2009 DOM Annual Report - Department of Medicine - University of ...

Department of Medicinean annual update in Pulmonary Medicine and the Robert M. RogersLectureship.QUALITYThe Division of Pulmonary, Allergy and Critical Care Medicine supportsa continuous quality improvement process in both the inpatient andoutpatient care enviroments. The Medical ICU process, termed theRules of Evidence program, establishes a comprehensive ventilatorcare bundle based upon Level I critical care clinical trials. The Divisionconsistently exceeds the care standard for rapid patient access (within72 hours) for all the specialty clinics within the Comprehensive LungCenter. Effective use of information technology in both the inpatientand outpatient environment provides important clinical alerts andguidelines to further support quality patient care.system. This study has shown that statins activate dendritic cellsto promote production of a protein called Ym1 that belongs to thechitinase family of proteins, recently shown to be associated withasthma. Lung dendritic cells isolated from statin-treated mice alsodisplayed increased Ym1 expression. The Ym1-expressing dendriticcells induced CD4+ T cells to differentiate along the Th2 lineage thatorchestrates asthma in both humans and experimental models. Thisstudy raises a cautionary note in the use of statins in patients withallergic diseases such as asthma (Arora, et al, Proc. Natl. Acad. Sci. USA,2006; 103:7777-7782)..In cystic fibrosis, mucus clearance from the lung is impaired due todehydration of the airway surface liquid (ASL). Absorption of the ASLis driven by an osmotic gradient established by the sodium absorptionthough epithelial sodium channels. The results of this workHIGH IMPACT PUBLICATIONSEach of the eight individual programs is composed of investigatorsin the areas of basic laboratory, translational, and clinical research.The following publications from the past year highlight importantadvances in our understanding of human lung disease from three ofthese programs.Statins are best known as cholesterol-lowering drugs. However,increasingly, additional effects of statins on biological processes,including effects on the immune system are being recognized. Theauthors have identified a novel effect of statins on the immunedemonstrate that a balance between channel activating proteases andanti-proteases regulates sodium absorption in the airway, and thatthis balance is disrupted in cystic fibrosis leading to excessive sodiumand ASL absorption. Therefore, impaired mucus clearance in thecystic fibrosis airway appears to be in part due to excessive proteaseactivity and suggests that inhalation of protease inhibitors may have abeneficial effect on mucus clearance (Myerburg et al, J Biol Chem, 2006;281:27942-9).48 Better medicine through research and education.