1 5255 81 PROGRESS IN UNDERSTANDING THE PATHOGENESIS OF BPD USING THE BABOON AND SHEEP MODELS. BRONCHOPULMONARY DYSPLASIA (BPD) IS AMONG THE MOST COMMON CHRONIC LUNG DISEASES IN INFANTS IN THE US. IMPROVED SURVIVAL OF PRETERM INFANTS WHO DEVELOPED BPD IS BECOMING INCREASINGLY IMPORTANT BECAUSE OF THE HIGH RISK FOR PERSISTENT PULMONARY MORBIDITIES SUCH AS POOR RESPIRATORY GAS EXCHANGE, PULMONARY HYPERTENSION, AND EXCESS AIRWAY EXPIRATORY RESISTANCE LATER IN LIFE. THIS REVIEW FOCUSES ON UNIQUE INSIGHTS PROVIDED BY THE TWO LARGE-ANIMAL, PHYSIOLOGICAL MODELS OF NEONATAL CHRONIC LUNG DISEASE: PRETERM BABOONS AND PRETERM LAMBS. THE MODELS' ARE VALUABLE BECAUSE THEY CONTRIBUTE TO BETTER UNDERSTANDING OF THE UNDERLYING MOLECULAR PATHOGENIC MECHANISMS. AN EPIGENETIC HYPOTHESIS IS PROPOSED AS A PATHOGENIC MECHANISM FOR BPD AND ITS PERSISTENT PULMONARY MORBIDITIES. 2013 2 1392 34 DIAGNOSTIC APPROACH TO PULMONARY HYPERTENSION IN PREMATURE NEONATES. BRONCHOPULMONARY DYSPLASIA (BPD) IS A FORM OF CHRONIC LUNG DISEASE IN PREMATURE INFANTS FOLLOWING RESPIRATORY DISTRESS AT BIRTH. WITH INCREASING SURVIVAL OF EXTREMELY LOW BIRTH WEIGHT INFANTS, ALVEOLAR SIMPLIFICATION IS THE DEFINING LUNG CHARACTERISTIC OF INFANTS WITH BPD, AND ALONG WITH PULMONARY HYPERTENSION, INCREASINGLY CONTRIBUTES TO BOTH RESPIRATORY MORBIDITY AND MORTALITY IN THESE INFANTS. GROWTH RESTRICTED INFANTS, INFANTS BORN TO MOTHERS WITH OLIGOHYDRAMNIOS OR FOLLOWING PROLONGED PRETERM RUPTURE OF MEMBRANES ARE AT PARTICULAR RISK FOR EARLY ONSET PULMONARY HYPERTENSION. ALTERED VASCULAR AND ALVEOLAR GROWTH PARTICULARLY IN CANALICULAR AND EARLY SACCULAR STAGES OF LUNG DEVELOPMENT FOLLOWING MECHANICAL VENTILATION AND OXYGEN THERAPY, RESULTS IN DEVELOPMENTAL LUNG ARREST LEADING TO BPD WITH PULMONARY HYPERTENSION (PH). EARLY RECOGNITION OF PH IN INFANTS WITH RISK FACTORS IS IMPORTANT FOR OPTIMAL MANAGEMENT OF THESE INFANTS. SCREENING TOOLS FOR EARLY DIAGNOSIS OF PH ARE EVOLVING; HOWEVER, ECHOCARDIOGRAPHY IS THE MAINSTAY FOR NON-INVASIVE DIAGNOSIS OF PH IN INFANTS. CARDIAC COMPUTED TOMOGRAPHY (CT) AND MAGNETIC RESONANCE ARE BEING USED AS IMAGING MODALITIES, HOWEVER THEIR ROLE IN IMPROVING OUTCOMES IN THESE PATIENTS IS UNCERTAIN. FOLLOW-UP OF INFANTS AT RISK FOR PH WILL HELP NOT ONLY IN EARLY DIAGNOSIS, BUT ALSO IN APPROPRIATE MANAGEMENT OF THESE INFANTS. AGGRESSIVE MANAGEMENT OF LUNG DISEASE, AVOIDANCE OF HYPOXEMIC EPISODES, AND OPTIMAL NUTRITION DETERMINE THE PROGRESSION OF PH, AS EPIGENETIC FACTORS MAY HAVE SIGNIFICANT EFFECTS, PARTICULARLY IN GROWTH-RESTRICTED INFANTS. INFANTS WITH DIAGNOSIS OF PH ARE MANAGED WITH PULMONARY VASODILATORS AND THOSE RESISTANT TO THERAPY NEED TO BE WORKED UP FOR THE PRESENCE OF CARDIO-VASCULAR ANOMALIES. THE MANAGEMENT OF INFANTS AND TODDLERS WITH PH, ESPECIALLY FOLLOWING PREMATURE BIRTH IS AN EMERGING FIELD. NONETHELESS, COMBINATION THERAPIES IN A MULTI-DISCIPLINARY SETTING IMPROVES OUTCOMES FOR THESE INFANTS. 2017 3 5287 28 PROSPECTIVE EPIGENOME AND TRANSCRIPTOME ANALYSES OF CORD AND PERIPHERAL BLOOD FROM PRETERM INFANTS AT RISK OF BRONCHOPULMONARY DYSPLASIA. BRONCHOPULMONARY DYSPLASIA (BPD) IS A PREVALENT CHRONIC LUNG DISEASE OF PREMATURITY WITH LIMITED TREATMENT OPTIONS. TO UNCOVER BIOMARKERS OF BPD RISK, THIS STUDY INVESTIGATED EPIGENETIC AND TRANSCRIPTOMIC SIGNATURES OF PREMATURITY AT BIRTH AND DURING THE NEONATAL PERIOD AT DAY 14 AND 28. PERIPHERAL BLOOD DNAS FROM PRETERM INFANTS WERE APPLIED TO METHYLATION ARRAYS AND CELL-TYPE COMPOSITION WAS ESTIMATED BY DECONVOLUTION. COVARIATE-ADJUSTED ROBUST LINEAR REGRESSION ELUCIDATED BPD- AND PROLONGED OXYGEN (>/= 14 DAYS) EXPOSURE-ASSOCIATED CPGS. RNAS FROM CORD AND PERIPHERAL BLOOD WERE SEQUENCED, AND DIFFERENTIALLY EXPRESSED GENES (DEGS) FOR BPD OR OXYGEN EXPOSURE