• Retinoic Acid: The Promise of Lung Regeneration
  • Brian L Tiep, MD
    Respiratory Disease Management Institute
    Pomona, CA 91767

  • When dealing with a disease destroys lung tissue and the ability to breathe, the concept of disease reversal and lung regeneration is most welcome. We often cast these concepts aside as being too far in the future to benefit present disease sufferers. However, two scientific investigators, Drs. Gloria and Donald Massaros have raised our hopes that this might be possible - and sooner than we think. They created an animal model that seemed to work. They first caused rats to develop a rat version of emphysema. They then gave these rats retinoids (retinoic acid), which are substances related to vitamin A. Retinoids are well known for their ability to regulate normal lung growth and development and emphysema is a process that destroys lung. The Massaros became enamored with notion that retinoids might be able to regenerate lung growth and basically cure emphysema. They gave these rats a retinoid drug called all-trans retinoic acid (ATRA). They found what appeared to be regeneration of normal lung from emphysema. The regenerated lung had the structure of normal lung and appeared to function normally as well.

    As might be expected, this development created quite a stir in the medical community as well as patients. Perhaps this could be the beginning of a lung regeneration method for people with emphysema. It was also very exciting that a substance so closely related to vitamin A might become a possible cure for emphysema.

    A pilot study was carried out in 20 emphysema patients, and published in American Journal of Respiratory and Critical Care Medicine 2002 March (Vol 165 (no 5) p.718-723. They found that during 3 months of treatment the drug was well tolerated and associated with only mild side effects such as headache and muscle aches and pain. Unfortunately, there was no change in the patient's lungs as measured by X-ray CT scan or lung function.

    Among the findings of that study and other related studies was that the drug may have had some effect on the formation and progression of emphysema, perhaps a suggestion of change in lung function, and some biochemical changes that could impact the disease process. These retinoids appear to be safe although more studies are needed to fully verify their safety. The original promise of this line of research presently remains unfulfilled. However, researchers are learning more about these compounds from human and animal studies and this line of research could eventually lead to compounds that will regenerate lung tissue. Please stay tuned.

    Meanwhile, you can maximize your ability to live happy and effective lives in spite of COPD. Ask your doctor to refer you to pulmonary rehabilitation. While you are at it, ask your doctor for a rapid action plan in case of a flare-up (otherwise called an "attack", an "episode", an "infection"). Live an active life.

    A few simple suggestions could help:

    1.Every day - get up and get dressed
    2.Take your medications (and oxygen) as prescribed.
    3.Make sure that you use good technique when taking your inhalers
    4.Cough and clear secretions - if you have them
    5.Do your pursed lips breathing
    6.Walk daily
    7.At the end of your walk - check to see if you are having a flare-up - are you more short of breath and is there a change in your sputum?
    8.If you have a flare-up or think you might be having one, call your doctor immediately and start your rapid action plan. This may prevent hospitalization.

    Again, stay tuned; learn all you can about your disease; live an active life; remain in control of your disease.

  • News
  • Thanks to Kathleen Norulak for finishing the newsletter last month!
  • Virginia Brown made a memorial donation in memory of Connie Hecht. Colleen Sticht made a memorial donation in memory of Frederick Carson.
  • We have received many letters asking for an update on Retinoic Acid. Our thanks to Dr. Tiep who has graciously provided us with the following information.
  • For more than ten years your editor has struggled to provide you with information-laden monthly newsletters. The time has come to join many other newsletters and become a quarterly publication. As a volunteer, I am finding that I just can't keep up with my personal responsibilities as I answer the many demands and needs of PERF. I hope to have a quarterly newsletter out in early November. If I catch up with other responsibilities, and recuperate from writer's block, you may hear from me sooner. Until that time, stay well!

  • Best wishes to all,
    Mary Burns

  • Do you have a question about respiratory disease that has been bothering you? If so, feel free to write and ask us, either through our web site or by mail. We answer all of your letters.