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The inhalation challenge test is considered to be the item for diagnosis of hypersensitivity pneumonitis (HP) and identifying the causative antigen in patients with fibrotic HP. However, the inhalation challenge test is not widely used.To evaluate the values of the inhalation challenge test by comparing with serum immunoglobulin (Ig)G test.This was a single-center, retrospective study. The patients with fibrotic HP were diagnosed pathologically by surgical lung biopsy or transbronchial lung cryobiopsy and were assumed to have bird-related fibrotic HP if they had a history of obvious avian exposure.On the basis of pathologic findings and history of avian exposure, 43 of 86 patients were diagnosed with having bird-related fibrotic HP. In 43 patients with bird-related fibrotic HP, 15 (35%) were positive for anti-bird IgG antibody and 36 (84%) were positive for the inhalation challenge test; in addition, the specificity of the inhalation challenge test was 67%. Patients with both positive results from inhalation challenge test and anti-bird IgG antibodies had a 2.7% decline in annual forced vital capacity (FVC) before the inhalation (P = .02). In patients with positive result from inhalation challenge test and negative result from anti-bird IgG antibodies, the annual FVC decreased by 5.8% (P = .03). FVC was not consistent in patients with positive result from the anti-bird IgG antibodies.The inhalation challenge test for bird-related fibrotic HP was more sensitive than the anti-bird IgG antibodies. Furthermore, the inhalation challenge test could select patients with similar disease progression.

Table S1. Cell samples used for CAGE profiling. Table S2. Public datasets used in this study. Table S3. Differentially expressed promoters in FANTOM5 NSCLC cell lines. Table S4. Up-regulated/hypomethylated promoters in NSCLC cell lines. Table S5. Epi-markers in NSCLC. Table S6. Extended information for Table 2. Table S7. Univariate and multivariate Cox regression models of TCGA LUAD and LUSC datasets. Table S8. Gene expression profiling of SAECs treated with 5-aza-dC and TSA. Table S9. Up-regulated/hypomethylated genes in NSCLC cell lines that show up-regulation by 5-aza-dC and TSA in SAECs. Table S10. Promoters and methylation array probes that overlap nine families of repetitive elements. Table S11. Promoters and methylation array probes that overlap REP522 repetitive elements. Table S12. Transcripts commonly down-regulated by two different MYEOV siRNAs in A549 cells. Table S13. The relationship between expression of 22 epi-markers and EGFR/KRAS mutation in TCGA LUAD dataset.

Lung cancer is the leading cause of cancer-related deaths worldwide. The majority of cancer driver mutations have been identified; however, relevant epigenetic regulation involved in tumorigenesis has only been fragmentarily analyzed. Epigenetically regulated genes have a great theranostic potential, especially in tumors with no apparent driver mutations. Here, epigenetically regulated genes were identified in lung cancer by an integrative analysis of promoter-level expression profiles from Cap Analysis of Gene Expression (CAGE) of 16 non–small cell lung cancer (NSCLC) cell lines and 16 normal lung primary cell specimens with DNA methylation data of 69 NSCLC cell lines and 6 normal lung epithelial cells. A core set of 49 coding genes and 10 long noncoding RNAs (lncRNA), which are upregulated in NSCLC cell lines due to promoter hypomethylation, was uncovered. Twenty-two epigenetically regulated genes were validated (upregulated genes with hypomethylated promoters) in the adenocarcinoma and squamous cell cancer subtypes of lung cancer using The Cancer Genome Atlas data. Furthermore, it was demonstrated that multiple copies of the REP522 DNA repeat family are prominently upregulated due to hypomethylation in NSCLC cell lines, which leads to cancer-specific expression of lncRNAs, such as RP1-90G24.10, AL022344.4, and PCAT7. Finally, Myeloma Overexpressed (MYEOV) was identified as the most promising candidate. Functional studies demonstrated that MYEOV promotes cell proliferation, survival, and invasion. Moreover, high MYEOV expression levels were associated with poor prognosis.Implications: This report identifies a robust list of 22 candidate driver genes that are epigenetically regulated in lung cancer; such genes may complement the known mutational drivers.Visual Overview: http://mcr.aacrjournals.org/content/molcanres/15/10/1354/F1.large.jpg. Mol Cancer Res; 15(10); 1354–65. ©2017 AACR.

Figure S1. Methylation and expression levels of genes in lung cancer and normal lung tissues. Figure S2. Expression levels of epi-markers in TCGA LUAD dataset. Figure S3. Expression levels of epi-markers in TCGA LUSC dataset. Figure S4. The signature of 22 epigenetically regulated genes in non-small cell lung cancer. Figure S5. ZENBU genome browser view of RP1-90G24.10 and AL022344.4. Figure S6. ZENBU genome browser view of MYEOV. Figure S7. Higher MYEOV expression is associated with poor prognosis in NSCLC.

