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Published in: BMC Pulmonary Medicine 1/2014

Open Access 01-12-2014 | Case report

Alveolar epithelial cells undergo epithelial-mesenchymal transition in acute interstitial pneumonia: a case report

Authors: Hongbo Li, Jinjin Zhang, Xiaodong Song, Tao Wang, Zhi Li, Dong Hao, Xiaozhi Wang, Qingyin Zheng, Cuiping Mao, Pan Xu, Changjun Lv

Published in: BMC Pulmonary Medicine | Issue 1/2014

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Abstract

Background

Acute interstitial pneumonia is a rare interstitial lung disease that rapidly progresses to respiratory failure or death. Several studies showed that myofibroblast plays an important role in the evolution of diffuse alveolar damage, which is the typical feature of acute interstitial pneumonia. However, no evidence exists whether alveolar epithelial cells are an additional source of myofibroblasts via epithelial-mesenchymal transition in acute interstitial pneumonia.

Case presentation

In this report, we present a case of acute interstitial pneumonia in a previously healthy 28-year-old non-smoking woman. Chest high-resolution computed tomography scan showed bilateral and diffusely ground-glass opacification. The biopsy was performed on the fifth day of her hospitalization, and results showed manifestation of acute exudative phase of diffuse alveolar damage characterized by hyaline membrane formation. On the basis of the preliminary diagnosis of acute interstitial pneumonia, high-dose glucocorticoid was used. However, this drug showed poor clinical response and could improve the patient’s symptoms only during the early phase. The patient eventually died of respiratory dysfunction. Histological findings in autopsy were consistent with the late form of acute interstitial pneumonia.

