COPD Metabolome, Smoking Oxidants and Aberrant Ciliated Cell Function

Cigarette smoking is the major cause of chronic obstructive pulmonary disease (COPD), the 4th
cause of mortality in the US. Central to COPD pathogenesis is "ciliopathy", dysfunction of
the airway ciliated cells that mediate transport of mucus to remove inhaled pathogens. The
COPD ciliopathy leads to mucus accumulation, impaired host defense and recurrent infections.
Using a state-of-the-art platform for global metabolite profiling and unique cohorts with
serum and lung biologic samples, our deliverables are to identify a metabolome focused on
biomarkers related to airway ciliopathy in COPD, and use the observed metabolic changes to:
(1) direct mechanistic studies to define ciliopathy at a molecular level; (2) identify novel
targets for therapeutic intervention in COPD; and (3) identify smokers at high risk for COPD.
Preliminary metabolic data led to our first clues - COPD smokers have decreased serum
citrulline levels, consistent with a deficiency in lung nitric oxide synthase (NOS) activity,
and thus lung nitric oxide (NO) deficiency. This, together with supporting data of a
smoking-induced NOS/NO-related ciliopathy, and knowledge that smokers have significant
oxidant-related changes in the airway epithelial transcriptome, led to our aims, combining
metabolomics of defined cohorts, murine and human mechanistic studies and computational /
statistical integration.

Aim 1. To carry out metabolic profiling of banked biologic samples of our characterized
cohorts to assess the hypothesis that COPD is associated with a unique metabolome in serum
and lung epithelial lining fluid, and that subsets of the COPD metabolome are linked to the
ciliopathy of COPD.

Aim 2. To combine metabolic profiling and in vitro studies of human and murine airway
epithelium to evaluate the hypothesis that there is a link between the COPD metabolome
(focusing on the inferred NO deficiency) and mechanisms underlying the ciliopathy of COPD.

Aim 3. Characterize and quantify the cigarette smoke induced "redoxome" in lung and serum and
assess its role in ciliated cell dysfunction. Studies seek to identify a link between
smoking, a burden of oxidants to the lung epithelium and the pathogenesis of COPD -
potentially providing biomarker(s) that predict which smokers will develop COPD and
identifying new targets for therapy of COPD.

Inclusion Criteria:

All study subjects should be able to provide informed consent Males or females ages 18
years and older Must provide HIV informed consent Lung disease proven by at least one of
the following: symptoms consistent with pulmonary disease; (2) chest X-rays consistent with
lung disease; (3) pulmonary function tests consistent with lung disease; (4) lung biopsy
consistent with lung disease; (5) family history of lung disease; and/or (6) diseases of
organs with known association with lung disease

Exclusion Criteria:

Individuals not deemed in good overall health by the investigator will not be accepted into
the study.

Habitual use of drugs and/or alcohol within the past six months (Acceptable: Marijuana one
time in three months; average of two alcoholic beverages per day; drug and/or alcohol abuse
is defined as per the DSM-IV Substance Abuse Criteria).

Individuals with history of chronic lung disease, including asthma or with recurrent or
recent (within three months) acute pulmonary disease will not be accepted into the study.

Individuals with allergies to atropine or any local anesthetic will not be accepted into
the study.

Individuals with allergies to pilocarpine, isoproterenol, terbutaline, atropine or
aminophylline will not be accepted into the study.

Females who are pregnant or nursing will not be accepted into the study Any history of
allergies to xylocaine, lidocaine, versed, valium, atropine, pilocarpine, isoproterenol,
terbutaline, aminophylline, or any local anesthetic will not be included in the study
Patient refuses consent