<clinical_study>
  <!-- This xml conforms to an XML Schema at:
    https://clinicaltrials.gov/ct2/html/images/info/public.xsd -->
  <required_header>
    <download_date>ClinicalTrials.gov processed this data on September 20, 2023</download_date>
    <link_text>Link to the current ClinicalTrials.gov record.</link_text>
    <url>https://clinicaltrials.gov/ct2/show/NCT04494334</url>
  </required_header>
  <id_info>
    <org_study_id>19SM5398</org_study_id>
    <secondary_id>239911</secondary_id>
    <nct_id>NCT04494334</nct_id>
  </id_info>
  <brief_title>Development of Airway Absorption Sampling Methods</brief_title>
  <acronym>FIBRO-SAM</acronym>
  <official_title>Development of Airway Absorption Sampling Methods for Biomarker Assessment in Probable Idiopathic Pulmonary Fibrosis (IPF) Patients</official_title>
  <sponsors>
    <lead_sponsor>
      <agency>Imperial College London</agency>
      <agency_class>Other</agency_class>
    </lead_sponsor>
    <collaborator>
      <agency>Genentech, Inc.</agency>
      <agency_class>Industry</agency_class>
    </collaborator>
  </sponsors>
  <source>Imperial College London</source>
  <oversight_info>
    <has_dmc>No</has_dmc>
    <is_fda_regulated_drug>No</is_fda_regulated_drug>
    <is_fda_regulated_device>No</is_fda_regulated_device>
  </oversight_info>
  <brief_summary>
    <textblock>
      The study will measure airway inflammation in probable idiopathic pulmonary fibrosis (IPF)&#xD;
      and sarcoidosis as well as in healthy volunteers. This can help understand the molecular&#xD;
      basis of these diseases, why these diseases happen, and what makes patients develop lung&#xD;
      fibrosis. These insights should one day help to monitor patients and aid in their diagnosis&#xD;
      and treatment.&#xD;
    </textblock>
  </brief_summary>
  <detailed_description>
    <textblock>
      IPF is a progressive disease caused by irreversible scarring of the lung, and disease&#xD;
      trajectory is not easily predicted based on clinical measurements. Biomarkers reflective of&#xD;
      molecular pathways involved in IPF may help inform patient trajectory, but have been&#xD;
      difficult to identify in circulation due to the disease manifesting in the lung. The study&#xD;
      team will measure biomarkers from Probable IPF patients, sarcoidosis patients, and healthy&#xD;
      volunteers using novel sampling methods involving absorption of upper and lower airway&#xD;
      fluids. These novel sampling methods may enable less invasive and potentially more sensitive&#xD;
      methods to detect disease activity and will be performed in IPF and sarcoidosis patients&#xD;
      during a routine bronchoscopy procedure. The study team will compare the levels of biomarkers&#xD;
      that have been shown to be predictive of disease course in airway fluids of probable IPF&#xD;
      patients versus sarcoidosis and healthy controls. This study may help understand the&#xD;
      molecular basis of IPF, and improve the understanding of diagnosis and treatment.&#xD;
    </textblock>
  </detailed_description>
  <overall_status>Withdrawn</overall_status>
  <why_stopped>
    Study terminated by funder- terminated before CCC and recruitment- no recruitment and no data&#xD;
    collection&#xD;
  </why_stopped>
  <start_date type="Actual">January 1, 2022</start_date>
  <completion_date type="Actual">January 1, 2022</completion_date>
  <primary_completion_date type="Actual">January 1, 2022</primary_completion_date>
  <study_type>Observational</study_type>
  <has_expanded_access>No</has_expanded_access>
  <study_design_info>
    <observational_model>Cohort</observational_model>
    <time_perspective>Cross-Sectional</time_perspective>
  </study_design_info>
  <primary_outcome>
    <measure>Levels of the of biomarker/mediator surfactant protein D (SPD) in bronchial Lining fluid in IPF and sarcoidosis patients</measure>
    <time_frame>Baseline Bronchoscopy visit</time_frame>
    <description>Comparisons will be made of bronchial lining fluid levels of biomarker/mediator surfactant protein D (SPD), in patients with IPF and sarcoidosis.</description>
  </primary_outcome>
  <primary_outcome>
