Abstract
BackgroundPulmonary hypertension (PH) represents an important complication of idiopathic pulmonary fibrosis (IPF) with a negative impact on patient survival. Herpes viruses are thought to play an etiological role in the development and/or progression of IPF. The influence of viruses on PH associated with IPF is unknown. We aimed to investigate the influence of viruses in IPF patients focusing on aspects related to PH. A laboratory mouse model of gamma-herpesvirus (MHV-68) induced pulmonary fibrosis was also assessed.MethodsLung tissue samples from 55 IPF patients and 41 controls were studied by molecular analysis to detect various viral genomes. Viral molecular data obtained were correlated with mean pulmonary arterial pressure (mPAP) and arterial remodelling. Different clinical and morphological variables were studied by univariate and multivariate analyses at time of transplant and in the early post-transplant period. The same lung tissue analyses were performed in MHV-68 infected mice.ResultsA higher frequency of virus positive cases was found in IPF patients than in controls (p = 0.0003) and only herpes virus genomes were detected. Viral cases showed higher mPAP (p = 0.01), poorer performance in the six minute walking test (6MWT; p = 0.002) and higher frequency of primary graft (PGD) dysfunction after lung transplant (p = 0.02). Increased arterial thickening, particularly of the intimal layer (p = 0.002 and p = 0.004) and higher TGF-β expression (p = 0.002) were demonstrated in viral cases. The remodelled vessels showed increased vessel cell proliferation (Ki-67 positive cells) in the proximity to metaplastic epithelial cells and macrophages. Viral infection was associated with higher mPAP (p = 0.03), poorer performance in the 6MWT (p = 0.008) and PGD (p = 0.02) after adjusting for other covariates/intermediate factors. In MHV-68 infected mice, morphological features were similar to those of patients.ConclusionHerpesviral infections may contribute to the development of PH in IPF patients.
Highlights
Idiopathic pulmonary fibrosis (IPF), morphologically usual interstitial pneumonia, is a chronic progressive disease of unknown aetiology with irreversible scarring in the lung [1]
The aim of the study was to investigate the relevance of respiratory viruses in idiopathic pulmonary fibrosis (IPF) patients, with special emphasis on cases complicated by pulmonary hypertension (PH)
IPF showed a higher frequency of viral infection than control cases (40% vs 7.3%; p = 0.0003)
Summary
Idiopathic pulmonary fibrosis (IPF), morphologically usual interstitial pneumonia, is a chronic progressive disease of unknown aetiology with irreversible scarring in the lung [1]. Lung cancer and pulmonary hypertension (PH) are the main complications which adversely affect the survival of IPF patients. Different from acute exacerbation which can occur at any stage of the disease, lung cancer and pulmonary hypertension (PH) are more likely in advanced disease. For the latter, a frequency of 20–90% has been reported and it carries severe consequences including decreased exercise capacity and increased mortality before and after lung transplantation [4,5,6,7]. Pulmonary hypertension (PH) represents an important complication of idiopathic pulmonary fibrosis (IPF) with a negative impact on patient survival. A laboratory mouse model of gamma-herpesvirus (MHV-68) induced pulmonary fibrosis was assessed
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