Idiopathic pulmonary fibrosis (IPF)

Characterization of the patients is crucial and includes symptoms (questionnaires), lung function tests (spirometry, body plethysmography, diffusion capacity, and impulse oscillometry), imaging (Chest X-ray and computer tomography), 6 minute walk test, echocardiography and blood chemistry. Sampling of biological material from the lung is performed by bronchoscopy where tissues and cells from the large and from the small airways are harvested.

We are interested in exploring inflammatory mechanisms in the lung and systemically in common respiratory disorders. Specifically, the link between the inflammatory response and development of structural changes (remodeling) in the lung is explored. We collaborate with a number of highly skilled laboratories depending on our research questions, using various methods including immunohistochemistry, flow cytometry, PCR, cell culture techniques and omics methods. During the last year, the research group has also been involved in projects dealing with Covid-19.

Idiopathic pulmonary fibrosis (IPF)

Idiopathic pulmonary fibrosis (IPF) is a deadly, progressive form of lung fibrosis, with a reported median survival of 2-5 year. The disease is characterized by progressive cough and dyspnoea and the disease result in increased healthcare resources utilization and high direct medical costs. An estimation of incidence is 7-16/100.000 and a prevalence of 14-42 /100.000. In a recent study, based on ICD codes, the incidence in Sweden was estimated to 13.9/100.000, and the prevalence to 68/100.000 in the year 2015. The exact prevalence of IPF in Sweden is, however, unknown. There is a need to establish new tools to characterize this disease to enable a rational allocation of resources inside the national health-care program. We also need to build up a solid platform to enable translational research to detect new biomarkers and new therapy targets. 

The program will target the goal to create a national registry for IPF and a highly qualified translational centre for the diagnosis and care of IPF and rare lung diseases in Stockholm. We have build-up a national registry including 25 pulmonary units throughout the country. We use the same registry platform as in Finland, which makes it possible to directly compare two health care systems. In addition, the set up of a biobank to collect biological samples from patients with IPF for research purposes is in progress. Currently, we collect blood cells and serum/plasma, but in a near future we are planning to include samples from the upper and lower respiratory tract and tissue obtained by bronchoscopy. This sub-project will provide not only basic data on disease manifestations of IPF in Sweden, but also, in a longer perspective, shed light on inflammatory and fibrotic mechanisms on this devastating model of an interstitial lung disease.

Chronic Obstructive Lung Disease (COPD)

COPD is a disease with a prevalence of 10% and is increasing with age. The patients experience dyspnoea, cough but have also significant co-morbidities and systemic manifestations. There are obvious gender differences both in the epidemiology and in the clinical presentation of the disease. In addition, manifestations of COPD caused by chronic cigarette smoking also vary between different individuals of the same sex. This leads to the consequence that COPD patients differ in particular with regard to emphysema, bronchitis, bronchiolitis, reversibility of bronchodilators rate of exacerbations and systemic involvement. The reasons for development of these various responses to cigarette-smoke exposure are largely unknown. 

Smoking-associated COPD

In a cohort of 40 COPD-patients, 40 smokers with normal lung function and 40 neversmokers (Karolinska COSMIC study) we have made significant attempts, by performing bronchoscopy, to characterize inflammation and structural changes in various levels in the airways as well as in the systemic circulation. A 9-year follow-up of the COSMIC patient cohort has now been finished where symptom registration, spirometry and high-resolution computed tomography are performed. The study will, in particular, gain knowledge on predisposing factors for developing of airway obstruction in smokers.

Chronic airway obstruction associated to prematurity

There are a number of other risk factors besides smoking for development of  chronic airway obstruction. We are interested in early events, i.e. low birth weight and premature birth. In collaboration with Sachs´ Childrens Hospital, Södersjukhuset, Stockholm, adult prematurely born children with and without bronchopulmonary dysplasia (PBD) are compared with mild asthmatics and matched healthy neversmokers in a cross-sectional study (LUNAPRE-study). Bronchoscopy, imaging, lung function tests, echocardiography is, among other methods, used. The study will explore one explanation to chronic airway obstruction not caused by tobacco smoke. The clinical part has recently been completed and a number of researchers, including PhD students and post-docs, are now compiling data and performing experiments looking on various aspects of pulmonary complications in adult age due to prematurity.