    <measure>Levels of the biomarker/mediator CCL18 in bronchial Lining fluid in IPF and sarcoidosis patients.</measure>
    <time_frame>Baseline Bronchoscopy visit</time_frame>
    <description>Comparisons will be made of bronchial lining fluid levels of biomarker/mediator CCL18 in patients with IPF and sarcoidosis</description>
  </primary_outcome>
  <primary_outcome>
    <measure>Levels of the biomarker/mediator CXCL13 in bronchial Lining fluid in IPF and sarcoidosis patients.</measure>
    <time_frame>Baseline Bronchoscopy visit</time_frame>
    <description>Comparisons will be made of bronchial lining fluid levels of biomarker/mediator CXCL13 in patients with IPF and sarcoidosis.</description>
  </primary_outcome>
  <primary_outcome>
    <measure>Levels of the of biomarker/mediator periostin in bronchial Lining fluid in IPF and sarcoidosis patients.</measure>
    <time_frame>Baseline Bronchoscopy visit</time_frame>
    <description>Comparisons will be made of bronchial lining fluid levels of biomarker/mediator periostin in patients with IPF and sarcoidosis.</description>
  </primary_outcome>
  <secondary_outcome>
    <measure>Levels of Periostin in nasosorption samples within and across the 3 groups of participants</measure>
    <time_frame>Through study completion, an average of 1 year</time_frame>
    <description>Comparisons will be made of airways levels of biomarker/mediator periostin between patients with IPF and sarcoidosis and health volunteers.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Levels of surfactant protein (SPD) in nasosorption samples within and across the 3 groups</measure>
    <time_frame>Through study completion, an average of 1 year</time_frame>
    <description>Comparisons will be made of airways levels of biomarker/mediator surfactant protein D (SPD) between patients with IPF and sarcoidosis and health volunteers.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Levels of CCL18 in nasosorption samples within and across the 3 groups</measure>
    <time_frame>Through study completion, an average of 1 year</time_frame>
    <description>Comparisons will be made of airways levels of biomarker/mediator CCL18 between patients with IPF and sarcoidosis and health volunteers.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Levels of CXCL13 in nasosorption samples within and across the 3 groups</measure>
    <time_frame>Through study completion, an average of 1 year</time_frame>
    <description>Comparisons will be made of airways levels of biomarker/mediator CXCL13 between patients with IPF and sarcoidosis and health volunteers.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Levels of periostin in blood within and across the 3 groups of participants</measure>
    <time_frame>Through study completion, an average of 1 year</time_frame>
    <description>Comparison will be made of periostin levels in blood with nasosorption and bronchosorption levels across the 3 participant groups.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Levels of surfactant protein D (SPD in blood within and across the 3 groups of participants</measure>
    <time_frame>Through study completion, an average of 1 year</time_frame>
    <description>Comparison will be made of surfactant protein D (SPD levels in blood with nasosorption and bronchosorption levels across the 3 participant groups</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Levels of CCL18 in blood within and across the 3 groups of participants</measure>
    <time_frame>Through study completion, an average of 1 year</time_frame>
    <description>Comparison will be made of CCL18 levels in blood with nasosorption and bronchosorption levels across the 3 participant groups.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Levels of CXCL13 in blood within and across the 3 groups of participants</measure>
    <time_frame>Through study completion, an average of 1 year</time_frame>
    <description>Comparison will be made of CXCL13 levels in blood with nasosorption and bronchosorption levels across the 3 participant groups.</description>
  </secondary_outcome>
  <number_of_groups>3</number_of_groups>
  <enrollment type="Actual">0</enrollment>
  <condition>Idiopathic Pulmonary Fibrosis</condition>
  <condition>Sarcoidosis</condition>
