Idiopathic pulmonary fibrosis (IPF), the most common and severe interstitial lung disease (ILD), is minimally responsive to current medical therapies, and has a mortality rate comparable to that of many end-stage malignancies. There is increasing awareness that IPF may transition through an asymptomatic stage where the primary detectable abnormalities are radiologic. It is our belief that risk factor modification and medical therapies, when instituted at an early stage, will lead to improved care for patients at risk to develop IPF. However, for this field to progress it will be imperative to develop comprehensive clinical, radiologic, physiologic, and molecular profiles to determine which subjects are at greatest risk to develop pulmonary fibrosis. Recently we demonstrated that smokers with interstitial lung abnormalities (ILA) on chest computed tomography (CT), who had not been previously diagnosed with ILD, had reduced total lung capacity, exercise capacity, and emphysema compared to smokers without ILA. We hypothesize that some of these subjects with ILA are at increased risk to develop IPF. To pursue our hypothesis we will capitalize on existing chest CTs, histopathologic, and genotypic data from large well-phenotyped cohorts. This proposal has the following Specific Aims:
Aim 1) We will identify the clinical predictors of ILA and ILA progression utilizing both the COPDGene and Framingham Heart Study cohorts;
Aim 2) Using a Brigham and Women's Hospital cohort of subjects with both preoperative chest CTs and lung tissue specimens we will determine the correlation between ILA and histopathologic evidence of interstitial pneumonitis/pulmonary fibrosis and;
Aim 3) we will evaluate the genetics and epigenetic correlations between ILA and IPF utilizing the above cohorts.

Public Health Relevance

Idiopathic pulmonary fibrosis (IPF), a disorder characterized by lung scarring, is not responsive to current medical therapies, and has a prognosis comparable to that of many end-stage malignancies. Identifying an early/asymptomatic stage of IPF may lead to improved care for these patients. This proposal will characterize large groups of subjects who may be at risk to develop IPF, identify the environmental, genetic, and epigenetic factors that may increase this risk, and evaluate if these factors are linked to those of patients with IPF.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Research Project (R01)
Project #
1R01HL111024-01A1
Application #
8436654
Study Section
Respiratory Integrative Biology and Translational Research Study Section (RIBT)
Program Officer
Gan, Weiniu
Project Start
2013-07-01
Project End
2018-06-30
Budget Start
2013-07-01
Budget End
2014-06-30
Support Year
1
Fiscal Year
2013
Total Cost
$419,355
Indirect Cost
$181,592
Name
Brigham and Women's Hospital
Department
Type
DUNS #
030811269
City
Boston
State
MA
Country
United States
Zip Code
02115
Doyle, Tracy J; Dellaripa, Paul F; Batra, Kerri et al. (2014) Functional impact of a spectrum of interstitial lung abnormalities in rheumatoid arthritis. Chest 146:41-50
Putman, Rachel K; Rosas, Ivan O; Hunninghake, Gary M (2014) Genetics and early detection in idiopathic pulmonary fibrosis. Am J Respir Crit Care Med 189:770-8