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• Journal article
  Feary J, Yu Y, Kabir T, Schofield S, Bevan A, Askinyte V, Honan K, Emirali L, Rubbi A, Willis AE, Cullinan P, Anand S, Martins LMet al., 2025,

  Assessment of cancer biomarkers in the Grenfell firefighter cohort study

  , Scientific Reports, Vol: 15

  Firefighters are exposed to a diverse range of harmful substances, including polycyclic aromatic hydrocarbons, benzene, and other carcinogens. These toxic compounds induce DNA damage, often causing the formation of DNA adducts and other lesions that can contribute to the development of various diseases, including cancer. Recent advancements in molecular diagnostics have shown that circulating cell-free DNA (cfDNA) in plasma is a valuable biomarker for detecting DNA damage and disease states. In this study, we explored whether changes in the quantity and quality of plasma cfDNA might reveal DNA lesions or serve as early markers for diseases such as cancer in UK firefighters. Whilst there are few published epidemiological studies of risk of cancer in UK firefighters, there are none on molecular markers in this population. All the 685 firefighters who participated in the study were employed by the London Fire Brigade in 2017; many of them also attended the Grenfell Tower fire, the most devastating fire to occur in the UK in modern history. In this exploratory analysis, we sought to gain insights into the potential long-term health impacts of toxic smoke exposure on these first responders by analysing both the concentration of cfDNA present and specific genetic alterations in cfDNA. Using next-generation sequencing and a panel that detects pathogenic DNA variants linked to various cancers, we analysed a subset of 261 firefighters. Our findings revealed that 11 firefighters carried pathogenic DNA variants associated with cancer, but we found no association between fire smoke exposure and the presence of these variants.

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• Journal article
  Khan AA, Vernugopan V, Wallis G, Feary Jet al., 2025,

  Artificial stone silicosis presenting as suspected Tuberculosis: A series of 3 cases at a district general hospital

  , Clinical Infection in Practice, Vol: 27

  Silicosis is an ancient condition re-emerging globally due to outbreaks of accelerated disease related to the use of artificial stone. The initial presentations of three patients with silicosis due to artificial stone exposure at a district general hospital in London, all of whom presented with clinical symptoms and radiological features assumed to be tuberculosis, are reported. The associations between silica exposure and this infection are also described. This series aims to highlight that artificial stone silicosis is now a significant occupational lung disease in the UK of which clinicians working in infectious diseases should be aware of.

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• Journal article
  Shah A, Kosmidis C, 2025,

  Aspergillus -related lung disease: A wake-up call to navigate complexity in a neglected condition

  , Thorax, Vol: 80, Pages: 1-2, ISSN: 0040-6376
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• Journal article
  Fisher MC, 2025,

  Origins of the ‘vampire fungus’ that causes white-nose syndrome in bats

  , Nature, ISSN: 0028-0836
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• Journal article
  Papadopoulou E, Sykes DL, Goeminne P, Machado A, Marghlani D, McNeil L, Norwell J, Paixão C, Shoemark A, Boyd J, Ekkelenkamp M, Thee S, Shah Aet al., 2025,

  Patients’ perspectives on antimicrobial resistance in chronic respiratory disease: an AMR-Lung – European Lung Foundation global patient survey

  , ERJ Open Research, ISSN: 2312-0541

  Background:Antimicrobial resistance (AMR) represents a significant global health threat, particularly for people with chronic respiratory diseases. However, their experiences, knowledge, priorities and concerns have not been comprehensively assessed. This study aimed to gauge patients’ perspectives of AMR burden in chronic respiratory disease.Methods:An anonymous web-based patient survey was developed by AMR-Lung ERS Clinical Research Collaboration and members from the European Lung Foundation patient advisory groups, consisting of 39 questions, translated into 20 languages and held online over a 2-month period. Multivariable logistic regression analyses were used to explore disease-specific burden and factors potentially affecting AMR across different healthcare settings.Results:Among 2012 respondents from 57 countries on all 6 continents, 30.7% recalled having an AMR-associated infection, while 12.6% perceived their last antimicrobial course as ineffective. 30.5% received long-term prophylactic antimicrobials, with 44.6% of them recalling an AMR-associated infection. 17.6% reported antimicrobial use without medical prescription, while 9.5% perceived prescriptions as delayed. Respondents recognised mostly their healthcare professionals as an information source regarding AMR, but 27% were unaware of AMR prior to the survey. Patients from high-income countries were more likely to be knowledgeable about AMR, and less inclined to use antimicrobials without prescription and to perceive them as ineffective. Respondents overwhelmingly viewed AMR as a personal (76.4%) and global (79.6%) threat.Conclusions:This global large-scale survey ascertains for the first time the high AMR burden from the perspective of people with chronic respiratory diseases, accentuating the need to promote AMR awareness, judicious antimicrobial use, and accessibility to quality healthcare.