Chronic airway obstruction in neversmokers (BRONCHO-SCAPIS study)

Recently, it has become evident that chronic airway obstruction in never-smokers is more prevalent than previously known. A number of epidemiological studies suggest that at least 20-25 % of all COP-patients have never smoked. In this national multicenter study we will identify factors associated with chronic airway obstruction in never-smokers and to determine the molecular mechanisms of this disease in order to find potential targets for intervention. Also, we will identify prognostic markers in early stages of disease.

This National project was in 2016 awarded the annual big research grant (SEK 15 000 000) from the Swedish Heart-Lung Foundation. The project are based on a national population-based cohort, Swedish CArdioPulmonary bioImage Study (SCAPIS) including 30 000 well characterized individuals. In this group, we will identify persons with chronic airway obstruction who have never smoked. These patients, and appropriate control groups, will be invited to each clinic for in-depth clinical characterization. Associating factors, including occupational and environmental, will be identified. Bronchoscopy will be performed in some patients, with the aim of collecting airways and lung samples. Molecular phenotyping including, immunohistochemistry and "omics" strategies will take place. A research network including six university hospitals in Sweden (Umeå, Uppsala, Stockholm, Linköping, Gothenburg, Lund) have been formed. In 2017, the first patients were screened and all sites are now including. We have, however, been forced to pause the project because of the pandemic situation, but we plan to restart during fall 2020.

Covid-10 projects

The research group are also involved in projects dealing with Covid-19. In the project “Pathphysiology, diagnosis and follow-up of Covid-19 and related diseases: an imaging approach, ImCOV, (PI Sven Nyren, associate professor, Dept Radiology, Karolinska University Hospital Solna and Mats Danielsson, professor, the Royal Institute of Technology (KTH) we aim to examine in what way imaging can be combined with patient related data to improve clinical decision-making in patients with Covid-19 and similar conditions by developing deep neural networks (AI). In the project “Follow-up of patients with severe Covid-19 pneumonia”, UppCOV, (PI Judith Bruchfeld, associate professor and Michael Runold) we aim to characterize the long-term consequences of Covid-19 pneumonia. Patients are included in our out-patient section and examination include computed tomography of the lung, lung function assessments, questionnaires and biological samples for biobank. There is also a close collaboration with “Recovery of Covid-19 patients” (ReCOV study, PI Malin Nygren-Bonnier). 

The research group

Magnus Sköld, Group leader, Professor of Respiratory Medicine, MD, PhD, Department of Medicine Solna, Karolinska Institutet, Senior Consultant, Department of Respiratory Medicine and Allergy, Karolinska University Hospital

Reza Karimi, MD, PhD, Senior Consultant, Department of Respiratory Medicine and Allergy, Karolinska University Hospital Solna

Ioanna Kotortsi, MD, Ph D-student, ST Respiratory Medicine, Department of Respiratory Medicine and Allergy, Karolinska University Hospital Solna

Ida Pesonen, MD, Ph D-student, ST Respiratory Medicine, Department of Respiratory Medicine and Allergy, Karolinska University Hospital Solna

Melvin Pourbazargan, MD, PhD-student, ST Internal Medicine, S:t Görans Hospital, Stockholm, Sweden

Dimitrios Kalafatis, MSc, PhD-student, Division of Respiratory Medicine, Dept of Medicine Solna

Giovanni Ferrara, associated, MD, PhD, Professor, University of Alberta, Edmonton, AB, Canada

Terezia Pincikova, MD, PhD, post doc, Department of Respiratory Medicine and Allergy, Karolinska University Hospital 

Maria Diakopoulou, MD, clinical resource, IPF. 

Jing Gao, MD, PhD, post doc, Division of Respiratory Medicine, Dept Medicine Solna

Maria Ahlsén, PhD, national study co-ordinator BRONCHO-SCAPIS and study co-ordinator UppCOV and ImCOV.

