportion of patients requiring rescue treatment during the double-blind period due to worsening sarcoidosis. Secondary endpoints include assessment of lung function, respiratory symptoms, and corticosteroid burden. Additionally, quality-of-life assessments, serum biomarkers, and a composite clinical benefit endpoint will be explored. Discussion: This study will be one of the largest Phase 2 trials in the last decade for active CPS. Data from this trial will potentially provide valuable insights into disease endpoints, patient selection, and optimizing trial design.</p

The diversity of myeloid immune cells shaping wound repair and fibrosis in the lung

In healthy circumstances the immune system coordinates tissue repair responses in a tight balance that entails efficient inflammation for removal of potential threats, proper wound closure, and regeneration to regain tissue function. Pathological conditions, continuous exposure to noxious agents, and even ageing can dysregulate immune responses after injury. This dysregulation can lead to a chronic repair mechanism known as fibrosis. Alterations in wound healing can occur in many organs, but our focus lies with the lung as it requires highly regulated immune and repair responses with its continuous exposure to airborne threats. Dysregulated repair responses can lead to pulmonary fibrosis but the exact reason for its development is often not known. Here, we review the diversity of innate immune cells of myeloid origin that are involved in tissue repair and we illustrate how these cell types can contribute to the development of pulmonary fibrosis. Moreover, we briefly discuss the effect of age on innate immune responses and therefore on wound healing and we conclude with the implications of current knowledge on the avenues for future research

Theaflavin Inhibits LPS-Induced IL-6, MCP-1, and ICAM-1 Expression in Bone Marrow-Derived Macrophages Through the Blockade of NF-κB and MAPK Signaling Pathways

Theaflavin, the main polyphenol in black tea, has anti-inflammatory, antioxidative, anti-mutagenic, and anti-carcinogenic properties. The aim of this study was to evaluate the effects of theaflavin on lipopolysaccharide (LPS)-induced innate signaling and expression of pro-inflammatory mediators in bone marrow-derived macrophages isolated from ICR mice. The effects of theaflavin on the expression of proinflammatory mediators, LPS-induced nuclear factor-kappa B (NF-κB), and mitogen-activated protein kinase (MAPK) signaling pathways were examined by reverse transcriptase-polymerase chain reaction (RT-PCR), Western blotting, and immunofluorescence. LPS-induced interleukin-6 (IL-6), monocyte chemoattractant protein-1 (MCP-1), and intercellular adhesion molecule-1 (ICAM-1) expression was inhibited by theaflavin. LPS-induced inhibitor kappa B alpha (IκBα) degradation and nuclear translocation of RelA were blocked by theaflavin. LPS-induced phosphorylation of extracellular signal-regulated kinase1/2 (ERK1/2), c-Jun-N-terminal kinase (JNK), and p38 MAPK was inhibited by theaflavin. The inhibitory effect of theaflavin on IL-6, MCP-1, and ICAM-1 expression was completely inhibited by Bay11-7082 (NF-κB inhibitor). The inhibitory effect of theaflavin on IL-6 and ICAM-1 expression was inhibited by SB203580 (p38 MAPK inhibitor). The inhibitory effect of theaflavin on MCP-1 expression was inhibited by SP600125 (JNK inhibitor). These results indicate that theaflavin prevents LPS-induced IL-6, MCP-1, and ICAM-1 expression through blockade of NF-κB and MAPK signaling pathways in bone marrow-derived macrophages

Granuloma formation in pulmonary sarcoidosis

Sarcoidosis is a granulomatous disorder of unknown cause, affecting multiple organs, but mainly the lungs. The exact order of immunological events remains obscure. Reviewing current literature, combined with careful clinical observations, we propose a model for granuloma formation in pulmonary sarcoidosis. A tight collaboration between macrophages, dendritic cells, and lymphocyte subsets, initiates the first steps toward granuloma formation, orchestrated by cytokines and chemokines. In a substantial part of pulmonary sarcoidosis patients, granuloma formation becomes an on-going process, leading to debilitating disease, and sometimes death. The immunological response, determining granuloma sustainment is not well

Fibrocytes are increased in lung and peripheral blood of patients with idiopathic pulmonary fibrosis

Background: Fibrocytes are implicated in Idiopathic Pulmonary Fibrosis (IPF) pathogenesis and increased proportions in the circulation are associated with poor prognosis. Upon tissue injury, fibrocytes migrate to the affected organ. In IPF patients, circulating fibrocytes are increased especially during exacerbations, however fibrocytes in the lungs have not been examined. Therefore, we sought to evaluate if fibrocytes can be detected in IPF lungs and we compare percentages and phenotypic characteristics of lung fibrocytes with circulating fibrocytes in IPF. Methods: First we optimized flow cytometric detection circulating fibrocytes using a unique combination of intra- and extra-cellular markers to establish a solid gating strategy. Next we analyzed lung fibrocytes in single cell suspensions of explanted IPF and control lungs and compared characteristics and numbers with circulating fibrocytes of IPF. Results: Using a gating strategy for both circulating and lung fibrocytes, which excludes potentially contaminating cell populations (e.g. neutrophils and different leukocyte subsets), we show that patients with IPF have increased proportions of fibrocytes, not only in the circulation, but also in explanted end-stage IPF lungs. These lung fibrocytes have increased surface expression of HLA-DR, increased intracellular collagen-1 expression, and also altered forward and side scatter characteristics compared with their circulating counterparts. Conclusions: These findings demonstrate that lung fibrocytes in IPF patients can be quantified and characterized by flow cytometry. Lung fibrocytes have different characteristics than circulating fibrocytes and represent an intermediate cell population between circulating fibrocytes and lung fibroblast. Therefore, more insight in their phenotype might lead to specific therapeutic targeting in fibrotic lung diseases