Kulkarni T, Yuan K, Tran-Nguyen TK, et al. - Researchers examined how BMI changes influence outcome, plasma adipokines, and adaptive immune activation among idiopathic pulmonary fibrosis (IPF) patients. From the University of Pittsburgh, data of an IPF discovery cohort (n = 131) was analyzed, and patients from the University of Alabama at Birmingham (n = 148) were assessed for confirming the findings. They determined plasma adipokines via ELISA and T-cell phenotypes via flow cytometry. Individuals with the greatest rates of BMI decrements vs those with more stable BMI had worse transplant-free 1-year survival in both discovery and replication cohorts, when adjusted for age, baseline BMI, and pulmonary function. Greater mortality after later lung transplantations was observed in correlation with BMI decrements > 0.68%/month. Although correlation exists between circulating leptin and adiponectin levels and BMI, neither adipokine was prognostic per se. Thet noted a significant association of BMI decrements with raised proportions of circulating end-differentiated (CD28null) CD4 T-cells (CD28%), a validated marker of repetitive T-cell activation and IPF prognoses.