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• Journal article
  Tanaka A, Filippidis F, El Asmar ML, Reed A, Morley-Smith A, Gerovasili Vet al., 2025,

  Pregnancy outcomes and management in lung and heart transplant recipients: a systematic review

  , JHLT Open, ISSN: 2950-1334

  Immunosuppression advances have enabled organ transplant recipients to consider parenthood, but pregnancy poses risks to maternal and fetal health. This systematic review examines pregnancy outcomes and immunosuppression management in cardiothoracic transplant recipients. We conducted a literature search of PubMed/Medline, Embase, and Maternity & Infant Care Database in December 2022. We identified 54 relevant studies and data from the Transplant Pregnancy Registry International (TPRI), covering 404 pregnancies from 272 heart recipients (HTR) and 148 pregnancies from 121 lung recipients (LTR). Live births occurred in 74.3% of HTR and 65.5% of LTR pregnancies (22% preterm). Graft dysfunction developed in 11.5% (during) and 12.4% (after) of HTR pregnancies, and 17.6% (during) and 18% (after) of LTR pregnancies. Other complications included hypertension (HTR: 36.9%, LTR: 58.8%), preeclampsia (HTR: 19.7%, LTR: 12.2%), and diabetes (HTR: 11%, LTR: 27%). Mortality was 17.4% for HTR and 26.5% for LTR. Half of HTR and two-thirds of LTR were on Tacrolimus. Common immunosuppression changes included discontinuation of Mycophenolate Mofetil (MMF), Azathioprine, or Sirolimus with corticosteroid dose adjustment. Despite high successful pregnancy rates, HLTR may face substantial risks of graft dysfunction and maternal death post-pregnancy. (182 words)

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• Journal article
  Thng KX, Tiew PY, Mac Aogáin M, Narayana JK, Jaggi TK, Ivan FX, Shuttleworth M, Long MB, Richardson H, Lind H, Alferes de Lima Headley D, Robertson K, Pollock J, Goeminne PC, Shteinberg M, De Soyza A, Aliberti S, Altenburg J, Haworth CS, Sibila O, Polverino E, Loebinger MR, Ringshausen FC, Lorent N, Dimakou K, Shoemark A, Chalmers JD, Chotirmall SHet al., 2025,

  Sputum metagenomics in bronchiectasis reveals pan-European variation: an EMBARC-BRIDGE study

  , European Respiratory Journal, Pages: 2500054-2500054, ISSN: 0903-1936

  <jats:sec><jats:title>Background</jats:title><jats:p>The EMBARC registry shows considerable variation in culturable microbes in sputum between different European countries. The additive role of next generation metagenomic sequencing remains unexplored and association with antimicrobial resistomes unknown.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>We prospectively assessed sputum from N=349 individuals recruited into the EMBARC-BRIDGE study with next-generation shotgun metagenomic sequencing including three European regions: Northern and Western Europe, Southern Europe and the United Kingdom, including samples from ten European countries. Microbiome and resistome profiles were assessed in relation to clinical outcomes.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Next generation metagenomic sequencing reproduced differences between countries in microbial profiles previously shown by culture in the EMBARC study. Metagenomics provided enhanced detection for some bronchiectasis pathogens including<jats:italic>P. aeruginosa</jats:italic>,<jats:italic>H. influenzae</jats:italic>and<jats:italic>S. pneumoniae</jats:italic>. Three metagenomic microbial clusters dominated by the genera<jats:italic>Pseudomonas, Streptococcus</jats:italic>and<jats:italic>Haemophilus</jats:italic>demonstrated pan-European but variable distribution. Diverse resistomes, linked to underlying microbiomes, were identified across Europe, with significantly higher diversity of resistance gene determinants in Southern Europe. Resistome composition significantly differed between regions characterised by regionally contrasting multi-drug-resistant profiles. The EMBARC-BRIDGE cohort validated established bronchiectasis resistotypes: RT1 and RT2, which occur at varying frequency across regions. Despite g

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• Journal article
  Lee CT, Ghandi SA, Elmrayed S, Barnes H, Lorenzetti D, Salibury ML, Stewart ID, Barber C, Peters CE, Feary J, Johannson KAet al., 2025,

  Inhalational exposures associated with risk of interstitial lung disease: a systematic review and meta-analysis

