News in brief: Progression to IPF predicted by monocyte/neutrophil levels; New lung target may offer potential treatment for COPD; Transparency register to reveal surgeon outcomes

Progression to IPF predicted by monocyte/neutrophil levels

Increased levels of monocytes and neutrophils in patients with an ‘indeterminate for usual interstitial pneumonia’ (iUIP) CT pattern could potentially help identify those at greater risk of developing idiopathic pulmonary fibrosis (IPF), indicate findings of a retrospective analysis.

In the analysis, led by Dr Andrew Achaich, from the Interstitial Lung Disease Service at Oxford University Hospitals NHS Foundation Trust and published in BMJ Open Respiratory Research, 21% of a single-centre cohort of 230 patients followed up for lung fibrosis had iUIP CT pattern.

The researchers found that, of evaluable cases, 53% with iUIP on initial CT scan progressed to probable or definite UIP CT pattern over an average of four years. Further analyses also found that elevated monocyte and neutrophil levels at initial CT were significantly associated with progression in disease.

The findings suggest that “iUIP CT pattern is an important entity, a precursor to IPF in some patients within a few years,” and that “increased neutrophils and monocytes levels“might identify this group of patients with higher risk of progression to IPF”, the authors concluded.

However, they also highlighted several limitations to the study. For one, monocyte, neutrophil and lymphocyte levels were measured at a single point, so there is a risk that they are not representative of steady-state values.

Also, given the small number of patients the study is likely underpowered, and therefore “findings are primarily indicative rather than definitive signals,” they said.

New lung target may offer potential treatment for COPD

A small RNA molecule called microRNA-21 identified by Australian researchers  may be a therapeutic target whose inhibition may be a potential treatment for COPD.

In a pre-clinical study, researchers at the Centenary Institute and University of Technology Sydney investigated aberrant expression of microRNAs (miRNAs) in the lungs of mice models of COPD.  They found that miR-21 was the second highest up-regulated miRNA, particularly in airway epithelium and lung macrophages. Its expression in human lung tissue correlated with reduced lung function in COPD. They subsequently showed that, use of a microRNA-21 inhibitor (antagomir-21) both reduced microRNA-21 expression and also suppressed the influx of inflammatory cells – macrophages, neutrophils and lymphocytes – into the airways and lungs. Lung production of pro-inflammatory cytokines was inhibited through use of antagomir-21, which also improved lung capacity and function in these models, the researchers reported in Science Translational Medicine.

“The development of effective COPD treatments has been hampered by a lack of understanding of the disease’s underlying mechanisms. Our data defines microRNA-21 as a novel therapeutic target and its inhibitors as a potential new treatment for this major, currently intractable lung disease,” said study investigator Professor Phil Hansbro, Director of the Centenary UTS Centre for Inflammation.

Transparency register to reveal surgeon outcomes

A bill that will require surgeons and hospitals to be transparent about their surgical performance outcomes on a public register has had its second reading in Senate.

The Health Insurance Legislation Amendment (Transparent Patient Outcomes) Bill 2021 will establish Transparent Patient Outcomes registers for a range of medical specialties such as plastic, reconstructive and orthopaedic surgery, which its proponents say will allow consumers to make informed choices after viewing the performance of individual practitioners and patient outcomes for procedures they are poised to undergo.

Speaking on 23 November, Senator Stirling Griff said the transparency register will include information such as the number and type of surgical procedures performed by a practitioner, their surgical revision rate, their patient mortality rate, any prosthesis device they may use, patient data and any other information deemed relevant to that specialty. This information would also be available at the facility level.

“Such a database would provide objective comparable statistics and would provide prospective patients factual information through which they could exercise greater self-determination in their choice of practitioner (rather than relying on trust, assurance or referrals) and the database could also serve to reassure an anxious patient,” he said.

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