Chronic obstructive pulmonary disease (COPD) is primarily caused by inhalation of cigarette smoke and is the third leading cause of death worldwide. Pulmonary surfactant, a complex of phospholipids and proteins, plays an essential role in respiration by reducing the surface tension in the alveoli. Lysophosphatidylcholine acyltransferase 1 (LPCAT1) is an enzyme that catalyzes the biosynthesis of surfactant lipids and is expressed in type 2 alveolar epithelial cells. Its dysfunction is suggested to be involved in various lung diseases; however, the relationship between LPCAT1 and COPD remains unclear. To investigate the role of LPCAT1 in the pathology of COPD, we analyzed an elastase-induced emphysema model using Lpcat1 knockout (KO) mice. In Lpcat1 KO mice, elastase-induced emphysema was significantly exacerbated with increased apoptotic cells, which was not ameliorated by supplementation with dipalmitoylphosphatidylcholine, which is a major component of the surfactant synthesized by LPCAT1. We subsequently evaluated the effects of cigarette smoking on primary human type 2 alveolar epithelial cells (hAEC2s) and found that cigarette smoke extract (CSE) downregulated the expression of Lpcat1. Furthermore, RNA sequencing analysis revealed that the apoptosis pathway was significantly enriched in CSE-treated primary hAEC2s. Finally, we downregulated the expression of Lpcat1 using small interfering RNA, which resulted in enhanced CSE-induced apoptosis in A549 cells. Taken together, cigarette smoke-induced downregulation of LPCAT1 can promote the exacerbation of pulmonary emphysema by increasing the susceptibility of alveolar epithelial cells to apoptosis, thereby suggesting that Lpcat1 is a novel therapeutic target for irreversible emphysema.

Supplementary Table S1. Sequences of artificial miRNAs against TAZ. Supplementary Table S2. Primers used for quantitative RT-PCR. Supplementary Table S3. Correlation between TAZ gene expression (202134_s_at) and clinicopathological parameters of 196 NSCLC patients included in the Uppsala gene microarray. Supplementary Table S4. Correlation between TAZ protein expression and clinicopathological parameters of 345 NSCLC patients included in the Uppsala tissue microarray. Supplementary Table S5. 259 TAZ-regulated genes commonly upregulated by TAZ overexpression or downregulated by TAZ knockdown in at least two cells out of A549, H441, MCF10A, and SW480 cells.

Purpose: TAZ, also known as WWTR1, has recently been suggested as an oncogene in non–small cell lung cancer (NSCLC). We investigated the clinical relevance of TAZ expression and its functional role in NSCLC tumorigenesis.Experimental Design: We characterized TAZ at the DNA (n = 192), mRNA (n = 196), and protein levels (n = 345) in an NSCLC patient cohort. Gene expression analysis was complemented by a meta-analysis of public datasets (n = 1,382). The effects of TAZ on cell proliferation and cell cycle were analyzed in cell cultures and on tumor growth in mice. TAZ-dependent microarray-based expression profiles in NSCLC cells were combined with molecular profiles in human NSCLC tissues for in silico analysis.Results: Higher TAZ mRNA and protein levels were associated with shorter patient survival. Transduction of TAZ enhanced cell proliferation and tumorigenesis in bronchial epithelial cells, whereas TAZ silencing suppressed cell proliferation and induced cell cycle arrest in NSCLC cells. Microarray and cell culture experiments showed that ErbB ligands (amphiregulin, epiregulin, and neuregulin 1) are downstream targets of TAZ. Our in silico analysis revealed a TAZ signature that substantiated the clinical impact of TAZ and confirmed its relationship to the epidermal growth factor receptor signaling pathway.Conclusion: TAZ expression defines a clinically distinct subgroup of patients with NSCLC. ErbB ligands are suggested to mediate the effects of TAZ on lung cancer progression. Our findings emphasize the tumorigenic role of TAZ and may serve as the basis for new treatment strategies. Clin Cancer Res; 20(17); 4660–72. ©2014 AACR.

Fibroblasts provide a structural framework for multiple organs, and are essential for wound repair and fibrotic processes. Here, we demonstrate functional roles of forkhead box L1 (FOXL1), a transc...

Background Chronic hypersensitivity pneumonitis (CHP) remains a diagnostic challenge. The process of collecting and extracting serum and droppings from causative animals for the inhalation challenge test is complicated and the risk of inducing disease progression exists. Objective To investigate the utility and safety of an inhalation challenge test using pigeon eggs. Methods Pigeon eggs were pasteurized and mixed with a saline solution to produce an inhalation fluid. An inhalation challenge test was conducted on 19 patients with bird-related CHP and 17 patients with interstitial lung disease other than bird-related CHP. To identify antigens in pigeon eggs, the antigen-antibody responses of the pigeon eggs and serum from patients were evaluated using Western blotting. Results The mean changes in C-reactive protein, alveolar-arterial oxygen difference, erythrocyte sedimentation rate, and lactate dehydrogenase significantly increased by 0.32 mg/dL (P = .014), 7.8 Torr (P = .002), 1.4 mm/h (P = .012), and 5.4 U/mL (P = .0019), respectively, in bird-related CHP group compared to the control 24 hours after the inhalation challenge test. Furthermore, within 24 hours of the inhalation test, the mean forced vital capacity decreased by 2.3% in the bird-related CHP group compared with a decline of 0.05% in the control group (P = .035). Serum collected from seven bird-related CHP patients who underwent the inhalation challenge test and reacted to antigens with molecular weights of 37-75 KDa, and these molecular weights were consistent with egg albumin and globulin. Conclusion Since a mild response was observed after the inhalation challenge test using pigeon eggs, this test was an obvious candidate for diagnosing bird-related CHP.

