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Li Q, Chen Y, Zhang G, Zhang H. Structural analysis of SgvP involved in carbon-sulfur bond formation during griseoviridin biosynthesis. FEBS Lett 2017; 591:1295-1304. [PMID: 28380253 DOI: 10.1002/1873-3468.12643] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 03/29/2017] [Accepted: 03/30/2017] [Indexed: 11/11/2022]
Abstract
Griseoviridin (GV) is a broad-spectrum antibiotic with antibacterial and antifungal activity. In the GV biosynthetic pathway, SgvP catalyzes formation of the carbon-sulfur bond in GV. Herein, we report the recombinant expression and characterization of SgvP from Streptomyces griseoviridis NRRL2427. We also present the 2.6 Å crystal structure of SgvP, which is the first structure of a cytochrome P450 involved in carbon-sulfur bond formation in GV. Structural analysis indicates that Pro237 in the I-helix of SgvP may play a critical role in dioxygen binding and proton transfer during the catalytic cycle. Of the three channels we observed in SgvP, channel 3 may be essential for substrate ingress and egress from the active site, while channels 1 and 2 may be the solvent and water pathway, respectively. DATABASE Coordinate and structure factor were deposited in the Protein Data Bank database under the accession number 4MM0.
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Affiliation(s)
- Qin Li
- College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, Hubei, China.,Key Laboratory of Special Pathogens and Biosafety, Center for Emerging Infectious Diseases, Wuhan Institute of Virology, Chinese Academy of Sciences, Hubei, China
| | - Yan Chen
- Dalian Institute for Food Control, Dalian Food and Drug Administration, Liaoning, China
| | - Guiqin Zhang
- Dainan Senior High School, Taizhou, Jiangsu, China
| | - Huaidong Zhang
- Key Laboratory of Special Pathogens and Biosafety, Center for Emerging Infectious Diseases, Wuhan Institute of Virology, Chinese Academy of Sciences, Hubei, China
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Alam R, Good J, Rollins D, Verma M, Chu H, Pham TH, Martin RJ. Airway and serum biochemical correlates of refractory neutrophilic asthma. J Allergy Clin Immunol 2017; 140:1004-1014.e13. [PMID: 28163052 PMCID: PMC5540819 DOI: 10.1016/j.jaci.2016.12.963] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 11/03/2016] [Accepted: 12/12/2016] [Indexed: 01/22/2023]
Abstract
Background Despite progress in the diagnosis and management of asthma, many patients have poorly controlled or refractory asthma (RA). The mechanism of this RA is not well understood. Objective We sought to explore the relationship between neutrophils and other biomarkers of RA. Method Sixty patients with RA, 30 patients with nonrefractory asthma (NRA), and 20 healthy subjects were enrolled. We performed a comprehensive characterization of these study subjects, which included laboratory and pulmonary function studies, chest computed tomography, and bronchoscopy with bronchoalveolar lavage (BAL). We analyzed BAL fluid and serum for a total of 244 biomolecules using a multiplex assay and correlated them with clinical and other laboratory parameters. Results RA was significantly different from NRA with regard to pulmonary function indices, bronchial basement membrane thickness, and BAL fluid neutrophil and lymphocyte counts but not eosinophil counts. BAL fluid neutrophil counts negatively and positively correlated with forced vital capacity and age, respectively. Of the 244 biomolecules studied, 52 and 14 biomolecules from BAL fluid and serum, respectively, were significantly different among the study groups. Thirteen of these 52 molecules correlated with BAL fluid neutrophil counts. BAL fluid from 40% of patients with RA was positive for a pathogenic microbe. Infection-negative neutrophilic RA was associated with an increase in levels of select biomarkers of inflammation in the serum, suggesting the presence of systemic inflammation. Conclusions RA was associated with increased numbers of neutrophils and proneutrophilic biomolecules in the airways. Subclinical infection was present in 40% of patients with RA, which likely contributed to neutrophilic inflammation. A subgroup of patients with noninfected neutrophilic RA was associated with systemic inflammation.
