Publications by authors named "Gunnar Gudmundsson"

81 Publications

Progression of traction bronchiectasis/bronchiolectasis in interstitial lung abnormalities is associated with increased all-cause mortality: Age Gene/Environment Susceptibility-Reykjavik Study.

Eur J Radiol Open 2021 10;8:100334. Epub 2021 Mar 10.

Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.

Purpose: The aim of this study is to assess the role of traction bronchiectasis/bronchiolectasis and its progression as a predictor for early fibrosis in interstitial lung abnormalities (ILA).

Methods: Three hundred twenty-seven ILA participants out of 5764 in the Age, Gene/Environment Susceptibility (AGES)-Reykjavik Study who had undergone chest CT twice with an interval of approximately five-years were enrolled in this study. Traction bronchiectasis/bronchiolectasis index (TBI) was classified on a four-point scale: 0, ILA without traction bronchiectasis/bronchiolectasis; 1, ILA with bronchiolectasis but without bronchiectasis or architectural distortion; 2, ILA with mild to moderate traction bronchiectasis; 3, ILA and severe traction bronchiectasis and/or honeycombing. Traction bronchiectasis (TB) progression was classified on a five-point scale: 1, Improved; 2, Probably improved; 3, No change; 4, Probably progressed; 5, Progressed. Overall survival (OS) among participants with different TB Progression Score and between the TB progression group and No TB progression group was also investigated. Hazard radio (HR) was estimated with Cox proportional hazards model.

Results: The higher the TBI at baseline, the higher TB Progression Score (P < 0.001). All five participants with TBI = 3 at baseline progressed; 46 (90 %) of 51 participants with TBI = 2 progressed. TB progression was also associated with shorter OS with statistically significant difference (adjusted HR = 1.68, P < 0.001).

Conclusion: TB progression was visualized on chest CT frequently and clearly. It has the potential to be the predictor for poorer prognosis of ILA.
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http://dx.doi.org/10.1016/j.ejro.2021.100334DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7960545PMC
March 2021

[The impact of lung diseases, smoking and e-cigarette use on the severity of COVID-19 illness at diagnosis].

Laeknabladid 2020 Dec;106(12):574-579

Landspitali National University Hospital, Department of Respiratory Medicine.

Introduction: The COVID-19 pandemic has caused public health and economic turmoil across the globe. Severe COVID-19 disease most often presents with pneumonia and complications in acutely ill patients often stem from the lungs. The associations of lung disease, smoking and e-cigarette use with the incidence and severity of COVID-19 are unclear on a population level.

Methods: Data on 1761 patients from the Icelandic outpatient Landspitali COVID-19 Clinic were used. The prevalence of smoking, e-cigarette use and underlying lung diseases was calculated in the cohort, with stratification based on age groups and a clinical classification of symptom severity. It was tested whether these prevalences differed between age groups and classes of symptom severity.

Results: Most patients were in the age group between 35-54 years of age and a large majority had mild symptoms at diagnosis. The prevalence of smoking was 6% with the highest prevalence among 35-54 year olds. The prevalence of e-cigarette use was 4%. It was most prevalent in the age group between 18-34 years. There was no difference in the prevalence of smoking or e-cigarette use between classes of symptom severity. The prevalence of lung disease was 9%. It was higher among older patients and patients with more severe symptoms.

Conclusion: The age distribution and prevalence of lung disease and their risk factors are described in the context of COVID-19 incidence and symptom severity in a whole-nation cohort of Icelanders. The cohort is younger and had less severe symptoms than in many previosly published studies of COVID-19. Interestingly, the prevalences of smoking and e-cigarette use were lower than in the Icelandic general population and they were not associated with symptom severity at diagnosis. To conclude, the results presented here indicate that underlying lung diseases are prevalent among people with severe COVID-19 symptoms but fail to demonstrate an association between cigarette smoking or e-cigarette smoking with COVID-19 severity.
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http://dx.doi.org/10.17992/lbl.2020.12.611DOI Listing
December 2020

Frustrated Caring: Family Members' Experience of Motivating COPD Patients Towards Self-Management.

Int J Chron Obstruct Pulmon Dis 2020 17;15:2953-2965. Epub 2020 Nov 17.

Reykjalundur Rehabilitation Center, Lung Department, Mosfellsbaer, Iceland.

Aim: The aim of this phenomenological study was to explore principal family members' experience of motivating patients with chronic obstructive pulmonary disease (COPD) towards self-management.

Methods: Interviews were conducted with 10 family members (spouses and adult children) of COPD patients. The interviews were audio recorded, transcribed and analyzed thematically.

Results: Being a principal family member of a COPD patient is characterized by frustrated caring; wanting the best for him/her and yet carrying a heavier burden than the person feels equipped for, lacking both knowledge about the disease progress and information about available healthcare resources. The situation demands much energy, due to COPD patients' lack of stamina; family members' fear of the patient's possible breathlessness; willingness to help, though sometimes meeting with negative reactions from the patient; and feeling ignored by health professionals (HPs). Family members expressed a need for a formal connection between patient-family-HPs. The increasing burden experienced by patients' family members is characterized by a sequential process in three phases of the patient's declining self-management. In the early phase, family and patient are ignorant of COPD yet recognize the patient's smoking as a risky lifestyle. In the intermediary phase, signs of COPD become evident to the family. The first turning point is when the family first observes the patient's acute exacerbation. A second turning point is in the advanced phase, when family and patient recognize COPD as a progressive disease, possibly fatal. We also identified family members' views on COPD patients' needs, and their own roles, main frustrations and concerns.

Conclusion: Family members' experience of motivating COPD patients towards self-management is a sequential process where the family experiences advancing caring burden and declining self-management by the patient. We propose the establishment of COPD patients' teams consisting of patient-family-HP, aimed at the patients' best possible self-management.
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http://dx.doi.org/10.2147/COPD.S273903DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7680160PMC
November 2020

Associations of ω-3 Fatty Acids With Interstitial Lung Disease and Lung Imaging Abnormalities Among Adults.

