Airway mucin concentration as a marker of chronic bronchitis

Mehmet Kesimer, Amina A. Ford, Agathe Ceppe, Giorgia Radicioni, Rui Cao, C. William Davis, Claire M. Doerschuk, Neil E. Alexis, Wayne H. Anderson, Ashley G. Henderson, Graham R. Barr, Eugene R. Bleecker, Stephanie A. Christenson, Christopher B. Cooper, Mei Lan K. Han, Nadia Hansel, Annette T. Hastie, Eric A. Hoffman, Richard E. Kanner, Fernando Martinez & 4 others Rober Paine, Prescott G. Woodruff, Wanda K. O'Neal, Richard C. Boucher

Research output: Contribution to journalArticle

Abstract

Background: Chronic obstructive pulmonary disease (COPD) is characterized by chronic bronchitic and emphysematous components. In one biophysical model, the concentration of mucin on the airway surfaces is hypothesized to be a key variable that controls mucus transport in healthy persons versus cessation of transport in persons with muco-obstructive lung diseases. Under this model, it is postulated that a high mucin concentration produces the sputum and disease progression that are characteristic of chronic bronchitis. Methods: We characterized the COPD status of 917 participants from the Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS) using questionnaires administered to participants, chest tomography, spirometry, and examination of induced sputum. Total mucin concentrations in sputum were measured with the use of size-exclusion chromatography and refractometry. In 148 of these participants, the respiratory secreted mucins MUC5AC and MUC5B were quantitated by means of mass spectrometry. Data from chronicbronchitis questionnaires and data on total mucin concentrations in sputum were also analyzed in an independent 94-participant cohort. Results: Mean (±SE) total mucin concentrations were higher in current or former smokers with severe COPD than in controls who had never smoked (3166±402 vs. 1515±152 μg per milliliter) and were higher in participants with two or more respiratory exacerbations per year than in those with zero exacerbations (4194±878 vs. 2458±113 μg per milliliter). The absolute concentrations of MUC5B and MUC5AC in current or former smokers with severe COPD were approximately 3 times as high and 10 times as high, respectively, as in controls who had never smoked. Receiver-operating-characteristic curve analysis of the association between total mucin concentration and a diagnosis of chronic bronchitis yielded areas under the curve of 0.72 (95% confidence interval [CI], 0.65 to 0.79) for the SPIROMICS cohort and 0.82 (95% CI, 0.73 to 0.92) for the independent cohort. Conclusions: Airway mucin concentrations may quantitate a key component of the chronic bronchitis pathophysiologic cascade that produces sputum and mediates disease severity. Studies designed to explore total mucin concentrations in sputum as a diagnostic biomarker and therapeutic target for chronic bronchitis appear to be warranted. (Funded by the National Heart, Lung, and Blood Institute and others.)

Original languageEnglish (US)
Pages (from-to)911-922
Number of pages12
JournalNew England Journal of Medicine
Volume377
Issue number10
DOIs
StatePublished - Sep 7 2017

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Chronic Bronchitis
Mucins
Sputum
Chronic Obstructive Pulmonary Disease
Outcome Assessment (Health Care)
Confidence Intervals
National Heart, Lung, and Blood Institute (U.S.)
Obstructive Lung Diseases
Refractometry
Spirometry
Mucus
ROC Curve
Area Under Curve
Gel Chromatography
Disease Progression
Mass Spectrometry
Cohort Studies
Thorax
Biomarkers
Tomography

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Kesimer, M., Ford, A. A., Ceppe, A., Radicioni, G., Cao, R., Davis, C. W., ... Boucher, R. C. (2017). Airway mucin concentration as a marker of chronic bronchitis. New England Journal of Medicine, 377(10), 911-922. https://doi.org/10.1056/NEJMoa1701632

Airway mucin concentration as a marker of chronic bronchitis. / Kesimer, Mehmet; Ford, Amina A.; Ceppe, Agathe; Radicioni, Giorgia; Cao, Rui; Davis, C. William; Doerschuk, Claire M.; Alexis, Neil E.; Anderson, Wayne H.; Henderson, Ashley G.; Barr, Graham R.; Bleecker, Eugene R.; Christenson, Stephanie A.; Cooper, Christopher B.; Han, Mei Lan K.; Hansel, Nadia; Hastie, Annette T.; Hoffman, Eric A.; Kanner, Richard E.; Martinez, Fernando; Paine, Rober; Woodruff, Prescott G.; O'Neal, Wanda K.; Boucher, Richard C.

In: New England Journal of Medicine, Vol. 377, No. 10, 07.09.2017, p. 911-922.