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Affiliation(s)
- Rafeul Alam
- Department of Medicine, National Jewish Health, Denver, Colo.
| | - James Good
- Department of Medicine, National Jewish Health, Denver, Colo
| | - Donald Rollins
- Department of Medicine, National Jewish Health, Denver, Colo
| | - Mukesh Verma
- Department of Medicine, National Jewish Health, Denver, Colo
| | - HongWei Chu
- Department of Medicine, National Jewish Health, Denver, Colo
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Shaulov A, Ganzel C, Benyamini N, Barshay Y, Goldschmidt N, Lavie D, Libster D, Gural A, Avni B, Gatt ME. Progressive refractory light chain amyloidosis and multiple myeloma patients are responsive to the addition of clarithromycin to IMiD based therapy. Am J Hematol 2017; 92:131-135. [PMID: 27804150 DOI: 10.1002/ajh.24596] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Revised: 10/20/2016] [Accepted: 10/27/2016] [Indexed: 11/09/2022]
Abstract
Multiple myeloma (MM) and primary systemic light chain amyloidosis (AL) are both chronic plasma cell dyscrasias with different clinical expression but limited treatment options for relapsed refractory disease. We report the effect of the addition of clarithromycin on 31 MM and 17 AL with relapsed or refractory disease who had an insufficient response or disease progression while on an IMiD based therapy. In this high risk population, hematological response was reported in 48% of MM patients and 94% of AL patients. Responses were reported early in both groups (median 35 days) and were more sustained in AL patients. Adverse events were common and included mostly grade 1-2 fatigue, infections and abdominal discomfort. Cytopenias were common and cardiac complications were rare in both MM and AL patients. Clarithromycin-IMiD combination therapy appears to be both effective and safe in progressive MM and primarily in AL patients, although a prospective clinical trial is warranted to validate these results. Am. J. Hematol. 92:131-135, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Adir Shaulov
- Department of Hematology; Hadassah Hebrew University Medical Center; Jerusalem Israel
| | - Chezi Ganzel
- Department of Hematology; Shaare-Zedek Medical Center; Jerusalem Israel
| | - Noam Benyamini
- Department of Hematology; Rambam Medical Center; Haifa Israel
| | | | - Neta Goldschmidt
- Department of Hematology; Hadassah Hebrew University Medical Center; Jerusalem Israel
| | - David Lavie
- Department of Hematology; Hadassah Hebrew University Medical Center; Jerusalem Israel
| | - Diana Libster
- Department of Hematology; Hadassah Hebrew University Medical Center; Jerusalem Israel
| | - Alex Gural
- Department of Hematology; Hadassah Hebrew University Medical Center; Jerusalem Israel
| | - Batia Avni
- Department of Hematology; Hadassah Hebrew University Medical Center; Jerusalem Israel
| | - Moshe E. Gatt
- Department of Hematology; Hadassah Hebrew University Medical Center; Jerusalem Israel
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Asthma Yardstick. Ann Allergy Asthma Immunol 2017; 118:133-142.e3. [DOI: 10.1016/j.anai.2016.12.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 12/14/2016] [Accepted: 12/15/2016] [Indexed: 01/13/2023]
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Choi Y, Park H, Park HS, Kim YK. Extracellular Vesicles, a Key Mediator to Link Environmental Microbiota to Airway Immunity. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2017; 9:101-106. [PMID: 28102054 PMCID: PMC5266118 DOI: 10.4168/aair.2017.9.2.101] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 09/21/2016] [Accepted: 09/23/2016] [Indexed: 12/27/2022]
Abstract
Asthma is considered the hallmark of chronic airway inflammation, in which several inflammatory cells of the innate and adaptive immune system act together. The disease is thought to be caused by a combination of genetic and environmental factors; however, precise mechanisms for airway inflammation remain unclear. The human microbiota provides an increasingly favored explanation for inflammatory diseases; an altered microbiota composition has been shown to regulate immune responses. However, given the complexity of the microbiota, additional research is needed to elucidate its role in the development of disease. One of the candidate molecules that link microbiota to disease is the extracellular vesicles (EVs). EVs are secreted by diverse cell types and they possess the pathophysiological function of delivering signals between bacteria and host. We discuss the role of the microbiota in the development of asthma through releasing EVs.
