Abstract
BackgroundDisease progression in COPD patient is associated to lung function decline, leading to a higher risk of hypoxaemia and associated comorbidities, notably cardiovascular diseases (CVD). Adiponectin (Ad) is an adipokine with cardio-protective properties. In COPD patients, conflicting results were previously reported regarding Ad plasmatic (Adpl) level, probably because COPD is a heterogeneous disease with multifactorial influence. Among these factors, gender and hypoxaemia could interact in a variety of ways with Ad pathway. Therefore, we postulated that these components could influence Adpl level and its multimers in COPD patients and contribute to the appearance of a distinct endotype associated to an altered CVD risk.MethodsOne hundred COPD patients were recruited: 61 were men and 39 were women. Patients who were not severely hypoxemic were allocated to non-hypoxemic group which included 46 patients: 27 men and 19 women. Hypoxemic group included 54 patients: 34 men and 20 women. For all patients, Adpl level and proportion of its different forms were measured. Differences between groups were evaluated by Rank-Sum tests. The relationship between these measures and BMI, blood gas analysis (PaO2, PaCO2), or lung function (FEV1, FEV1/FVC, TLCO, TLC, RV) were evaluated by Pearson correlation analysis.ResultsDespite similar age, BMI and obstruction severity, women had a higher TLC and RV (median: TLC = 105%; RV = 166%) than men (median: TLC = 87%; RV = 132%). Adpl level was higher in women (median = 11,152 ng/ml) than in men (median = 10,239 ng/ml) and was negatively associated with hyperinflation (R = − 0,43) and hypercapnia (R = − 0,42). The proportion of the most active forms of Ad (HMW) was increased in hypoxemic women (median = 10%) compared with non-hypoxemic women (median = 8%) but was not modulated in men.ConclusionCOPD pathophysiology seemed to be different in hypoxemic women and was associated to Ad modulations. Hyperinflation and air-trapping in association with hypercapnia and hypoxaemia, could contribute to a modulation of Adpl level and of its HMW forms. These results suggest the development of a distinct endotypic presentation, based on gender.
Highlights
Disease progression in Chronic obstructive pulmonary disease (COPD) patient is associated to lung function decline, leading to a higher risk of hypoxaemia and associated comorbidities, notably cardiovascular diseases (CVD)
When the cohort was separated according to gender, no difference was observed for age, BMI, Forced expiratory volume in one second (FEV1), Carbon dioxide partial pressure (PaCO2) or TLCO
We cannot exclude any influence of other concomitant factors such as medication, physical activity or cardio-vascular co-morbidities. Altogether, these data suggested that men and women with severe hypoxaemia exhibited a different pathophysiology of COPD, which is linked to Ad modulation
Summary
Disease progression in COPD patient is associated to lung function decline, leading to a higher risk of hypoxaemia and associated comorbidities, notably cardiovascular diseases (CVD). In COPD patients, conflicting results were previously reported regarding Ad plasmatic (Adpl) level, probably because COPD is a heterogeneous disease with multifactorial influence Among these factors, gender and hypoxaemia could interact in a variety of ways with Ad pathway. Women were described to exhibit a greater susceptibility to tobacco, faster annual decline of lung function and worse quality of life [3, 4] This increased effect of tobacco smoke on women was suggested to be due to gender differences in airway structure [5,6,7], but inflammatory response to tobacco smoke was suspected to differ at the level of the small airways [8] and to be at the origin of a more extensive airway remodelling [9]. The prevalence of co-morbidities varies with gender in COPD patients and men were described to be more susceptible to CVD and diabetes mellitus [10]
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