Am J Epidemiol 2021 01;190(1):95-108

Docosahexaenoic acid (DHA), an ω-3 polyunsaturated fatty acid, attenuates interstitial lung disease (ILD) in experimental models, but human studies are lacking. We examined associations of circulating levels of DHA and other polyunsaturated fatty acids with hospitalization and death due to ILD over 12 years in the Multi-Ethnic Study of Atherosclerosis (MESA; n = 6,573). We examined cross-sectional associations with CT lung abnormalities in MESA (2000-2012; n = 6,541), the Framingham Heart Study (2005-2011; n = 3,917), and the Age, Gene/Environment Susceptibility-Reykjavik Study (AGES-Reykjavik) (2002-2006; n = 1,106). Polyunsaturated fatty acid levels were determined from fasting blood samples and extracted from plasma phospholipids (MESA and AGES-Reykjavik) or red blood cell membranes (Framingham Heart Study). Higher DHA levels were associated with a lower risk of hospitalization due to ILD (per standard-deviation increment, adjusted rate ratio = 0.69, 95% confidence interval (CI): 0.48, 0.99) and a lower rate of death due to ILD (per standard-deviation increment, adjusted hazard ratio = 0.68, 95% CI: 0.47, 0.98). Higher DHA was associated with fewer interstitial lung abnormalities on computed tomography (per natural log increment, pooled adjusted odds ratio = 0.65, 95% CI: 0.46, 0.91). Higher DHA levels were associated with a lower risk of hospitalization and death due to ILD and fewer lung abnormalities on computed tomography in a meta-analysis of data from population-based cohort studies.
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http://dx.doi.org/10.1093/aje/kwaa168DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7784523PMC
January 2021

The associations of interstitial lung abnormalities with cancer diagnoses and mortality.

Eur Respir J 2020 12 17;56(6). Epub 2020 Dec 17.

Faculty of Medicine, University of Iceland, Reykjavik, Iceland.

An increased incidence of lung cancer is well known among patients with idiopathic pulmonary fibrosis. It is not known whether interstitial lung abnormalities, early fibrotic changes of the lung, are a risk factor for lung cancer in the general population.The study's objective was to assess whether interstitial lung abnormalities were associated with diagnoses of, and mortality from, lung cancer and other cancers. Data from the AGES-Reykjavik study, a cohort of 5764 older Icelandic adults, were used. Outcome data were ascertained from electronic medical records. Gray's tests, Cox proportional hazards models and proportional subdistribution hazards models were used to analyse associations of interstitial lung abnormalities with lung cancer diagnoses and lung cancer mortality as well as diagnoses and mortality from all cancers.There was a greater cumulative incidence of lung cancer diagnoses (p<0.001) and lung cancer mortality (p<0.001) in participants with interstitial lung abnormalities than in others. Interstitial lung abnormalities were associated with an increased hazard of lung cancer diagnosis (hazard ratio 2.77) and lung cancer mortality (hazard ratio 2.89) in adjusted Cox models. Associations of interstitial lung abnormalities with all cancers were found in models including lung cancers but not in models excluding lung cancers.People with interstitial lung abnormalities are at increased risk of lung cancer and lung cancer mortality, but not of other cancers. This implies that an association between fibrotic and neoplastic diseases of the lung exists from the early stages of lung fibrosis and suggests that interstitial lung abnormalities could be considered as a risk factor in lung cancer screening efforts.
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http://dx.doi.org/10.1183/13993003.02154-2019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7876778PMC
December 2020

[Bronchiectasis - a review].

Laeknabladid 2020 Jul;106(7):352-361

Department of Radiology Karolinska University Hospital Stockholm, Sweden.

Bronchiectasis is a disease that is characterized by permanent bronchial dilation. This can be localized or diffuse in the lungs. The disease can occur at any age and causes cough, sputum production and repeated infections. It is more common in women and incidence increases with age. Bronchiectasis is characterized by repeated episodes of worsening symptoms that are usually caused by respiratory infections. The cause of bronchiectasis can be unknown but it can be caused by respiratory diseases and diseases outside the chest. Examples of such diseases are asthma, chronic obstructive pulmonary disease, rheumatoid arthritis in addition to immune deficiency. Disease profile is therefore different for each patient. Bronchiectasis is diagnosed with computerized tomography of the chest in addition to clinical symptoms. Workup to diagnose other diseases that could be causing it is therefore important. For that detailed history, physical examination and additional investigations are appropriate. Patients with bronchiectasis have decreased health related quality of life and increased mortality. Treatment focuses on treatment of underlying diseases, airway clearance and treatment of infections. Pulmonary rehabilititation is also important. Regular follow-up is important. This is a review on bronchiectasis that is intended for a spectrum of physicians, because bronchiectasis can be seen in primary care, hospitals and out of hospital.
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http://dx.doi.org/10.17992/lbl.2020.0708.592DOI Listing
July 2020

Traction Bronchiectasis/Bronchiolectasis is Associated with Interstitial Lung Abnormality Mortality.

Eur J Radiol 2020 Aug 18;129:109073. Epub 2020 May 18.

Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA. Electronic address:

Purpose: To investigate if the presence and severity of traction bronchiectasis/bronchiolectasis are associated with poorer survival in subjects with ILA.

Method: The study included 3,594 subjects (378 subjects with ILA and 3,216 subjects without ILA) in AGES-Reykjavik Study. Chest CT scans of 378 subjects with ILA were evaluated for traction bronchiectasis/bronchiolectasis, defined as dilatation of bronchi/bronchioles within areas demonstrating ILA. Traction bronchiectasis/bronchiolectasis Index (TBI) was assigned as: TBI = 0, ILA without traction bronchiectasis/bronchiolectasis: TBI = 1, ILA with bronchiolectasis but without bronchiectasis or architectural distortion: TBI = 2, ILA with mild to moderate traction bronchiectasis: TBI = 3, ILA and severe traction bronchiectasis and/or honeycombing. Overall survival (OS) was compared among the subjects in different TBI groups and those without ILA.

Results: The median OS was 12.93 years (95%CI; 12.67 - 13.43) in the subjects without ILA; 11.95 years (10.03 - not reached) in TBI-0 group; 8.52 years (7.57 - 9.30) in TBI-1 group; 7.63 years (6.09 - 9.10) in TBI-2 group; 5.40 years (1.85 - 5.98) in TBI-3 group. The multivariable Cox models demonstrated significantly shorter OS of TBI-1, TBI-2, and TBI-3 groups compared to subjects without ILA (P < 0.0001), whereas TBI-0 group had no significant OS difference compared to subjects without ILA, after adjusting for age, sex, and smoking status.

