Systemic inflammatory profile and response to anti-tumor necrosis factor therapy in chronic obstructive pulmonary disease.
BACKGROUND
Chronic obstructive pulmonary disease (COPD) is characterized by progressive worsening of airflow limitation associated with abnormally inflamed airways in older smokers. Despite correlative evidence for a role for tumor necrosis factor-alpha in the pathogenesis of COPD, the anti-tumor necrosis factor-alpha, infliximab did not show clinical efficacy in a double-blind, placebo-controlled, phase II clinical trial. This study sought to evaluate the systemic inflammatory profile associated with COPD and to assess the impact of tumor necrosis factor neutralization on systemic inflammation.


METHODS
Serum samples (n = 234) from the phase II trial were collected at baseline and after 24 weeks of placebo or infliximab. Additionally, baseline serum samples were obtained from an independent COPD cohort (n = 160) and 2 healthy control cohorts (n = 50; n = 109). Serum concentrations of a broad panel of inflammation-associated analytes were measured using a 92-analyte multiplex assay.


RESULTS
Twenty-five proteins were significantly elevated and 2 were decreased in COPD, including highly elevated CD40 ligand, brain-derived neurotrophic factor, epidermal growth factor, acute-phase proteins, and neutrophil-associated proteins. This profile was largely independent of smoking status, age, and clinical phenotype. The majority of these associations of serum analytes with COPD are novel findings. Increased serum creatine kinase-muscle/brain and myoglobin correlated modestly with decreased forced expiratory volume at 1 second, suggesting cardiac involvement. Infliximab did not affect this systemic inflammatory profile.


CONCLUSIONS
A robust systemic inflammatory profile was associated with COPD. This profile was generally independent of disease severity. Because anti-tumor necrosis factor-alpha did not influence systemic inflammation, how to control the underlying pathology beyond symptom suppression remains unclear.
Immunology Biomarkers, Janssen Research & Development, LLC, Malvern, PA, USA. Mloza@its.jnj.com
Matthew J
MJ
Loza
Rosemary
R
Watt
Frédéric
F
Baribaud
Elliot S
ES
Barnathan
Stephen I
SI
Rennard
D000209:Acute-Phase Proteins / Q000032:analysis; D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D019208:Brain-Derived Neurotrophic Factor / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D019013:CD40 Antigens / Q000097:blood; D003402:Creatine Kinase / Q000097:blood; D004815:Epidermal Growth Factor / Q000097:blood; D005260:Female; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000188:drug therapy; D000069285:Infliximab; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000097:blood / Q000188:drug therapy*; D012720:Severity of Illness Index; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
D000209:Acute-Phase Proteins; D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D019208:Brain-Derived Neurotrophic Factor; D019013:CD40 Antigens; D014409:Tumor Necrosis Factor-alpha; D004815:Epidermal Growth Factor; D002097:C-Reactive Protein; D000069285:Infliximab; D003402:Creatine Kinase