Medicine - Book Report/Review Example

Aspergillus fumigatus is one of the most commonly observed fungi that colonize the respiratory tract in people suffering from cystic fibrosis. Allergic bronchopulmonary aspergillosis (ABPA) is an exaggerated immune response to A. fumigatus and causes the deterioration of pulmonary function. Prior to the study under review, number of gaps existed in our knowledge of cystic fibrosis and colonization by A. fumigatus. These include: The impact of A. fumigatus on inflammation and airway disease in patients with cystic fibrosis was unclear. The role of A. fugmigatus in the absence of allergic bronchopulmonary aspergillosis (ABPA) was unclear. While work on azole based agents such as itraconazole in cystic fibrosis accompanied by ABPA were underway, the anti-inflammatory effects of vitamin D and other vitamin D receptor (VDR) agonists in case of A. fumigatus colonization in cystic fibrosis in absence of ABPA are unknown. This study therefore aimed at filling in these gaps in our knowledge about cystic fibrosis and A. fumigatus colonization. The current paper aims to review this study on the effect of A. fumigatus on VDR expression in patients with cystic fibrosis, conducted by Coughlan et al. in 2012. ...
Since the aim of the study is to understand the interaction of A. fumigatus infection with vitamin D and VDR agonists in cystic fibrosis patients lacking ABPA, it observes the interaction of azoles such as itraconazole, in addition to A. fumigatus and its toxins both in vitro and in vivo. The VDR gene and its protein expression in culture filtrates and tracheal epithelial and bronchial epithelial cells of patients with cystic fibrosis have been observed. The findings and results have been discussed in terms of the observations made in this regard. The researchers did not formulate a hypothesis to test, and have based their results on experimental observations made both in vitro and in vivo. Central Question for Research As already stated, there is no central hypothesis in this research. However, the entire research has been based on one central question: what is the “effect of A. fumigatus on VDR expression in the CF airway” and what is the “treatment effectiveness of itraconazole in A. fumigatus colonization without ABPA” (1 p1000)? Earlier studies in mice have shown that in even in the absence of ABPA, the fungus A. fumigatus is harmful as it leads to severe Th2-biased pulmonary inflammation. Moreover, it is also seen that deficiency of vitamin D may be a risk factor for cystic fibrosis accompanied with ABPA. Experimentally, in vitro treatment using vitamin D has been shown to reduce the expression of IL-5 and IL-13, which is favorable. Other studies have also shown that IL-5 and IL-13 production is elevated and pulmonary inflammation is high when VDR is deleted. Therefore, there is a link between vitamin D and IL-5 and IL-13 levels in cystic fibrosis and A. fumigatus infection. This forms the central basis for research in this study. The effect of ...Show more