Yale Interstitial Lung Disease (ILD)

The Yale Interstitial Lung Diseases (ILD) Center is a recognized center of excellence at Yale Medical School and Yale-New Haven Hospital.  The interstitial lung diseases are difficult to diagnose and treat, and represent a body of pulmonary diseases that often require tertiary referral from community physicians, including experienced pulmonologists. The multidisciplinary Interstitial Lung Disease Center was established in 1997 to address the needs of these patients.

The interstitial lung diseases include many complex diseases ranging from idiopathic pulmonary fibrosis (IPF) and connective tissue disease-associated ILD to occupational lung disease and sarcoidosis.  The Yale ILD Program is the only one of its kind in Connecticut.  Patients come from throughout the state as well as from New York, Rhode Island, New Jersey, Massachusetts, as well as from countries outside the United States to be evaluated and treated at a center with exceptional experience with these diseases.  

More than 100 diseases are included under the heading of interstitial lung diseases and include:

  • Idiopathic pulmonary fibrosis
  • Connective tissue disease-associated interstitial lung disease
  • Hypersensitivity pneumonitis
  • Sarcoidosis
  • Bronchiolitis Obliterans Organizing Pneumonia (BOOP)
  • Cryptogenic Organizing Pneumonia (COP)
  • Non-Specific Interstitial Pneumonia (NSIP)
  • Respiratory Bronchiolitis-Associated ILD (RB-ILD)
  • Desquamative Interstitial Pneumonia (DIP)
  • Lymphocytic Interstitial Pneumonia (LIP)
  • Pulmonary Alveolar Proteinosis
  • Lymphangioleiomyomatosis (LAM)
  • Eosinophilic pneumonias
  • Asbestosis
  • Silicosis
  • Langerhan's cell histiocytosis
  • Chronic eosinophilic pneumonia
  • Pulmonary vasculitis
  • Pulmonary hemorrhage syndromes
  • Familial pulmonary fibrosis

ILD patients with inflammatory lung disease (including connective tissue disease associated ILD, vasculitis, hypersensitivity pneumonitis and drug-induced ILD) sometimes require immunosuppressive medications.  The ILD center has developed monitoring programs with nursing involvement to ensure that patient safety is maintained for patients treated with such agents.  In addition, the ILD center has developed close working relationships with transplant programs around the country to ensure efficient referral and a quick path to active listing when appropriate.

collapse

The Yale ILD Program has initiated a patient support group for those affected by IPF.   We have offered educational programs on subjects such as oxygen systems and use, disease education, clinical trials education, and lung transplantation.  Patients and their families have genuinely enjoyed these sessions. 

We have collaborated with the Pulmonary Fibrosis Foundation, a national patient advocacy organization, to create a patient-focused webinar entitled “Almost Everything You Need to Know About IPF.”  This program features members of the Yale ILD Program and is permanently posted on the Foundation’s web page.  (Link: http://www.pulmonaryfibrosis.org/almosteverything)

collapse

The Yale ILD Program offers clinical trial enrollment for patients with idiopathic pulmonary fibrosis as part of a multidisciplinary and integrated approach to treatment.  Yale is one of 26 Centers of Excellence in the NHLBI-funded IPFNet consortium, which offers clinical studies for idiopathic pulmonary fibrosis (IPF). Results of these studies have been reported in the Lancet and the New England Journal of Medicine during this past year. The Yale ILD Program also offers phase II and III clinical trials of investigational agents through industry sponsors.  Because IPF is a disease with no known treatment, the ILD program works to give patients the opportunity to receive novel agents and to contribute to the medical knowledge of this disease.  See more at our Clinical Trials page.

collapse

The particular focus of research in the laboratories of Dr. Erica Herzog  and Dr. Jack Elias  has been examining the role of alternatively activated macrophages and Semaphorin 7a in IPF and other fibrotic lung diseases, including scleroderma.  The Yale ILD program has been recently selected to participate in a multicenter NIH-funded program on sarcoidosis.

The research of the Interstitial Lung Disease Program is dedicated to understanding common mechanisms promoting pulmonary fibrosis. This condition, which is characterized by the accumulation of scar tissue in the lung, is a major cause of death in Americans.  Work in Dr. Herzog’s laboratory has identified a number of novel pathways that might control the development of this disease.  Our studies focus on the role of Semaphorin 7a, a protein that is implicated in both brain development and inflammation, in the pathogenesis of pulmonary scar.  We are also performing studies of fibrosis using an artificial lung technique that was developed here at Yale. Finally, we are heavily involved in the search for predictive biomarkers that might allow physicians to identify patients with active disease and understand what separates these people from those with stable disease.  It is hoped that this unique combination of translational studies will allow better insight into diseases such as Idiopathic Pulmonary Fibrosis, Scleroderma related Interstitial Lung Disease, and Sarcoidosis, with the ultimate goal of developing preventative or treatment strategies.

