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Interstitial lung disease
Original research
Peripheral blood leucocyte telomere length is associated with progression of interstitial lung disease in systemic sclerosis
  1. Shuo Liu1,2,
  2. Melody P Chung3,
  3. Brett Ley1,
  4. Sarah French4,
  5. Brett M Elicker5,
  6. David F Fiorentino6,
  7. Lorinda S Chung7,
  8. Francesco Boin8,
  9. Paul J Wolters1
  1. 1 Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California San Francisco, San Francisco, California, USA
  2. 2 Pulmonary and Critical Care Medicine, Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
  3. 3 Division of Immunology and Rheumatology, Stanford University School of Medicine, Stanford, California, USA
  4. 4 Division of Rheumatology, Department of Medicine, University of California San Francisco, San Francisco, California, USA
  5. 5 Division of Radiology, University of California San Francisco, San Francisco, California, USA
  6. 6 Department of Dermatology, Stanford University School of Medicine, Stanford, California, USA
  7. 7 Division of Immunology and Rheumatology, Department of Dermatology, Stanford University School of Medicine, Stanford, California, USA
  8. 8 Division of Rheumatology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
  1. Correspondence to Dr Paul J Wolters, Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California San Francisco, San Francisco, California, USA; Paul.Wolters{at}ucsf.edu

Abstract

Background Peripheral blood leucocyte telomere length (PBL-TL) is associated with outcomes in patients with idiopathic pulmonary fibrosis. Whether PBL-TL is associated with progression of systemic sclerosis-associated interstitial lung disease (SSc-ILD) is unknown.

Methods A retrospective observational cohort study was performed using prospectively collected data from 213 patients with SSc followed at the University of California San Francisco (UCSF) Scleroderma Center. PBL-TL was measured by quantitative PCR of DNA isolated from peripheral blood. Associations between PBL-TL and pulmonary function test trends in patients with SSc-ILD were assessed by longitudinal analysis using Generalised Linear Mixed Models. Findings were validated in a cohort of 61 patients with SSc-ILD enrolled in the Stanford University Scleroderma Center database.

Results Patients with UCSF SSc with ILD were found to have shorter PBL-TL compared with those without ILD (6554±671 base pairs (bp) vs 6782±698 bp, p=0.01). Shorter PBL-TL was associated with the presence of ILD (adjusted OR 2.1 per 1000 bp TL decrease, 95% CI [1.25 to 3.70], p=0.006). PBL-TL was shorter in patients with SSc-ILD lacking SSc-specific autoantibodies compared with seropositive subjects (6237±647 bp vs 6651±653 bp, p=0.004). Shorter PBL-TL was associated with increased risk for lung function deterioration with an average of 67 mL greater loss in per year for every 1000 bp decrease in PBL-TL in the combined SSc-ILD cohorts (longitudinal analysis, adjusted model: 95% CI −104 mL to −33 mL, p<0.001).

Conclusions These findings suggest that telomere dysfunction may be associated with SSc-ILD progression and that PBL-TL measurement may be useful for stratifying risk for SSc-ILD progression.

  • systemic disease and lungs
  • interstitial fibrosis
  • rare lung diseases
  • connective tissue disease associated lung disease

Data availability statement

Data are available upon reasonable request.

https://doi.org/10.1136/thoraxjnl-2020-215918

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • Contributors BIPI was given the opportunity to review the manuscript for medical and scientific accuracy as it relates to BIPI substances, as well as intellectual property considerations.

    • Funding Study was funded in part by National Natural Science Foundation of China (81700063), Scleroderma Research Foundation, the Nina Ireland Program for Lung Health, and an investigator initiated proposal from Boehringer Ingelheim Pharmaceuticals, Inc. (BIPI; BIPI had no role in the design, analysis or interpretation of the results in this study; BIPI was given the opportunity to review the manuscript for medical and scientific accuracy as it relates to BIPI substances, as well as intellectual property considerations).

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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