Conclusions: The presence and severity of traction bronchiectasis/bronchiolectasis are associated with shorter survival. The traction bronchiectasis/bronchiolectasis is an important contributor to increased mortality among subjects with ILA.
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http://dx.doi.org/10.1016/j.ejrad.2020.109073DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7930316PMC
August 2020

Unexpected large eruptions from buoyant magma bodies within viscoelastic crust.

Nat Commun 2020 May 15;11(1):2403. Epub 2020 May 15.

Geological Survey of Japan, AIST, 1-1-1 Higashi, Tsukuba, Ibaraki, 305-8567, Japan.

Large volume effusive eruptions with relatively minor observed precursory signals are at odds with widely used models to interpret volcano deformation. Here we propose a new modelling framework that resolves this discrepancy by accounting for magma buoyancy, viscoelastic crustal properties, and sustained magma channels. At low magma accumulation rates, the stability of deep magma bodies is governed by the magma-host rock density contrast and the magma body thickness. During eruptions, inelastic processes including magma mush erosion and thermal effects, can form a sustained channel that supports magma flow, driven by the pressure difference between the magma body and surface vents. At failure onset, it may be difficult to forecast the final eruption volume; pressure in a magma body may drop well below the lithostatic load, create under-pressure and initiate a caldera collapse, despite only modest precursors.
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http://dx.doi.org/10.1038/s41467-020-16054-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7229005PMC
May 2020

Genome-Wide Association Study of Susceptibility to Idiopathic Pulmonary Fibrosis.

Am J Respir Crit Care Med 2020 03;201(5):564-574

Department of Health Sciences, University of Leicester, Leicester, United Kingdom.

Idiopathic pulmonary fibrosis (IPF) is a complex lung disease characterized by scarring of the lung that is believed to result from an atypical response to injury of the epithelium. Genome-wide association studies have reported signals of association implicating multiple pathways including host defense, telomere maintenance, signaling, and cell-cell adhesion. To improve our understanding of factors that increase IPF susceptibility by identifying previously unreported genetic associations. We conducted genome-wide analyses across three independent studies and meta-analyzed these results to generate the largest genome-wide association study of IPF to date (2,668 IPF cases and 8,591 controls). We performed replication in two independent studies (1,456 IPF cases and 11,874 controls) and functional analyses (including statistical fine-mapping, investigations into gene expression, and testing for enrichment of IPF susceptibility signals in regulatory regions) to determine putatively causal genes. Polygenic risk scores were used to assess the collective effect of variants not reported as associated with IPF. We identified and replicated three new genome-wide significant ( < 5 × 10) signals of association with IPF susceptibility (associated with altered gene expression of , , and ) and confirmed associations at 11 previously reported loci. Polygenic risk score analyses showed that the combined effect of many thousands of as yet unreported IPF susceptibility variants contribute to IPF susceptibility. The observation that decreased expression associates with increased susceptibility to IPF supports recent studies demonstrating the importance of mTOR signaling in lung fibrosis. New signals of association implicating and suggest a possible role of mitotic spindle-assembly genes in IPF susceptibility.
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http://dx.doi.org/10.1164/rccm.201905-1017OCDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7047454PMC
March 2020

[High altitude illness and related diseases - a review].

Laeknabladid 2019 Nov;105(11):499-507

Faculty of Medicine, University of Iceland, Department of Respiratory Medicine, Landspítali University Hospital of Iceland.

Upon reaching a height over 2500 m above seal level symptoms of altitude illness can develop over 1 - 5 days. The risk is mainly -determined by the altitude and rate of ascent and the symptoms vary. Most common are symptoms of acute mountain illness (AMS) but more dangerous high altitude cerebral edema (HACE) and high altitude pulmonary edema (HAPE) can also develop. The causes of AMS, HACE and HAPE are lack of oxygen and insufficient acclimatization, but the presenting form is determined by the responses of the body to the lack of oxygen. The most common symptoms of AMS include headache, fatique and nausea, but insomnia and nausea are also common. The most common symptoms of HAPE are breathlessness and lassitude whereas the cardinal sign of HACE is ataxia, but confusion and loss of consciousness can also develop. In this article all three main forms of altitude illness are reviewed. The emphasis is on preventive measures and treatment but new knowledge on pathogenesis is also addressed.
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http://dx.doi.org/10.17992/lbl.2019.11.257DOI Listing
November 2019

[Effects of cardiac rehabilitation on the physical capacity of individuals with heart failure].

Laeknabladid 2019 Nov;105(11):491-497

Janus Health Promotion.

Purpose: Limited information is available on the effects of cardiac rehabilitation (CR) on individuals with heart failure (HF) in Iceland. The aim of this study was to analyze whether CR yielded increased physical capacity (PC) (w/kg) as measured by maximum exercise test at the end of the training period.

Materials And Methods: This is a retrospective data study from January 2010 to June 2018. Participants were patients with HF and also patients with ejection fraction (EF) 45% or less. Age and other diagnoses did not limit participation. Information about EF and exercise test at the beginning and end of the training period had to be recorded. Relative change in PC on these tests was evaluated by general linear models for repeated measurements. During the study period, 112 participants were enrolled, 27 did not finish the training period and 9 had incomplete data. Data from 76 participants aged 36-83 were analyzed.

Results: Participants' PC increased on average by 16% (p<0.001; confidence interval 13-18%). On average, those who attended training more than twice a week improved their PC by 18% which is -significantly more than those who trained twice or less who improved by 6%. The age group 65-83 improved by 19%, which is significantly more compared to the age group 36-64, which added 12%. No significant difference was in improvement between groups with EF under 40% or 40% and more.

Conclusion: Focused CR for individuals with HF and individuals with impaired EF resulted in increased PC.
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http://dx.doi.org/10.17992/lbl.2019.11.256DOI Listing
November 2019

[Air pollution in Iceland and the effects on human health. Review].

Laeknabladid 2019 Oktober;105(10):443-452

Center of Public Health, Faculty of Medicine, University of Iceland.