The mTOR pathway is one of the key signal cascades in the pathogenesis of idiopathic pulmonary fibrosis. Previous studies have mainly focused on this pathway in the fibroblasts and/or myofibroblasts, but not in the epithelial cells. In this study, we sought to investigate the role of the mTOR pathway in lung epithelial cells in lung fibrosis. Using Sftpc-mTORSL1+IT transgenic mice, in which active mTOR is conditionally expressed in lung epithelial cells, we assessed the effects of chronically activated mTOR in lung epithelial cells on lung phenotypes as well as bleomycin-induced lung fibrosis. Furthermore, we isolated alveolar epithelial cell type 2 from mice and performed RNA sequencing. Sftpc-mTORSL1+IT transgenic mice had no obvious abnormal findings, but, after bleomycin administration, showed more severe fibrotic changes and lower lung compliance than control mice. RNA sequencing revealed Angptl4 (angiopoietin-like protein 4) as a candidate downstream gene of the mTOR pathway. In vitro studies revealed that ANGPTL4, as well as mTOR, promoted tight junction vulnerability and epithelial-mesenchymal transition. mTOR activation in lung epithelial cells promoted lung fibrosis and the expression of ANGPTL4, a novel downstream target of the mTOR pathway, which could be related to the etiology of fibrosis.

TAZ (transcriptional coactivator with PDZ-binding motif) and YAP (Yes-associated protein) are key molecules of the Hippo pathway. Recent studies revealed that these molecules are essential in lung development; however, the precise signaling cascade involving these molecules and the differences in their roles during lung development remain unknown. We aimed to investigate YAP and TAZ functions using lung epithelium-specific Taz and Yap conditional knockout mice. We generated lung epithelium-specific Taz and Yap conditional knockout mice and investigated the functions of YAP and TAZ in lung development. Selective TAZ deficiency in mouse lung epithelial cells resulted in abnormal alveolarization, which mimics lung emphysema, in adults, whereas YAP deficiency caused disruption of bronchial morphogenesis during the embryonic stage. We report that TAZ and YAP are sequentially expressed in the lung and that this could explain their different phenotypes. Furthermore, we report that YAP stimulates Shh (Sonic hedgehog) expression and regulates the FGF (fibroblast growth factor)-SHH feedback loop, thereby contributing to normal bronchial morphogenesis. We also found that TGF-β (transforming growth factor-β) stimulation induced Shh expression in the lung epithelial cells, and both TAZ and YAP are essential in this novel pathway. Our results provide a novel insight into the molecular mechanisms underlying lung development and contribute to a better understanding of the characteristics of TAZ and YAP.

Background: The inhalation challenge test is considered to be the “gold standard” for diagnosis of hypersensitivity pneumonitis (HP) and identifying the causative antigen in patients with fibrotic HP. However, the inhalation challenge test is not widely used. This study aimed to examine the value of the inhalation challenge test.Methods: This was a single-center, case control study. The patients with fibrotic HP were diagnosed pathologically by surgical lung biopsy or transbronchial lung cryobiopsy, and were assumed to be bird-related fibrotic HP if they had a history of obvious avian exposure. The patients with a histopathological diagnosis of fibrotic HP, no history of bird exposure and negative anti-bird antibodies were assumed to be non-bird-related fibrotic HP.Results: Based on pathological findings and history of avian exposure, 43 of 86 patients were diagnosed with bird-related fibrotic HP. In 43 patients with bird-related fibrotic HP, 15 (35%) were positive for anti-bird IgG antibody, and 36 (81%) were positive for the inhalation challenge test. Patients with both positive inhalation challenge test and anti-bird IgG antibodies had a 2.7% decline in annual FVC before the inhalation (p = 0.029). In patients with positive inhalation challenge test and the negative anti-bird IgG antibodies, the annual FVC decreased by 5.0% (p = 0.047). No significant FVC decline was observed in patients with negative inhalation challenge test and positive anti-bird IgG antibody, and those with both negative tests.Conclusions: The inhalation challenge test for bird-related fibrotic HP was more sensitive than anti-bird IgG antibodies. Furthermore, the inhalation challenge test was able to find a group of patients with FVC decline.

