Publications

BACKGROUND

The current interstitial lung disease (ILD) classification has overlapping clinical presentations and outcomes. Cluster analysis modeling is a valuable tool in identifying distinct clinical phenotypes in heterogeneous diseases. However, this approach has yet to be implemented in ILD.

METHODS

Using cluster analysis, novel ILD phenotypes were identified among subjects from a longitudinal ILD cohort, and outcomes were stratified according to phenotypic clusters compared with subgroups according to current American Thoracic Society/European Respiratory Society ILD classification criteria.

RESULTS

Among subjects with complete data for baseline variables (N = 770), four clusters were identified. Cluster 1 (ie, younger white obese female subjects) had the highest baseline FVC and diffusion capacity of the lung for carbon monoxide (Dlco). Cluster 2 (ie, younger African-American female subjects with elevated antinuclear antibody titers) had the lowest baseline FVC. Cluster 3 (ie, elderly white male smokers with coexistent emphysema) had intermediate FVC and Dlco. Cluster 4 (ie, elderly white male smokers with severe honeycombing) had the lowest baseline Dlco. Compared with classification according to ILD subgroup, stratification according to phenotypic clusters was associated with significant differences in monthly FVC decline (Cluster 4, -0.30% vs Cluster 2, 0.01%; P < .0001). Stratification by using clusters also independently predicted progression-free survival (P < .001) and transplant-free survival (P < .001).

CONCLUSIONS

Among adults with diverse chronic ILDs, cluster analysis using baseline characteristics identified four distinct clinical phenotypes that might better predict meaningful clinical outcomes than current ILD diagnostic criteria.

Gene flow between populations may either support local adaptation by supplying genetic variation on which selection may act, or counteract it if maladapted alleles arrive faster than can be purged by selection. Although both such effects have been documented within plant species' native ranges, how the balance of these forces influences local adaptation in invasive plant populations is less clear, in part because introduced species often have lower genetic variation initially but also tend to have good dispersal abilities. To evaluate the extent of gene flow and adaptation to local climate in invasive populations of Solidago canadensis, and the implications of this for range expansion, we compared population differentiation at microsatellite and chloroplast loci for populations across Switzerland and assessed the effect of environmental transfer distance using common gardens. We found that while patterns of differentiation at neutral genetic markers suggested that populations are connected through extensive pollen and seed movement, common-garden plants nonetheless exhibited modest adaptation to local climate conditions. Growth rate and flower production declined with climatic distance from a plant's home site, with clones from colder home sites performing better at or above the range limit. Such adaptation in invasive species is likely to promote further spread, particularly under climate change, as the genotypes positioned near the range edge may be best able to take advantage of lengthening growing seasons to expand the range.