posted May 01, 2008 08:51 PM         

Looking back, doctors admit the experiment had a good chance of yielding useful results and promising clues to a cure.
But in 2006, the University of Pittsburgh School of Medicine doctors thought it was a bit of a gamble when they decided to gather cells from patients with a killer lung disease and test them in healthy cadaver lungs.

"I really enjoy going to casinos, and sometimes you win," said Dr. Steven Duncan, a professor in the School of Medicine. "With this study, we won. It was pure speculation, and it worked out."

Duncan and Dr. Frank Sciurba, director of Pitt's Emphysema Research Center, recently reported their experiment gave solid evidence that chronic obstructive pulmonary disease, or COPD -- which kills about 130,000 people in the United States every year -- is an autoimmune disease, in which the body attacks itself.

Now they're enrolling Western Pennsylvanians to test a drug treatment with the potential of becoming the first to halt progression of the lung disease.
"Existing therapies don't really have an effect on lung function," Sciurba said. "They help people feel better, and that is really important, but there is no compelling evidence that the current therapies change the long-term outcome."

COPD is an umbrella term for some lung conditions that limit a person's ability to get air into or out of the lungs, keeping oxygen from the blood. It almost always is associated with a history of cigarette smoking. The lungs are damaged from long-term, continuous irritation.

"It was like an asthma attack all the time. I just couldn't breathe," said Vearl Franke of Latrobe, a COPD patient who was misdiagnosed for several years and now has his COPD under control.

Researchers say COPD is a growing disease and Western Pennsylvania has a large number of patients because of the region's aging population and high number of smokers. Pitt is expanding its Division of Pulmonary and Critical Care Medicine and recruiting top COPD researchers.

The National Institutes of Health projects the disease will become the world's third-leading cause of death by 2030. Almost one in four Western Pennsylvania adults smoke, according the state Department of Health.

Pitt's chair of the department of medicine, Dr. Steven Shapiro, is a COPD expert who came from Harvard University about two years ago. He brought his research team and convinced Harvard's vice chair of integrated clinical services, COPD researcher Dr. John Reilly, to become Pitt's School of Medicine's vice chair of clinical affairs this summer.

"Our first step is really to prevent the progression of the disease, and I think we're close to that," Shapiro said. "In terms of reversing or curing it, that is much more complicated, but I think this place is positioned well. There's a lot of potential in the things we're doing here."

COPD is perplexing because it doesn't improve or even stop worsening after patients stop smoking, Sciurba said. If cigarette smoke destroys lung tissue, common sense says once the irritant is removed the still-healthy portions of the lungs should remain so, he said. Something else must perpetuate the lung destruction.

"The immune system is a beautiful system," Duncan said. "Normally it works well, but with chronicity and extremes in exacerbation, then it can go haywire and malfunction and develop responses against itself. That is autoimmunity."

In Pitt's study, 68 percent of smokers and former smokers with COPD had abnormal antibodies that indicate autoimmunity, compared with 13 percent of former smokers without COPD and 10 percent of people who never smoked.

"This isn't to say that autoimmunity is causing the COPD or making it worse, but I think it is," Duncan said.

If that is the case, doctors should be able to stop the lung destruction by treating the autoimmunity. They give lung transplant patients an inhaled drug, cyclosporine, to calm the immune system and keep it from attacking the donor lung. They're recruiting COPD patients to test whether the drug affects them similarly.

Competing COPD researcher Norbert Voelkel, a professor of internal medicine at Virginia Commonwealth University, said he isn't convinced the study proved the autoimmunity hypothesis. But he said positive results from the clinical trial would make the idea hard to refute.

Diagnosed with COPD three years ago, retiree Mary Glasser, 65, of Bethel Park developed a voracious appetite for research and has volunteered for numerous studies with Sciurba.

"COPD is a progressive disease, but perhaps I can keep it at arm's length," she said.

Allison M. Heinrichs can be reached at aheinrichs@tribweb.com or 412-380-5607.

posted May 02, 2008 03:12 PM         

I'm going to give him the heads up on this info and from the other string you started.