Background Interleukin-6 (IL-6) is elevated in SARS-CoV-2 infection. IL-6 regulates acute-phase proteins, such as alpha-1 antitrypsin (AAT), a key lung anti-protease. We investigated the protease-anti-protease balance in the circulation and pulmonary compartments in SARS-CoV-2 acute respiratory distress syndrome (ARDS) compared to non-SARS-CoV-2 ARDS (nsARDS) and the effects of tocilizumab (IL-6 receptor antagonist) on anti-protease defence in SARS-CoV-2 infection. Methods Levels and activity of AAT and neutrophil elastase (NE) were measured in plasma, airway tissue and tracheal secretions (TA) of people with SARS-CoV-2 ARDS or nsARDS. AAT and IL-6 levels were evaluated in people with moderate SARS-CoV-2 infection who received standard of care +/- tocilizumab. Findings AAT plasma levels doubled in SARS-CoV-2 ARDS. In lung parenchyma AAT levels were increased, as was the percentage of neutrophils involved in NET formation. A protease-anti-protease imbalance was detected in TA with active NE and no active AAT. The airway anti-protease, secretory leukoprotease inhibitor was decreased in SARS-CoV-2-infected lungs and cleaved in TA. In nsARDS, plasma AAT levels were elevated but TA samples had less AAT cleavage, with no detectable active NE in most samples. Induction of AAT in ARDS occurred mainly through IL-6. Tocilizumab down-regulated AAT during SARS-CoV-2 infection. Interpretation There is a protease-anti-protease imbalance in the airways of SARS-CoV-2-ARDS patients. This imbalance is a target for anti-protease therapy. Funding NIH Serological Sciences Network, National Heart, Lung, and Blood Institute and National Institute of Diabetes and Digestive and Kidney Diseases.

Background Obstructive lung disease (OLD) is a risk factor for postoperative pulmonary complications (PPC) and is incidentally discovered during preoperative evaluation. The key treatments for OLD are inhaled long-acting bronchodilators (LAB). However, the advantage of preoperative bronchodilator treatment for patients with OLD remains unclear. The aim of this study is to elucidate the effect of preoperative LAB treatment in patients with untreated OLD on postoperative outcomes. Methods In this propensity-matched cohort study, we included patients who were referred to the pulmonologists for untreated OLD. The patients were either treated with LAB or left untreated. The primary outcome was the incidence of prolonged oxygen therapy (>3 days) in the postoperative period. We evaluated patients' characteristics with and without the use of LAB using propensity score (PS) matching weight. Subsequently, the outcomes in the two groups were compared. Results We analysed 614 patients; 132 patients were part of the LAB group and 482 were included in the control group. In the crude analysis, the incidence of prolonged oxygen therapy was higher in the LAB group than in the control group (odds ratio [OR] = 1.35; P = 0.04). However, after PS matching weight, no statistically significant differences in prolonged oxygen therapy (OR = 1.15), incidence of prolonged intensive care unit stay, endotracheal re-intubation postoperatively and in-hospital death between the groups were identified. Conclusion There is a limited benefit of preoperative treatment with inhaled LAB for the reduction of PPC in patients with untreated OLD.

Naftopidil, an α‐1 adrenoceptor antagonist with few adverse effects, is prescribed for prostate hyperplasia. Naftopidil inhibits prostate fibroblast proliferation; however, its effects on lung fibroblasts and fibrosis remain largely unknown. Two normal and one idiopathic pulmonary fibrosis human lung fibroblast lines were cultured with various naftopidil concentrations with or without phenoxybenzamine, an irreversible α‐1 adrenoceptor inhibitor. We examined the incorporation of 5‐bromo‐2ʹ‐deoxyuridine into DNA and lactic acid dehydrogenase release by enzyme‐linked immunosorbent assay, cell cycle analysis by flow cytometry, scratch wound‐healing assay, and mRNA expressions of type IV collagen and α‐smooth muscle actin by polymerase chain reaction. Effects of naftopidil on bleomycin‐induced lung fibrosis in mice were evaluated using histology, micro‐computed tomography, and surfactant protein‐D levels in serum. Naftopidil, dose‐dependently but independently of phenoxybenzamine, inhibited 5‐bromo‐2ʹ‐deoxyuridine incorporation in lung fibroblasts. Naftopidil induced G1 cell cycle arrest, but lactic acid dehydrogenase release and migration ability of lung fibroblasts were unaffected. Naftopidil decreased mRNA expressions of type IV collagen and α‐smooth muscle actin in one normal lung fibroblast line. Histological and micro‐computed tomography examination revealed that naftopidil attenuated lung fibrosis and decreased serum surfactant protein‐D levels in bleomycin‐induced lung fibrosis in mice. In conclusion, naftopidil may have therapeutic effects on lung fibrosis.

The nose is the portal for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection, suggesting the nose as a target for topical antiviral therapies. The purpose of this study was to assess both the in vivo and in vitro efficacy of a detergent-based virucidal agent, Johnson and Johnson's Baby Shampoo (JJ), in SARS-CoV-2-infected subjects.Subjects were randomized into three treatment groups: (1) twice daily nasal irrigation with JJ in hypertonic saline, (2) hypertonic saline alone, and (3) no intervention. Complementary in vitro experiments were performed in cultured human nasal epithelia. The primary outcome measure in the clinical trial was change in SARS-CoV-2 viral load over 21 days. Secondary outcomes included symptom scores and change in daily temperature. Outcome measures for in vitro studies included change in viral titers.Seventy-two subjects completed the clinical study (n = 24 per group). Despite demonstrated safety and robust efficacy in in vitro virucidal assays, JJ irrigations had no impact on viral titers or symptom scores in treated subjects relative to controls. Similar findings were observed administering JJ to infected cultured human airway epithelia using protocols mimicking the clinical trial regimen. Additional studies of cultured human nasal epithelia demonstrated that lack of efficacy reflected pharmacokinetic failure, with the most virucidal JJ detergent components rapidly absorbed from nasal surfaces.In this randomized clinical trial of subjects with SARS-CoV-2 infection, a topical detergent-based virucidal agent had no effect on viral load or symptom scores. Complementary in vitro studies confirmed a lack of efficacy, reflective of pharmacokinetic failure and rapid absorption from nasal surfaces.