WERE DETERMINED. ESTIMATED NEUTROPHIL-LYMPHOCYTE RATIOS IN PERIPHERAL BLOOD AT DAY 14 IN BPD INFANTS WERE SIGNIFICANTLY HIGHER THAN NONBPD INFANTS, SUGGESTING AN HEIGHTENED INFLAMMATORY RESPONSE IN DEVELOPING BPD. BPD-DEGS IN CORD BLOOD INDICATED LYMPHOPOIESIS INHIBITION, ALTERED TH1/TH2 RESPONSES, DNA DAMAGE, AND ORGAN DEGENERATION. ON DAY 14, BPD-ASSOCIATED CPGS WERE HIGHLY ENRICHED IN NEUTROPHIL ACTIVATION, INFECTION, AND CD4 + T CELL QUANTITY, AND BPD-DEGS WERE INVOLVED IN DNA DAMAGE, CELLULAR SENESCENCE, T CELL HOMEOSTASIS, AND HYPER-CYTOKINESIS. ON DAY 28, BPD-ASSOCIATED CPGS ALONG WITH BPD-DEGS WERE ENRICHED FOR PHAGOCYTOSIS, NEUROLOGICAL DISORDER, AND NUCLEOTIDE METABOLISM. OXYGEN SUPPLEMENTATION MARKEDLY DOWNREGULATED MITOCHONDRIAL BIOGENESIS GENES AND ALTERED CPGS ANNOTATED TO DEVELOPMENTAL GENES. PREMATURITY-ALTERED DNA METHYLATION COULD CAUSE ABNORMAL LYMPHOPOIESIS, CELLULAR ASSEMBLY AND CELL CYCLE PROGRESSION TO INCREASE BPD RISK. SIMILAR PATHWAYS BETWEEN EPIGENOME AND TRANSCRIPTOME NETWORKS SUGGEST COORDINATION OF THE TWO IN DYSREGULATING LEUKOPOIESIS, ADAPTIVE IMMUNITY, AND INNATE IMMUNITY. THE RESULTS PROVIDE MOLECULAR INSIGHTS INTO BIOMARKERS FOR EARLY DETECTION AND PREVENTION OF BPD. 2023 4 2850 26 FROM CHILD ABUSE TO DEVELOPING BORDERLINE PERSONALITY DISORDER INTO ADULTHOOD: EXPLORING THE NEUROMORPHOLOGICAL AND EPIGENETIC PATHWAY. BORDERLINE PERSONALITY DISORDER (BPD) IS ONE OF THE MOST COMMON PERSONALITY DISORDERS SEEN IN THE GENERAL POPULATION. AMONG MULTIPLE IDENTIFIED RISK FACTORS, ONE OF THE MOST INFLUENTIAL ELEMENTS IS EXPOSURE TO AN ADVERSE CHILDHOOD EXPERIENCE IN TERMS OF EMOTIONAL, PHYSICAL, OR SEXUAL ABUSE. A CASCADE OF NEUROMORPHOLOGICAL AND EPIGENETIC CHANGES OCCURS IN RESPONSE TO THESE CHILDHOOD STRESSORS, WHICH MAY HAVE A STRONG LINK TO THE DEVELOPMENT OF BPD. PUBMED AND GOOGLE SCHOLAR WERE SEARCHED FOR ARTICLES RELEVANT TO CHILD ABUSE AND THE DEVELOPMENT OF BPD. THE SEARCH WAS NOT RESTRICTED TO ANY TIME FRAME OR GEOGRAPHIC LOCATION. SIGNIFICANT EPIGENETIC AND NEUROMORPHOLOGICAL CHANGES ARE SEEN WITH CHILD ABUSE, CONTRIBUTING TO THE DEVELOPMENT OF BPD. CHRONIC STRESSORS LEAD TO HYPOTHALAMIC-PITUITARY AXIS (HPA) ACTIVATION, RELEASING CORTISOL THAT ACTS ON THE PREFRONTAL CORTEX, AMYGDALA, AND HIPPOCAMPUS, PRODUCING THE BEHAVIORAL PATTERNS SEEN IN BPD. OVERSTIMULATION OF GRAY MATTER LEADS TO PERMANENT NEUROMORPHOLOGICAL CHANGES, WHICH CAN BE VISUALIZED IN FUNCTIONAL MRI/BRAIN SCANS. HYPERMETHYLATION OF MESSENGER RIBONUCLEIC ACID IN VARIOUS SITES SUGGESTS THE IMPACT OF CHILD ABUSE ON THE GENETIC LEVEL. INTERESTINGLY, THE PREVALENCE OF BPD IS SEEN EQUALLY IN BOTH GENDERS BUT IS DIAGNOSED MORE FREQUENTLY IN FEMALES BECAUSE THEY TEND TO BE MORE LIKELY TO SEEK HELP. UNDERSTANDING THE IMPACT OF EARLY AGE LIFE STRESSORS INTO ADULTHOOD CALLS FOR SERIOUS FOCUS ON EARLY DIAGNOSIS AND INTERVENTION. THIS IMPLIES THE NEED FOR MORE STUDIES IN PATIENTS WITH BPD WITH OR WITHOUT ANY CHILDHOOD TRAUMATIC EXPERIENCE AND A BETTER UNDERSTANDING OF THE CHANGES THAT OCCUR BIOPSYCHOLOGICALLY AND GENETICALLY IN RESPONSE TO TRAUMA. 2020 5 610 29 BEYOND THE GENOME: EPIGENETIC MECHANISMS IN LUNG REMODELING. THE LUNG DEVELOPS FROM A VERY SIMPLE OUTPOUCHING OF THE FOREGUT INTO A HIGHLY COMPLEX, FINELY STRUCTURED ORGAN WITH MULTIPLE SPECIALIZED CELL TYPES THAT ARE REQUIRED FOR ITS NORMAL PHYSIOLOGICAL FUNCTION. DURING BOTH THE DEVELOPMENT OF THE LUNG AND ITS REMODELING IN THE CONTEXT OF DISEASE OR RESPONSE TO INJURY, GENE EXPRESSION MUST BE ACTIVATED AND SILENCED IN A COORDINATED MANNER TO ACHIEVE THE TREMENDOUS PHENOTYPIC HETEROGENEITY OF CELL TYPES REQUIRED FOR HOMEOSTASIS AND PATHOGENESIS. EPIGENETIC MECHANISMS, CONSISTING OF DNA BASE MODIFICATIONS SUCH AS METHYLATION, ALTERATION OF