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Essential need for rethink of COPD airway pathology: implications for new drug approaches for prevention of lung cancer as well as small airway fibrosis

Authors Sohal SS, Walters EH

Received 14 August 2017

Accepted for publication 15 August 2017

Published 7 September 2017 Volume 2017:12 Pages 2677—2679

DOI https://doi.org/10.2147/COPD.S149092

Checked for plagiarism Yes

Editor who approved publication: Dr Richard Russell

Sukhwinder Singh Sohal, Eugene Haydn Walters

School of Health Sciences, University of Tasmania, Launceston, TAS, Australia 
 
We read with interest the recent comprehensive review by Sowmya P Lakshmi et al on potential new therapies for COPD in the International Journal of Chronic Obstructive Pulmonary Disease.1 The review says that only by understanding the core pathological processes, new therapeutics emerge, and it encourages that leading respiratory journals are recognizing this. However, we would suggest that, in this review, the overall view of the pathology of COPD airway disease does not reflect the current literature. In particular, the airway wall in at least mild to moderate COPD is hypo-cellular and hypo-vascular, with markedly active epithelial–mesenchymal transition (EMT)2 as part of epithelial activation and reprogramming.3 This process is closely related to small airway fibrosis and airflow obstruction. Inhaled corticosteroids (ICSs) affect these key epithelial cellular activation and vascular aspects of COPD,2 and more research on alternatives to corticosteroid on these aspects is urgently needed. It is of interest that the peroxisome proliferator-activated receptor system that the reviewers mention has implication for EMT induction,1 as has the TGF/Activin family and the Wnt system; these pathways are replete with potential drug targets. 
 
View the original paper by Lakshimi and colleagues.
 

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