Despite signs of infection, the involvement of the oral cavity in COVID-19 is poorly understood. To address this, single-cell RNA sequencing data-sets were integrated from human minor salivary glands and gingiva to identify 11 epithelial, 7 mesenchymal, and 15 immune cell clusters. Analysis of SARS-CoV-2 viral entry factor expression showed enrichment in epithelia including the ducts and acini of the salivary glands and the suprabasal cells of the mucosae. COVID-19 autopsy tissues confirmed in vivo SARS-CoV-2 infection in the salivary glands and mucosa. Saliva from SARS-CoV-2-infected individuals harbored epithelial cells exhibitingACE2expression and SARS-CoV-2 RNA. Matched nasopharyngeal and saliva samples found distinct viral shedding dynamics and viral burden in saliva correlated with COVID-19 symptoms including taste loss. Upon recovery, this cohort exhibited salivary antibodies against SARS-CoV-2 proteins. Collectively, the oral cavity represents a robust site for COVID-19 infection and implicates saliva in viral transmission.

TitleA mouse model of asthma­–chronic obstructive pulmonary disease overlap induced by intratracheal papain

IntroductionPatients with interstitial lung disease (ILD) are known to develop an acute exacerbation (AE) after surgery. Previous studies have evaluated the predictors of postoperative AE. However, it remains unclear whether the results of those studies can be generalised to patients with different types of ILD and/or extrapolated to those who undergo non-pulmonary surgery. This study aimed to elucidate the predictors of the development of AE after surgery with general anaesthesia in patients with ILD.MethodsWe conducted a nested matched case–control study of 700 patients from an initial cohort of 50 840 patients. We excluded those who underwent solid organ or bone marrow transplantation. The cases were patients with ILD who developed AE within 30 days postoperatively, whereas the controls did not develop AE. Each case (n=28) was matched with four controls (n=112) for sex, year of surgery and multiple operations within 30 days. Furthermore, a multivariable conditional logistic regression analysis was used to identify significant predictors, as indicated by a p value of ResultsAfter adjusting for potential confounders, the multivariable conditional logistic regression analysis identified honeycombing on CT (OR 3.09; 95% CI 1.07 to 8.92), a per cent predicted FVC ConclusionsWe found that the three factors were independent predictors for the development of postoperative AE in patients with ILD. These predictors are advantageous because they can be readily evaluated before surgery by surgeons and anaesthesiologists even without consulting experienced pulmonologists.

The master regulator of neuroendocrine differentiation, achaete-scute complex homolog 1 (ASCL1) defines a subgroup of lung adenocarcinoma. However, the mechanistic role of ASCL1 in lung tumorigenesis and its relation to the immune microenvironment is principally unknown. Here, the immune landscape of ASCL1-positive lung adenocarcinomas was characterized by immunohistochemistry. Furthermore, ASCL1 was transduced in mouse lung adenocarcinoma cell lines and comparative RNA-sequencing and secretome analyses were performed. The effects of ASCL1 on tumorigenesis were explored in an orthotopic syngeneic transplantation model. ASCL1-positive lung adenocarcinomas revealed lower infiltration of CD8+, CD4+, CD20+, and FOXP3+ lymphocytes and CD163+ macrophages indicating an immune desert phenotype. Ectopic ASCL1 upregulated cyclin transcript levels, stimulated cell proliferation, and enhanced tumor growth in mice. ASCL1 suppressed secretion of chemokines, including CCL20, CXCL2, CXCL10, and CXCL16, indicating effects on immune cell trafficking. In accordance with lower lymphocytes infiltration, ASCL1-positive lung adenocarcinomas demonstrated lower abundance of CXCR3-and CCR6-expressing cells. In conclusion, ASCL1 mediates its tumor-promoting effect not only through cell-autonomous signaling but also by modulating chemokine production and immune responses. These findings suggest that ASCL1-positive tumors represent a clinically relevant lung cancer entity.

The Raman spectra of novel ferroelectric ceramics SnxSr1-xTiO3 (x = 0.1, 0.05 and 0.02) were obtained to clarify the mechanism of their ferroelectric phase transitions. Two transverse-optic modes in the ferroelectric phase showed softening toward the ferroelectric transition temperature. A comparison of the spectra obtained for SnxSr1-xTiO3 with the spectrum of PbxSr1-xTiO3 facilitated the assignment of the observed modes under the assumption of the ferroelectric phase in C4v1 symmetry. However, several peaks violating the Raman selection rules were observed, suggesting the emergence and growth of polar regions even in the paraelectric phase.