Lisa Carlson, RN, research nurse, co-ordinator Swedish National IPF registry

Heléne Blomqvist, research nurse, co-ordinator BRONCHO-SCAPIS, clinical part

Monika Ezerskyte, laboratory manager, co-ordinator BRONCHO-SCAPIS, laboratory part

Margitha Dahl, RN, research nurse

Susanne Schedin, RN, research nurse

Simon Scherp, RN, research nurse

Eva-Marie Karlsson, research administrator

Funding

Swedish Heart-Lung Foundation, ALF Medicine (Karolinska Institutet and Stockholm County Council), Swedish Asthma and Allergy Foundation, King Gustaf V and Queen Victorias Freemasons Foundation, Hesselmans stiftelse, Swedish Medical Research Council, Karolinska Institutet.

Recent Publications Magnus Sköld (since 2015)

Signs of immune activation and local inflammation are present in the bronchial tissue of patients with untreated early rheumatoid arthritis.
Reynisdottir G, Olsen H, Joshua V, Engström M, Forsslund H, Karimi R, et al
Ann. Rheum. Dis. 2016 09;75(9):1722-7

Linoleic acid-derived lipid mediators increase in a female-dominated subphenotype of COPD.
Balgoma D, Yang M, Sjödin M, Snowden S, Karimi R, Levänen B, et al
Eur. Respir. J. 2016 06;47(6):1645-56

Pirfenidone and nintedanib modulate properties of fibroblasts and myofibroblasts in idiopathic pulmonary fibrosis.
Lehtonen ST, Veijola A, Karvonen H, Lappi-Blanco E, Sormunen R, Korpela S, et al
Respir. Res. 2016 Feb;17():14

Vital capacity and COPD: the Swedish CArdioPulmonary bioImage Study (SCAPIS).
Torén K, Olin AC, Lindberg A, Vikgren J, Schiöler L, Brandberg J, et al
Int J Chron Obstruct Pulmon Dis 2016 ;11():927-33

Idiopathic pulmonary fibrosis in Sweden: report from the first year of activity of the Swedish IPF-Registry.
Ferrara G, Carlson L, Palm A, Einarsson J, Olivesten C, Sköld M
Eur Clin Respir J 2016 ;3():31090

Safety and tolerability of acetylcysteine and pirfenidone combination therapy in idiopathic pulmonary fibrosis: a randomised, double-blind, placebo-controlled, phase 2 trial.
Behr J, Bendstrup E, Crestani B, Günther A, Olschewski H, Sköld CM, et al
Lancet Respir Med 2016 06;4(6):445-53

A retrospective chart review of pirfenidone-treated patients in Sweden: the REPRIS study.
Sköld CM, Janson C, Elf ÅK, Fiaschi M, Wiklund K, Persson HL
Eur Clin Respir J 2016 ;3():32035

The lung microbiota in early rheumatoid arthritis and autoimmunity.
Scher JU, Joshua V, Artacho A, Abdollahi-Roodsaz S, Öckinger J, Kullberg S, et al
Microbiome 2016 11;4(1):60

Gender differences in the T-cell profiles of the airways in COPD patients associated with clinical phenotypes.
Forsslund H, Yang M, Mikko M, Karimi R, Nyrén S, Engvall B, et al
Int J Chron Obstruct Pulmon Dis 2017 ;12():35-48

Translation and validation of the King's Brief Interstitial Lung Disease (K-BILD) questionnaire in French, Italian, Swedish, and Dutch.
Wapenaar M, Patel AS, Birring SS, Domburg RTV, Bakker EW, Vindigni V, et al
Chron Respir Dis 2017 May;14(2):140-150

Treatment of idiopathic pulmonary fibrosis: a position paper from a Nordic expert group.
Sköld CM, Bendstrup E, Myllärniemi M, Gudmundsson G, Sjåheim T, Hilberg O, et al
J. Intern. Med. 2017 02;281(2):149-166

Differences in regional air trapping in current smokers with normal spirometry.
Karimi R, Tornling G, Forsslund H, Mikko M, Wheelock ÅM, Nyrén S, et al
Eur. Respir. J. 2017 01;49(1):