collapse

Our Faculty

Antin-Ozerkis, Danielle Elyse

Director, Yale Interstitial Lung Disease Program

Associate Professor of Medicine (Pulmonary)

Gulati, Mridu

Assistant Professor of Medicine (Pulmonary)

Herzog, Erica Lyndrup

Associate Professor of Medicine (Pulmonary)
Director, Translational Lung Research Program
Co-Director, Yale Fibrosis Program
Assistant Director, Medical Student Research, Department of Medicine
Director, Interstitial Lung Disease Center of Excellence

Homer, Robert J

Professor of Pathology and of Medicine (Pulmonary)
Director, Medical Student Course Module
Director of Medical Studies

Kaminski, Naftali

Boehringer Ingelheim Pharmaceuticals, Inc. Professor of Medicine (Pulmonary)
Section Chief (7/1/13 - present)

Redlich, Carrie A

Professor of Medicine (Occupational Medicine)
Director, Occupational and Environmental Medicine Program

Rubinowitz, Ami N

Associate Professor of Diagnostic Radiology
Co-Chief, Thoracic Radiology

Siner, Jonathan Meiss

Assistant Professor of Medicine (Pulmonary)
Medical Director - Medical Intensive Care Unit, Yale-New Haven Hospital

Publications

The following is a select list of publications related to interstitial lung disease and pulmonary fibrosis from the ILD program during the past 1-2 years, demonstrating the contribution of all members of the program to the fields of clinical and basic science understanding in ILD.

Clinical

  • A Placebo-Controlled Randomized Trial of Warfarin in Idiopathic Pulmonary Fibrosis.  Noth I, Anstrom KJ, Calvert SB, de Andrade J, Flaherty KR, Glazer C, Kaner RJ, Olman MA; The Idiopathic Pulmonary Fibrosis Clinical Research Network (IPFnet).   Am J Respir Crit Care Med. 2012 May 3.  (Investigator D. Antin-Ozerkis)
  • Prednisone, azathioprine, and N-acetylcysteine for pulmonary fibrosis.  Idiopathic Pulmonary Fibrosis Clinical Research Network, Raghu G, Anstrom KJ, King TE Jr, Lasky JA, Martinez FJ.  N Engl J Med. 2012 May 24;366(21):1968-77. Epub 2012 May 20.  (Investigator D. Antin-Ozerkis)
  • Pirfenidone in patients with idiopathic pulmonary fibrosis (CAPACITY): two randomized trials. Noble PW, Albera C, Bradford WZ, Costabel U, Glassberg MK, Kardatzke D, King TE Jr, Lancaster L, Sahn SA, Szwarcberg J, Valeyre D, du Bois RM; CAPACITY Study Group.  Lancet. 2011 May 21;377(9779):1760-9. Epub 2011 May 13. (Investigator D. Antin-Ozerkis)
  • Pirfenidone treatment of idiopathic pulmonary fibrosis.  Gan Y, Herzog EL, Gomer RH.  Ther Clin Risk Manag. 2011 Feb 8;7:39-47.
  • Pulmonary Manifestations of Rheumatoid Arthritis.  Antin-Ozerkis D, Evans J, Rubinowitz A, Homer RJ, and Matthay RA.   Clinics in Chest Medicine, 31(3):451-78, September 2010.
  • Interstitial Lung Disease in Older Patients, in Aging and Lung Disease.  Antin-Ozerkis D.   A Clinical Guide, Respiratory Medicine, Pisani M, ed.2011.
  • Imaging and Differential Diagnosis of Cystic Lung Disease.  Oliva I, Antin-Ozerkis D, Rubinowitz A.  PCCSU Volume 25, Lesson 23, January 2012.
  • Connective Tissue Disease-Associated Interstitial Lung Disease.  Antin-Ozerkis D, Rubinowitz A, Evans J, Homer RJ, and Matthay RA.   Clinics in Chest Medicine, 33(1): 123-49, March 2012.
  • Cryptogenic Organizing Pneumonia.  Antin-Ozerkis D and Gulati M.  Clinical Decision Support in Medicine.  2012 In Press.
  • Diagnostic assessment of patients with interstitial lung disease.  Gulati M.Prim Care Respir J. 2011 Jun;20(2):120-7.