Small cell lung cancer (SCLC) is a neuroendocrine tumour that exhibits rapid growth and metastatic spread. Although SCLC represents a prototypically undifferentiated cancer type, thyroid transcription factor-1 (TTF-1, gene symbol NKX2-1), a master regulator for pulmonary epithelial cell differentiation and lung morphogenesis, is strongly upregulated in this aggressive cancer type. The aim of this study was to evaluate a functional role for TTF-1 in SCLC. We demonstrated that achaete-scute complex homolog 1 (ASCL1), an essential transcription factor for neuroendocrine differentiation, positively regulated TTF-1 in SCLC cell lines. Subsequently, we described genes and microRNAs (miRNAs) that were possibly controlled by TTF-1 and identified nuclear factor IB (NFIB), a recently characterised driver of SCLC progression, as a transcriptional target of TTF-1. Our findings shine light on a regulatory axis in SCLC consisting of ASCL1/TTF-1/NFIB that potentially contributes to the tumourigenesis of SCLC. Copyright © 2018 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.

Lung fibroblasts participate in the pathogenesis of respiratory diseases, including lung cancer and pulmonary fibrosis. Although fibroblasts are ubiquitous constituents of various organs, their cellular diversity among different organs has been poorly characterized. Here, we aimed to investigate the distinct gene signature of lung fibroblasts that represents its pulmonary origin and the underlying gene regulatory networks. Promoter-level differential expression analysis by cap analysis of gene expression (CAGE) sequencing revealed distinct gene expression patterns of fibroblasts derived from different anatomical sites and identified 88 coding genes with higher expression in lung fibroblasts relative to other fibroblasts. Multiple key transcription factors important for lung mesenchyme development, including the T-box transcription factors TBX2, TBX4, and TBX5 were enriched in this lung-specific signature and were associated with super-enhancers. TBX4 showed highly specific expression in lung fibroblasts and was required for cell proliferation and collagen gel contraction capacity. Transcriptome analysis revealed that TBX4 could broadly regulate fibroblast-related pathways and partly contribute to super-enhancer-mediated transcriptional programs. Of pathological importance, lung fibroblast-specific genes were globally downregulated in lung cancer-associated fibroblasts (CAFs). Notably, TBX2, TBX4, and TBX5 were downregulated and hypermethylated in lung CAFs, suggesting an association between epigenetic silencing of these factors and phenotypic alteration of lung fibroblasts in cancer. Our study highlights the importance of T-box transcription factors, especially TBX4, and super-enhancers in the roles of lung fibroblasts in pulmonary physiology and pathogenesis.

Lung cancer is the leading cause of cancer-related deaths worldwide. The majority of cancer driver mutations have been identified; however, relevant epigenetic regulation involved in tumorigenesis has only been fragmentarily analyzed. Epigenetically regulated genes have a great theranostic potential, especially in tumors with no apparent driver mutations. Here, epigenetically regulated genes were identified in lung cancer by an integrative analysis of promoter-level expression profiles from Cap Analysis of Gene Expression (CAGE) of 16 non–small cell lung cancer (NSCLC) cell lines and 16 normal lung primary cell specimens with DNA methylation data of 69 NSCLC cell lines and 6 normal lung epithelial cells. A core set of 49 coding genes and 10 long noncoding RNAs (lncRNA), which are upregulated in NSCLC cell lines due to promoter hypomethylation, was uncovered. Twenty-two epigenetically regulated genes were validated (upregulated genes with hypomethylated promoters) in the adenocarcinoma and squamous cell cancer subtypes of lung cancer using The Cancer Genome Atlas data. Furthermore, it was demonstrated that multiple copies of the REP522 DNA repeat family are prominently upregulated due to hypomethylation in NSCLC cell lines, which leads to cancer-specific expression of lncRNAs, such as RP1-90G24.10, AL022344.4, and PCAT7. Finally, Myeloma Overexpressed (MYEOV) was identified as the most promising candidate. Functional studies demonstrated that MYEOV promotes cell proliferation, survival, and invasion. Moreover, high MYEOV expression levels were associated with poor prognosis. Implications: This report identifies a robust list of 22 candidate driver genes that are epigenetically regulated in lung cancer; such genes may complement the known mutational drivers. Visual Overview: http://mcr.aacrjournals.org/content/molcanres/15/10/1354/F1.large.jpg. Mol Cancer Res; 15(10); 1354–65. ©2017 AACR.

Introduction Patients with haematological malignancies usually have a plethora of respiratory complications. Bronchoscopy is one of the most important procedures used to diagnose respiratory complications. Despite enormous benefit, patients should be carefully selected for bronchoscopy as the process is invasive; however, there are only few reports evaluating the contributing factors of bronchoscopy that result in the definitive diagnosis of respiratory complications in these patients. Objective This study aimed to elucidate and identify the contributing factors of bronchoscopy for definitive diagnosis in patients with haematological malignancies. Methods We retrospectively analysed 275 patients with haematological malignancies who later showed respiratory complications, requiring consultation with pulmonologists. We found that 62 patients underwent bronchoscopy. Our data analysis focused on this particular subset of patients to identify the factors crucial for definitive diagnosis via bronchoscopy. Results Bronchoscopy provided definitive diagnosis for 25 patients (diagnostic yield = 40.3%). We determined that nodular shadow was associated with high diagnostic yields by multivariate logistic regression [odds ratio (OR): 6.6 (2.1-23)]. Furthermore, in several bronchoscopic procedures, biopsy also contributed to definitive diagnosis of patients with nodular shadow [OR: 17 (1.5-180)]. Life-threatening complications were not observed due to bronchoscopy in our study. Conclusions Our study demonstrated that patients with haematological malignancies who showed lung nodular shadows are more likely to be definitively diagnosed by bronchoscopy, whereas transbronchial biopsy may also be beneficial for these patients.

