Document Detail


Idiopathic and collagen vascular disease nonspecific interstitial pneumonia: clinical significance of remodeling process.
MedLine Citation:
PMID:  17294340     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Recently, active remodeling may indicate a good prognosis in idiopathic interstitial pneumonias. In this study we sought to validate the importance of the collagen/elastic system in the extracellular matrix remodeling and to study the relationships between the collagen/elastic system in nonspecific interstitial idiopathic pneumonia (NSIP) and collagen vascular disease associated with nonspecific interstitial idiopathic pneumonia (CVD-NSIP). We examined collagen/elastic system fibers in open lung biopsies of 20 idiopathic NSIP and 21 CVD-NSIP patients. The clinical features were analyzed with respect to age, gender, pulmonary functional tests, chest X-ray and computed tomography, treatment, and survival. We used the picrosirius polarization method and Weigert's resorcin-fuchsin histochemistry and morphometric analysis to evaluate the amount of collagen/elastic system fibers and their association with the NSIP histologic pattern. No differences in clinical features and pulmonary function tests were observed between idiopathic NSIP and CVD-NSIP, but a significantly higher collagen and elastic fiber proliferation was detected in CVD-NSIP lungs and fibrosing NSIP histologic pattern. Multivariate Cox model analysis demonstrated that sex and quantitative elastic fiber staining added important prognostic information (p=0.01) and was indicative of a worse prognosis than collagen staining. A cut point at the mean staining of 1.5% for elastic fibers divided the patients into two groups with distinctive survival times. Those with elastic fibers greater than 1.5% had a median survival time of just 52 months. We concluded that idiopathic NSIP and CVD-NSIP were clinically similar but pathologically different, suggesting that different remodeling profiles in NSIP may represent evolutionary adapted responses to injury grade, which depend, at least in part, on the extent of elastic extracellular matrix deposition. Patients with greater than 1.5% of elastic fibers comprise a subset with a high risk for dying due to NSIP and may be an appropriate target for prospective studies.
Authors:
Carlos Henrique Chirnev Felício; Edwin Roger Parra; Vera Luiza Capelozzi
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2007-02-09
Journal Detail:
Title:  Lung     Volume:  185     ISSN:  0341-2040     ISO Abbreviation:  Lung     Publication Date:    2007 Jan-Feb
Date Detail:
Created Date:  2007-02-20     Completed Date:  2007-04-23     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7701875     Medline TA:  Lung     Country:  United States    
Other Details:
Languages:  eng     Pagination:  39-46     Citation Subset:  IM    
Affiliation:
Department of Pathology, University of São Paulo Medical School, University of São Paulo, São Paulo, Brazil.
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MeSH Terms
Descriptor/Qualifier:
Adrenal Cortex Hormones / therapeutic use
Adult
Aged
Aged, 80 and over
Biopsy
Collagen / analysis
Elastic Tissue
Female
Humans
Immunosuppressive Agents / therapeutic use
Longitudinal Studies
Lung / pathology*,  radiography
Lung Diseases, Interstitial / classification,  mortality,  pathology*
Male
Middle Aged
Prognosis
Regression Analysis
Respiratory Function Tests
Risk Factors
Chemical
Reg. No./Substance:
0/Adrenal Cortex Hormones; 0/Immunosuppressive Agents; 9007-34-5/Collagen

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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