Metabolomics analysis identifies sex-associated metabotypes of oxidative stress and the autotaxin-lysoPA axis in COPD.
Naz S, Kolmert J, Yang M, Reinke SN, Kamleh MA, Snowden S, et al
Eur. Respir. J. 2017 06;49(6):

Measures of bronchodilator response of FEV1, FVC and SVC in a Swedish general population sample aged 50-64 years, the SCAPIS Pilot Study.
Torén K, Bake B, Olin AC, Engström G, Blomberg A, Vikgren J, et al
Int J Chron Obstruct Pulmon Dis 2017 ;12():973-980

Mutational status predicts the risk of thromboembolic events in lung adenocarcinoma.
Davidsson E, Murgia N, Ortiz-Villalón C, Wiklundh E, Sköld M, Kölbeck KG, et al
Multidiscip Respir Med 2017 ;12():16

Lung function development after preterm birth in relation to severity of Bronchopulmonary dysplasia.
Um-Bergström P, Hallberg J, Thunqvist P, Berggren-Broström E, Anderson M, Adenfelt G, et al
BMC Pulm Med 2017 Jun;17(1):97

Interleukin-26 Production in Human Primary Bronchial Epithelial Cells in Response to Viral Stimulation: Modulation by Th17 cytokines.
Che KF, Kaarteenaho R, Lappi-Blanco E, Levänen B, Sun J, Wheelock Å, et al
Mol. Med. 2017 10;23():247-257

Enhanced CD8+ cytolytic T cell responses in the peripheral circulation of patients with sarcoidosis and non-Löfgren's disease.
Parasa VR, Forsslund H, Enger T, Lorenz D, Kullberg S, Eklund A, et al
Respir Med 2018 05;138S():S38-S44

Long-term smoking alters abundance of over half of the proteome in bronchoalveolar lavage cell in smokers with normal spirometry, with effects on molecular pathways associated with COPD.
Yang M, Kohler M, Heyder T, Forsslund H, Garberg HK, Karimi R, et al
Respir. Res. 2018 03;19(1):40

Proteomic profiling of lung immune cells reveals dysregulation of phagocytotic pathways in female-dominated molecular COPD phenotype.
Yang M, Kohler M, Heyder T, Forsslund H, Garberg HK, Karimi R, et al
Respir. Res. 2018 03;19(1):39

Best supportive care for idiopathic pulmonary fibrosis: current gaps and future directions.
Ferrara G, Luppi F, Birring SS, Cerri S, Caminati A, Sköld M, et al
Eur Respir Rev 2018 Mar;27(147):

Integration of multi-omics datasets enables molecular classification of COPD.
Li CX, Wheelock CE, Sköld CM, Wheelock ÅM
Eur. Respir. J. 2018 05;51(5):

Bronchoalveolar lavage (BAL) cells in idiopathic pulmonary fibrosis express a complex pro-inflammatory, pro-repair, angiogenic activation pattern, likely associated with macrophage iron accumulation.
Lee J, Arisi I, Puxeddu E, Mramba LK, Amicosante M, Swaisgood CM, et al
PLoS ONE 2018 ;13(4):e0194803

The neutrophil-mobilizing cytokine interleukin-26 in the airways of long-term tobacco smokers.
Che KF, Tufvesson E, Tengvall S, Lappi-Blanco E, Kaarteenaho R, Levänen B, et al
Clin. Sci. 2018 05;132(9):959-983

Delay and inequalities in the treatment of idiopathic pulmonary fibrosis: the case of two Nordic countries.
Pesonen I, Carlson L, Murgia N, Kaarteenaho R, Sköld CM, Myllärniemi M, et al
Multidiscip Respir Med 2018 ;13():14

Long-term safety of pirfenidone: results of the prospective, observational PASSPORT study.
Cottin V, Koschel D, Günther A, Albera C, Azuma A, Sköld CM, et al
ERJ Open Res 2018 Oct;4(4):

An LC-MS/MS workflow to characterize 16 regio- and stereoisomeric trihydroxyoctadecenoic acids.
Fuchs D, Hamberg M, Sköld CM, Wheelock ÅM, Wheelock CE
J. Lipid Res. 2018 10;59(10):2025-2033