This review is on air pollution in Iceland and how it affects human health. Air pollution can be described as a condition, where levels of compounds in the atmosphere are so high that it has undesirable or harmful effects on the general public or undesirable effects on the nature, flora and fauna, or man-built structures. Air pollution can have anthropogenic sources such as burning of fossil fuels, or natural sources such as volcanic eruptions, geothermal areas, and resuspension of soil (sandstorms). Air pollution decreases quality of health and shortens the lifespan. The health effects of air pollution can be divided into direct effects on health where, air pollution causes diseases and indirect effects, where air pollution increases symptoms of underlying diseases. Health protection limits are defined for certain ambient air pollutants. They are to act as reference levels for safe for individuals and are put forth to protect long-term human health. Outdoor air quality has been measured on a regular basis in Reykjavik since 1986. For the first years, only PM10 was measured on a single station, but over the years the number of pollutants measured has increased and more measuring stations have been added. In Iceland air quality is considered very good in general and the ambient pollutant concentrations are usually within defined limits. This is explained by multiple factors such as size of the country and other geographical features as well as weather conditions. Natural disasters can cause increased air pollutant concentrations, as recent volcano eruptions have shown. Several studies have been conducted on the association of air pollution and health of the Icelandic population, but it is essential that this association be examined further to increase the knowledge of adverse health effects of air pollution in Iceland.
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http://dx.doi.org/10.17992/lbl.2019.10.252DOI Listing
April 2020

Diagnostic imaging in adult 
non-cystic fibrosis bronchiectasis.

Breathe (Sheff) 2019 Sep;15(3):190-197

Dept of Respiratory Medicine, Landspitali University Hospital, Reykjavik, Iceland.

Radiology plays a key role in the diagnosis of bronchiectasis, defined as permanent dilatation of the bronchial lumen. Volumetric thin-section multidetector computed tomography is an excellent noninvasive modality to evaluate bronchiectasis. Bronchiectasis is categorised by morphological appearance. Cylindrical bronchiectasis has a smooth tubular configuration and is the most common form. Varicose bronchiectasis has irregular contours with alternating dilating and contracting lumen. Cystic bronchiectasis is the most severe form and exhibits saccular dilatation of bronchi. Bronchial dilatation is the hallmark of bronchiectasis and is evaluated in relation to the accompanying pulmonary artery. A broncho-arterial ratio exceeding 1:1 should be considered abnormal. Normal bronchi are narrower in diameter the further they are from the lung hila. Lack of normal bronchial tapering over 2 cm in length, distal from an airway bifurcation, is the most sensitive sign of bronchiectasis. Findings commonly associated with bronchiectasis include bronchial wall thickening, mucus plugging and tree-in-bud opacities. Bronchiectasis results from a myriad of conditions, with post-infectious bronchiectasis being the most common. Imaging can sometimes discern the cause of bronchiectasis. However, in most cases it is nonspecific or only suggestive of aetiology. While morphological types are nonspecific, the distribution of abnormality offers clues to aetiology.

Key Points: Bronchiectasis is a chronic progressive condition with significant disease burden and frequent exacerbations, for which the diagnosis relies on cross-sectional imaging.The major imaging findings include bronchial dilatation, bronchial contour abnormalities and visualisation of the normally invisible peripheral airways.Bronchiectasis is the end result of various conditions, including immunodeficiencies, mucociliary disorders and infections. Imaging is often nonspecific with regard to aetiology but can be suggestive.Distribution of abnormality in the lung offers helpful clues for establishing aetiology.

Educational Aims: To review the cross-sectional imaging appearance of bronchiectasis and the common associated findings.To get a sense of how radiology can aid in establishing the aetiology of bronchiectasis.
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http://dx.doi.org/10.1183/20734735.0009-2019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6717619PMC
September 2019

[Asbestos and its effects on health of Icelanders - review].

Laeknabladid 2019 Juli;105(7):327-334

Laekning Health Care Centre, Lagmula, Reykjavik.

Asbestos are crystallized silicate minerals that form fibers with different structures and characteristics. Asbestos fibers are very durable and can tolerate very high temperatures. Therefore it was common to use asbestos as a fire retardants, heat insulation and where high temperature is used. Asbestos has been banned in Iceland from 1983 but can still be found in large amounts in buildings, ships and hot water pipes. Large amounts of asbestos were imported in the years before the ban but diminished soon to almost nothing today. Needle or filamentous shaped dust is released when working with asbestos. It is this dust that is dangerous for health. The latent time from exposure to disease can be up to forty years. Asbestos reaches the lungs via inhalation and can cause asbestosis that is a form of lung fibrosis with slow progression. Asbestos can also cause benign pleural effusions, pleural plaques and diffuse pleural thickening. Asbestos is a carcinogen. Lung cancer is most common but asbestos is also a risk factor for cancers of other organs. Mesothelioma is most common in the pleura but can be seen in other membranes. The incidence of these tumors is high in Iceland and is still increasing among males. Of all the European countries mortality is highest in Iceland. It is important for physicians to include asbestos exposure in the differential diagnosis of lung diseases and when lung cancer is diagnosed.
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http://dx.doi.org/10.17992/lbl.2019.0708.241DOI Listing
February 2020

Overlap of Genetic Risk between Interstitial Lung Abnormalities and Idiopathic Pulmonary Fibrosis.

Am J Respir Crit Care Med 2019 12;200(11):1402-1413

Division of Pulmonary and Critical Care Medicine.

Interstitial lung abnormalities (ILAs) are associated with the highest genetic risk locus for idiopathic pulmonary fibrosis (IPF); however, the extent to which there are unique associations among individuals with ILAs or additional overlap with IPF is not known. To perform a genome-wide association study (GWAS) of ILAs. ILAs and a subpleural-predominant subtype were assessed on chest computed tomography (CT) scans in the AGES (Age Gene/Environment Susceptibility), COPDGene (Genetic Epidemiology of Chronic Obstructive Pulmonary Disease [COPD]), Framingham Heart, ECLIPSE (Evaluation of COPD Longitudinally to Identify Predictive Surrogate End-points), MESA (Multi-Ethnic Study of Atherosclerosis), and SPIROMICS (Subpopulations and Intermediate Outcome Measures in COPD Study) studies. We performed a GWAS of ILAs in each cohort and combined the results using a meta-analysis. We assessed for overlapping associations in independent GWASs of IPF. Genome-wide genotyping data were available for 1,699 individuals with ILAs and 10,274 control subjects. The (mucin 5B) promoter variant rs35705950 was significantly associated with both ILAs ( = 2.6 × 10) and subpleural ILAs ( = 1.6 × 10). We discovered novel genome-wide associations near (rs6886640,  = 3.8 × 10) and (rs73199442,  = 4.8 × 10) with ILAs, and near (rs7744971,  = 4.2 × 10) with subpleural-predominant ILAs. These novel associations were not associated with IPF. Among 12 previously reported IPF GWAS loci, five (, , , , and ) were significantly associated ( < 0.05/12) with ILAs. In a GWAS of ILAs in six studies, we confirmed the association with a promoter variant and found strong evidence for an effect of previously described IPF loci; however, novel ILA associations were not associated with IPF. These findings highlight common genetically driven biologic pathways between ILAs and IPF, and also suggest distinct ones.
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http://dx.doi.org/10.1164/rccm.201903-0511OCDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6884045PMC
December 2019

COPD patients' experiences, self-reported needs, and needs-driven strategies to cope with self-management.

