Idiopathic Pulmonary Fibrosis (IPF) is a relentless and devastating disease leading ultimately to breathlessness, respiratory failure, and death within three years from the time of diagnosis. These grim facts emphasize that it is imperative to understand how IPF develops in order to design novel and rational therapeutics for this disease. We have found that expression levels of the transcription factor twist1 are associated with lung function in IPF. Furthermore, our data suggest that high and low expression of twist1 may predict distinct manifestations of lung fibrosis. Low twist1 expression is associated with increased inflammation, and high twist1 is associated with more prominent scarring. Thus, the study of twist1 in IPF is critical: the knowledge gained from the study of twist1 has the clear potential to impact the clinical care of IPF patients in very meaningful and profound ways: the study of twist1 may uncover biomarkers to identify IPF patients at the greatest risk of death and who need to be prioritized for lung transplant.
The first aim of our study is to determine if low levels of twist1 in fibroblasts will promote pulmonary fibrosis by regulating the pro-inflammatory molecule CXCL12.
The second aim proposes to study if high levels of twist1 will promote fibrosis through a different mechanism: by facilitating the survival of fibroblasts through two novel effector molecules, survivin and miR-214. We will employ human tissues and cells as well as unique transgenic animals to test our hypotheses. Hence, the goal of this application is to elucidate a new molecular model where expression of twist1 results in pathologic signaling in the lung leading to fibrosis. Ultimately, we aim to uncover unique targets to treat IPF.

Public Health Relevance

Idiopathic Pulmonary Fibrosis (IPF) is a progressive and fatal scarring of the lung. Lung transplantation may be the only therapeutic option. This study is designed to test the role of twist1 in experimental pulmonary fibrosis. We hypothesize that twist1 contributes to the distinct presentations of IPF in different patients and that twist1 may be a potential therapeutic target to treat this disease.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Research Project (R01)
Project #
Application #
Study Section
Lung Injury, Repair, and Remodeling Study Section (LIRR)
Program Officer
Harabin, Andrea L
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
University of Pittsburgh
Internal Medicine/Medicine
Schools of Medicine
United States
Zip Code
Gibson, Kevin F; Kass, Daniel J (2018) Clinical Trials in Idiopathic Pulmonary Fibrosis in the ""Posttreatment Era"". JAMA 319:2275-2276
Yoon, Joo Heung; Nouraie, Mehdi; Chen, Xiaoping et al. (2018) Characteristics of lung cancer among patients with idiopathic pulmonary fibrosis and interstitial lung disease - analysis of institutional and population data. Respir Res 19:195
Li, Fu Jun; Surolia, Ranu; Li, Huashi et al. (2017) Autoimmunity to Vimentin Is Associated with Outcomes of Patients with Idiopathic Pulmonary Fibrosis. J Immunol 199:1596-1605
Kass, Daniel J; Kaminski, Naftali (2017) Time to share: lessons from post hoc analyses of IPF trials. Thorax 72:101-102
Tan, Jiangning; Tedrow, John R; Nouraie, Mehdi et al. (2017) Loss of Twist1 in the Mesenchymal Compartment Promotes Increased Fibrosis in Experimental Lung Injury by Enhanced Expression of CXCL12. J Immunol 198:2269-2285
Christmann, Romy B; Wooten, Alicia; Sampaio-Barros, Percival et al. (2016) miR-155 in the progression of lung fibrosis in systemic sclerosis. Arthritis Res Ther 18:155
Lear, Travis; McKelvey, Alison C; Rajbhandari, Shristi et al. (2016) Ubiquitin E3 ligase FIEL1 regulates fibrotic lung injury through SUMO-E3 ligase PIAS4. J Exp Med 213:1029-46
Kass, Daniel J; Kaminski, Naftali (2011) Evolving genomic approaches to idiopathic pulmonary fibrosis: moving beyond genes. Clin Transl Sci 4:372-9