The bacteriology in adult patients with pneumonia and parapneumonic effusions: increased yield with DNA sequencing method.
Johansson N, Vondracek M, Backman-Johansson C, Sköld MC, Andersson-Ydsten K, Hedlund J
Eur. J. Clin. Microbiol. Infect. Dis. 2019 Feb;38(2):297-304

Patient journey and treatment patterns in adults with IPF based on health care data in Sweden from 2001 to 2015.
Sköld CM, Arnheim-Dahlström L, Bartley K, Janson C, Kirchgaessler KU, Levine A, et al
Respir Med 2019 Aug;155():72-78

The viral protein corona directs viral pathogenesis and amyloid aggregation.
Ezzat K, Pernemalm M, Pålsson S, Roberts TC, Järver P, Dondalska A, et al
Nat Commun 2019 05;10(1):2331

Pulmonary outcomes in adults with a history of Bronchopulmonary Dysplasia differ from patients with asthma.
Um-Bergström P, Hallberg J, Pourbazargan M, Berggren-Broström E, Ferrara G, Eriksson MJ, et al
Respir. Res. 2019 May;20(1):102

Patient journey and treatment patterns in adults with IPF based on health care data in Sweden from 2001 to 2015.
Sköld CM, Arnheim-Dahlström L, Bartley K, Janson C, Kirchgaessler KU, Levine A, et al
Respir Med 2019 Aug;155():72-78

Secretory anti-citrullinated protein antibodies in serum associate with lung involvement in early rheumatoid arthritis.
Roos Ljungberg K, Joshua V, Skogh T, Eklund A, Sköld CM, Svärd A, Catrina AI,Kastbom A.
Rheumatology (Oxford). 2019 Sep 5. pii: kez377. doi: 10.1093/rheumatology/kez377. [Epub ahead of print].

Visual and Quantitative Evaluation of Emphysema: A Case-Control Study of 1111 Participants in the Pilot Swedish CArdioPulmonary BioImage Study (SCAPIS).
Vikgren J, Khalil M, Cederlund K, Sörensen K, Boijsen M, Brandberg J, et al
Acad Radiol 2019 Jul;():

The Association of Body Mass Index, Weight Gain and Central Obesity with Activity-Related Breathlessness: The Swedish CArdioPulmonary bioImage Study.
Ekström MP, Blomberg A, Bergström G, Brandberg J, Caidahl K, Engström G, Engvall J, Eriksson M, Gränsbo K, Hansen T, Jernberg T, Nilsson L, Nilsson U, Olin AC, Persson L, Rosengren A, Sandelin M, Sköld M, Sundström J, Swahn E, Söderberg S, Tanash HA, Torén K, Östgren CJ, Lindberg E.
Thorax. 2019 Oct;74(10):958-964. doi: 10.1136/thoraxjnl-2019-213349. Epub 2019 Aug 21.

Validation of the Swedish Multidimensional Dyspnea Profile (MDP) in outpatients with cardiorespiratory disease.
Ekström M, Bornefalk H, Sköld M, Janson C, Blomberg A, Sandberg, J, Bornefalk-Hermansson A, Igelström H, Sundh J.
BMJ Open Respir Res. 2019 Sep 18;6(1): e000381. doi: 10.1136/bmjresp-2018-000381. eCollection 2019.

Dysregulation of the tryptophan pathway evidences gender differences in COPD.
Naz S, Bhat M, Ståhl S, Forsslund H, Sköld CM, Wheelock ÅM, Wheelock CE.
Metabolites 2019 Oct 1;9(10). pii: E212. doi: 10.3390/metabo9100212.