Research output: Contribution to journalArticle

Kesimer, M, Ford, AA, Ceppe, A, Radicioni, G, Cao, R, Davis, CW, Doerschuk, CM, Alexis, NE, Anderson, WH, Henderson, AG, Barr, GR, Bleecker, ER, Christenson, SA, Cooper, CB, Han, MLK, Hansel, N, Hastie, AT, Hoffman, EA, Kanner, RE, Martinez, F, Paine, R, Woodruff, PG, O'Neal, WK & Boucher, RC 2017, 'Airway mucin concentration as a marker of chronic bronchitis', New England Journal of Medicine, vol. 377, no. 10, pp. 911-922. https://doi.org/10.1056/NEJMoa1701632
Kesimer M, Ford AA, Ceppe A, Radicioni G, Cao R, Davis CW et al. Airway mucin concentration as a marker of chronic bronchitis. New England Journal of Medicine. 2017 Sep 7;377(10):911-922. https://doi.org/10.1056/NEJMoa1701632
Kesimer, Mehmet ; Ford, Amina A. ; Ceppe, Agathe ; Radicioni, Giorgia ; Cao, Rui ; Davis, C. William ; Doerschuk, Claire M. ; Alexis, Neil E. ; Anderson, Wayne H. ; Henderson, Ashley G. ; Barr, Graham R. ; Bleecker, Eugene R. ; Christenson, Stephanie A. ; Cooper, Christopher B. ; Han, Mei Lan K. ; Hansel, Nadia ; Hastie, Annette T. ; Hoffman, Eric A. ; Kanner, Richard E. ; Martinez, Fernando ; Paine, Rober ; Woodruff, Prescott G. ; O'Neal, Wanda K. ; Boucher, Richard C. / Airway mucin concentration as a marker of chronic bronchitis. In: New England Journal of Medicine. 2017 ; Vol. 377, No. 10. pp. 911-922.
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abstract = "Background: Chronic obstructive pulmonary disease (COPD) is characterized by chronic bronchitic and emphysematous components. In one biophysical model, the concentration of mucin on the airway surfaces is hypothesized to be a key variable that controls mucus transport in healthy persons versus cessation of transport in persons with muco-obstructive lung diseases. Under this model, it is postulated that a high mucin concentration produces the sputum and disease progression that are characteristic of chronic bronchitis. Methods: We characterized the COPD status of 917 participants from the Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS) using questionnaires administered to participants, chest tomography, spirometry, and examination of induced sputum. Total mucin concentrations in sputum were measured with the use of size-exclusion chromatography and refractometry. In 148 of these participants, the respiratory secreted mucins MUC5AC and MUC5B were quantitated by means of mass spectrometry. Data from chronicbronchitis questionnaires and data on total mucin concentrations in sputum were also analyzed in an independent 94-participant cohort. Results: Mean (±SE) total mucin concentrations were higher in current or former smokers with severe COPD than in controls who had never smoked (3166±402 vs. 1515±152 μg per milliliter) and were higher in participants with two or more respiratory exacerbations per year than in those with zero exacerbations (4194±878 vs. 2458±113 μg per milliliter). The absolute concentrations of MUC5B and MUC5AC in current or former smokers with severe COPD were approximately 3 times as high and 10 times as high, respectively, as in controls who had never smoked. Receiver-operating-characteristic curve analysis of the association between total mucin concentration and a diagnosis of chronic bronchitis yielded areas under the curve of 0.72 (95{\%} confidence interval [CI], 0.65 to 0.79) for the SPIROMICS cohort and 0.82 (95{\%} CI, 0.73 to 0.92) for the independent cohort. Conclusions: Airway mucin concentrations may quantitate a key component of the chronic bronchitis pathophysiologic cascade that produces sputum and mediates disease severity. Studies designed to explore total mucin concentrations in sputum as a diagnostic biomarker and therapeutic target for chronic bronchitis appear to be warranted. (Funded by the National Heart, Lung, and Blood Institute and others.)",
author = "Mehmet Kesimer and Ford, {Amina A.} and Agathe Ceppe and Giorgia Radicioni and Rui Cao and Davis, {C. William} and Doerschuk, {Claire M.} and Alexis, {Neil E.} and Anderson, {Wayne H.} and Henderson, {Ashley G.} and Barr, {Graham R.} and Bleecker, {Eugene R.} and Christenson, {Stephanie A.} and Cooper, {Christopher B.} and Han, {Mei Lan K.} and Nadia Hansel and Hastie, {Annette T.} and Hoffman, {Eric A.} and Kanner, {Richard E.} and Fernando Martinez and Rober Paine and Woodruff, {Prescott G.} and O'Neal, {Wanda K.} and Boucher, {Richard C.}",
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TY - JOUR

T1 - Airway mucin concentration as a marker of chronic bronchitis

AU - Kesimer, Mehmet

AU - Ford, Amina A.

AU - Ceppe, Agathe

AU - Radicioni, Giorgia

AU - Cao, Rui

AU - Davis, C. William

AU - Doerschuk, Claire M.

AU - Alexis, Neil E.