Int J Chron Obstruct Pulmon Dis 2019 16;14:1033-1043. Epub 2019 May 16.

Reykjalundur Rehabilitation Center, Mosfellsbaer, Iceland.

COPD is a common cause of morbidity and mortality. The aim of this study was to explore patients' experiences, self-reported needs, and needs-driven strategies to cope with self-management of COPD. In this phenomenological study, 10 participants with mild to severe COPD were interviewed 1-2 times, until data saturation was reached. In total, 15 in-depth interviews were conducted, recorded, transcribed, and analyzed. COPD negatively affected participants' physical and psychosocial well-being, their family relationships, and social life. They described their experiences of COPD like fighting a war without weapons in an ever-shrinking world with a loss of freedom at most levels, always fearing possible breathlessness. Fourteen needs were identified and eight clusters of needs-driven strategies that participants used to cope with self-management of COPD. Coping with the reality of COPD, a life-threatening disease, meant coping with dyspnea, feelings of suffocation, indescribable smoking addiction, anxiety, and lack of knowledge about the disease. Reduced participation in family and social life meant loss of ability to perform usual and treasured activities. Having a positive mindset, accepting help and assuming healthy lifestyle was important, as well as receiving continuous professional health care services. The participants' needs-driven strategies comprised conducting financial arrangements, maintaining hope, and fighting their smoking addiction, seeking knowledge about COPD, thinking differently, facing the broken chain of health care, and struggling with accepting support. Procrastination and avoidance were also evident. Finally, the study also found that participants experienced a perpetuating cycle of dyspnea, anxiety, and fear of breathlessness due to COPD which could lead to more severe dyspnea and even panic attacks. COPD negatively affects patients' physical and psychosocial well-being, family relationships and, social life. Identifying patients' self-reported needs and needs-driven strategies can enable clinicians to empower patients by educating them to improve their self-management.
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http://dx.doi.org/10.2147/COPD.S201068DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6529673PMC
January 2020

Resequencing Study Confirms That Host Defense and Cell Senescence Gene Variants Contribute to the Risk of Idiopathic Pulmonary Fibrosis.

Authors:
Camille Moore Rachel Z Blumhagen Ivana V Yang Avram Walts Julie Powers Tarik Walker Makenna Bishop Pamela Russell Brian Vestal Jonathan Cardwell Cheryl R Markin Susan K Mathai Marvin I Schwarz Mark P Steele Joyce Lee Kevin K Brown James E Loyd James D Crapo Edwin K Silverman Michael H Cho Judith A James Joel M Guthridge Joy D Cogan Jonathan A Kropski Jeffrey J Swigris Carol Bair Dong Soon Kim Wonjun Ji Hocheol Kim Jin Woo Song Lisa A Maier Karin A Pacheco Nikhil Hirani Azin S Poon Feng Li R Gisli Jenkins Rebecca Braybrooke Gauri Saini Toby M Maher Philip L Molyneaux Peter Saunders Yingze Zhang Kevin F Gibson Daniel J Kass Mauricio Rojas John Sembrat Paul J Wolters Harold R Collard John S Sundy Thomas O'Riordan Mary E Strek Imre Noth Shwu-Fan Ma Mary K Porteous Maryl E Kreider Namrata B Patel Yoshikazu Inoue Masaki Hirose Toru Arai Shinobu Akagawa Oliver Eickelberg Isis Enlil Fernandez Jürgen Behr Nesrin Mogulkoc Tamera J Corte Ian Glaspole Sara Tomassetti Claudia Ravaglia Venerino Poletti Bruno Crestani Raphael Borie Caroline Kannengiesser Helen Parfrey Christine Fiddler Doris Rassl Maria Molina-Molina Carlos Machahua Ana Montes Worboys Gunnar Gudmundsson Helgi J Isaksson David J Lederer Anna J Podolanczuk Sydney B Montesi Elisabeth Bendstrup Vivi Danchel Moises Selman Annie Pardo Michael T Henry Michael P Keane Peter Doran Martina Vašáková Martina Sterclova Christopher J Ryerson Pearce G Wilcox Tsukasa Okamoto Haruhiko Furusawa Yasunari Miyazaki Geoffrey Laurent Svetlana Baltic Cecilia Prele Yuben Moodley Barry S Shea Ken Ohta Maho Suzukawa Osamu Narumoto Steven D Nathan Drew C Venuto Merte L Woldehanna Nurdan Kokturk Joao A de Andrade Tracy Luckhardt Tejaswini Kulkarni Francesco Bonella Seamus C Donnelly Aoife McElroy Michelle E Armstong Alvaro Aranda Roberto G Carbone Francesco Puppo Kenneth B Beckman Deborah A Nickerson Tasha E Fingerlin David A Schwartz

Am J Respir Crit Care Med 2019 07;200(2):199-208

1 National Jewish Health, Denver, Colorado.

Several common and rare genetic variants have been associated with idiopathic pulmonary fibrosis, a progressive fibrotic condition that is localized to the lung. To develop an integrated understanding of the rare and common variants located in multiple loci that have been reported to contribute to the risk of disease. We performed deep targeted resequencing (3.69 Mb of DNA) in cases ( = 3,624) and control subjects ( = 4,442) across genes and regions previously associated with disease. We tested for associations between disease and ) individual common variants via logistic regression and ) groups of rare variants via sequence kernel association tests. Statistically significant common variant association signals occurred in all 10 of the regions chosen based on genome-wide association studies. The strongest risk variant is the promoter variant rs35705950, with an odds ratio of 5.45 (95% confidence interval, 4.91-6.06) for one copy of the risk allele and 18.68 (95% confidence interval, 13.34-26.17) for two copies of the risk allele ( = 9.60 × 10). In addition to identifying for the first time that rare variation in is associated with disease, we confirmed the role of rare variation in the and gene regions in the risk of IPF, and found that the and regions have independent common and rare variant signals. A limited number of common and rare variants contribute to the risk of idiopathic pulmonary fibrosis in each of the resequencing regions, and these genetic variants focus on biological mechanisms of host defense and cell senescence.
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http://dx.doi.org/10.1164/rccm.201810-1891OCDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6635791PMC
July 2019

Imaging Patterns Are Associated with Interstitial Lung Abnormality Progression and Mortality.