Background: Transcriptional co-activator with PDZ-binding motif (TAZ) and Yes-associated protein (YAP) are key downstream effectors of the Hippo pathway. TAZ is considered as a homolog of YAP. Recent studies revealed that TAZ knockout mice exhibit lung emphysema, while YAP knockout mice show abnormalities in bronchial morphogenesis, and the cause of these differences remains unknown. Objective: To compare the role of TAZ and YAP in lung development, by generating lung epithelial-specific conditional knockout mice (cKO mice) of Taz and Yap. Methods: Taz and Yap cKO mice were generated by using a surfactant protein C-driven Cre recombinase allele. To identify genes affected by Yap ablation from lung epithelial cells, RNA-seq analysis was performed in Yap cKO embryo lung. We confirmed our in vivo findings by using human lung epithelial cell lines, which YAP and TAZ were suppressed by siRNA. Results: In lung development, Yap was highly expressed in embryonic stage of lung development, conversely Taz was highly expressed in the early alveolar stage. Taz cKO adult mice exhibited lung emphysema in adults, whereas Yap cKO mice were lethal at birth and showed bronchial branching abnormalities. RNA-seq analysis revealed that YAP ablation decreased Sonic hedgehog (Shh) expression, which is essential in proper branching morphogenesis. We also found that TGF-beta stimulation induces Shh expression in cell lines, which was suppressed by knockdown of TAZ or YAP. Conclusion: Our results indicate that TAZ and YAP function at different stages of lung development in lung epithelial cells and essential for proper lung development. Our results suggested the existence of a novel pathway between TGF-beta and Shh.

Background: Chronic Obstructive Pulmonary Disease (COPD) is a systemic inflammatory disease, and often causes weight loss, which is considered as a poor prognostic factor. A Japanese herbal medicine, Hochu-ekki-to (TJ-41), was reported to prevent weight loss in a small study of COPD patients, while its biological mechanism is unknown. Objective: The objective of our study was to evaluate the role of TJ-41 using mouse lung emphysema model, and to investigate its biological mechanism in vivo and in vitro. Methods: We used lung epithelial specific Taz conditional knockout mice (Taz CKO mice) as emphysema model mice, and fed a diet containing 2% TJ-41 or a control diet for 12 weeks. During administration, body weights were measured. After seeding, Taz CKO mice and control mice were subjected to BALF analysis, and lung mRNA expressions of inflammatory cytokines were analysed by RT-PCR. Results: After treatment, Taz CKO mice showed higher body weights in TJ-41 group compared to control diet group. BALF analysis showed decreased number of inflammatory cells in TJ-41 group, and among inflammatory cytokines, IL-8 expression was also significantly decreased. Conclusion: Our results suggest the possibility that TJ-41 attenuates lung inflammation, and thereby prevents weight loss of COPD patients. Among inflammatory cytokines, IL-8 is downregulated by administration of TJ-41, which coincided with decreased number of inflammatory cells in BALF in TJ-41 group. Our study sheds light on the biological mechanism of TJ-41 in lung emphysema, and suggests its potential for anti-inflammatory therapy for COPD patients.

Backgrounds: Ｃhronic obstructive pulmonary disease (COPD) is a pulmonary disease with permanent airflow obstruction and emphysema, and acute exacerbation of COPD is often induced by infection often resulting in a poor prognosis. Reactive oxygen species (ROS), producted in mitochondria, has been reported to accelerate the establishment of COPD. Sirtuin3(SIRT3) is the mitochondrial NAD(+)-dependent deacetylase, which regulates ROS formation and proinflammatory responses. It is also reported to be related with lifespan longevity. Aims: The aim of our study was to investigate the role of SIRT3 in COPD exacerbation mouse model generated by porcine pancreatic elastase(PPE) and lipopolysaccharide(LPS). Methods: PPE followed by LPS was administered intratracheally to wild-type (WT) or SIRT3 overexpressing transgenic(SIRT3 OE), SIRT3 knockout (SIRT3 KO) male mice. The next day (early phase) and 4weeks later (late phase) after LPS administration, BALF analysis and lung function test was conducted. Results: In early phase, the BALF cell count of SIRT3 OE mice was significantly increased compared to control WT mice, whereas that of SIRT3 KO mice was significantly decreased. In late phase, the lung compliance was increased in SIRT3 OE mice compared to WT mice, and decreased in SIRT3 KO mice. Conclusions: Our study showed that SIRT3 surpressed acute lung injury and emphysematous worsening in COPD model mice. SIRT3 would serve as a new therapeutic target to COPD and COPD exacerbation.

