Chest
Clinical InvestigationsThe Increase in Serum Soluble ST2 Protein Upon Acute Exacerbation of Idiopathic Pulmonary Fibrosis
Section snippets
Subjects
We conducted a retrospective study of 49 patients with IPF who were admitted to Jichi Medical School Hospital. The median age at the time of hospital admission was 66.9 years (range, 44 to 84 years). The diagnosis of IPF was based on an international consensus statement (ICS).1The diagnoses of IPF were obtained by video-assisted thoracoscopic surgery (VATS) in 20 patients, and by autopsy in 4 patients (Table 1). In the remaining 25 patients, IPF was diagnosed clinically on the basis of a
Serum Concentration of ST2 in Patients With IPF
The serum ST2 levels in the 64 events of patients with IPF were elevated compared to those of healthy control subjects (median values of patients with IPF vs healthy control subjects, 0.94 ng/mL vs 0.42 ng/mL, respectively), and there was a significant difference in serum ST2 levels between the two groups (p < 0.0001, Fig 1). We classified 64 subjects into two groups: the 50 subjects whose events occurred in stable IPF, and the 14 subjects whose events occurred on acute exacerbation of IPF.
Discussion
Although little is known about the pathogenesis of IPF, it is hypothesized that several interacting factors that modify the fibrotic response include the genetic background of the patient, environmental inflammatory triggers, and the predominant inflammatory phenotype (Th1 or Th2).32The inflammatory response may modulate tissue injury, fibrosis, or both during the evolution of IPF. It has been reported that the inflammatory response in IPF is thought to be associated with proinflammatory
Conclusion
Our results show that the serum ST2 levels are significantly elevated in patients with acute exacerbation of IPF, and that these levels correlate with the serum levels of LDH and CRP, and inversely correlate with Pao2, Pao2/Fio2, and %VC. These results suggest that ST2 in the serum may increase, possibly reflecting the development of the inflammatory process and the Th2 immune response in the IPF lung. The regulation of ST2 expression, interaction with other cytokines, and local expression of
ACKNOWLEDGMENT
The authors thank Mrs. Tomoko Ikahata.
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This work was supported by a grant-in-aid for interstitial lung disease from the Japanese Ministry of Health, Labour and Welfare, and a grant-in-aid for scientific research 13670612 from the Japanese Ministry of Education, Culture, Sports, Science and Technology.
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