Am J Respir Crit Care Med 2019 07;200(2):175-183

1 Pulmonary and Critical Care Division.

Interstitial lung abnormalities (ILA) are radiologic abnormalities on chest computed tomography scans that have been associated with an early or mild form of pulmonary fibrosis. Although ILA have been associated with radiologic progression, it is not known if specific imaging patterns are associated with progression or risk of mortality. To determine the role of imaging patterns on the risk of death and ILA progression. ILA (and imaging pattern) were assessed in 5,320 participants from the AGES-Reykjavik Study, and ILA progression was assessed in 3,167 participants. Multivariable logistic regression was used to assess factors associated with ILA progression, and Cox proportional hazards models were used to assess time to mortality. Over 5 years, 327 (10%) had ILA on at least one computed tomography, and 1,435 (45%) did not have ILA on either computed tomography. Of those with ILA, 238 (73%) had imaging progression, whereas 89 (27%) had stable to improved imaging; increasing age and copies of genotype were associated with imaging progression. The definite fibrosis pattern was associated with the highest risk of progression (odds ratio, 8.4; 95% confidence interval, 2.7-25;  = 0.0003). Specific imaging patterns were also associated with an increased risk of death. After adjustment, both a probable usual interstitial pneumonia and usual interstitial pneumonia pattern were associated with an increased risk of death when compared with those indeterminate for usual interstitial pneumonia (hazard ratio, 1.7; 95% confidence interval, 1.2-2.4; = 0.001; hazard ratio, 3.9; 95% confidence interval, 2.3-6.8; < 0.0001), respectively. In those with ILA, imaging patterns can be used to help predict who is at the greatest risk of progression and early death.
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http://dx.doi.org/10.1164/rccm.201809-1652OCDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6635786PMC
July 2019

Analysis of pulmonary features and treatment approaches in the COPA syndrome.

ERJ Open Res 2018 Apr 27;4(2). Epub 2018 Jun 27.

Dept of Medicine, Division of Pulmonary and Critical Care, University of California San Francisco, San Francisco, CA, USA.

The COPA syndrome is a monogenic, autoimmune lung and joint disorder first identified in 2015. This study sought to define the main pulmonary features of the COPA syndrome in an international cohort of patients, analyse patient responses to treatment and highlight when genetic testing should be considered. We established a cohort of subjects (N=14) with COPA syndrome seen at multiple centres including the University of California, San Francisco, CA, USA. All subjects had one of the previously established mutations in the gene, and had clinically apparent lung disease and arthritis. We analysed cohort characteristics using descriptive statistics. All subjects manifested symptoms before the age of 12 years, had a family history of disease, and developed diffuse parenchymal lung disease and arthritis. 50% had diffuse alveolar haemorrhage. The most common pulmonary findings included cysts on chest computed tomography and evidence of follicular bronchiolitis on lung biopsy. All subjects were positive for anti-neutrophil cytoplasmic antibody, anti-nuclear antibody or both and 71% of subjects had rheumatoid factor positivity. All subjects received immunosuppressive therapy. COPA syndrome is an autoimmune disorder defined by diffuse parenchymal lung disease and arthritis. We analysed an international cohort of subjects with genetically confirmed COPA syndrome and found that common pulmonary features included cysts, follicular bronchiolitis and diffuse alveolar haemorrhage. Common extrapulmonary features included early age of onset, family history of disease, autoantibody positivity and arthritis. Longitudinal data demonstrated improvement on chest radiology but an overall decline in pulmonary function despite chronic treatment.
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http://dx.doi.org/10.1183/23120541.00017-2018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6019741PMC
April 2018

Interstitial lung abnormalities and self-reported health and functional status.

Thorax 2018 09 9;73(9):884-886. Epub 2018 Jan 9.

Faculty of Medicine, University of Iceland, Reykjavik, Iceland.

We investigated the association between interstitial lung abnormalities (ILA) and self-reported measures of health and functional status in 5764 participants from the Age, Gene/Environment Susceptibility-Reykjavik study. The associations of ILA to activities of daily living (ADLs), general health status and physical activity were explored using logistic regression models. Participants with ILA were less likely to be independent in ADLs (OR 0.70; 95% CI 0.55 to 0.90) to have good or better self-reported health (OR 0.66; 95% CI 0.52 to 0.82) and to participate in physical activity (OR 0.72; CI 0.56 to 0.91). The results demonstrate ILA's association with worsening self-reported health and functional status.
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http://dx.doi.org/10.1136/thoraxjnl-2017-210956DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6037567PMC
September 2018

COPA syndrome in an Icelandic family caused by a recurrent missense mutation in COPA.

BMC Med Genet 2017 11 14;18(1):129. Epub 2017 Nov 14.

deCODE Genetics/Amgen, Inc, Sturlugata 8, 101, Reykjavik, Iceland.

Background: Rare missense mutations in the gene encoding coatomer subunit alpha (COPA) have recently been shown to cause autoimmune interstitial lung, joint and kidney disease, also known as COPA syndrome, under a dominant mode of inheritance.

Case Presentation: Here we describe an Icelandic family with three affected individuals over two generations with a rare clinical presentation of lung and joint disease and a histological diagnosis of follicular bronchiolitis. We performed whole-genome sequencing (WGS) of the three affected as well as three unaffected members of the family, and searched for rare genotypes associated with disease using 30,067 sequenced Icelanders as a reference population. We assessed all coding and splicing variants, prioritizing variants in genes known to cause interstitial lung disease. We detected a heterozygous missense mutation, p.Glu241Lys, in the COPA gene, private to the affected family members. The mutation occurred de novo in the paternal germline of the index case and was absent from 30,067 Icelandic genomes and 141,353 individuals from the genome Aggregation Database (gnomAD). The mutation occurs within the conserved and functionally important WD40 domain of the COPA protein.