Gender differences at presentation of Idiopathic Pulmonary Fibrosis in Sweden.
KalafatisD, Gao J, Pesonen I, Carlson L, Sköld CM, Ferrara G
BMC Pulm Med. 2019, Nov 27;19(1):222. doi: 10.1186/s12890-019-0994-4. PMID: 31771560

Chronic airflow limitation and its relation to respiratory symptoms among ever-smokers and never-smokers: a cross-sectional study.
Torén, K, Schiöler L, Lindberg A, Andersson A, Behndig AF, Bergström G, Blomberg A, Caidahl K, Engvall JE, Eriksson MJ, Hamrefors V, Janson C, Kylhammar D, Lindberg E, Lindén A, Malinovschi A, Persson HL, Sandelin M, Eriksson Ström J, Tanash H, Vikgren J, Östgren CJ, Wollmer P, Sköld CM.
BMJ Open Resp Res 2020;7:e000600. doi:10.1136/bmjresp-2020-000600

Six-Minute Walking Test Outweighs Other Predictors of Mortality in Idiopathic Pulmonary Fibrosis.
Pesonen IHA, Gao J, Kalafatis K, Carlson L, Sköld CM, Ferrara G. 
A Real-life study from the Swedish IPF Registry. Respiratory Medicine: X 
Volume 2, November 2020, 100017, https://doi.org/10.1016/j.yrmex.2020.100017 

Assessment of Global Lung Function Initiative (GLI) reference equations for diffusing capacity in relation to respiratory burden in the Swedish CArdioPulmonary BioImage Study (SCAPIS). 
Malinovschi A, Zhou X, Bake B, Bergström G, Blomberg A, Brisman J, Caidahl K, Engstrom G, Eriksson, M, Frølich A, Janson C, Jansson K, Vikgren J, Lindberg A, Linder R, Mannila M, Persson L, Sköld CM, Toren K, Östgren CJ, Wollmer P, Engvall J.
Eur Respir J. 2020 Aug 13;56(2):1901995. doi: 10.1183/13993003.01995-2019.  

Minimal clinically important differences and feasibility of Dyspnea-12 and the Multidimensional Dyspnea Profile in cardiorespiratory disease. J Pain Symptom Manage.
Ekström M, Bornefalk H, Sköld CM, Janson C, Blomberg A, Bornefalk-Hermansson A, Igelström H, Sandberg J, Sundh J.
2020 Nov;60(5):968-975.e1. doi: 10.1016/j.jpainsymman.2020.05.028. Epub 2020 Jun 6 

Association between number and type of different ACPA fine specificities with lung abnormalities in early, untreated rheumatoid arthritis. 
Joshua V, Hensvold AH, Reynisdottir G, Hansson M, Cornillet M, Nogueira L, Serre G, Nyren S, Karimi R, Eklund A, Sköld CM, Grunewald J, Chatzidionysiou K, Catrina AI. 
RMD Open. 2020 Sep;6(2):e001278. doi: 10.1136/rmdopen-2020-001278. PMID: 32917833 

Considerations for improving quality of care of patients with rheumatoid arthritis and associated comorbidities. 
Kvien TK, Balsa A, Betteridge N, Buch MH, Durez P, Favalli E, Favier G, Gabay C, Geenen R, Gouni-Berthold I, van den Hoogen F, Kent A, Klareskog L, Østergaard M, Pavelka K, Polido-Pereira J, Grete Semb AG, Sköld M, Dougados M.
RMD Open 2020 Jul;6(2): e001211. 

Ambulatory oxygen for treatment of exertional hypoxaemia in pulmonary fibrosis (PFOX trial): a randomised controlled trial. 
Holland AE, Corte T, Chambers DC, Palmer A, Ekström M, Glaspole I, Goh NSL, Hepworth G, Khor YH, Hoffman M, Vlahos R, Sköld M, Dowman L, Troy LK, Prasad JD, Walsh J, McDonald CF. 
BMJ Open 2020 Dec 13;10(12):e040798. doi: 10.1136/bmjopen-2020-040798 

Smoking-associated increase in mucins 1 and 4 in human airways. 
Merikallio H, Kaarteenaho R, Lindén S, Padra M, Karimi R, Li CX, Lappi-Blanco E, Wheelock, Sköld CM. 
Respir Res. 2020 Sep 18;21(1):239. doi: 10.1186/s12931-020-01498-7. PMID: 32948202 

Minimal clinical important differences for Dyspnea-12 and MDP scores are similar at 2 weeks and 6 months: follow-up of a longitudinal clinical study. 
Ekström M, Bornefalk H, Sandberg J, Sköld CM, Janson C, Blomberg A, Bornefalk-Hermansson A, Currow DC, Johnson MJ, Sundh J. 
Eur Respir J. 2020 Dec 17:2002823. doi: 10.1183/13993003.02823-2020. Online ahead of print. PMID: 33334935 