  <arm_group>
    <arm_group_label>Healthy Volunteers</arm_group_label>
    <description>These will be age matched healthy volunteers (n=15) who will not undergo bronchoscopy</description>
  </arm_group>
  <arm_group>
    <arm_group_label>Probable Idiopathic Pulmonary Fibrosis</arm_group_label>
    <description>Patients with probable IPF, who will be having bronchoscopy as part of their clinical diagnostic work up</description>
  </arm_group>
  <arm_group>
    <arm_group_label>Sarcoidosis,</arm_group_label>
    <description>Patients with sarcoidosis who will be having bronchoscopy as part of their clinical diagnostic work up</description>
  </arm_group>
  <intervention>
    <intervention_type>Procedure</intervention_type>
    <intervention_name>Bronchoscopy for Probable Idiopathic Pulmonary Fibrosis and Sarcoidosis</intervention_name>
    <description>Blood samples and Nasosorption sampling</description>
    <arm_group_label>Probable Idiopathic Pulmonary Fibrosis</arm_group_label>
    <arm_group_label>Sarcoidosis,</arm_group_label>
  </intervention>
  <eligibility>
    <study_pop>
      <textblock>
        Patients diagnosed with probable IPF and Sarcoidosis will be included. Patients with&#xD;
        probable IPF and Sarcoidosis will be selected from clinic lists for patients undergoing&#xD;
        bronchoscopy as part of their clinical assessment, and they will be invited to participate&#xD;
        in this study that involves additional sampling for clinical research purposes.&#xD;
&#xD;
        Probable IPF patients must have Usual Interstitial Pneumonitis (UIP) on CT scan and will be&#xD;
        sub classified by gas transfer (DLco corrected for haemoglobin as detailed below;&#xD;
&#xD;
          -  Mild (DLco&gt;60)&#xD;
&#xD;
          -  Moderate (DLco 40-60)&#xD;
&#xD;
          -  Severe (DLco&lt;40)&#xD;
&#xD;
        Healthy volunteers (age/sex matched, non-smoking, without a clinical history of atopy).&#xD;
&#xD;
        The patient populations will include:&#xD;
&#xD;
          -  Probable Idiopathic Pulmonary Fibrosis (IPF), n=30&#xD;
&#xD;
          -  Sarcoidosis patients, n=15&#xD;
&#xD;
          -  Healthy Volunteers n=15&#xD;
      </textblock>
    </study_pop>
    <sampling_method>Non-Probability Sample</sampling_method>
    <criteria>
      <textblock>
        Inclusion Criteria:&#xD;
&#xD;
          -  Inclusion Criteria for Probable Idiopathic Pulmonary Fibrosis (IPF)&#xD;
&#xD;
          -  Adult male or female patients aged 40 to 85 years&#xD;
&#xD;
          -  Women of childbearing age should not be pregnant, planning to get pregnant or&#xD;
             breast-feeding.&#xD;
&#xD;
          -  Command of the English language to be able to give informed consent.&#xD;
&#xD;
          -  Probable IPF requiring bronchoscopy to confirm the diagnosis, agreed within the local&#xD;
             multi-disciplinary team (MDT).,according to the American Thoracic Society/European&#xD;
             Respiratory Society/Japanese Respiratory Society/ American Latin Thoracic Association&#xD;
             (ATS/ERS/JRS/ALAT) guidelines (2018) (3)&#xD;
&#xD;
          -  IPF disease diagnosis within the past 5 years&#xD;
&#xD;
          -  Usual Interstitial Pneumonia (UIP) on HRCT scan.&#xD;
&#xD;
          -  Recent lung function criteria:&#xD;
&#xD;
               -  Forced vital capacity (FVC) &gt;40% of predicted value.&#xD;
&#xD;
               -  Carbon monoxide diffusing lung capacity (DLco) corrected for haemoglobin &gt;30% of&#xD;
                  predicted value&#xD;
&#xD;
        Inclusion criteria for Sarcoidosis&#xD;
&#xD;
          -  Adult male or female patients aged 18 years and over&#xD;
&#xD;
          -  Women of childbearing age should not be pregnant, planning to get pregnant or&#xD;
             breast-feeding.&#xD;
&#xD;
          -  Clinical symptoms, CT scan and biopsy diagnosis of sarcoidosis&#xD;
&#xD;
          -  Patients with lung parenchymal disease and pulmonary stage II or more&#xD;
&#xD;
          -  Recent lung function criteria&#xD;
&#xD;
               -  FVC&gt;50% predicted&#xD;
&#xD;
               -  DLCO &gt;40% predicted&#xD;
&#xD;
        Inclusion criteria for Healthy Volunteers&#xD;
&#xD;
