title: Budesonide/formoterol enhances the expression of pro Surfactant Protein-B in lungs of COPD patients.
abstract: Pulmonary surfactants are essential components of lung homeostasis. In chronic obstructive pulmonary disease (COPD), surfactant expression decreases in lungs whereas, there is a paradoxical increase in protein expression in plasma. The latter has been associated with poor health outcomes in COPD. The purpose of this study was to determine the relationship of surfactants and other pneumoproteins in bronchoalveolar lavage (BAL) fluid and plasma to airflow limitation and the effects of budesonide/formoterol on this relationship.
  
  
  METHODS
  We recruited (clinical trials.gov identifier: NCT00569712) 7 smokers without COPD and 30 ex and current smokers with COPD who were free of exacerbations for at least 4 weeks. All subjects were treated with budesonide/formoterol 400/12 µg twice a day for 4 weeks. BAL fluid and plasma samples were obtained at baseline and the end of the 4 weeks. We measured lung-predominant pneumoproteins: pro-Surfactant Protein-B (pro-SFTPB), Surfactant Protein-D (SP-D), Club Cell Secretory Protein-16 (CCSP-16) and Pulmonary and Activation-Regulated Chemokine (PARC/CCL-18) in BAL fluid and plasma.
  
  
  RESULTS
  BAL Pro-SFTPB concentrations had the strongest relationship with airflow limitation as measured by FEV1/FVC (Spearman rho=0.509; p=0.001) and FEV1% of predicted (Spearman rho= 0.362; p=0.028). Plasma CCSP-16 concentrations were also significantly related to airflow limitation (Spearman rho=0.362; p=0.028 for FEV1% of predicted). The other biomarkers in BAL fluid or plasma were not significantly associated with airflow limitation. In COPD subjects, budesonide/formoterol significantly increased the BAL concentrations of pro-SFTPB by a median of 62.46 ng/ml (p=0.022) or 48.7% from baseline median value.
  
  
  CONCLUSIONS
  Increased severity of COPD is associated with reduced Pro-SFTPB levels in BAL fluid. Short-term treatment with budesonide/formoterol increases these levels in BAL fluid. Long term studies will be needed to determine the clinical relevance of this observation.
authors.affiliation: UBC James Hogg Research Centre for Cardiovascular and Pulmonary Research, St. Paul's Hospital/Providence Health Care, University of British Columbia, Vancouver, BC, Canada ; Department of Medicine (Division of Respiratory Medicine), Dong-A University, Busan, Korea.
authors.forename: Soo Jung
authors.initials: SJ
authors.lastname: Um
authors.affiliation: Department of Medicine (Division of Respiratory Medicine), University of British Columbia, Vancouver, BC, Canada ; BC Cancer Agency, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Stephen
authors.initials: S
authors.lastname: Lam
authors.affiliation: UBC James Hogg Research Centre for Cardiovascular and Pulmonary Research, St. Paul's Hospital/Providence Health Care, University of British Columbia, Vancouver, BC, Canada ; Department of Radiology, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Harvey
authors.initials: H
authors.lastname: Coxson
authors.affiliation: UBC James Hogg Research Centre for Cardiovascular and Pulmonary Research, St. Paul's Hospital/Providence Health Care, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Shu Fan Paul
authors.initials: SF
authors.lastname: Man
authors.affiliation: UBC James Hogg Research Centre for Cardiovascular and Pulmonary Research, St. Paul's Hospital/Providence Health Care, University of British Columbia, Vancouver, BC, Canada ; Department of Medicine (Division of Respiratory Medicine), University of British Columbia, Vancouver, BC, Canada.
authors.forename: Don D
authors.initials: DD
authors.lastname: Sin
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D018893:Bronchoalveolar Lavage; D019819:Budesonide / Q000494:pharmacology*; D004347:Drug Interactions; D004983:Ethanolamines / Q000494:pharmacology*; D005260:Female; D000068759:Formoterol Fumarate; D005786:Gene Expression Regulation / Q000187:drug effects*; D006801:Humans; D008168:Lung / Q000187:drug effects* / Q000378:metabolism*; D008297:Male; D011498:Protein Precursors / Q000378:metabolism*; D011510:Proteolipids / Q000378:metabolism*; D029424:Pulmonary Disease, Chronic Obstructive / Q000097:blood / Q000378:metabolism*
chemical_list: D015415:Biomarkers; D004983:Ethanolamines; D011498:Protein Precursors; D011510:Proteolipids; C105511:surfactant protein B propeptide; D019819:Budesonide; D000068759:Formoterol Fumarate