Conclusions: This is the second report of the p.Glu241Lys mutation in COPA, indicating the recurrent nature of the mutation. The mutation was reported to co-segregate with COPA syndrome in a large family from the USA with five affected members, and classified as pathogenic. The two separate occurrences of the p.Glu241Lys mutation in cases and its absence from a large number of sequenced genomes confirms its role in the pathogenesis of the COPA syndrome.
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http://dx.doi.org/10.1186/s12881-017-0490-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5686906PMC
November 2017

The promoter polymorphism is associated with specific interstitial lung abnormality subtypes.

Eur Respir J 2017 09 11;50(3). Epub 2017 Sep 11.

Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA

The promoter polymorphism (rs35705950) has been associated with interstitial lung abnormalities (ILA) in white participants from the general population; whether these findings are replicated and influenced by the ILA subtype is not known. We evaluated the associations between the genotype and ILA in cohorts with extensive imaging characterisation.We performed ILA phenotyping and promoter genotyping in 5308 and 9292 participants from the AGES-Reykjavik and COPDGene cohorts, respectively.We found that ILA was present in 7% of participants from the AGES-Reykjavik, 8% of non-Hispanic white participants from COPDGene and 7% of African-American participants from COPDGene. Although the genotype was strongly associated (after correction for multiple testing) with ILA (OR 2.1, 95% CI 1.8-2.4, p=1×10), there was evidence of significant heterogeneity between cohorts (I=81%). When narrowed to specific radiologic subtypes, ( subpleural ILA), the genotype remained strongly associated (OR 2.6, 95% CI 2.2-3.1, p=1×10) with minimal heterogeneity (I=0%). Although there was no evidence that the genotype influenced survival, there was evidence that genotype improved risk prediction for possible usual interstitial pneumonia (UIP) or a UIP pattern in non-Hispanic white populations.The promoter polymorphism is strongly associated with ILA and specific radiologic subtypes of ILA, with varying degrees of heterogeneity in the underlying populations.
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http://dx.doi.org/10.1183/13993003.00537-2017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5687883PMC
September 2017

[Effects of volcanic eruptions on human health in Iceland. Review].

Laeknabladid 2016 Oktober;102(10):433-441

Volcanic eruptions are common in Iceland and have caused health problems ever since the settlement of Iceland. Here we describe volcanic activity and the effects of volcanic gases and ash on human health in Iceland. Volcanic gases expelled during eruptions can be highly toxic for humans if their concentrations are high, irritating the mucus membranes of the eyes and upper respiratory tract at lower concentrations. They can also be very irritating to the skin. Volcanic ash is also irritating for the mucus membranes of the eyes and upper respiratory tract. The smalles particles of volcanic ash can reach the alveoli of the lungs. Described are four examples of volcanic eruptions that have affected the health of Icelanders. The eruption of Laki volcanic fissure in 1783-1784 is the volcanic eruption that has caused the highest mortality and had the greatest effects on the well-being of Icelanders. Despite multiple volcanic eruptions during the last decades in Iceland mortality has been low and effects on human health have been limited, although studies on longterm effects are lacking. Studies on the effects of the Eyjafjallajökul eruption in 2010 on human health showed increased physical and mental symptoms, especially in those having respiratory disorders. The Directorate of Health in Iceland and other services have responded promptly to recurrent volcanic eruptions over the last few years and given detailed instructions on how to minimize the effects on the public health. Key words: volcanic eruptions, Iceland, volcanic ash, volcanic gases, health effects, mortality. Correspondence: Gunnar Guðmundsson, ggudmund@landspitali.is.
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http://dx.doi.org/10.17992/lbl.2016.10.101DOI Listing
August 2017

Airflow obstruction, atherosclerosis and cardiovascular risk factors in the AGES Reykjavik study.

Atherosclerosis 2016 09 28;252:122-127. Epub 2016 Jul 28.

Faculty of Medicine, University of Iceland, Reykjavik, Iceland; The Icelandic Heart Association, Kopavogur, Iceland.

Background And Aims: Airflow limitation, i.e. reduced forced expiratory volume in 1-s (FEV1), is associated with increased prevalence of atherosclerosis, however, causal mechanisms remain elusive. The objective of the study was to determine if the association between airflow obstruction and markers of atherosclerosis is mediated by systemic inflammation.

Methods: 1154 subjects from the longitudinal AGES Reykjavik study were included. Population characteristics, systemic inflammation markers from blood (white blood cell counts (WBC) and level of C-reactive protein (CRP)) were compared between patients with and without airflow limitation defined by reduced FEV1 on spirometry. Atherosclerosis burden was quantified by measurements of coronary artery calcium, aortic arch and distal aortic calcification in addition to carotid intimal media thickness (CIMT).

Results: Subjects were split into four groups according to smoking status and whether airflow limitation was present. There was a higher overall burden of atherosclerosis in ever-smokers compared to never-smokers, and in individuals with airflow obstruction compared to individuals without airflow obstruction. After adjusting for population characteristics, Framingham cardiovascular risk factors and markers of systemic inflammation (WBC and CRP), there was a significantly increased aortic arch and distal aorta calcification and higher CIMT measurement in individuals with airflow obstruction compared to individuals without airflow obstruction. After adjusting for population characteristics, Framingham cardiovascular risk factors and markers of systemic inflammation (WBC and CRP), there was a significantly increased aortic arch and distal aorta calcification and higher CIMT measurement in individuals with airflow obstruction compared to individuals without airflow obstruction.

Conclusions: Systemic inflammation (WBC and CRP) does not appear to mediate the association between airflow limitation and atherosclerosis. Only airflow limitation and not systemic inflammation (WBC and CRP) appears to be an independent predictor of atherosclerosis.
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http://dx.doi.org/10.1016/j.atherosclerosis.2016.07.919DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5963694PMC
September 2016

Malignant mesothelioma incidence by nation-wide cancer registry: a population-based study.

J Occup Med Toxicol 2016 26;11:37. Epub 2016 Jul 26.

Department of Preventive Medicine, University of Iceland, Stapi/ Hringbraut, Reykjavik, Iceland.

Background: Malignant mesothelioma caused by asbestos exposure has a long latency period. A ban on asbestos use may not be apparent in decreased incidence in the population until after several decades. The aim was to evaluate changes in the incidence of malignant mesothelioma, and the possible impact of the asbestos ban implemented in Iceland in 1983.

