Inflammation in COPD: pathogenesis, local and systemic effects

Vol. 52 No. 1 Suppl., 2011
This supplement was not sponsored by Outside Organizations.


Cornelia Barbu, Mihaela Iordache, M. G. Man

COPD is a disease characterized by inflammation both in its stable phase and during exacerbations. Inflammation is present in the respiratory compartment, the inflammatory cells and different mediators of inflammation being present. Studies have shown that some mediators of inflammation have a high level at systemic level also, inducing a certain grade of systemic inflammation, mainly responsible for the systemic manifestation of the disease. It seems that the both local and the systemic inflammation are amplified during exacerbations. The purpose of this paper is to review the respiratory inflammatory reaction, to identify the main actors involved in the stable phase of the disease and during exacerbations, the systemic inflammation accompanying the local inflammation, and to find the possible interrelations between the systemic and local inflammation, on one hand, and the respiratory and extra-respiratory manifestations of COPD on the other hand. The understanding of the pathogenic mechanisms, which stay at the base of inflammation and of the possible interrelations shown, represents a theoretical interest and also a practical one, concerning the targets of different therapeutic agents which could be used in the management and in the control of the disease.

Corresponding author: Cornelia Barbu, MD, PhD, e-mail:

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V. Surlin, M. Ioana, I. E. Plesea

Colorectal cancer (CRC) is the third most common cancer in men and second in women. Progression and invasion of colorectal cancer is a multistep process involving multiple interactions between the tumor and the surrounding stroma mediated by many proteins, among them metalloproteinases (MMPs) and tissular inhibitors of metalloproteinases (TIMPs). We aimed to review the correlations between the expression of the MMPs and TIMPs genes and the clinicopathologic variables of the CRC. Levels of MMPs genes expression in colorectal cancer correlate with the depth of invasion, hematogenous and lymphatic metastasis, poor differentiation, Duke's stage and prognosis. Levels of TIMP's genes expression correlate with better prognosis and longer survival. There are also some controversial data explained by the fact that most of the studies addressed one or few MMPs and/or TIMPs. The methods to assess the variance in gene expression were not always the same. The promoter regions of metalloproteinases present many polymorphisms and all have allele-specific effects on regulation of MMP gene transcription. Numerous studies on the association of these polymorphisms with cancer susceptibility have been carried out. Most of the studies addressed one or two polymorphisms and their implications. A meta-analysis is necessary to confirm significant correlations. The heterogenicity of the MMPs and TIMPs genetic patterns generated by different studies on colorectal cancer does not allow us to have an overall correlation with clinicopathologic variables and the prognosis of the disease. Studies that involve many MMPs, TIMPs polymorphisms and their tissular expression would be more valuable to better assess the role of those enzymes in the progression of the disease and may serve as a starting point for selective therapeutic approaches.

Corresponding author: Valeriu Surlin, MD, PhD, e-mail:

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