Oxidative Stress and Nutritional Intakes in Lung Patients With Bronchiolitis Obliterans Syndrome

doi:10.1016/j.transproceed.2009.04.012

Transplantation Proceedings

Volume 41, Issue 9, November 2009, Pages 3838-3844

https://doi.org/10.1016/j.transproceed.2009.04.012 Get rights and content

Abstract

Survival after lung transplantation is limited by bronchiolitis obliterans syndrome (BOS). Oxidative stress (OxS) can be associated with BOS due to chronic inflammation. The type of fat and antioxidant intakes may also contribute to OxS. Our aim was to compare OxS and nutritional intakes in non-BOS versus various stages of BOS. Fifty-eight lung recipients with versus without BOS were prospectively classified as: non-BOS; BOS Op-1 (mild), and BOS 2–3 (severe). We measured nutritional intake and plasma vitamins A, C, and E. Among a subgroup of 37 patients, OxS was assessed by measuring lipid peroxidation (LPO μmol/L MDA) and oxidized glutathione (GSSG) in bronchoalveolar lavage BAL fluid (BALF). One-way analysis of variance was used to compare groups. Results are reported as mean values ± standard errors of the mean. There was no significant difference in demographic features on time posttransplant among groups. Although there were comparable cell counts in BALF, severe BOS patients showed significantly higher BALF LPO concentrations when compared with milder stage of BOS or with non-BOS (P = .001, for both). Severe BOS recipients also displayed higher BALF GSSG concentrations compared to milder stage of BOS (P = .001) or non-BOS (P = .007). In conclusion, patients with severe BOS were more oxidatively stressed compared with mild and non-BOS recipients.

Section snippets

Study Participants

This cross-sectional investigation included 66 lung transplant patients consecutively recruited from April 2005 to October 2006. Three patients declined to participate, three did not show up for their scheduled clinic appointment, and two patients were too sick to participate. The 58 remaining patients recruited from our ambulatory lung transplant clinic included 37 who were between 12 and 24 months posttransplantation (plasma and BALF available) and 21 who were >24 months (plasma values only).

Results

The characteristics of the 58 lung transplant recipients enrolled in the study are shown in Table 1. The 37 patients with BALF measurements are described in Table 2. Patients were classified into three groups, according to the changes from their baseline FEV₁: non-BOS; BOS Op-1; and BOS 2–3. There were no significant differences among the three patient groups with respect to BMI, gender, age, diabetes mellitus, primary underlying lung disease or type of lung transplant (single versus bilateral)

Discussion

Our results suggested that lung recipients with severe stages of BOS (BOS 2–3) were more oxidatively stressed compared with those of a milder stage of BOS (BOS Op-1) or non-BOS lung recipients, as indicated by increased BALF levels of LPO and GSSG.

Several studies have reported increased OxS among solid organ transplants33, 34, 35; however, information regarding lung patients is scarce, but indicate an increased OxS in this patient population. One prospective study³⁶ reported increased BALF MDA

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These potent chemo-attractants for neutrophils might account for the excess of neutrophils observed even among patients with mild lung impairments. In addition, neutrophils and their reactive oxygen species (ROS) are able to perpetuate inflammation and remodel airways [23,24]. In fact, it was recently shown that lipid and protein oxidation was significantly elevated in BAL specimens from children with post-infectious BO [25].
Airway inflammation plays a major role in the progression of chronic lung diseases. The features of airway inflammation are not well defined among patients with cases of bronchiolitis obliterans (BO) that began in childhood.
To investigate the sputum cell and cytokine profiles of stable cases of BO regarding lung function and the involvement of small airway disease (SAD).
Twenty patients with BO (median age = 14.5, range = 7–23 years) and 22 healthy controls (median age = 16.5 years, range = 7–24 years) were investigated. Lung function parameters and bronchial reversibility testing as well as sputum cell and cytokine profiles (IL-1β, IL-6, IL-8, TNF-α, IL-5, IFN-γ, and NFκB regulation) were analysed using quantitative RT-PCR and cytometric bead assay (CBA) in induced sputum.
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A cross-sectional study assessing dietary intake and physical activity in canadian patients with nonalcoholic fatty liver disease vs healthy controls
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Weight and height were measured to calculate body mass index (BMI), and waist circumference was measured. Participants were instructed by an experienced nutritionist to complete a 7-day food record using the Food Portion Visual 2.0 Chart (Nutrition Consulting Enterprises, Framingham, MA), which is validated for men and women 20 to 70+ years of age29 and has been used in our previous studies.30-32 Food records were reviewed carefully by the nutritionist to clarify questions and complete missing details.
Poor diet and a sedentary lifestyle can contribute to nonalcoholic fatty liver disease (NAFLD).
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More patients with NASH (58.5%) were obese compared with patients with simple steatosis (24.2%) and healthy controls (7.4%; P<0.01). Patients with NAFLD showed more insulin resistance than healthy controls. The reported energy intake was below estimated requirements in all groups (P≤0.001). The proportion of subjects from each group exceeding acceptable energy intake from fat was as follows: simple steatosis: 27.3%; NASH: 46.3%; healthy controls: 63.0% (simple steatosis vs health controls; P<0.05) and from saturated fat: simple steatosis: 42.4%; NASH: 70.7%; healthy controls: 63.0% (simple steatosis vs. NASH; P<0.05). In each group, >80% of subjects did not consume enough linoleic or linolenic acid, vitamin D, and vitamin E, and >60% exceeded the upper intake level for sodium. Only 53.1% of patients with simple steatosis and 53.8% of patients with NASH, but 84.6% of healthy controls, met recommendations for physical activity (P=0.020). Plasma vitamin C was normal, similar among groups, and correlated with vitamin C intakes.
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Thoracic transplantationLungOxidative Stress and Nutritional Intakes in Lung Patients With Bronchiolitis Obliterans Syndrome

Abstract

Section snippets

Study Participants

Results

Discussion

J Heart Lung Transplant

J Thorac Cardiovasc Surg

J Heart Lung Transplant

Am J Transplant

Am J Transplant

Am J Clin Nutr

Mech Ageing Dev

Am J Clin Nutr

Am J Clin Nutr

Am J Clin Nutr

J Am Diet Assoc

J Biol Chem

J Am Diet Assoc

Transplant Proc

Dig Liver Dis

Am Heart J

Pulm Pharmacol Ther

Am J Clin Nutr

Am J Gastroenterol

Am J Clin Nutr

Am J Clin Nutr

Am J Transplant

Immunologic mechanisms underlying bronchiolitis obliterans

Curr Opin Crit Care

Mechanisms of airway obliteration after lung transplantation

Proc Am Thorac Soc

Bronchiolitis obliterans syndrome: incidence, natural history, prognosis and risk factors

J Heart Lung Transplant

Analysis of risk factors for the development of bronchiolitis obliterans syndrome

Am J Respir Crit Care Med

Gastroesophageal reflux disease in lung transplant recipients

Clin Transplant

The role of neutrophils in the pathogenesis of obliterative bronchiolitis after lung transplantation

Transpl Infect Dis

Thoracic transplantation
Lung
Oxidative Stress and Nutritional Intakes in Lung Patients With Bronchiolitis Obliterans Syndrome