Conclusions

The results in this study revealed that alveolar epithelial cells underwent epithelial-mesenchymal transition and may be an important origin of myofibroblasts in the progression of acute interstitial pneumonia. Conducting research on the transformation of alveolar epithelial cells into myofibroblasts in the lung tissue of patients with acute interstitial pneumonia may be beneficial for the treatment of this disease. However, to our knowledge, no research has been conducted on this topic.
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Literature
1.
go back to reference American Thoracic Society, European Respiratory Society.American Thoracic Society/European Respiratory Society international Multidisciplinary Consensus Classification of the Idiopathic Interstitial Pneumonias: This joint statement of the American Thoracic Society (ATS) and the European Respiratory Society (ERS) was adopted by the ATS board of directors. June 2001 and by the ERS Executive Committee. June 2001. Am J Respir Crit Care Med. 2002, 165: 277-304.CrossRef American Thoracic Society, European Respiratory Society.American Thoracic Society/European Respiratory Society international Multidisciplinary Consensus Classification of the Idiopathic Interstitial Pneumonias: This joint statement of the American Thoracic Society (ATS) and the European Respiratory Society (ERS) was adopted by the ATS board of directors. June 2001 and by the ERS Executive Committee. June 2001. Am J Respir Crit Care Med. 2002, 165: 277-304.CrossRef
2.
go back to reference Suh GY, Kang EH, Chung MP, Lee KS, Han J, Kitaichi M, Kwon OJ: Early intervention can improve clinical outcome of acute interstitial pneumonia. Chest. 2006, 129: 753-761. 10.1378/chest.129.3.753.CrossRefPubMed Suh GY, Kang EH, Chung MP, Lee KS, Han J, Kitaichi M, Kwon OJ: Early intervention can improve clinical outcome of acute interstitial pneumonia. Chest. 2006, 129: 753-761. 10.1378/chest.129.3.753.CrossRefPubMed
3.
go back to reference Mukhopadhyay S, Parambil JG: Acute interstitial pneumonia (AIP): relationship to Hamman-Rich syndrome, diffuse alveolar damage (DAD), and acute respiratory distress syndrome (ARDS). Semin Respir Crit Care Med. 2012, 33: 476-485. 10.1055/s-0032-1325158.CrossRefPubMed Mukhopadhyay S, Parambil JG: Acute interstitial pneumonia (AIP): relationship to Hamman-Rich syndrome, diffuse alveolar damage (DAD), and acute respiratory distress syndrome (ARDS). Semin Respir Crit Care Med. 2012, 33: 476-485. 10.1055/s-0032-1325158.CrossRefPubMed
4.
go back to reference Katzenstein AL, Bloor CM, Leibow AA: Diffuse alveolar damage: the role of oxygen, shock, and related factors.A review. Am J Pathol. 1976, 85: 209-228.PubMedPubMedCentral Katzenstein AL, Bloor CM, Leibow AA: Diffuse alveolar damage: the role of oxygen, shock, and related factors.A review. Am J Pathol. 1976, 85: 209-228.PubMedPubMedCentral
5.
go back to reference Quefatieh A, Stone CH, DiGiovine B, Toews GB, Hyzy RC: Low hospital mortality in patients with acute interstitial pneumonia. Chest. 2003, 124: 554-559. 10.1378/chest.124.2.554.CrossRefPubMed Quefatieh A, Stone CH, DiGiovine B, Toews GB, Hyzy RC: Low hospital mortality in patients with acute interstitial pneumonia. Chest. 2003, 124: 554-559. 10.1378/chest.124.2.554.CrossRefPubMed
6.
go back to reference Flier SN, Tanjore H, Kokkotou EG, Sugimoto H, Zeisberg M, Kalluri R: Identification of epithelial to mesenchymal transition as a novel source of fibroblasts in intestinal fibrosis. J Biol Chem. 2010, 285: 20202-20212. 10.1074/jbc.M110.102012.CrossRefPubMedPubMedCentral Flier SN, Tanjore H, Kokkotou EG, Sugimoto H, Zeisberg M, Kalluri R: Identification of epithelial to mesenchymal transition as a novel source of fibroblasts in intestinal fibrosis. J Biol Chem. 2010, 285: 20202-20212. 10.1074/jbc.M110.102012.CrossRefPubMedPubMedCentral
7.
go back to reference Acloque H, Adams MS, Fishwick K, Bronner-Fraser M, Nieto MA: Epithelial-mesenchymal transitions: the importance of changing cell state indevelopment and disease. J Clin Invest. 2009, 119: 1438-1449. 10.1172/JCI38019.CrossRefPubMedPubMedCentral Acloque H, Adams MS, Fishwick K, Bronner-Fraser M, Nieto MA: Epithelial-mesenchymal transitions: the importance of changing cell state indevelopment and disease. J Clin Invest. 2009, 119: 1438-1449. 10.1172/JCI38019.CrossRefPubMedPubMedCentral