HISTONES RESULTING IN CHROMATIN MODIFICATION, AND THE ACTION OF NONCODING RNA, CONTROL THE REGULATION OF INFORMATION "BEYOND THE GENOME" REQUIRED FOR BOTH LUNG MODELING AND REMODELING. EPIGENETIC REGULATION IS SUBJECT TO MODIFICATION BY ENVIRONMENTAL STIMULI, SUCH AS OXIDATIVE STRESS, INFECTION, AND AGING, AND IS THUS CRITICALLY IMPORTANT IN CHRONIC REMODELING DISORDERS SUCH AS IDIOPATHIC PULMONARY FIBROSIS (IPF), CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD), BRONCHOPULMONARY DYSPLASIA (BPD), AND PULMONARY HYPERTENSION (PH). TECHNOLOGICAL ADVANCES HAVE MADE IT POSSIBLE TO EVALUATE GENOME-WIDE EPIGENETIC CHANGES (EPIGENOMICS) IN DISEASES OF LUNG REMODELING, CLARIFYING EXISTING PATHOPHYSIOLOGICAL PARADIGMS AND UNCOVERING NOVEL MECHANISMS OF DISEASE. MANY OF THESE REPRESENT NEW THERAPEUTIC TARGETS. ADVANCES IN EPIGENOMIC TECHNOLOGY WILL ACCELERATE OUR UNDERSTANDING OF LUNG DEVELOPMENT AND REMODELING, AND LEAD TO NOVEL TREATMENTS FOR CHRONIC LUNG DISEASES. 2014 6 6440 26 THERAPEUTIC APPROACHES FOR CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) EXACERBATIONS. CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) IS A PROGRESSIVE PULMONARY DISORDER UNDERPINNED BY POORLY REVERSIBLE AIRFLOW RESULTING FROM CHRONIC BRONCHITIS OR EMPHYSEMA. THE PREVALENCE AND MORTALITY OF COPD CONTINUE TO INCREASE. PHARMACOTHERAPY FOR PATIENTS WITH COPD HAS INCLUDED ANTIBIOTICS, BRONCHODILATORS, AND ANTI-INFLAMMATORY CORTICOSTEROIDS (BUT WITH LITTLE SUCCESS). ORAL DISEASES HAVE LONG BEEN ESTABLISHED AS CLINICAL RISK FACTORS FOR DEVELOPING RESPIRATORY DISEASES. THE ESTABLISHMENT OF A VERY SIMILAR MICROBIOME IN THE MOUTH AND THE LUNG CONFIRMS THE ORAL-LUNG CONNECTION. THE ASPIRATION OF PATHOGENIC MICROBES FROM THE ORAL CAVITY HAS BEEN IMPLICATED IN SEVERAL RESPIRATORY DISEASES, INCLUDING PNEUMONIA AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD). THIS REVIEW FOCUSES ON CURRENT AND FUTURE PHARMACOTHERAPEUTIC APPROACHES FOR COPD EXACERBATION INCLUDING ANTIMICROBIALS, MUCOREGULATORS, THE USE OF BRONCHODILATORS AND ANTI-INFLAMMATORY DRUGS, MODIFYING EPIGENETIC MARKS, AND MODULATING DYSBIOSIS OF THE MICROBIOME. 2022 7 6915 20 [VULNERABILITY OF WOMEN TO TOBACCO: THE BRONCHO-PULMONARY CONSEQUENCES (ASTHMA, COPD)]. SMOKING REMAINS COMMON, WITH AN EXPOSURE THAT BEGINS EARLY DURING PREGNANCY. IT INDUCES EPIGENETIC CHANGES, WITH A TRANS-GENERATIONAL TRANSMISSION. SMOKING INCREASES THE RISK OF UNCONTROLLED ASTHMA DURING CHILDHOOD AND ADULT LIFE. ASTHMA IS ALSO ASSOCIATED WITH INCREASED RISK OF A DECLINE OF LUNG FUNCTION AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD). WOMEN ARE MORE AT RISK OF DEVELOPING EARLY AND SEVERE COPD. THE MECHANISMS ARE CURRENTLY POORLY KNOWN. 2019 8 2737 27 EXPOSING A DEADLY ALLIANCE: NOVEL INSIGHTS INTO THE BIOLOGICAL LINKS BETWEEN COPD AND LUNG CANCER. CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) AFFECTS MORE THAN 200 MILLION PEOPLE WORLDWIDE AND IS EXPECTED TO BECOME THE THIRD LEADING CAUSE OF DEATH IN 2020. COPD IS CHARACTERIZED BY PROGRESSIVE AIRFLOW LIMITATION, DUE TO A COMBINATION OF CHRONIC INFLAMMATION AND REMODELING OF THE SMALL AIRWAYS (BRONCHIOLITIS) AND LOSS OF ELASTIC RECOIL CAUSED BY DESTRUCTION OF THE ALVEOLAR WALLS (EMPHYSEMA). LUNG CANCER IS THE MOST IMPORTANT CAUSE OF CANCER-RELATED DEATH IN THE WORLD. (CIGARETTE) SMOKING IS THE PRINCIPAL CULPRIT CAUSING BOTH COPD AND LUNG CANCER; IN ADDITION, EXPOSURE TO ENVIRONMENTAL TOBACCO SMOKE, BIOMASS FUEL SMOKE, COAL SMOKE AND OUTDOOR AIR POLLUTION HAVE ALSO BEEN ASSOCIATED WITH AN INCREASED INCIDENCE OF BOTH DISEASES. IMPORTANTLY, SMOKERS WITH COPD--DEFINED AS EITHER NOT FULLY REVERSIBLE AIRFLOW LIMITATION OR EMPHYSEMA--HAVE A TWO- TO FOUR-FOLD INCREASED RISK TO DEVELOP LUNG CANCER. IN THIS REVIEW, WE HIGHLIGHT SEVERAL OF THE GENETIC, EPIGENETIC AND INFLAMMATORY MECHANISMS, WHICH LINK COPD AND CARCINOGENESIS IN THE LUNGS. ELUCIDATING THE BIOLOGICAL PATHWAYS AND NETWORKS, WHICH UNDERLIE THE INCREASED SUSCEPTIBILITY OF LUNG CANCER IN PATIENTS WITH COPD, HAS IMPORTANT IMPLICATIONS FOR SCREENING, PREVENTION, DIAGNOSIS AND TREATMENT OF THESE TWO DEVASTATING PULMONARY DISEASES. 