Scientific

  • Fibrocytes in Scleroderma Lung Disease in Fibrocytes: New insights into tissue repair and systemic fibroses.   Mathai S. K. and Herzog EL. World Scientific Publishing Co. Singapore 2012 in press.
  • Murray LA, Rubinowitz AS, Herzog EL. Interstitial Lung Disease: Are IPF and Scleroderma ILD the same disease? Curr Op Rheum 2012 in press.
  • Sticking it to fibrocytes with serum amyloid P.  Mathur AM, Herzog EL. J Leuk Bio 2012 in press.
  • An Assessment of Epithelial and Mesenchymal Phenotypes in Experimental and Clinical Pulmonary Fibrosis.   Dunmore R, Carruthers AM, Bell MJ, Zhang H, Hogaboam CM, Herzog EL, Knight DA, Martinez FJ, Sleeman MA, Murray LA. ISRN Pulmonology in press 2012.
  • Chit1 as a biomarker and disease mediator in Systemic Sclerosis.  Lee CG, Herzog EL*, Ahangari F, Varga J, Feghali-Bostwick C, Jimenez S, Peng X, Gulati MS, Elias JA.  Associated Lung Disease. Journal of Immunology in press, 2012. *co-first author
  • Fibrocytes: emerging effector cells in chronic inflammation.  Peng H, Herzog EL.  Curr Opin Pharmacol. 2012 Mar 29.
  • YKL-40, a chitinase-like protein at the intersection of inflammation and remodeling.  Lee CG, Dela Cruz CS, Herzog EL, Rosenberg SM, Ahangari F, Elias JA. Am J Respir Crit Care Med. 2012 Apr 1;185(7):692-4.
  • Local apoptosis promotes collagen production in monocyte derived cells.  Peng X, Mathai S, Murray LM, Russell TR, Reilkoff RA, Chen Q, Elias JA, Bucala RJ, Homer RJ, Herzog EL. Fibrogenesis and Tissue Repair 2011 May 17;4(1):12. PMID:21586112; PMCID: PMC3123188
  • Gan Y, Reilkoff RA, Peng XY, Russell TR, Chen QC, Mathai SK, Gulati M, Homer RJ, Elias, JA, Bucala RJ, and Herzog EL. Role of Semaphorin 7a in TGF?1-induced lung fibrosis, fibrocyte differentiation, and scleroderma-related interstitial lung disease. Arth Rheum 2011. Aug 63(8):2484-94. PMID:21484765
  • Fibrocytes: emerging effector cells in chronic inflammation.  Reilkoff RA, Bucala R, Herzog EL. Nat Rev Immunol. 2011 Jun;11(6):427-35. Epub 2011 May 20.
  • Modern concepts on the role of inflammation in pulmonary fibrosis. Homer RJ, Elias JA, Lee CG, Herzog E.  Arch Pathol Lab Med. 2011 Jun;135(6):780-8. Review.
  • Local apoptosis promotes collagen production by monocyte-derived cells in transforming growth factor β1-induced lung fibrosis.  Peng X, Mathai SK, Murray LA, Russell T, Reilkoff R, Chen Q, Gulati M, Elias JA, Bucala R, Gan Y, Herzog EL.  Fibrogenesis Tissue Repair. 2011 May 17;4(1):12.
  • Serum Amyloid P Inhibits TGF?- Driven Lung Fibrosis.   Murray LM, Chen QC, Kramer MS, Hesson DM, Argentieri RL, Peng X, Gulati M, van Rooijen NR, Homer RJ, Elias JA, Hogaboam CM and Herzog EL. Int J Biochem Cell Biol. 2011 Jan;43(1):154-62 PMID 21044893.
  • TGF-beta driven lung fibrosis is macrophage dependent and blocked by Serum amyloid P. Murray, L. A., Q. Chen, M. S. Kramer, D. P. Hesson, R. L. Argentieri, X. Peng, M. Gulati, R. J. Homer, T. Russell, N. van Rooijen, J. A. Elias, C. M. Hogaboam, and E. L. Herzog.  Int J Biochem Cell Biol 2011;43:154-162
  • Bioengineered lung for in vivo implantation.   Petersen T, Calle E, Zhao L, Lee EJ, Gui L, Raredon MS, Gavrilov K, Herzog EL, and Niklason L. Science 2010 Jul; 329:538-41.
  • Circulating monocytes from systemic sclerosis patients with interstitial lung disease show an enhanced profibrotic phenotype.  Mathai SK, Gulati M, Peng X, Russell TR, Shaw AC, Rubinowitz AN, Murray LA, Siner JM, Antin-Ozerkis DE, Montgomery RR, Reilkoff RA, Bucala RJ, Herzog EL.  Lab Invest. 2010 Jun;90(6):812-23. Epub 2010 Apr 19.
  • Recent advances in pulmonary fibrosis: implications for scleroderma. Homer RJ, Herzog EL. Curr Opin Rheumatol 2010: 22(6):683-9.  PMID  20693906
  • Inhibition of pulmonary fibrosis in mice by CXCL10 requires glycosaminoglycan binding and syndecan-4. Jiang D, Liang J, Campanella GS, Guo R, Yu S, Xie T, Liu N, Jung Y, Homer R, Meltzer EB, Li Y, Tager AM, Goetinck PF, Luster AD, Noble PW.  J Clin Invest 2010, 120:2049-2057.