AU - Anderson, Wayne H.

AU - Henderson, Ashley G.

AU - Barr, Graham R.

AU - Bleecker, Eugene R.

AU - Christenson, Stephanie A.

AU - Cooper, Christopher B.

AU - Han, Mei Lan K.

AU - Hansel, Nadia

AU - Hastie, Annette T.

AU - Hoffman, Eric A.

AU - Kanner, Richard E.

AU - Martinez, Fernando

AU - Paine, Rober

AU - Woodruff, Prescott G.

AU - O'Neal, Wanda K.

AU - Boucher, Richard C.

PY - 2017/9/7

Y1 - 2017/9/7

N2 - Background: Chronic obstructive pulmonary disease (COPD) is characterized by chronic bronchitic and emphysematous components. In one biophysical model, the concentration of mucin on the airway surfaces is hypothesized to be a key variable that controls mucus transport in healthy persons versus cessation of transport in persons with muco-obstructive lung diseases. Under this model, it is postulated that a high mucin concentration produces the sputum and disease progression that are characteristic of chronic bronchitis. Methods: We characterized the COPD status of 917 participants from the Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS) using questionnaires administered to participants, chest tomography, spirometry, and examination of induced sputum. Total mucin concentrations in sputum were measured with the use of size-exclusion chromatography and refractometry. In 148 of these participants, the respiratory secreted mucins MUC5AC and MUC5B were quantitated by means of mass spectrometry. Data from chronicbronchitis questionnaires and data on total mucin concentrations in sputum were also analyzed in an independent 94-participant cohort. Results: Mean (±SE) total mucin concentrations were higher in current or former smokers with severe COPD than in controls who had never smoked (3166±402 vs. 1515±152 μg per milliliter) and were higher in participants with two or more respiratory exacerbations per year than in those with zero exacerbations (4194±878 vs. 2458±113 μg per milliliter). The absolute concentrations of MUC5B and MUC5AC in current or former smokers with severe COPD were approximately 3 times as high and 10 times as high, respectively, as in controls who had never smoked. Receiver-operating-characteristic curve analysis of the association between total mucin concentration and a diagnosis of chronic bronchitis yielded areas under the curve of 0.72 (95% confidence interval [CI], 0.65 to 0.79) for the SPIROMICS cohort and 0.82 (95% CI, 0.73 to 0.92) for the independent cohort. Conclusions: Airway mucin concentrations may quantitate a key component of the chronic bronchitis pathophysiologic cascade that produces sputum and mediates disease severity. Studies designed to explore total mucin concentrations in sputum as a diagnostic biomarker and therapeutic target for chronic bronchitis appear to be warranted. (Funded by the National Heart, Lung, and Blood Institute and others.)

AB - Background: Chronic obstructive pulmonary disease (COPD) is characterized by chronic bronchitic and emphysematous components. In one biophysical model, the concentration of mucin on the airway surfaces is hypothesized to be a key variable that controls mucus transport in healthy persons versus cessation of transport in persons with muco-obstructive lung diseases. Under this model, it is postulated that a high mucin concentration produces the sputum and disease progression that are characteristic of chronic bronchitis. Methods: We characterized the COPD status of 917 participants from the Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS) using questionnaires administered to participants, chest tomography, spirometry, and examination of induced sputum. Total mucin concentrations in sputum were measured with the use of size-exclusion chromatography and refractometry. In 148 of these participants, the respiratory secreted mucins MUC5AC and MUC5B were quantitated by means of mass spectrometry. Data from chronicbronchitis questionnaires and data on total mucin concentrations in sputum were also analyzed in an independent 94-participant cohort. Results: Mean (±SE) total mucin concentrations were higher in current or former smokers with severe COPD than in controls who had never smoked (3166±402 vs. 1515±152 μg per milliliter) and were higher in participants with two or more respiratory exacerbations per year than in those with zero exacerbations (4194±878 vs. 2458±113 μg per milliliter). The absolute concentrations of MUC5B and MUC5AC in current or former smokers with severe COPD were approximately 3 times as high and 10 times as high, respectively, as in controls who had never smoked. Receiver-operating-characteristic curve analysis of the association between total mucin concentration and a diagnosis of chronic bronchitis yielded areas under the curve of 0.72 (95% confidence interval [CI], 0.65 to 0.79) for the SPIROMICS cohort and 0.82 (95% CI, 0.73 to 0.92) for the independent cohort. Conclusions: Airway mucin concentrations may quantitate a key component of the chronic bronchitis pathophysiologic cascade that produces sputum and mediates disease severity. Studies designed to explore total mucin concentrations in sputum as a diagnostic biomarker and therapeutic target for chronic bronchitis appear to be warranted. (Funded by the National Heart, Lung, and Blood Institute and others.)

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DO - 10.1056/NEJMoa1701632

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JO - New England Journal of Medicine

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