Decreased miR-24-3p potentiates the DNA damage response and increases susceptibility to Chronic Obstructive Pulmonary Disease. 
Nouws J, Wan F, Finnemore E, Roque W, Kim S, Bazan I, Li CX, Skold M, Yan X, Neumeister V, Sweasy J, Bindra R, Wheelock Å, Gomez-Villalobos J, Kaminski N, Lee PJ, Sauler M. 
JCI Insight. 2020 Dec 8:134218. doi: 10.1172/jci.insight.134218. Online ahead of print. PMID: 33290275. 

The ratio FEV1/FVC and its association to respiratory symptoms - a Swedish general population study. 
Torén K, Schiöler L, Lindberg A, Andersson A, Behndig AF, Bergström G, Blomberg A, Caidahl K, Engvall JE, Eriksson MJ, Hamrefors V, Janson C, Kylhammar D, Lindberg E, Lindén A, Malinovschi A, Persson HL, Sandelin M, Ström JE, Tanash H, Vikgren J, Östgren CJ, Wollmer P, Sköld CM.
Clin Physiol Funct Imaging. 2020 Dec 7. doi: 10.1111/cpf.12684. Online ahead of print. PMID: 33284499 

Baseline characteristics and survival of patients of idiopathic pulmonary fibrosis: a longitudinal analysis of the Swedish IPF Registry. 
Gao J, Kalafatis D, Carlson L, Pesonen I, Li CX, Wheelock Å, Magnusson J, Sköld CM. 
Respir Res 2021; 22:40 https://doi.org/10.1186/s12931-021-01634-x  

High-Precision Automated Workflow for Urinary Untargeted Metabolomic Epidemiology. 
Meister I, Zhang P, Sinha A, Sköld CM, Wheelock ÅM, Izumi T, Chaleckis R, Wheelock CE. 
Anal Chem 2021 Mar 30;93(12):5248-5258. doi: 10.1021/acs.analchem.1c00203. Epub 2021 Mar 19 

A common model for the breathlessness experience across cardiorespiratory disease. 
Finnegan SL, Pattinson KTS, Sundh J, Sköld M, Janson C, Blomberg A, Sandberg J, Ekström M.
ERJ Open Res. 2021 Jun 28;7(2):00818-2020. doi: 10.1183/23120541.00818-2020. eCollection 2021 Apr. PMID: 34195256 

Widespread Parenchymal Abnormalities and Pulmonary Embolism on Contrast-Enhanced CT Predict Disease Severity and Mortality in Hospitalized COVID-19 Patients. 
Jalde FC, Beckman MO, Svensson AM, Bell M, Sköld M, Strand F, Nyren S, Kistner A.  
Front Med (Lausanne). 2021 Jun 29;8:666723. doi: 10.3389/fmed.2021.666723. eCollection 2021.PMID: 34268322 

Randomised, controlled, open label, multicentre clinical trial to explore safety and efficacy of hyperbaric oxygen for preventing ICU admission, morbidity and mortality in adult patients with COVID-19. 
Kjellberg A, Douglas J, Pawlik MT, Kraus M, Oscarsson N, Zheng X, Bergman P, Frånberg O, Kowalski JH, Nyren SP, Silvanius M, Skold M, Catrina SB, Rodriguez-Wallberg KA, Lindholm P. 
BMJ Open. 2021 Jul 5;11(7):e046738. doi: 10.1136/bmjopen-2020-046738. PMID: 34226219 

Outcomes of patients with advanced idiopathic pulmonary fibrosis treated with nintedanib or pirfenidone in a real-world multicentre cohort. 
Durheim MT, Bendstrup E, Carlson L, Sutinen EM, Hyldgaard C, Kalafatis D, Myllärniemi M, Sköld CM, Sjåheim T. 
Respirology. 2021 Jul 22. doi: 10.1111/resp.14116. Online ahead of print.PMID: 34291523