2013 9 2169 22 EPIGENETIC MECHANISMS IN PARENCHYMAL LUNG DISEASES: BYSTANDERS OR THERAPEUTIC TARGETS? EPIGENETIC RESPONSES DUE TO ENVIRONMENTAL CHANGES ALTER CHROMATIN STRUCTURE, WHICH IN TURN MODIFIES THE PHENOTYPE, GENE EXPRESSION PROFILE, AND ACTIVITY OF EACH CELL TYPE THAT HAS A ROLE IN THE PATHOPHYSIOLOGY OF A DISEASE. PULMONARY DISEASES ARE ONE OF THE MAJOR CAUSES OF DEATH IN THE WORLD, INCLUDING LUNG CANCER, IDIOPATHIC PULMONARY FIBROSIS (IPF), CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD), PULMONARY HYPERTENSION (PH), LUNG TUBERCULOSIS, PULMONARY EMBOLISM, AND ASTHMA. SEVERAL LINES OF EVIDENCE INDICATE THAT EPIGENETIC MODIFICATIONS MAY BE ONE OF THE MAIN FACTORS TO EXPLAIN THE INCREASING INCIDENCE AND PREVALENCE OF LUNG DISEASES INCLUDING IPF AND COPD. INTERESTINGLY, ISOLATED FIBROBLASTS AND SMOOTH MUSCLE CELLS FROM PATIENTS WITH PULMONARY DISEASES SUCH AS IPF AND PH THAT WERE CULTURED EX VIVO MAINTAINED THE DISEASE PHENOTYPE. THE CELLS OFTEN SHOW A HYPER-PROLIFERATIVE, APOPTOSIS-RESISTANT PHENOTYPE WITH INCREASED EXPRESSION OF EXTRACELLULAR MATRIX (ECM) AND ACTIVATED FOCAL ADHESIONS SUGGESTING THE PRESENCE OF AN EPIGENETICALLY IMPRINTED PHENOTYPE. MOREOVER, MANY ABNORMALITIES OBSERVED IN MOLECULAR PROCESSES IN IPF PATIENTS ARE SHOWN TO BE EPIGENETICALLY REGULATED, SUCH AS INNATE IMMUNITY, CELLULAR SENESCENCE, AND APOPTOTIC CELL DEATH. DNA METHYLATION, HISTONE MODIFICATION, AND MICRORNA REGULATION CONSTITUTE THE MOST COMMON EPIGENETIC MODIFICATION MECHANISMS. 2022 10 4135 29 MECHANISMS OF LUNG DAMAGE AND DEVELOPMENT OF COPD DUE TO HOUSEHOLD BIOMASS-SMOKE EXPOSURE: INFLAMMATION, OXIDATIVE STRESS, MICRORNAS, AND GENE POLYMORPHISMS. CHRONIC EXPOSURE TO INDOOR BIOMASS SMOKE FROM THE COMBUSTION OF SOLID ORGANIC FUELS IS A MAJOR CAUSE OF DISEASE BURDEN WORLDWIDE. ALMOST 3 BILLION PEOPLE USE SOLID FUELS SUCH AS WOOD, CHARCOAL, AND CROP RESIDUES FOR INDOOR COOKING AND HEATING, ACCOUNTING FOR APPROXIMATELY 50% OF ALL HOUSEHOLDS AND 90% OF RURAL HOUSEHOLDS GLOBALLY. BIOMASS SMOKE CONTAINS MANY HAZARDOUS POLLUTANTS, RESULTING IN HOUSEHOLD AIR POLLUTION (HAP) EXPOSURE THAT OFTEN EXCEEDS INTERNATIONAL STANDARDS. LONG-TERM BIOMASS-SMOKE EXPOSURE IS ASSOCIATED WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) IN ADULTS, A LEADING CAUSE OF MORBIDITY AND MORTALITY WORLDWIDE, CHRONIC BRONCHITIS, AND OTHER LUNG CONDITIONS. BIOMASS SMOKE-ASSOCIATED COPD DIFFERS FROM THE BEST-KNOWN CIGARETTE SMOKE-INDUCED COPD IN SEVERAL ASPECTS, SUCH AS A SLOWER DECLINE IN LUNG FUNCTION, GREATER AIRWAY INVOLVEMENT, AND LESS EMPHYSEMA, WHICH SUGGESTS A DIFFERENT PHENOTYPE AND PATHOPHYSIOLOGY. DESPITE THE HIGH BURDEN OF BIOMASS-ASSOCIATED COPD, THE MOLECULAR, GENETIC, AND EPIGENETIC MECHANISMS UNDERLYING ITS PATHOGENESIS ARE POORLY UNDERSTOOD. THIS REVIEW DESCRIBES THE PATHOGENIC MECHANISMS POTENTIALLY INVOLVED IN LUNG DAMAGE, THE DEVELOPMENT OF COPD ASSOCIATED WITH WOOD-DERIVED SMOKE EXPOSURE, AND THE INFLUENCE OF GENETIC AND EPIGENETIC FACTORS ON THE DEVELOPMENT OF THIS DISEASE. 