Airway epithelial integrity in bronchiectasis (BE): Preliminary data from the BRILLIANT study

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Introduction: In BE dysfunction of the respiratory epithelium contributes to disease pathogenesis and may represent a target for therapy. Few studies have characterized the lower airway epithelium in BE. Methods: This prospective observational study conducted in-depth characterisation of the epithelium in BE compared to controls. Patients underwent bronchoscopy when clinically stable. Samples from a lobe affected by bronchiectasis, and an unaffected lobe based on CT imaging were obtained by bronchial brushing and analysed using high-speed video microscopy and immunofluorescent staining. Epithelial disruption was evaluated by a 4 point score. Results were compared to clinical characteristics and microbiome analysis. Results: In 55 BE patients, there was a significant increase in epithelial disruption score compared to 18 controls (p=0.003). Reduced epithelial integrity in the affected lobe was associated with worse bronchiectasis severity (BSI p=0.005) and breathlessness (MRC dyspnoea p=0.02). Disruption of the epithelium was correlated with impaired cilia function (amplitude per second (p=0.04, r=-0.29)). Decreased epithelial integrity was associated with reduced microbiome diversity (Shannon index r=-0.453, p=0.018). Sputum positive for pathogenic bacteria such as P.aeruginosa, H. influenzae and S. aureus showed greater disruption. There was a significant increase in ICAM-1 in the affected compared with the unaffected lobe (n=10, p=0.037). Conclusion: Epithelial disruption in the lower airways is associated with infection and clinical severity in BE.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.