Increased plasma osteopontin in frequent exacerbator and acute exacerbation of COPD.

INTRODUCTION: Osteopontin (OPN) is a phosphorylated glycoprotein expressed by diverse tissues including bone, brain, kidney, liver and lung. Limited data exist regarding OPN in chronic obstructive pulmonary disease (COPD) and the exacerbation of this condition. OBJECTIVES: The aim of this study was to evaluate plasma OPN levels and investigate the clinical usefulness of plasma OPN measurement in patients with COPD. METHODS: Plasma OPN levels were measured and compared in patients with COPD exacerbation (n = 64), patients with stable COPD (n = 68) and healthy controls (n = 30). In patients with COPD exacerbation, plasma OPN levels were measured repeatedly in convalescence. Patients with stable COPD were categorized into frequent and infrequent exacerbators according to their frequency of exacerbation, and plasma OPN levels were compared between these two groups. Plasma OPN levels were determined by enzyme-linked immunosorbent assay. RESULTS: Patients with COPD exacerbation had increased plasma OPN levels compared with those with stable COPD and healthy controls (32.6 ± 29.6, 17.6 ± 11.1, 8.4 ± 6.1 ng/mL, respectively; P < 0.001). In patients with COPD exacerbation, plasma OPN levels were significantly decreased in convalescence (44.8 ± 43.5 vs 24.6 ± 13.6 ng/mL; P = 0.034). Frequent exacerbators had higher plasma OPN levels compared with infrequent exacerbators (22.5 ± 12.0 vs 15.0 ± 9.8 ng/mL; P = 0.008). CONCLUSIONS: Plasma OPN levels were increased in patients with COPD exacerbation and frequent exacerbators, which suggests a possible role for OPN as a biomarker of COPD exacerbation.

Clinical Features according to the Frequency of Acute Exacerbation in COPD.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is now regarded as a heterogenous disease, with variable phenotypes. Acute exacerbation of COPD is a major event that alters the natural course of disease. The frequency of COPD exacerbation is variable among patients. We analyzed clinical features, according to the frequency of acute exacerbation in COPD. METHODS: Sixty patients, who visited Gyeongsang National University Hospital from March 2010 to October 2010, were enrolled. Patients were divided into two groups, according to their frequency of acute exacerbation. Frequent exacerbator is defined as the patient who has two or more exacerbation per one year. We reviewed patients' medical records and investigated modified Medical Research Council (MMRC) dyspnea scale, smoking history and frequency of acute exacerbation. We also conducted pulmonary function test and 6-minute walking test, calculated body mass index, degree of airway obstruction and dyspnea and exercise capacity (BODE) index and measured CD146 cells in the peripheral blood. RESULTS: The number of frequent exacerbators and infrequent exacerbators was 20 and 40, respectively. The frequent exacerbator group had more severe airway obstruction (forced expiratory volume in one second [FEV(1)], 45% vs. 65.3%, p=0.001; FEV(1)/forced vital capacity, 44.3% vs. 50.5%, p=0.046). MMRC dyspnea scale and BODE index were significantly higher in the frequent exacerbator group (1.8 vs. 1.1, p=0.016; 3.9 vs. 2.1, p=0.014, respectively). The fraction of CD146 cells significantly increased in the frequent exacerbator group (2.0 vs. 1.0, p<0.001). CONCLUSION: Frequent exacerbator had more severe airway obstruction and higher symptom score and BODE index. However, circulating endothelial cells measured by CD146 needed to be confirmed in the future.

Bowel perforation after erlotinib treatment in a patient with non-small cell lung cancer.

Erlotinib is accepted as a standard second-line chemotherapeutic agent in patients with non-small cell lung cancer who are refractory or resistant to first-line platinum- based chemotherapy. There has been no previous report of bowel perforation with or without gastrointestinal metastases related to erlotinib in patients with non-small cell lung cancer. The exact mechanism of bowel perforation in patients who received erlotinib remains unclear. In this report, we report the first case of enterocutaneous fistula in a female patient with metastatic non-small cell lung cancer 9 months, following medication with erlotinib as second-line chemotherapy.

Serum angiopoietin-2 levels are elevated during acute exacerbations of COPD.

BACKGROUND AND OBJECTIVE: Recently, angiopoietin-2 (Ang-2) was identified as a ligand of the endothelial receptor tyrosine kinase, Tie-2. Ang-2 is an angiopoietin-1 antagonist that plays a role in vascular destabilization and remodelling, which may increase in some diseases. However, serum Ang-2 levels have not been evaluated in patients with COPD. In this study, we examined serum Ang-2 concentrations in patients experiencing COPD exacerbations and in patients with stable COPD. METHODS: Serum samples were obtained from 49 patients experiencing COPD exacerbations, 22 patients with stable COPD and 18 healthy control subjects. Serum Ang-2 concentrations were measured by ELISA. RESULTS: Serum Ang-2 concentrations were significantly higher in patients with acute exacerbations of COPD than in those with stable COPD or control subjects, and were significantly positively correlated with serum CRP levels but inversely correlated with PaO(2) in patients with exacerbations. In addition, Ang-2 levels decreased significantly after clinical recovery from the acute exacerbation. CONCLUSIONS: Serum Ang-2 levels are significantly elevated during acute exacerbations of COPD, as compared with stable COPD.