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Montelukast for Bronchiolitis Obliterans Syndrome After Lung TransplantationMontelukast for Bronchiolitis Obliterans Syndrome FREE TO VIEW

Sami O. Simons, MD; Monique H. Reijers, MD, PhD
Author and Funding Information

From the Department of Pulmonary Medicine, Radboud University Nijmegen Medical Centre.

Correspondence to: Sami O. Simons, MD, Radboud University Nijmegen Medical Centre, Department of Pulmonary Medicine-454, PO Box 9101, 6500 HB Nijmegen, The Netherlands; e-mail: s.simons@long.umcn.nl


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2012 American College of Chest Physicians


Chest. 2012;141(1):274-275. doi:10.1378/chest.11-1979
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To the Editor:

We read with interest the review by Todd and Palmer1 published in a recent issue of CHEST (August 2011). It gives an excellent overview of the pathogenesis of bronchiolitis obliterans syndrome after lung transplantation, placing emphasis on future clinical translational treatment directions.

Although their review is thorough, we have missed one important translational development, namely, the leukotriene B4 pathway in the pathophysiology of bronchiolitis obliterans syndrome after lung transplantation. Leukotriene B4 is a lipid mediator that has been shown to have potent chemotactic activity for effector T lymphocytes mediated through its receptor, BLT1.2 In a murine model, Medoff and colleagues2 have demonstrated that BLT1 controls effector CD8+ T-cell trafficking into the lung and that BLT1-mediated CD8+ T-cell recruitment plays an important role in the development of airway fibroproliferation and obliteration. Indeed, in human lung transplant recipients, BLT1 is upregulated on T lymphocytes isolated from the airways of patients with bronchiolitis obliterans.2 Montelukast, a drug used for the treatment of asthma, inhibits leukotriene activity.3 In a pilot study of 11 patients with bronchiolitis obliterans syndrome after lung transplantation, the addition of montelukast to immunosuppressive drugs decreased FEV1 decline after 6 months of treatment compared with a retrospective cohort of 11 patients.4 Intervening in the leukotriene B4 pathway through the addition of montelukast may thus be another promising research direction with clinically relevant treatment implications for bronchiolitis obliterans syndrome after lung transplantation.

Todd JL, Palmer SM. Bronchiolitis obliterans syndrome: the final frontier for lung transplantation. Chest. 2011;1402:502-508 [PubMed] [CrossRef]
 
Medoff BD, Seung E, Wain JC, et al. BLT1-mediated T cell trafficking is critical for rejection and obliterative bronchiolitis after lung transplantation. J Exp Med. 2005;2021:97-110 [PubMed]
 
Drazen JM, Israel E, O’Byrne PM. Treatment of asthma with drugs modifying the leukotriene pathway. N Engl J Med. 1999;3403:197-206 [PubMed]
 
Verleden GM, Verleden SE, Vos R, et al. Montelukast for bronchiolitis obliterans syndrome after lung transplantation: a pilot study. Transpl Int. 2011;247:651-656 [PubMed]
 

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References

Todd JL, Palmer SM. Bronchiolitis obliterans syndrome: the final frontier for lung transplantation. Chest. 2011;1402:502-508 [PubMed] [CrossRef]
 
Medoff BD, Seung E, Wain JC, et al. BLT1-mediated T cell trafficking is critical for rejection and obliterative bronchiolitis after lung transplantation. J Exp Med. 2005;2021:97-110 [PubMed]
 
Drazen JM, Israel E, O’Byrne PM. Treatment of asthma with drugs modifying the leukotriene pathway. N Engl J Med. 1999;3403:197-206 [PubMed]
 
Verleden GM, Verleden SE, Vos R, et al. Montelukast for bronchiolitis obliterans syndrome after lung transplantation: a pilot study. Transpl Int. 2011;247:651-656 [PubMed]
 
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