2022 11 4450 30 MOLECULAR MECHANISMS AND CELLULAR CONTRIBUTION FROM LUNG FIBROSIS TO LUNG CANCER DEVELOPMENT. IDIOPATHIC PULMONARY FIBROSIS (IPF) IS A CHRONIC, PROGRESSIVE, FIBROSING INTERSTITIAL LUNG DISEASE (ILD) OF UNKNOWN AETIOLOGY, WITH A MEDIAN SURVIVAL OF 2-4 YEARS FROM THE TIME OF DIAGNOSIS. ALTHOUGH IPF HAS UNKNOWN AETIOLOGY BY DEFINITION, THERE HAVE BEEN IDENTIFIED SEVERAL RISKS FACTORS INCREASING THE PROBABILITY OF THE ONSET AND PROGRESSION OF THE DISEASE IN IPF PATIENTS SUCH AS CIGARETTE SMOKING AND ENVIRONMENTAL RISK FACTORS ASSOCIATED WITH DOMESTIC AND OCCUPATIONAL EXPOSURE. AMONG THEM, CIGARETTE SMOKING TOGETHER WITH CONCOMITANT EMPHYSEMA MIGHT PREDISPOSE IPF PATIENTS TO LUNG CANCER (LC), MOSTLY TO NON-SMALL CELL LUNG CANCER (NSCLC), INCREASING THE RISK OF LUNG CANCER DEVELOPMENT. TO THIS PURPOSE, IPF AND LC SHARE SEVERAL CELLULAR AND MOLECULAR PROCESSES DRIVING THE PROGRESSION OF BOTH PATHOLOGIES SUCH AS FIBROBLAST TRANSITION PROLIFERATION AND ACTIVATION, ENDOPLASMIC RETICULUM STRESS, OXIDATIVE STRESS, AND MANY GENETIC AND EPIGENETIC MARKERS THAT PREDISPOSE IPF PATIENTS TO LC DEVELOPMENT. NINTEDANIB, A TYROSINE-KINASE INHIBITOR, WAS FIRSTLY DEVELOPED AS AN ANTICANCER DRUG AND THEN RECOGNIZED AS AN ANTI-FIBROTIC AGENT BASED ON THE COMMON TARGET MOLECULAR PATHWAY. IN THIS REVIEW OUR AIM IS TO DESCRIBE THE UPDATED STUDIES ON COMMON CELLULAR AND MOLECULAR MECHANISMS BETWEEN IPF AND LUNG CANCER, KNOWLEDGE OF WHICH MIGHT HELP TO FIND NOVEL THERAPEUTIC TARGETS FOR THIS DISEASE COMBINATION. 2021 12 680 23 BRAIN INJURY IN CHRONICALLY VENTILATED PRETERM NEONATES: COLLATERAL DAMAGE RELATED TO VENTILATION STRATEGY. BRAIN INJURY IS A FREQUENT COMORBIDITY IN CHRONICALLY VENTILATED PRETERM INFANTS. HOWEVER, THE MOLECULAR BASIS OF THE BRAIN INJURY REMAINS INCOMPLETELY UNDERSTOOD. THIS ARTICLE DISCUSSES THE SUBTLE (DIFFUSE) FORM OF BRAIN INJURY THAT HAS WHITE MATTER AND GRAY MATTER LESIONS WITHOUT GERMINAL MATRIX HEMORRHAGE-INTRAVENTRICULAR HEMORRHAGE, POSTHEMORRHAGIC HYDROCEPHALUS, OR CYSTIC PERIVENTRICULAR LEUKOMALACIA. THIS ARTICLE SYNTHESIZES DATA THAT SUGGEST THAT DIFFUSE LESIONS TO WHITE MATTER AND GRAY MATTER ARE COLLATERAL DAMAGE RELATED TO VENTILATOR STRATEGY. EVIDENCE IS INTRODUCED FROM THE 2 LARGE-ANIMAL, PHYSIOLOGIC MODELS OF EVOLVING NEONATAL CHRONIC LUNG DISEASE THAT SUGGEST THAT AN EPIGENETIC MECHANISM MAY UNDERLIE THE COLLATERAL DAMAGE. 2012 13 5484 22 REVEALING THE PATHOGENIC AND AGING-RELATED MECHANISMS OF THE ENIGMATIC IDIOPATHIC PULMONARY FIBROSIS. AN INTEGRAL MODEL. A GROWING BODY OF EVIDENCE INDICATES THAT ABERRANT ACTIVATION OF ALVEOLAR EPITHELIAL CELLS AND FIBROBLASTS IN AN AGING LUNG PLAYS A CRITICAL ROLE IN THE PATHOGENESIS OF IDIOPATHIC PULMONARY FIBROSIS (IPF). HOWEVER, THE BIOPATHOLOGICAL PROCESSES LINKING AGING WITH IPF AND THE MECHANISMS RESPONSIBLE FOR THE ABNORMAL ACTIVATION OF EPITHELIAL CELLS AND FIBROBLASTS HAVE NOT BEEN ELUCIDATED. MANY OF THE HALLMARKS OF AGING (E.G., GENOMIC INSTABILITY, TELOMERE ATTRITION, EPIGENETIC ALTERATIONS, MITOCHONDRIAL DYSFUNCTION, AND CELLULAR SENESCENCE) HAVE BEEN PROPOSED AS ESSENTIAL MECHANISMS FOR THE DEVELOPMENT OF IPF; HOWEVER, THESE DISTURBANCES ARE NOT RESTRICTED TO IPF AND ALSO OCCUR IN OTHER AGING-RELATED LUNG DISORDERS, PRIMARILY CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD). THEREFORE, AN UNANSWERED QUESTION IS WHY A CURRENT/FORMER SMOKER OF ABOUT 60 YEARS OF AGE WITH SHORTER TELOMERES, ALVEOLAR EPITHELIAL SENESCENCE, EXCESSIVE OXIDATIVE STRESS, AND MITOCHONDRIAL DYSFUNCTION DEVELOPS IPF AND NOT COPD; IN OTHER WORDS, WHAT MAKES OLD LUNGS SPECIFICALLY SUSCEPTIBLE TO DEVELOP IPF? IN THIS PERSPECTIVE, WE PROPOSE AN INTEGRAL MODEL IN WHICH THE COMBINATION OF SOME GENE VARIANTS AND/OR GENE EXPRESSION IN THE AGING LUNG RESULTS IN THE LOSS OF EPITHELIAL INTEGRITY AND CONSEQUENTLY IN THE FAILURE OF THE ALVEOLI TO CORRECTLY RESPOND TO INJURY AND TO FACE THE STRESS ASSOCIATED WITH MECHANICAL STRETCH. AFTERWARD, A DISTINCTIVE EPIGENETIC "REPROGRAMMING" THAT AFFECTS BOTH EPITHELIAL CELLS AND FIBROBLASTS PROVOKES, AMONG OTHERS, THE RECAPITULATION OF DEVELOPMENTAL PATHWAYS AND THE ABERRANT ACTIVATION AND MISCOMMUNICATION BETWEEN BOTH CELL TYPES, RESULTING IN THE EXAGGERATED PRODUCTION AND ACCUMULATION OF EXTRACELLULAR MATRIX AND THE SUBSEQUENT DESTRUCTION OF THE LUNG ARCHITECTURE. 