          -  Age between 40 to 85 years, age and sex to match the group with IPF&#xD;
&#xD;
          -  Healthy subjects without any diseases that may cause inflammation&#xD;
&#xD;
          -  Women of childbearing age should not be pregnant, planning to get pregnant or&#xD;
             breast-feeding.&#xD;
&#xD;
          -  Currently non-smokers: see exclusion criteria&#xD;
&#xD;
        Exclusion Criteria:Exclusion Criteria for probable IPF and Sarcoidosis Patients&#xD;
&#xD;
        Respiratory Conditions other than IPF or sarcoidosis:&#xD;
&#xD;
          -  Confirmed diagnosis of occupational lung disease&#xD;
&#xD;
          -  Drug-induced lung disease or hypersensitivity pneumonitis&#xD;
&#xD;
          -  Lung and systemic autoimmune disease including connective tissue disease. Patients&#xD;
             with an auto-immune profile considered diagnostic for a specific connective tissue&#xD;
             disease will be excluded, even in the absence of systemic symptoms. Non-specific rises&#xD;
             in auto antibodies e.g. rheumatoid factor; anti-nuclear antibody etc. will not be used&#xD;
             to exclude individuals from the study.&#xD;
&#xD;
          -  Asbestosis or other asbestos related disease (pleural plaques, mesothelioma, asbestos&#xD;
             pleural effusions)&#xD;
&#xD;
          -  Granulomatous lung disease.&#xD;
&#xD;
          -  Pulmonary artery hypertension (PAH) requiring a specific treatment.&#xD;
&#xD;
          -  Predominant chronic obstructive pulmonary disease (COPD) with forced expiratory volume&#xD;
             in 1 second /forced vital capacity (FEV1/FVC) &lt;0.70.&#xD;
&#xD;
          -  Patients with active tuberculosis or incompletely treated latent tuberculosis&#xD;
             infection&#xD;
&#xD;
          -  Lung cancer&#xD;
&#xD;
          -  Upper respiratory tract infections in the past 6 weeks.&#xD;
&#xD;
        Systemic Conditions&#xD;
&#xD;
          -  History of vasculitis, autoimmune or connective tissue disease&#xD;
&#xD;
          -  Known human immunodeficiency virus (HIV) or chronic viral hepatitis&#xD;
&#xD;
          -  Clinically significant diseases (other than IPF or sarcoidosis) that may alter&#xD;
             respiratory biomarkers: including other respiratory, gastrointestinal, endocrine,&#xD;
             haematological, cardiovascular, genitourinary, skin or neurological diseases.&#xD;
&#xD;
          -  Recent or ongoing malignant diseases.&#xD;
&#xD;
          -  Significant nasal anatomical defects preventing nasal sampling: including hypertrophy&#xD;
             of turbinates, major septum deviation, nasal polyposis or recurrent sinusitis and&#xD;
             nasal mucosal defects&#xD;
&#xD;
        Bronchoscopy Contraindications&#xD;
&#xD;
        Any contra-indication to bronchoscopy as set out in British Thoracic Society guidelines&#xD;
        (34)&#xD;
&#xD;
        Smoking&#xD;
&#xD;
        A detailed smoking history will be taken from all participants: to include total pack&#xD;
        years, smoking in the past year, and smoking in the past 2 weeks.&#xD;
&#xD;
        The history will include cigarettes, pipe smoking, cigars, vaping, and shisha. Any form of&#xD;
        smoking is not permitted within 2 weeks of bronchoscopy.&#xD;
&#xD;
        5.4.2 Exclusion Criteria for Healthy Volunteers&#xD;
&#xD;
          -  Current inflammatory/ immunological conditions. Any clinically significant diseases&#xD;
             that may alter respiratory biomarkers: including respiratory, gastrointestinal,&#xD;
             endocrine, haematological, cardiovascular, genitourinary, skin or neurological&#xD;
             diseases.&#xD;
&#xD;
          -  Recent or ongoing malignant diseases.&#xD;
&#xD;
          -  Significant nasal anatomical defects preventing nasal sampling: including hypertrophy&#xD;
             of turbinates, major septum deviation, nasal polyposis or recurrent sinusitis and&#xD;
             nasal mucosal defects&#xD;
&#xD;
          -  Upper respiratory tract infections in the past 6 weeks.&#xD;
&#xD;
          -  Cigarette smoking:&#xD;
&#xD;
        no cigarettes in the last 2 weeks not more than 10 cigarettes in the past year &lt;10 year&#xD;
