TY - JOUR T1 - Reduced neutrophil elastase inhibitor elafin and elevated transforming growth factor-β<sub>1</sub> are linked to inflammatory response in sputum of cystic fibrosis patients with <em>Pseudomonas aeruginosa</em> JF - ERJ Open Research JO - erjor DO - 10.1183/23120541.00636-2020 VL - 7 IS - 3 SP - 00636-2020 AU - Jan C. Thomassen AU - Tobias Trojan AU - Maxine Walz AU - Christina Vohlen AU - Gregor Fink AU - Ernst Rietschel AU - Miguel A. Alejandre Alcazar AU - Silke van Koningsbruggen-Rietschel Y1 - 2021/07/01 UR - http://openres.ersjournals.com/content/7/3/00636-2020.abstract N2 - Research question Pulmonary disease progression in patients with cystic fibrosis (CF) is characterised by inflammation and fibrosis and aggravated by Pseudomonas aeruginosa (Pa). We investigated the impact of Pa specifically on: 1) protease/antiprotease balance; 2) inflammation; and 3) the link of both parameters to clinical parameters of CF patients.Methods Transforming growth factor-β1 (TGF-β1), interleukin (IL)-1β, IL-8, neutrophil elastase (NE) and elastase inhibitor elafin were measured (ELISA assays), and gene expression of the NF-κB pathway was assessed (reverse transcriptase PCR) in the sputum of 60 CF patients with a minimum age of 5 years. Spirometry was assessed according to American Thoracic Society guidelines.Results Our results demonstrated the following: 1) NE was markedly increased in Pa-positive sputum, whereas elafin was significantly decreased; 2) increased IL-1β/IL-8 levels were associated with both Pa infection and reduced forced expiratory volume in 1 s, and sputum TGF-β1 was elevated in Pa-infected CF patients and linked to an impaired lung function; and 3) gene expression of NF-κB signalling components was increased in sputum of Pa-infected patients, and these findings were positively correlated with IL-8.Conclusion Our study links Pa infection to an imbalance of NE and NE inhibitor elafin and increased inflammatory mediators. Moreover, our data demonstrate an association between high TGF-β1 sputum levels and a progress in chronic lung inflammation and pulmonary fibrosis in CF. Controlling the excessive airway inflammation by inhibition of NE and TGF-β1 might be promising therapeutic strategies in future CF therapy and a possible complement to cystic fibrosis transmembrane conductance regulator (CFTR) modulators.P. aeruginosa infection is linked to an imbalance of NE and NE inhibitor elafin, and increased TGF-β1 sputum levels. Inhibition of NE and TGF-β1 are promising therapeutic strategies in future CF therapy. https://bit.ly/3emeI0u ER -