2014 14 3514 25 IDIOPATHIC PULMONARY FIBROSIS: PATHOGENESIS AND THERAPEUTIC APPROACHES. IDIOPATHIC PULMONARY FIBROSIS (IPF), ALSO TERMED CRYPTOGENIC FIBROSING ALVEOLITIS, IS A CLINICOPATHOLOGICAL SYNDROME CHARACTERISED BY COUGH, EXERTIONAL DYSPNEOA, BASILAR CRACKLES, A RESTRICTIVE DEFECT ON PULMONARY FUNCTION TESTS, HONEYCOMBING ON HIGH-RESOLUTION, THIN-SECTION COMPUTED TOMOGRAPHIC SCANS AND THE HISTOLOGICAL DIAGNOSIS OF USUAL INTERSTITIAL PNEUMONIA ON LUNG BIOPSY. THE COURSE IS USUALLY INDOLENT BUT INEXORABLE. MOST PATIENTS DIE OF PROGRESSIVE RESPIRATORY FAILURE WITHIN 3-8 YEARS OF THE ONSET OF SYMPTOMS. CURRENT THERAPIES ARE OF UNPROVEN BENEFIT. ALTHOUGH THE PATHOGENESIS OF IPF HAS NOT BEEN ELUCIDATED, EARLY CONCEPTS FOCUSED ON LUNG INJURY LEADING TO A CYCLE OF CHRONIC ALVEOLAR INFLAMMATION EVENTUATING IN FIBROSIS AND DESTRUCTION OF THE LUNG ARCHITECTURE. ANTI-INFLAMMATORY THERAPIES EMPLOYING CORTICOSTEROIDS OR IMMUNOSUPPRESSIVE OR CYTOTOXIC AGENTS HAVE BEEN DISAPPOINTING. MORE RECENT HYPOTHESES ACKNOWLEDGE THAT SEQUENTIAL ALVEOLAR EPITHELIAL CELL INJURY IS LIKELY TO BE A KEY EVENT IN THE PATHOGENESIS OF IPF, BUT THE CARDINAL EVENT IS AN ABERRANT HOST RESPONSE TO WOUND HEALING. IN THIS CONTEXT, ABNORMAL EPITHELIAL-MESENCHYMAL INTERACTIONS, ALTERED FIBROBLAST PHENOTYPES, EXAGGERATED FIBROBLAST PROLIFERATION, AND EXCESSIVE DEPOSITION OF COLLAGEN AND EXTRACELLULAR MATRIX ARE PIVOTAL TO THE FIBROTIC PROCESS. SEVERAL CLINICAL TRIALS ARE CURRENTLY UNDERWAY OR IN THE PLANNING STAGES, AND INCLUDE DRUGS SUCH AS INTERFERON-GAMMA 1B, PIRFENIDONE, ACETYLCYSTEINE, ETANERCEPT (A TUMOR NECROSIS FACTOR-ALPHA ANTAGONIST), BOSENTAN (AN ENDOTHELIN-1 RECEPTOR ANTAGONIST) AND ZILEUTON (A 5-LYPOXYGENASE INHIBITOR). FUTURE THERAPEUTIC STRATEGIES SHOULD BE FOCUSED ON ALVEOLAR EPITHELIAL CELLS AIMED AT ENHANCING RE-EPITHELIALISATION AND ON FIBROBLASTIC/MYOFIBROBLASTIC FOCI, WHICH PLAY AN ESSENTIAL ROLE IN THE DEVELOPMENT OF IPF. STEM CELL PROGENITORS OF THE ALVEOLAR EPITHELIAL CELLS AND GENETIC AND EPIGENETIC THERAPIES ARE ATTRACTIVE FUTURE APPROACHES FOR THIS AND OTHER FIBROTIC LUNG DISORDERS. 2004 15 2278 26 EPIGENETIC REGULATION BY SUV4-20H1 IN CARDIOPULMONARY PROGENITOR CELLS IS REQUIRED TO PREVENT PULMONARY HYPERTENSION AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE. BACKGROUND: THE PATHOGENESIS OF LIFE-THREATENING CARDIOPULMONARY DISEASES SUCH AS PULMONARY HYPERTENSION (PH) AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) ORIGINATES FROM A COMPLEX INTERPLAY OF ENVIRONMENTAL FACTORS AND GENETIC PREDISPOSITIONS THAT IS NOT FULLY UNDERSTOOD. LIKEWISE, LITTLE IS KNOWN ABOUT DEVELOPMENTAL ABNORMALITIES OR EPIGENETIC DYSREGULATIONS THAT MIGHT PREDISPOSE FOR PH OR COPD IN ADULT INDIVIDUALS. METHODS: TO IDENTIFY PATHOLOGY-ASSOCIATED EPIGENETIC ALTERATION IN DISEASED LUNG TISSUES, WE SCREENED A COHORT OF HUMAN PATIENTS WITH PH AND COPD FOR CHANGES OF HISTONE MODIFICATIONS BY IMMUNOFLUORESCENCE STAINING. TO ANALYZE THE FUNCTION OF H4K20ME2/3 IN LUNG PATHOGENESIS, WE DEVELOPED A SERIES OF SUV4-20H1 KNOCKOUT MOUSE LINES TARGETING CARDIOPULMONARY PROGENITOR CELLS AND DIFFERENT HEART AND LUNG CELL TYPES, FOLLOWED BY HEMODYNAMIC STUDIES AND MORPHOMETRIC ASSESSMENT OF TISSUE SAMPLES. MOLECULAR, CELLULAR, AND BIOCHEMICAL TECHNIQUES WERE APPLIED TO ANALYZE THE FUNCTION OF SUV4-20H1-DEPENDENT EPIGENETIC PROCESSES IN CARDIOPULMONARY PROGENITOR CELLS AND THEIR DERIVATIVES. RESULTS: WE DISCOVERED A STRONG REDUCTION OF THE HISTONE MODIFICATIONS OF H4K20ME2/3 IN HUMAN PATIENTS