        lifetime pack history of smoking&#xD;
&#xD;
        -&#xD;
      </textblock>
    </criteria>
    <gender>All</gender>
    <minimum_age>40 Years</minimum_age>
    <maximum_age>85 Years</maximum_age>
  </eligibility>
  <overall_official>
    <last_name>Melissa Wickremasinghe</last_name>
    <role>Principal Investigator</role>
    <affiliation>Physician</affiliation>
  </overall_official>
  <verification_date>September 2023</verification_date>
  <study_first_submitted>June 9, 2020</study_first_submitted>
  <study_first_submitted_qc>July 29, 2020</study_first_submitted_qc>
  <study_first_posted type="Actual">July 31, 2020</study_first_posted>
  <last_update_submitted>September 13, 2023</last_update_submitted>
  <last_update_submitted_qc>September 13, 2023</last_update_submitted_qc>
  <last_update_posted type="Actual">September 15, 2023</last_update_posted>
  <responsible_party>
    <responsible_party_type>Sponsor</responsible_party_type>
  </responsible_party>
  <condition_browse>
    <!-- CAUTION:  The following MeSH terms are assigned with an imperfect algorithm            -->
    <mesh_term>Pulmonary Fibrosis</mesh_term>
    <mesh_term>Idiopathic Pulmonary Fibrosis</mesh_term>
    <mesh_term>Sarcoidosis</mesh_term>
    <mesh_term>Fibrosis</mesh_term>
  </condition_browse>
  <patient_data>
    <sharing_ipd>No</sharing_ipd>
  </patient_data>
  <provided_document_section>
    <provided_document>
      <document_type>Study Protocol and Statistical Analysis Plan</document_type>
      <document_has_protocol>Yes</document_has_protocol>
      <document_has_icf>No</document_has_icf>
      <document_has_sap>Yes</document_has_sap>
      <document_date>June 8, 2020</document_date>
      <document_url>https://ClinicalTrials.gov/ProvidedDocs/34/NCT04494334/Prot_SAP_000.pdf</document_url>
    </provided_document>
  </provided_document_section>
  <!-- Results have not yet been posted for this study                                          -->
</clinical_study>


download date: ClinicalTrials.gov processed this data on September 20, 2023
link text: Link to the current ClinicalTrials.gov record.
url: https://clinicaltrials.gov/ct2/show/NCT04494334
org study id: 19SM5398
secondary id: 239911
nct id: NCT04494334
lead sponsor: 
collaborator: 
has dmc: No
is fda regulated drug: No
is fda regulated device: No
The study will measure airway inflammation in probable idiopathic pulmonary fibrosis (IPF)
      and sarcoidosis as well as in healthy volunteers. This can help understand the molecular
      basis of these diseases, why these diseases happen, and what makes patients develop lung
      fibrosis. These insights should one day help to monitor patients and aid in their diagnosis
      and treatment.
IPF is a progressive disease caused by irreversible scarring of the lung, and disease
      trajectory is not easily predicted based on clinical measurements. Biomarkers reflective of
      molecular pathways involved in IPF may help inform patient trajectory, but have been
      difficult to identify in circulation due to the disease manifesting in the lung. The study
      team will measure biomarkers from Probable IPF patients, sarcoidosis patients, and healthy
      volunteers using novel sampling methods involving absorption of upper and lower airway
      fluids. These novel sampling methods may enable less invasive and potentially more sensitive
      methods to detect disease activity and will be performed in IPF and sarcoidosis patients
      during a routine bronchoscopy procedure. The study team will compare the levels of biomarkers
      that have been shown to be predictive of disease course in airway fluids of probable IPF
      patients versus sarcoidosis and healthy controls. This study may help understand the
      molecular basis of IPF, and improve the understanding of diagnosis and treatment.
observational model: Cohort
time perspective: Cross-Sectional
measure: Levels of the of biomarker/mediator surfactant protein D (SPD) in bronchial Lining fluid in IPF and sarcoidosis patients
time frame: Baseline Bronchoscopy visit
description: Comparisons will be made of bronchial lining fluid levels of biomarker/mediator surfactant protein D (SPD), in patients with IPF and sarcoidosis.
