Airway mucus hyperconcentration in non–cystic fibrosis bronchiectasis

Kathryn A. Ramsey, Alice C.H. Chen, Giorgia Radicioni, Rohan Lourie, Megan Martin, Amy Broomfield, Yong H. Sheng, Sumaira Z. Hasnain, Graham Radford-Smith, Lisa A. Simms, Lucy Burr, David J. Thornton, Simon D. Bowler, Stephanie Livengood, Agathe Ceppe, Michael R. Knowles, Peadar G. Noone, Scott H. Donaldson, David B. Hill, Camille EhreBrian Button, Neil E. Alexis, Mehmet Kesimer, Richard C. Boucher, Michael A. McGuckin

    Research output: Contribution to journalArticlepeer-review

    88 Citations (Scopus)

    Abstract

    Rationale: Non–cystic fibrosis bronchiectasis is characterized by airway mucus accumulation and sputum production, but the role of mucus concentration in the pathogenesis of these abnormalities has not been characterized. Objectives: This study was designed to: 1) measure mucus concentration and biophysical properties of bronchiectasis mucus; 2) identify the secreted mucins contained in bronchiectasis mucus; 3) relate mucus properties to airway epithelial mucin RNA/protein expression; and 4) explore relationships between mucus hyperconcentration and disease severity. Methods: Sputum samples were collected from subjects with bronchiectasis, with and without chronic erythromycin administration, and healthy control subjects. Sputum percent solid concentrations, total and individual mucin concentrations, osmotic pressures, rheological properties, and inflammatory mediators were measured. Intracellular mucins were measured in endobronchial biopsies by immunohistochemistry and gene expression. MUC5B (mucin 5B) polymorphisms were identified by quantitative PCR. In a replication bronchiectasis cohort, spontaneously expectorated and hypertonic saline-induced sputa were collected, and mucus/mucin concentrations were measured. Measurements and Main Results: Bronchiectasis sputum exhibited increased percent solids, total and individual (MUC5B and MUC5AC) mucin concentrations, osmotic pressure, and elastic and viscous moduli compared with healthy sputum. Within subjects with bronchiectasis, sputum percent solids correlated inversely with FEV1 and positively with bronchiectasis extent, as measured by high-resolution computed tomography, and inflammatory mediators. No difference was detected in MUC5B rs35705950 SNP allele frequency between bronchiectasis and healthy individuals. Hypertonic saline inhalation acutely reduced non–cystic fibrosis bronchiectasis mucus concentration by 5%. Conclusions: Hyperconcentrated airway mucus is characteristic of subjects with bronchiectasis, likely contributes to disease pathophysiology, and may be a target for pharmacotherapy.

    Original languageEnglish
    Pages (from-to)661-670
    Number of pages10
    JournalAmerican Journal of Respiratory and Critical Care Medicine
    Volume201
    Issue number6
    DOIs
    Publication statusPublished - 15 Mar 2020

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