  , Thorax, ISSN: 0040-6376

  RationaleInhalational exposures are associated with risk of developing interstitial lung disease (ILD), yet the relationship between specific exposures and ILD is poorly characterized. ObjectiveIdentify inhalational exposures associated with ILD and estimate the effects of exposures on ILD risk.MethodsMEDLINE and EMBASE databases were searched from 1990 until 2022 to identify inhalational exposures associated with ILD diagnosis. ILDs where causality is well-established (hypersensitivity pneumonitis, pneumoconiosis) and sarcoidosis were excluded. Two independent reviewers screened abstracts with full-text review and data extraction of eligible studies. Where possible, data were pooled and multi-level meta-analysis was specified using a random effects model. Sources of heterogeneity and risk of bias were assessed. Main ResultsNinety-six studies were included in the systematic review, representing 40,819,116 subjects (295,167 had ILD, 40,523,949 controls). For the meta-analysis, fifty-four studies were included (40,490,793 subjects: 273,899 ILD, 40,216,894 controls). Exposures associated with significantly increased ILD risk included smoking (OR 1.69, 95% CI 1.47-1.94), organic exposures (OR 1.56, 95% CI 1.12-2.16), metals (OR 1.52, 95% CI 1.07-2.16), dust (OR 1.45, 95% CI 1.20-1.76), and asbestos (OR 1.53, 95% CI 1.08-2.15). Silica and fumes had positive associations with ILD that trended toward significance. ConclusionsThis systematic review and multilevel meta-analysis is the first to comprehensively assess the effect of inhalational exposures on overall risk of ILD, with multiple putative exposures identified. Future work should investigate novel occupational exposures associated with ILD, characterize the gene-environment interaction, and develop preventative strategies.

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• Journal article
  Marczylo EL, Jackson S, Bell C, Andrews D, Clift MJD, Crawford I, Fejer G, Ferguson RMW, Fisher MC, Goode EJ, Isaac J, Kinnersley R, Morrissey JA, Pozdniakova S, Viegas C, Ward A, Wouters IM, Coulon F, Nasir ZA, Douglas Pet al., 2025,

  Promoting global collaboration to improve bioaerosol exposure assessment and understanding of associated health impacts: outcomes from a series of workshops

  , Microbiology (Reading, England), Vol: 171

  We are surrounded, in both indoor and outdoor environments, by air containing particles of biological origin (bioaerosols). We constantly inhale them, and, depending upon their size, they deposit in different parts of our airways. Despite their ubiquitous nature and our constant exposure, bioaerosol diversity and composition of the environment are not well characterized, and we understand little about which bioaerosols we are exposed to and how this impacts our health, either positively or negatively. Indoor/Outdoor Bioaerosols Interface and Relationships Network (BioAirNet), a Clean Air Programme-funded network, has recognized the need for the bioaerosol community to reflect on the current challenges facing bioaerosol exposure assessment and the determination of the associated cellular/molecular responses driving specific health outcomes. A series of online workshops for the bioaerosol community were hosted by BioAirNet in September 2022, which aimed to bring together global expertise to discuss the current challenges impeding improved assessment of bioaerosol exposure and understanding of the downstream cellular and molecular mechanisms driving health outcomes by discussing these challenges; considering where we need to be, where we are now and how we get there. Professional facilitation was key to their success, enabling the multidisciplinary bioaerosol community to explore and address these challenges within a focused and productive environment to prioritize themes and agree on action plans for continued momentum following the workshops. These themes were as follows: (1) conceptual model; (2) stakeholder mapping; (3) knowledge transfer; (4) writing project and (5) conference-type event, collectively covering research, knowledge mobilization and networking activities. A subsequent in-person follow-up workshop was held in November 2023. It provided an opportunity to share progress on the five themes, critique what had already been done and act as a launch-pad to p

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• Journal article
  Howlett P, Szram J, Feary J, 2025,

  Occupational lung disease: What the general physician needs to know

  , Clinical Medicine, Journal of the Royal College of Physicians of London, Vol: 25, ISSN: 1470-2118

  Occupational exposures are a common and preventable cause of lung disease. About one in six cases of chronic obstructive pulmonary disease (COPD) and asthma worldwide are related to work. Early recognition of occupational lung disease improves outcomes. Doctors should ask about work history in patients with respiratory symptoms. This educational review article briefly outlines key clinical features, relevant to the general physician, of common occupational lung diseases seen in the UK. These conditions include work-related asthma, pneumoconioses, hypersensitivity pneumonitis and COPD. Referral to a specialist is recommended when an occupational cause is suspected. Most occupational lung diseases are preventable with adequate workplace safety measures and early medical attention.

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