Background: Periostin, a biomarker that reflects Th2-driven inflammatory diseases, play important roles in the asthmatic airway. Although periostin is mainly produced in Bronchial Smooth Muscle (BSM) cells after IL-13 stimulation, the mechanism of periostin production remains unclear. Methods: In order to investigate the intracellular signaling pathway of periostin production under stimulation with IL-13, we performed RNA sequence analysis. BSM cells were stimulated with IL-13 for 0, 12, 24, 48hours. We evaluated the phosphorylation of signal transducer and activator of transcription factor 6 (STAT6), extracellular signal-regulated kinase (ERK) 1/2, and Akt after IL-13 stimulation. Furthermore, the influence of IL-13 receptor α2 knockdown and several phosphorylation inhibitors on periostin production was evaluated by using qPCR and ELISA. Results: Periostin increased in a time-dependent manner in the culture supernatant. The results of RNA sequence suggested that the involvement of JAK/STAT, ERK 1/2, PI3K/Akt pathways and IL13 receptor α2. IL-13-induced periostin was attenuated by inhibiting STAT6 phosphorylation and was strongly suppressed by inhibiting MEK 1/2 phosphorylation or PI3K phosphorylation. IL-13 receptor α2 is highly expressed during IL-13 stimulation and knockdown of IL-13 receptor α2 caused increase of periostin production. Conclusions: Our study demonstrates that BSM cells produce periostin after IL-13 stimulation through the JAK/STAT6, ERK1/2, and PI3K/Akt pathways and the relation of IL-13 receptor α2. These suggest that the mechanism of periostin production in BSM cells might help clarify asthma pathogenesis and discover new therapeutic targets for managing asthma.

Background and Aim: Recently, it has been recognized that asthma and COPD can coexist as asthma-COPD overlap (ACO). Due to the difference of clinical course, it is thought the pathogenesis of ACO is different from that of asthma or COPD; however, its animal models have not yet been established. In animal experiments, papain (a cysteine protease enzyme present in papaya) is known to cause asthmatic response by daily inhalation, and lung emphysema by intermittent inhalation. Here we developed ACO mice model by weekly intratracheal administrations of papain, and we examined whether the mice model well reflects the features of ACO, comparing its features with elastase induced COPD model. Methods: PBS, papain, or porcine pancreatic elastase (PPE) was intratracheally administered to female C57BL/6N mice (5-6 weeks old) on days 0, 7, 14, 21, while PPE on day 0 only. The mice were sacrificed on day 25. Lung mechanics, airway responsiveness to methacholine, bronchoalveolar lavage fluid (BALF), lung tissue, and mRNA in lung homogenates were analyzed. Results: In lung mechanics tests, both papain and PPE group showed significantly higher compliance and inspiratory capacity than PBS group, while the airway responsiveness to methacholine was significantly higher in papain group than in other groups. Papain increased eosinophils in BALF. Both papain and PPE induced alveolar air-space enlargement. In addition, type 2 inflammatory cytokines such as IL-13 and IL-25 were significantly higher in papain group than in other groups. Conclusions: Weekly papain administrations induced ACO like features in mice. Clarification of the underlying pathogenesis and development of novel treatment might be expected using this single-agent simple model.

Coronavirus infection causes diffuse alveolar damage leading to acute respiratory distress syndrome. The absence of ex vivo models of human alveolar epithelium is hindering an understanding of coronavirus disease 2019 (COVID-19) pathogenesis. Here, we report a feeder-free, scalable, chemically defined, and modular alveolosphere culture system for the propagation and differentiation of human alveolar type 2 cells/pneumocytes derived from primary lung tissue. Cultured pneumocytes express the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) receptor angiotensin-converting enzyme receptor type-2 (ACE2) and can be infected with virus. Transcriptome and histological analysis of infected alveolospheres mirror features of COVID-19 lungs, including emergence of interferon (IFN)-mediated inflammatory responses, loss of surfactant proteins, and apoptosis. Treatment of alveolospheres with IFNs recapitulates features of virus infection, including cell death. In contrast, alveolospheres pretreated with low-dose IFNs show a reduction in viral replication, suggesting the prophylactic effectiveness of IFNs against SARS-CoV-2. Human stem cell-based alveolospheres, thus, provide novel insights into COVID-19 pathogenesis and can serve as a model for understanding human respiratory diseases., Graphical Abstract, Highlights • Stroma-free long-term expansion and differentiation of adult human lung stem cells • AT2 response to SARS-CoV-2 infection mirrors features of COVID-19 lungs • Infected AT2s upregulate IFNs and apoptotic pathways and decrease surfactants • Low-dose IFN pre-treatment blocks SARS-CoV-2 replication in alveolospheres, Tata and colleagues report defined conditions for long-term expansion and differentiation of adult human primary alveolar stem cells. Cultured AT2s are conducive to SARS-CoV-2 infection and elicit transcriptome-wide changes that mirror COVID-19 histopathology, including upregulation of inflammatory responses, cell death, and downregulation of surfactant expression, leading to pneumocyte dysfunction.