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      Distinct “Immunoallertypes” of Disease and High Frequencies of Sensitization in Non–Cystic Fibrosis Bronchiectasis

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          Abstract

          Allergic sensitization is associated with poor clinical outcomes in asthma, chronic obstructive pulmonary disease, and cystic fibrosis; however, its presence, frequency, and clinical significance in non-cystic fibrosis bronchiectasis remain unclear.

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          Most cited references23

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          Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper

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            The lung is a site of platelet biogenesis and a reservoir for hematopoietic progenitors

            Platelets are critical for hemostasis, thrombosis, and inflammatory responses 1,2 , yet the events leading to mature platelet production remain incompletely understood 3 . The bone marrow (BM) is proposed to be a major site of platelet production although indirect evidence points towards a potential pulmonary contribution to platelet biogenesis 4-7 . By directly imaging the lung microcirculation in mice 8 , we discovered that a large number of megakaryocytes (MKs) circulate through the lungs where they dynamically release platelets. MKs releasing platelets in the lung are of extrapulmonary origin, such as the BM, where we observed large MKs migrating out of the BM space. The lung contribution to platelet biogenesis is substantial with approximately 50% of total platelet production or 10 million platelets per hour. Furthermore, we identified populations of mature and immature MKs along with hematopoietic progenitors that reside in the extravascular spaces of the lung. Under conditions of thrombocytopenia and relative stem cell deficiency in the BM 9 , these progenitors can migrate out of the lung, repopulate the BM, completely reconstitute blood platelet counts, and contribute to multiple hematopoietic lineages. These results position the lung as a primary site of terminal platelet production and an organ with considerable hematopoietic potential.
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              Conventional and monocyte-derived CD11b(+) dendritic cells initiate and maintain T helper 2 cell-mediated immunity to house dust mite allergen.

              Dendritic cells (DCs) are crucial for mounting allergic airway inflammation, but it is unclear which subset of DCs performs this task. By using CD64 and MAR-1 staining, we reliably separated CD11b(+) monocyte-derived DCs (moDCs) from conventional DCs (cDCs) and studied antigen uptake, migration, and presentation assays of lung and lymph node (LN) DCs in response to inhaled house dust mite (HDM). Mainly CD11b(+) cDCs but not CD103(+) cDCs induced T helper 2 (Th2) cell immunity in HDM-specific T cells in vitro and asthma in vivo. Studies in Flt3l(-/-) mice, lacking all cDCs, revealed that moDCs were also sufficient to induce Th2 cell-mediated immunity but only when high-dose HDM was given. The main function of moDCs was the production of proinflammatory chemokines and allergen presentation in the lung during challenge. Thus, we have identified migratory CD11b(+) cDCs as the principal subset inducing Th2 cell-mediated immunity in the LN, whereas moDCs orchestrate allergic inflammation in the lung. Copyright © 2013 Elsevier Inc. All rights reserved.
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                Author and article information

                Journal
                American Journal of Respiratory and Critical Care Medicine
                Am J Respir Crit Care Med
                American Thoracic Society
                1073-449X
                1535-4970
                April 2019
                April 2019
                : 199
                : 7
                : 842-853
                Affiliations
                [1 ]Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
                [2 ]Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
                [3 ]Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore
                [4 ]Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore
                [5 ]Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
                [6 ]Department of Biological Sciences, National University of Singapore, Singapore
                [7 ]Institute of Systems Biology, Universiti Kebangsaan Malaysia, Bangi, Selangor, Malaysia
                [8 ]Institute of Molecular and Cell Biology, A*STAR, Singapore
                [9 ]University of Dundee, Ninewells Hospital and Medical School, Dundee, Scotland; and
                [10 ]Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
                Article
                10.1164/rccm.201807-1355OC
                30265843
                c2a27d31-da3d-4c72-8b8c-69bc5b0a0c4d
                © 2019
                History

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