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We recently described that the presence of various anti-CarPs exhibited a consistent effect toward increasing the odds of ILD in RA. The anti-CarP-IgG isotype was most prevalent; however, anti-CarP-IgA had the highest OR (4.3),3 fueling the hypothesis that RA-related antibodies may originate in the respiratory mucosa, as suggested by Solomon et al. The high proportion of positive IgA-ACPA in IPF (21.3%-24.8%) in their study is noteworthy, in our opinion. This finding may be partially explained by the enzyme-linked immunosorbent assay test sensitivity considering that the proportion of positive IgA-ACPA in the healthy control subjects is also clearly higher (5.6%) than that observed in previous reports (< 2%).

Background Idiopathic pulmonary fibrosis (IPF) is a progressive and fatal lung disease with limited response to currently available therapies. Alveolar type II (ATII) cells act as progenitor cells in the adult lung, contributing to alveolar repair during pulmonary injury. However, in IPF, ATII cells die and are replaced by fibroblasts and myofibroblasts. In previous preclinical studies, we demonstrated that ATII-cell intratracheal transplantation was able to reduce pulmonary fibrosis. The main objective of this study was to investigate the safety and tolerability of ATII-cell intratracheal transplantation in patients with IPF. Methods We enrolled 16 patients with moderate and progressive IPF who underwent ATII-cell intratracheal transplantation through fiberoptic bronchoscopy. We evaluated the safety and tolerability of ATII-cell transplantation by assessing the emergent adverse side effects that appeared within 12 months. Moreover, pulmonary function, respiratory symptoms, and disease extent during 12 months of follow-up were evaluated. Results No significant adverse events were associated with the ATII-cell intratracheal transplantation. After 12 months of follow-up, there was no deterioration in pulmonary function, respiratory symptoms, or disease extent. Conclusions Our results support the hypothesis that ATII-cell intratracheal transplantation is safe and well tolerated in patients with IPF. This study opens the door to designing a clinical trial to elucidate the potential beneficial effects of ATII-cell therapy in IPF.

Background Assessment of patients with suspected interstitial lung disease (ILD) includes surgical lung biopsy (SLB) when clinical and radiological data are inconclusive. However, cryobiopsy is acquiring an important role in the ILD diagnostic process. The objective of this study was to evaluate the diagnostic yield, safety, and economic costs of the systematic use of cryobiopsy in the assessment of patients with suspected ILD. Methods This was a retrospective observational study of patients who had undergone transbronchial cryobiopsy for the evaluation of ILD from January 2011 to January 2014. The procedures were performed with a video bronchoscope using a cryoprobe for the collection of lung parenchyma specimens, which were analyzed by pathologists. Diagnostic yield, complications, and economic costs of this technique were analyzed. Results Criobiopsy specimens from a total of 33 patients were included. A specific diagnosis was obtained in 26, producing a diagnostic yield of 79%. In 5 patients, SLB was required for a histopathological confirmation of disease, but the procedure could not be performed in 4, due to severe comorbidities. The most frequent complications were pneumothorax (12%) and grade I (9%) or grade II (21%) bleeding. There were no life-threatening complications. The systematic use of cryobiopsy saved up to €59.846. Conclusion Cryobiopsy is a safe and potentially useful technique in the diagnostic assessment of patients with ILD. Furthermore, the systematic use of cryobiopsy has an important economic impact.

Resumen Introduccion En los pacientes con enfermedad pulmonar intersticial difusa (EPID) que presentan datos clinicos y radiologicos inconsistentes es recomendable la realizacion de una biopsia pulmonar quirurgica (BPQ). La criobiopsia es una tecnica endoscopica reciente menos invasiva que la BPQ que podria jugar un papel relevante en el diagnostico de las EPID. El objetivo del presente estudio es analizar la rentabilidad diagnostica, las complicaciones y los costes economicos derivados del uso de la criobiopsia en el diagnostico de las EPID. Metodos Estudio observacional retrospectivo en el que se incluyeron pacientes afectados de EPID tributarios de biopsia pulmonar, a los que se les practicaron criobiopsias desde enero de 2011 a enero de 2014. El procedimiento se realizo mediante videobroncoscopio, bajo anestesia general y ventilacion mecanica. Se analizo la rentabilidad diagnostica, las complicaciones producidas y los costes economicos derivados de esta tecnica. Resultados Se analizaron las muestras de criobiopsia de un total de 33 pacientes. Se obtuvo un diagnostico especifico en 26, lo que representa una rentabilidad diagnostica del 79%. Cinco pacientes hubieran requerido BPQ para confirmacion histologica, aunque en 4 de ellos no pudo realizarse por presentar comorbilidades graves. Las complicaciones mas frecuentes fueron el neumotorax (12%) y el sangrado moderado (21%). No hubo complicaciones graves. Considerando que a los pacientes con diagnostico especifico se les evito una BPQ, la criobiopsia represento un ahorro economico estimado de hasta 59.846 €. Conclusiones La criobiopsia es una tecnica segura y potencialmente util en el diagnostico de las EPID que permite, ademas, un ahorro economico considerable.