WITH COPD BUT NOT PATIENTS WITH PH THAT DEPEND ON THE ACTIVITY OF THE H4K20 DI-METHYLTRANSFERASE SUV4-20H1. LOSS OF SUV4-20H1 IN CARDIOPULMONARY PROGENITOR CELLS CAUSED A COPD-LIKE/PH PHENOTYPE IN MICE INCLUDING THE FORMATION OF PERIVASCULAR TERTIARY LYMPHOID TISSUE AND GOBLET CELL HYPERPLASIA, HYPERPROLIFERATION OF SMOOTH MUSCLE CELLS/MYOFIBROBLASTS, IMPAIRED ALVEOLARIZATION AND MATURATION DEFECTS OF THE MICROVASCULATURE LEADING TO MASSIVE RIGHT VENTRICULAR DILATATION AND PREMATURE DEATH. MECHANISTICALLY, SUV4-20H1 BINDS DIRECTLY TO THE 5'-UPSTREAM REGULATORY ELEMENT OF THE SUPEROXIDE DISMUTASE 3 (SOD3) GENE TO REPRESS ITS EXPRESSION. INCREASED LEVELS OF THE EXTRACELLULAR SOD3 ENZYME IN SUV4-20H1 MUTANTS INCREASES HYDROGEN PEROXIDE CONCENTRATIONS, CAUSING VASCULAR DEFECTS AND IMPAIRING ALVEOLARIZATION. CONCLUSIONS: OUR FINDINGS REVEAL A PIVOTAL ROLE OF THE HISTONE MODIFIER SUV4-20H1 IN CARDIOPULMONARY CODEVELOPMENT AND UNCOVER THE DEVELOPMENTAL ORIGINS OF CARDIOPULMONARY DISEASES. WE ASSUME THAT THE STUDY WILL FACILITATE THE UNDERSTANDING OF PATHOGENIC EVENTS CAUSING PH AND COPD AND AID THE DEVELOPMENT OF EPIGENETIC DRUGS FOR THE TREATMENT OF CARDIOPULMONARY DISEASES. 2021 16 1113 27 COMMON PATHWAYS IN IDIOPATHIC PULMONARY FIBROSIS AND CANCER. IDIOPATHIC PULMONARY FIBROSIS (IPF) IS MARKED BY A VERY DISAPPOINTING SURVIVAL RATE AND STILL REPRESENTS A CLINICAL DILEMMA. ACCORDING TO THE CURRENT PATHOGENIC HYPOTHESIS, CHRONIC DAMAGE OF THE ALVEOLAR EPITHELIUM IS FOLLOWED BY ABNORMAL TISSUE REPAIR AND IMPAIRMENT OF THE ALVEOLAR STRUCTURE. THIS PROCESS IS DRIVEN BY PATHOGENIC EVENTS VERY SIMILAR TO CANCER, INCLUDING EPIGENETIC AND GENETIC CHANGES, ALTERED RESPONSE TO REGULATORY SIGNALS, ABNORMAL EXPRESSION OF MICRORNAS AND ACTIVATION OF SPECIFIC SIGNALLING PATHWAYS. IPF ALSO RESEMBLES CANCER WITH REGARD TO ITS POOR RESPONSE TO MEDICAL TREATMENT AND PROGNOSIS, WHICH IS VERY OFTEN WORSE THAN MANY CANCERS. WE HAVE HYPOTHESISED THAT IPF MIGHT BE ASSIMILATED TO A NEOPROLIFERATIVE DISORDER OF THE LUNG. VIEWING IPF AS A CANCER-LIKE DISEASE MAY SATISFY THE NEED FOR A BETTER UNDERSTANDING OF THE PATHOGENESIS OF IPF BY EXPLOITING THE LARGE AMOUNT OF KNOWLEDGE THAT CANCER BIOLOGY EVOKES. THE RECOGNITION OF COMMON PATHOGENIC PATHWAYS BETWEEN THE TWO DISEASES MAY STIMULATE NEW CLINICAL TRIALS WITH CANCER DRUGS, DIFFERENT DRUG COMBINATIONS AND DIFFERENT LINES OF DRUGS, AS ALREADY EXPERIMENTED IN ONCOLOGY. MOREOVER, THE CONCEPT OF IPF AS A CANCER-LIKE DISORDER MAY IMPROVE THE ATTENTION GIVEN TO THIS DREADFUL DISEASE ON A PUBLIC, POLITICAL AND HEALTHCARE LEVEL. 2013 17 3814 28 INTRAUTERINE HYPOXIA AND EPIGENETIC PROGRAMMING IN LUNG DEVELOPMENT AND DISEASE. CLINICALLY, INTRAUTERINE HYPOXIA IS THE FOREMOST CAUSE OF PERINATAL MORBIDITY AND DEVELOPMENTAL PLASTICITY IN THE FETUS AND NEWBORN INFANT. UNDER HYPOXIA, DEVIATIONS OCCUR IN THE LUNG CELL EPIGENOME. EPIGENETIC MECHANISMS (E.G., DNA METHYLATION, HISTONE MODIFICATION, AND MIRNA EXPRESSION) CONTROL PHENOTYPIC PROGRAMMING AND ARE ASSOCIATED WITH PHYSIOLOGICAL RESPONSES AND THE RISK OF DEVELOPMENTAL DISORDERS, SUCH AS BRONCHOPULMONARY DYSPLASIA. THIS DEVELOPMENTAL DISORDER IS THE MOST FREQUENT CHRONIC PULMONARY COMPLICATION IN PRETERM LABOR. THE PATHOGENESIS OF THIS DISEASE INVOLVES MANY FACTORS, INCLUDING ABERRANT OXYGEN CONDITIONS AND MECHANICAL VENTILATION-MEDIATED LUNG INJURY, INFECTION/INFLAMMATION, AND EPIGENETIC/GENETIC RISK FACTORS. THIS REVIEW IS FOCUSED ON VARIOUS ASPECTS RELATED TO INTRAUTERINE HYPOXIA AND EPIGENETIC PROGRAMMING IN LUNG DEVELOPMENT AND DISEASE, SUMMARIZES OUR CURRENT KNOWLEDGE OF HYPOXIA-INDUCED EPIGENETIC PROGRAMMING AND DISCUSSES POTENTIAL THERAPEUTIC INTERVENTIONS FOR LUNG DISEASE. 