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Jamie L. Todd, MD; Scott M. Palmer, MD, MHS, FCCP
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From the Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Duke University Medical Center.

Correspondence to: Jamie L. Todd, MD, Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Duke University Medical Center, DUMC Box 2629, Durham, NC 27710; e-mail: Todd0021@mc.duke.edu


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):276. doi:10.1378/chest.11-2258
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To the Editor:

We thank Drs Simons and Reijers for their thoughtful correspondence regarding our recent review of bronchiolitis obliterans syndrome after lung transplantation.1 As they point out, emerging basic and clinical evidence suggests that manipulation of leukotriene B4 and its receptor BLT1 could be beneficial in bronchiolitis obliterans syndrome. We acknowledge that in order to maintain a concise submission, our review favored more mature lines of translational research and novel clinical therapeutics employed in larger cohorts of patients. As such, many preliminary yet promising areas of mechanistic and translational research were not discussed.

We, too, are intrigued by the basic observation that BLT1 receptor inhibition or deficiency results in attenuated effector T cell recruitment, airways epithelial damage, and obliterative airways disease in a variety of murine models.2 This work certainly provides a strong rationale for clinical trials of leukotriene receptor antagonists in patients with bronchiolitis obliterans syndrome who have received lung transplants. In our opinion, however, the clinical work to date in this area is still too preliminary to draw any definite conclusions. The clinical study noted by Simons and Reijers only included 11 patients, used historic controls, and had a relatively short follow-up time.3 We look forward to further prospective studies to confirm these promising initial results. Such well done prospective studies are critical to translate these and other exciting basic observations into meaningful clinical interventions and improved outcomes for lung transplant recipients.

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]
 
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]
 
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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