8.
go back to reference Selman M, Pardo A, Kaminski N: Idiopathic pulmonary fibrosis: aberrant recapitulation of developmental programs?. PLoS Med. 2008, 5: e62-10.1371/journal.pmed.0050062.CrossRefPubMedPubMedCentral Selman M, Pardo A, Kaminski N: Idiopathic pulmonary fibrosis: aberrant recapitulation of developmental programs?. PLoS Med. 2008, 5: e62-10.1371/journal.pmed.0050062.CrossRefPubMedPubMedCentral
9.
go back to reference Yilmaz M, Christofori G: EMT, the cytoskeleton, and cancer cell invasion. Cancer Metastasis Rev. 2009, 28: 15-33. 10.1007/s10555-008-9169-0.CrossRefPubMed Yilmaz M, Christofori G: EMT, the cytoskeleton, and cancer cell invasion. Cancer Metastasis Rev. 2009, 28: 15-33. 10.1007/s10555-008-9169-0.CrossRefPubMed
10.
go back to reference Travis WD, Costabel U, Hansell DM, King TE, Lynch DA, Nicholson AG, Ryerson CJ, Ryu JH, Selman M, Wells AU, Behr J, Bouros D, Brown KK, Colby TV, Collard HR, Cordeiro CR, Cottin V, Crestani B, Drent M, Dudden RF, Egan J, Flaherty K, Hogaboam C, Inoue Y, Johkoh T, Kim DS, Kitaichi M, Loyd J, Martinez FJ, Myers J, et al: An official American Thoracic Society/European Respiratory Society statement: update of the international multidisciplinary classification of the idiopathic interstitial pneumonias. Am J Respir Crit Care Med. 2013, 188: 733-748. 10.1164/rccm.201308-1483ST.CrossRefPubMed Travis WD, Costabel U, Hansell DM, King TE, Lynch DA, Nicholson AG, Ryerson CJ, Ryu JH, Selman M, Wells AU, Behr J, Bouros D, Brown KK, Colby TV, Collard HR, Cordeiro CR, Cottin V, Crestani B, Drent M, Dudden RF, Egan J, Flaherty K, Hogaboam C, Inoue Y, Johkoh T, Kim DS, Kitaichi M, Loyd J, Martinez FJ, Myers J, et al: An official American Thoracic Society/European Respiratory Society statement: update of the international multidisciplinary classification of the idiopathic interstitial pneumonias. Am J Respir Crit Care Med. 2013, 188: 733-748. 10.1164/rccm.201308-1483ST.CrossRefPubMed
11.
go back to reference Pache JC, Christakos PG, Gannon DE, Mitchell JJ, Low RB, Leslie KO: Myofibroblasts in diffuse alveolar damage of the lung. Mod Pathol. 1998, 11: 1064-1070.PubMed Pache JC, Christakos PG, Gannon DE, Mitchell JJ, Low RB, Leslie KO: Myofibroblasts in diffuse alveolar damage of the lung. Mod Pathol. 1998, 11: 1064-1070.PubMed
12.
go back to reference Vourlekis JS, Brown KK, Schwarz MI: Acute Interstitial Pneumonitis: current understanding regarding diagnosis, pathogenesis, and natural history. Semin Respir Crit Care Med. 2001, 22: 399-408. 10.1055/s-2001-17383.CrossRefPubMed Vourlekis JS, Brown KK, Schwarz MI: Acute Interstitial Pneumonitis: current understanding regarding diagnosis, pathogenesis, and natural history. Semin Respir Crit Care Med. 2001, 22: 399-408. 10.1055/s-2001-17383.CrossRefPubMed
13.
go back to reference Willis BC, Liebler JM, Luby-Phelps K, Nicholson AG, Crandall ED, du Bois RM, Borok Z: Induction of epithelial-mesenchymal transition in alveolar epithelial cells by transforming growth factor-beta1: potential role in idiopathic pulmonary fibrosis. Am J Pathol. 2005, 166: 1321-1332. 10.1016/S0002-9440(10)62351-6.CrossRefPubMedPubMedCentral Willis BC, Liebler JM, Luby-Phelps K, Nicholson AG, Crandall ED, du Bois RM, Borok Z: Induction of epithelial-mesenchymal transition in alveolar epithelial cells by transforming growth factor-beta1: potential role in idiopathic pulmonary fibrosis. Am J Pathol. 2005, 166: 1321-1332. 10.1016/S0002-9440(10)62351-6.CrossRefPubMedPubMedCentral
14.
go back to reference Buckley ST, Medina C, Davies AM, Ehrhardt C: Cytoskeletal re-arrangement in TGF-β1-induced alveolar epithelial-mesenchymal transition studied by atomic force microscopy and high-content analysis. Nanomedicine. 2012, 8: 355-364. 10.1016/j.nano.2011.06.021.PubMed Buckley ST, Medina C, Davies AM, Ehrhardt C: Cytoskeletal re-arrangement in TGF-β1-induced alveolar epithelial-mesenchymal transition studied by atomic force microscopy and high-content analysis. Nanomedicine. 2012, 8: 355-364. 10.1016/j.nano.2011.06.021.PubMed