2021 18 4954 22 PATHOGENESIS OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE. THE PATHOGENESIS OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) ENCOMPASSES A NUMBER OF INJURIOUS PROCESSES, INCLUDING AN ABNORMAL INFLAMMATORY RESPONSE IN THE LUNGS TO INHALED PARTICLES AND GASES. OTHER PROCESSES, SUCH AS FAILURE TO RESOLVE INFLAMMATION, ABNORMAL CELL REPAIR, APOPTOSIS, ABNORMAL CELLULAR MAINTENANCE PROGRAMS, EXTRACELLULAR MATRIX DESTRUCTION (PROTEASE/ANTIPROTEASE IMBALANCE), AND OXIDATIVE STRESS (OXIDANT/ANTIOXIDANT IMBALANCE) ALSO HAVE A ROLE. THE INFLAMMATORY RESPONSES TO THE INHALATION OF ACTIVE AND PASSIVE TOBACCO SMOKE AND URBAN AND RURAL AIR POLLUTION ARE MODIFIED BY GENETIC AND EPIGENETIC FACTORS. THE SUBSEQUENT CHRONIC INFLAMMATORY RESPONSES LEAD TO MUCUS HYPERSECRETION, AIRWAY REMODELING, AND ALVEOLAR DESTRUCTION. THIS ARTICLE PROVIDES AN UPDATE ON THE CELLULAR AND MOLECULAR MECHANISMS OF THESE PROCESSES IN THE PATHOGENESIS OF COPD. 2007 19 1143 27 CONCISE REVIEW: CLINICAL PROSPECTS FOR TREATING CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH REGENERATIVE APPROACHES. CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) IS BECOMING A MAJOR CAUSE OF DEATH WORLDWIDE. COPD IS CHARACTERIZED BY A PROGRESSIVE AND NOT FULLY REVERSIBLE AIRFLOW LIMITATION CAUSED BY CHRONIC SMALL AIRWAY DISEASE AND LUNG PARENCHYMAL DESTRUCTION. CLINICALLY AVAILABLE DRUGS IMPROVE AIRFLOW OBSTRUCTION AND RESPIRATORY SYMPTOMS BUT CANNOT CURE THE DISEASE. SLOWING THE PROGRESSIVE LUNG DESTRUCTION OR REBUILDING THE DESTROYED LUNG STRUCTURE IS A PROMISING STRATEGY TO CURE COPD. IN CONTRAST TO SMALL ANIMAL MODELS, PHARMACOLOGICAL LUNG REGENERATION IS DIFFICULT IN HUMAN COPD. MATURATION, AGING, AND SENESCENCE IN COPD LUNG CELLS, INCLUDING ENDOGENOUS STEM CELLS, MAY AFFECT THE REGENERATIVE CAPACITY FOLLOWING PHARMACOLOGICAL THERAPY. THE LUNG IS A COMPLEX ORGAN COMPOSED OF MORE THAN 40 DIFFERENT CELL TYPES; THEREFORE, DETAILED ANALYSES, SUCH AS EPIGENETIC MODIFICATION ANALYSIS, IN EACH SPECIFIC CELL TYPE HAVE NOT BEEN PERFORMED IN LUNGS WITH COPD. RECENTLY, A METHOD FOR THE DIRECT ISOLATION OF INDIVIDUAL CELL TYPES FROM HUMAN LUNG HAS BEEN DEVELOPED, AND FINGERPRINTS OF EACH CELL TYPE IN COPD LUNGS CAN BE ANALYZED. RESEARCH USING THIS TECHNIQUE COMBINED WITH THE RECENTLY DISCOVERED LUNG ENDOGENOUS STEM-PROGENITOR POPULATIONS WILL GIVE A BETTER UNDERSTANDING ABOUT THE FATE OF COPD LUNG CELLS AND PROVIDE A FUTURE FOR CELL-BASED THERAPY TO TREAT THIS INTRACTABLE DISEASE. 2012 20 6330 30 THE ROLE OF CIGARETTE SMOKE-INDUCED PULMONARY VASCULAR ENDOTHELIAL CELL APOPTOSIS IN COPD. CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) IS ONE OF THE MOST COMMON CHRONIC RESPIRATORY DISEASES WITH HIGH MORBIDITY AND MORTALITY. IT HAS BECOME THE FIFTH MOST BURDENED AND THE THIRD MOST DEADLY DISEASE IN THE GLOBAL ECONOMY AND INCREASES YEAR BY YEAR. THE PREVENTION AND TREATMENT OF COPD ARE URGENT. SMOKING IS THE MAIN AND MOST COMMON RISK FACTOR FOR COPD. CIGARETTE SMOKE (CS) CONTAINS A LARGE NUMBER OF TOXIC SUBSTANCES, CAN CAUSE A SERIES OF CHANGES IN THE TRACHEA, LUNG TISSUE, PULMONARY BLOOD VESSELS, AND PROMOTES THE OCCURRENCE AND DEVELOPMENT OF COPD. IN RECENT YEARS, THE DEVELOPMENT OF EPIGENETICS AND MOLECULAR BIOLOGY HAVE PROVIDED NEW GUIDANCE FOR REVEALING THE PATHOGENESIS, DIAGNOSIS, AND TREATMENT OF DISEASES. THE LATEST RESEARCH INDICATES THAT PULMONARY VASCULAR ENDOTHELIAL CELL APOPTOSIS INITIATES AND PARTICIPATES IN THE PATHOGENESIS OF COPD. IN THIS REVIEW, WE SUMMARIZE THE CURRENT RESEARCH ON THE EPIGENETIC MECHANISMS AND MOLECULAR BIOLOGY OF CS-INDUCED PULMONARY VASCULAR ENDOTHELIAL CELL APOPTOSIS IN COPD, PROVIDING A NEW RESEARCH DIRECTION FOR PATHOGENESIS OF COPD AND A NEW TARGET FOR THE DIAGNOSIS, TREATMENT, AND PREVENTION OF COPD. 2021