title: Airway Inflammation after Bronchial Thermoplasty for Severe Asthma.
abstract: BACKGROUND
  Bronchial thermoplasty is an alternative treatment for patients with severe, uncontrolled asthma in which the airway smooth muscle is eliminated using radioablation. Although this emerging therapy shows promising outcomes, little is known about its effects on airway inflammation.
  
  
  OBJECTIVE
  We examined the presence of bronchoalveolar lavage cytokines and expression of smooth muscle actin in patients with severe asthma before and in the weeks after bronchial thermoplasty.
  
  
  METHODS
  Endobronchial biopsies and bronchoalveolar lavage samples from 11 patients with severe asthma were collected from the right lower lobe before and 3 and 6 weeks after initial bronchial thermoplasty. Samples were analyzed for cell proportions and cytokine concentrations in bronchoalveolar lavage and for the presence of α-SMA in endobronchial biopsies.
  
  
  RESULTS
  α-SMA expression was decreased in endobronchial biopsies of 7 of 11 subjects by Week 6. In bronchoalveolar lavage fluid, both transforming growth factor-β1 and regulated upon activation, normal T-cell expressed and secreted (RANTES)/CCL5 were substantially decreased 3 and 6 weeks post bronchial thermoplasty in all patients. The cytokine tumor-necrosis-factor-related apoptosis-inducing ligand (TRAIL), which induces apoptosis in several cell types, was increased in concentration both 3 and 6 weeks post bronchial thermoplasty.
  
  
  CONCLUSIONS
  Clinical improvement and reduction in α-SMA after bronchial thermoplasty in severe, uncontrolled asthma is associated with substantial changes in key mediators of inflammation. These data confirm the substantial elimination of airway smooth muscle post thermoplasty in the human asthmatic airway and represent the first characterization of significant changes in airway inflammation in the first weeks after thermoplasty.
authors.affiliation: Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, Illinois.
authors.forename: Darcy R
authors.initials: DR
authors.lastname: Denner
authors.affiliation: Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, Illinois.
authors.forename: Diana C
authors.initials: DC
authors.lastname: Doeing
authors.affiliation: Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, Illinois.
authors.forename: D Kyle
authors.initials: DK
authors.lastname: Hogarth
authors.affiliation: Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, Illinois.
authors.forename: Karen
authors.initials: K
authors.lastname: Dugan
authors.affiliation: Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, Illinois.
authors.forename: Edward T
authors.initials: ET
authors.lastname: Naureckas
authors.affiliation: Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, Illinois.
authors.forename: Steven R
authors.initials: SR
authors.lastname: White
mesh_terms: D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D001249:Asthma / Q000188:drug therapy / Q000601:surgery*; D001706:Biopsy; D001980:Bronchi / Q000473:pathology; D001992:Bronchoalveolar Lavage Fluid / Q000166:cytology; D001999:Bronchoscopy; D017115:Catheter Ablation / Q000379:methods*; D016207:Cytokines / Q000032:analysis; D005260:Female; D006801:Humans; D007249:Inflammation / Q000188:drug therapy*; D008297:Male; D009130:Muscle, Smooth / Q000473:pathology; D011183:Postoperative Complications / Q000473:pathology*; D011241:Prednisone / Q000008:administration & dosage*; D011446:Prospective Studies; D012720:Severity of Illness Index
chemical_list: D000893:Anti-Inflammatory Agents; D016207:Cytokines; D011241:Prednisone
keywords: airway inflammation; airway smooth muscle; asthma; pulmonary disease