16.
go back to reference Bartis D, Mise N, Mahida RY, Eickelberg O, Thickett DR: Epithelial-mesenchymal transition in lung development and disease: does it exist and is it important?. Thorax. in press Bartis D, Mise N, Mahida RY, Eickelberg O, Thickett DR: Epithelial-mesenchymal transition in lung development and disease: does it exist and is it important?. Thorax. in press
17.
go back to reference Wang M, Zhang J, Song X, Liu W, Zhang L, Wang X, Lv C: Astaxanthin ameliorates lung fibrosis both in vivo and in vitro through preventing transdifferentiation, inhibiting proliferation and promoting apoptosis of activated cells. Food Chem Toxicol. 2013, 56: 450-458.CrossRefPubMed Wang M, Zhang J, Song X, Liu W, Zhang L, Wang X, Lv C: Astaxanthin ameliorates lung fibrosis both in vivo and in vitro through preventing transdifferentiation, inhibiting proliferation and promoting apoptosis of activated cells. Food Chem Toxicol. 2013, 56: 450-458.CrossRefPubMed
18.
go back to reference Song X, Liu W, Xie S, Wang M, Cao G, Mao C, Lv C: All-transretinoic acid ameliorates bleomycin-induced lung fibrosis by downregulating the TGF-β1/Smad3 signaling pathway in rats. Lab Invest. 2013, 3: 1219-1231.CrossRef Song X, Liu W, Xie S, Wang M, Cao G, Mao C, Lv C: All-transretinoic acid ameliorates bleomycin-induced lung fibrosis by downregulating the TGF-β1/Smad3 signaling pathway in rats. Lab Invest. 2013, 3: 1219-1231.CrossRef
19.
go back to reference Harada T, Nabeshima K, Hamasaki M, Uesugi N, Watanabe K, Iwasaki H: Epithelial-mesenchymal transition in human lungs with usual interstitial pneumonia: quantitative immunohistochemistry. Pathol Int. 2010, 60: 14-21. 10.1111/j.1440-1827.2009.02469.x.CrossRefPubMed Harada T, Nabeshima K, Hamasaki M, Uesugi N, Watanabe K, Iwasaki H: Epithelial-mesenchymal transition in human lungs with usual interstitial pneumonia: quantitative immunohistochemistry. Pathol Int. 2010, 60: 14-21. 10.1111/j.1440-1827.2009.02469.x.CrossRefPubMed
20.
go back to reference Yamada M, Kuwano K, Maeyama T, Hamada N, Yoshimi M, Nakanishi Y, Kasper M: Dual-immunohistochemistry provides little evidence for epithelial-mesenchymal transition in pulmonary fibrosis. Histochem Cell Biol. 2008, 129: 453-462. 10.1007/s00418-008-0388-9.CrossRefPubMed Yamada M, Kuwano K, Maeyama T, Hamada N, Yoshimi M, Nakanishi Y, Kasper M: Dual-immunohistochemistry provides little evidence for epithelial-mesenchymal transition in pulmonary fibrosis. Histochem Cell Biol. 2008, 129: 453-462. 10.1007/s00418-008-0388-9.CrossRefPubMed
21.
go back to reference Nagarajan D, Melo T, Deng Z, Almeida C, Zhao W: ERK/GSK3β/Snail signaling mediates radiation-induced alveolar epithelial-to-mesenchymal transition. Free Radic Biol Med. 2012, 52: 983-992. 10.1016/j.freeradbiomed.2011.11.024.CrossRefPubMed Nagarajan D, Melo T, Deng Z, Almeida C, Zhao W: ERK/GSK3β/Snail signaling mediates radiation-induced alveolar epithelial-to-mesenchymal transition. Free Radic Biol Med. 2012, 52: 983-992. 10.1016/j.freeradbiomed.2011.11.024.CrossRefPubMed
22.
go back to reference Jayachandran A, Königshoff M, Yu H, Rupniewska E, Hecker M, Klepetko W, Seeger W, Eickelberg O: SNAI transcription factors mediate epithelial-mesenchymal transition in lung fibrosis. Thorax. 2009, 64: 1053-1061. 10.1136/thx.2009.121798.CrossRefPubMed Jayachandran A, Königshoff M, Yu H, Rupniewska E, Hecker M, Klepetko W, Seeger W, Eickelberg O: SNAI transcription factors mediate epithelial-mesenchymal transition in lung fibrosis. Thorax. 2009, 64: 1053-1061. 10.1136/thx.2009.121798.CrossRefPubMed
Metadata
Title
Alveolar epithelial cells undergo epithelial-mesenchymal transition in acute interstitial pneumonia: a case report
Authors
Hongbo Li
Jinjin Zhang
Xiaodong Song
Tao Wang
Zhi Li
Dong Hao
Xiaozhi Wang
Qingyin Zheng
Cuiping Mao
Pan Xu
Changjun Lv
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Pulmonary Medicine / Issue 1/2014
Electronic ISSN: 1471-2466
DOI
https://doi.org/10.1186/1471-2466-14-67

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