measure: Levels of the biomarker/mediator CCL18 in bronchial Lining fluid in IPF and sarcoidosis patients.
time frame: Baseline Bronchoscopy visit
description: Comparisons will be made of bronchial lining fluid levels of biomarker/mediator CCL18 in patients with IPF and sarcoidosis
measure: Levels of the biomarker/mediator CXCL13 in bronchial Lining fluid in IPF and sarcoidosis patients.
time frame: Baseline Bronchoscopy visit
description: Comparisons will be made of bronchial lining fluid levels of biomarker/mediator CXCL13 in patients with IPF and sarcoidosis.
measure: Levels of the of biomarker/mediator periostin in bronchial Lining fluid in IPF and sarcoidosis patients.
time frame: Baseline Bronchoscopy visit
description: Comparisons will be made of bronchial lining fluid levels of biomarker/mediator periostin in patients with IPF and sarcoidosis.
measure: Levels of Periostin in nasosorption samples within and across the 3 groups of participants
time frame: Through study completion, an average of 1 year
description: Comparisons will be made of airways levels of biomarker/mediator periostin between patients with IPF and sarcoidosis and health volunteers.
measure: Levels of surfactant protein (SPD) in nasosorption samples within and across the 3 groups
time frame: Through study completion, an average of 1 year
description: Comparisons will be made of airways levels of biomarker/mediator surfactant protein D (SPD) between patients with IPF and sarcoidosis and health volunteers.
measure: Levels of CCL18 in nasosorption samples within and across the 3 groups
time frame: Through study completion, an average of 1 year
description: Comparisons will be made of airways levels of biomarker/mediator CCL18 between patients with IPF and sarcoidosis and health volunteers.
measure: Levels of CXCL13 in nasosorption samples within and across the 3 groups
time frame: Through study completion, an average of 1 year
description: Comparisons will be made of airways levels of biomarker/mediator CXCL13 between patients with IPF and sarcoidosis and health volunteers.
measure: Levels of periostin in blood within and across the 3 groups of participants
time frame: Through study completion, an average of 1 year
description: Comparison will be made of periostin levels in blood with nasosorption and bronchosorption levels across the 3 participant groups.
measure: Levels of surfactant protein D (SPD in blood within and across the 3 groups of participants
time frame: Through study completion, an average of 1 year
description: Comparison will be made of surfactant protein D (SPD levels in blood with nasosorption and bronchosorption levels across the 3 participant groups
measure: Levels of CCL18 in blood within and across the 3 groups of participants
time frame: Through study completion, an average of 1 year
description: Comparison will be made of CCL18 levels in blood with nasosorption and bronchosorption levels across the 3 participant groups.
measure: Levels of CXCL13 in blood within and across the 3 groups of participants
time frame: Through study completion, an average of 1 year
description: Comparison will be made of CXCL13 levels in blood with nasosorption and bronchosorption levels across the 3 participant groups.
arm group label: Healthy Volunteers
description: These will be age matched healthy volunteers (n=15) who will not undergo bronchoscopy
arm group label: Probable Idiopathic Pulmonary Fibrosis
description: Patients with probable IPF, who will be having bronchoscopy as part of their clinical diagnostic work up
arm group label: Sarcoidosis,
description: Patients with sarcoidosis who will be having bronchoscopy as part of their clinical diagnostic work up
intervention type: Procedure
intervention name: Bronchoscopy for Probable Idiopathic Pulmonary Fibrosis and Sarcoidosis
description: Blood samples and Nasosorption sampling
arm group label: Probable Idiopathic Pulmonary Fibrosis
arm group label: Sarcoidosis,
study pop: 
sampling method: Non-Probability Sample
criteria: 
gender: All
minimum age: 40 Years
maximum age: 85 Years
last name: Melissa Wickremasinghe
role: Principal Investigator
affiliation: Physician
responsible party type: Sponsor
mesh term: Pulmonary Fibrosis
mesh term: Idiopathic Pulmonary Fibrosis
mesh term: Sarcoidosis
mesh term: Fibrosis
sharing ipd: No
provided document: 