Methods: This is a population study on aggregate level; the source of data was the Icelandic Cancer Registry, the National Cause-of-Death Registry, and the National Register. Volume of asbestos import was obtained from Customs Tariff. The import figures reflect fairly accurately the amount used, as there are no mines in the country.

Results: Asbestos import peaked in 1980 at 15.0 kg/capita/year, diminishing to 0.3 kg/capita/year ten years after the ban in 1983, and to zero in the most recent years. Seventy-nine per cent of the cases of malignant mesothelioma were men, and 72 % were of pleural origin. Mesothelioma incidence increased steadily from 1965 to 2014, when it reached 21.4 per million among men, and 5.6 among women. Mortality in 2014 was 22.2 per million among men, and 4.8 among women.

Conclusion: Malignant mesothelioma incidence and mortality increased in the population during the period, despite the ban on asbestos use from 1983. This is in agreement with the long latency time for malignant mesothelioma. In line with the previously high per capita volume of asbestos import, many buildings, equipment, and structures contain asbestos, so there is an on-going risk of asbestos exposure during maintenance, renovations and replacements. It is thus difficult to predict when the incidence of malignant mesothelioma will decrease in the future. During the last ten-year period, the incidence in Iceland was higher than the recently reported incidence in neighbouring countries.
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http://dx.doi.org/10.1186/s12995-016-0127-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4960893PMC
July 2016

Gradual caldera collapse at Bárdarbunga volcano, Iceland, regulated by lateral magma outflow.

Science 2016 Jul;353(6296):aaf8988

University of Palermo, Piazza Marina, 61 90133, Palermo, Italy.

Large volcanic eruptions on Earth commonly occur with a collapse of the roof of a crustal magma reservoir, forming a caldera. Only a few such collapses occur per century, and the lack of detailed observations has obscured insight into the mechanical interplay between collapse and eruption. We use multiparameter geophysical and geochemical data to show that the 110-square-kilometer and 65-meter-deep collapse of Bárdarbunga caldera in 2014-2015 was initiated through withdrawal of magma, and lateral migration through a 48-kilometers-long dike, from a 12-kilometers deep reservoir. Interaction between the pressure exerted by the subsiding reservoir roof and the physical properties of the subsurface flow path explain the gradual, near-exponential decline of both collapse rate and the intensity of the 180-day-long eruption.
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http://dx.doi.org/10.1126/science.aaf8988DOI Listing
July 2016

Genome-wide imputation study identifies novel HLA locus for pulmonary fibrosis and potential role for auto-immunity in fibrotic idiopathic interstitial pneumonia.

BMC Genet 2016 06 7;17(1):74. Epub 2016 Jun 7.

Center for Genes, Environment and Health, National Jewish Health, Denver, CO, USA.

Background: Fibrotic idiopathic interstitial pneumonias (fIIP) are a group of fatal lung diseases with largely unknown etiology and without definitive treatment other than lung transplant to prolong life. There is strong evidence for the importance of both rare and common genetic risk alleles in familial and sporadic disease. We have previously used genome-wide single nucleotide polymorphism data to identify 10 risk loci for fIIP. Here we extend that work to imputed genome-wide genotypes and conduct new RNA sequencing studies of lung tissue to identify and characterize new fIIP risk loci.

Results: We performed genome-wide genotype imputation association analyses in 1616 non-Hispanic white (NHW) cases and 4683 NHW controls followed by validation and replication (878 cases, 2017 controls) genotyping and targeted gene expression in lung tissue. Following meta-analysis of the discovery and replication populations, we identified a novel fIIP locus in the HLA region of chromosome 6 (rs7887 P meta  = 3.7 × 10(-09)). Imputation of classic HLA alleles identified two in high linkage disequilibrium that are associated with fIIP (DRB1*15:01 P = 1.3 × 10(-7) and DQB1*06:02 P = 6.1 × 10(-8)). Targeted RNA-sequencing of the HLA locus identified 21 genes differentially expressed between fibrotic and control lung tissue (Q < 0.001), many of which are involved in immune and inflammatory response regulation. In addition, the putative risk alleles, DRB1*15:01 and DQB1*06:02, are associated with expression of the DQB1 gene among fIIP cases (Q < 1 × 10(-16)).

Conclusions: We have identified a genome-wide significant association between the HLA region and fIIP. Two HLA alleles are associated with fIIP and affect expression of HLA genes in lung tissue, indicating that the potential genetic risk due to HLA alleles may involve gene regulation in addition to altered protein structure. These studies reveal the importance of the HLA region for risk of fIIP and a basis for the potential etiologic role of auto-immunity in fIIP.
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http://dx.doi.org/10.1186/s12863-016-0377-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4895966PMC
June 2016

[Lung Transplantation in Icelanders].

Laeknabladid 2016 May;102(5):225-30

Introduction: Lung transplantation is a treatment option for end-stage lung diseases, excluding lung cancer, when life expectancy is short and quality of life is poor. In most instances pulmonary function and quality of life improves after lung transplantation. Infections and rejection are the most common complications and limit the feasibility of lung transplantation.

Materials And Methods: Retrospective analysis of lung transplantations performed on Icelanders from February 1988 to January 2015. Clinical information was obtained from medical records and a database was created. Information on demographics, underlying lung disease, type of transplantation, immunosuppression, rejection and other complications was collected.

Results: A total of 21 lung transplantations were performed, one of which was a retransplantation. There were 9 females and 11 males and the mean age was 45 years (20-61 years). Most of the operations were done at the Sahlgrenska hospital in Gothenburg. Bilateral lung transplantion was the most common operation. COPD was the most common indication. Rejection and infections were the most common complications. Eight of 20 patients have had acute rejection and half of the patients chronic rejection. Six of 20 patients are deceased, three died from chronic rejection. Median survival is 8,5 years. Five-year survival is 74%.

Conclusions: Lung transplantations are currently performed at the Sahlgrenska hospital in Gothenburg but follow-up is in the hands of specialized pulmonologists in Iceland. Complications and survival for Icelandic patients is similar to larger centers. Close cooperation with the transplanting center is essential.

Key Words: lung transplantation, Icelanders, indications, survival, complications.
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http://dx.doi.org/10.17992/lbl.2016.05.80DOI Listing
May 2016