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Airway remodelling in smokers with or without chronic obstructive pulmonary disease (COPD) and the effects of inhaled corticosteroids on remodelling in COPD


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Soltani Abhari, A 2010 , 'Airway remodelling in smokers with or without chronic obstructive pulmonary disease (COPD) and the effects of inhaled corticosteroids on remodelling in COPD', PhD thesis, University of Tasmania.

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Introduction: Smoking-related COPD is a worldwide health problem. Airway
remodelling is defined as structural changes occurring in chronic inflammatory diseases
of the airways. Our knowledge about airway remodelling in COPD is very limited. My
preliminary observational study of bronchial biopsies (BB) from COPD subjects
revealed reticular basement membrane (Rbm) fragmentation and vascular changes. I
hypothesised that these changes are specific for COPD and are related to the angiogenic
activity of vascular endothelial growth factor (VEGF) and transforming growth factor-ß
(TGF-ß). I also aimed to study the effects of inhaled corticosteroids (ICS) on these
airway changes.
Methods: A cross-sectional study compared BB from current smokers with COPD (SCOPD),
ex-smokers with COPD (ES-COPD), current smokers with normal lung
function (S-N) and healthy nonsmoking (H-N) subjects. BB were stained with anti-
Collagen IV, anti-VEGF and anti-TGF- ß antibodies. Rbm fragmentation and vessels in
the Rbm and lamina propria (LP) were measured. Anti-Factor VIII antibody was
compared with anti-Collagen IV antibody in detecting vessels.
Then a double-blind, randomized and placebo controlled study assessed the effects of
ICS on airway remodeling, VEGF and TGF- ß in COPD.
Results: Airway remodelling changes were also detectable in S-N. The Rbm was
fragmented. The length of splits was significantly greater in both COPD groups and in
S-N than controls (p<0.02). The Rbm was hypervascular and the LP hypovascular in
current smokers compared with controls (p<0.05). Vessels stained for VEGF and TGF-ß
were increased in the Rbm of both COPD groups and S-N (p<0.05). Factor VIII antibody confirmed my finding of hypovascularity of the LP in S-COPD. ICS reversed
Rbm splitting but did not have any effect on vessel remodelling and angiogenic
Discussion: My studies revealed novel aspects of Rbm and vascular remodelling in BB
from COPD subjects and S-N and for the first time showed that ICS are effective on
Rbm changes in COPD. Rbm fragmentation, we think, is probably a consequence of the
effects of proteolytic enzymes on the Rbm due to activation of epithelial-mesenchymal
transition (EMT) by smoking. This is under more investigation in our group. My study
could not explain the mechanisms to vessel changes in current smokers. Further studies
to examine the role of other angiogenic/antiangiogenic factors are now needed. Absence
of vascular changes in ES-COPD subjects may imply that vascular remodelling is
reversible with smoking cessation, but to test this we need a longitudinal smoking
cessation study.

Item Type: Thesis - PhD
Authors/Creators:Soltani Abhari, A
Keywords: airway remodelling, angiogenesis, COPD, smoking, corticosteroids, controlled trial, bronchial biopsy, VEGF
Additional Information:

Copyright © the Author. The publishers of the paper comprising Chapter Five hold the copyright for that
content and access to the material should be sought from the respective journal (
Respirator Research is an open access journal and available at: http://respiratoryresearch.
com/content/11/1/105). The remaining nonpublished content of the
thesis may be made available for loan and limited copying in accordance with the
Copyright Act 1968.Copying of any part of this thesis is
prohibited for two years from the date this statement was signed; after that time limited
copying is permitted in accordance with the copyright act 1968.
Amir Soltani

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