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Affiliation(s)
- Youngwoo Choi
- Department of Allergy and Clinical Immunology, Ajou University Medical Center, Suwon, Korea
| | - Hanki Park
- Department of Allergy and Clinical Immunology, Ajou University Medical Center, Suwon, Korea
| | - Hae Sim Park
- Department of Allergy and Clinical Immunology, Ajou University Medical Center, Suwon, Korea.
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Porter JD, Watson J, Roberts LR, Gill SK, Groves H, Dhariwal J, Almond MH, Wong E, Walton RP, Jones LH, Tregoning J, Kilty I, Johnston SL, Edwards MR. Identification of novel macrolides with antibacterial, anti-inflammatory and type I and III IFN-augmenting activity in airway epithelium. J Antimicrob Chemother 2016; 71:2767-81. [PMID: 27494903 PMCID: PMC5031920 DOI: 10.1093/jac/dkw222] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 05/04/2016] [Accepted: 05/09/2016] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Exacerbations of asthma and COPD are triggered by rhinoviruses. Uncontrolled inflammatory pathways, pathogenic bacterial burden and impaired antiviral immunity are thought to be important factors in disease severity and duration. Macrolides including azithromycin are often used to treat the above diseases, but exhibit variable levels of efficacy. Inhaled corticosteroids are also readily used in treatment, but may lack specificity. Ideally, new treatment alternatives should suppress unwanted inflammation, but spare beneficial antiviral immunity. METHODS In the present study, we screened 225 novel macrolides and tested them for enhanced antiviral activity against rhinovirus, as well as anti-inflammatory activity and activity against Gram-positive and Gram-negative bacteria. Primary bronchial epithelial cells were grown from 10 asthmatic individuals and the effects of macrolides on rhinovirus replication were also examined. Another 30 structurally similar macrolides were also examined. RESULTS The oleandomycin derivative Mac5, compared with azithromycin, showed superior induction (up to 5-fold, EC50 = 5-11 μM) of rhinovirus-induced type I IFNβ, type III IFNλ1 and type III IFNλ2/3 mRNA and the IFN-stimulated genes viperin and MxA, yet had no effect on IL-6 and IL-8 mRNA. Mac5 also suppressed rhinovirus replication at 48 h, proving antiviral activity. Mac5 showed antibacterial activity against Gram-positive Streptococcus pneumoniae; however, it did not have any antibacterial properties compared with azithromycin when used against Gram-negative Escherichia coli (as a model organism) and also the respiratory pathogens Pseudomonas aeruginosa and non-typeable Haemophilus influenzae. Further non-toxic Mac5 derivatives were identified with various anti-inflammatory, antiviral and antibacterial activities. CONCLUSIONS The data support the idea that macrolides have antiviral properties through a mechanism that is yet to be ascertained. We also provide evidence that macrolides can be developed with anti-inflammatory, antibacterial and antiviral activity and show surprising versatility depending on the clinical need.
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Affiliation(s)
- James D Porter
- Airway Disease Infection Section, National Heart Lung Institute, Imperial College London, London, UK MRC & Asthma UK Centre for Allergic Mechanisms of Asthma, London, UK
| | - Jennifer Watson
- Airway Disease Infection Section, National Heart Lung Institute, Imperial College London, London, UK
| | | | - Simren K Gill
- Mucosal Infection and Immunity Group, Section of Virology, Imperial College London, London, UK
| | - Helen Groves
- Mucosal Infection and Immunity Group, Section of Virology, Imperial College London, London, UK
| | - Jaideep Dhariwal
- Airway Disease Infection Section, National Heart Lung Institute, Imperial College London, London, UK MRC & Asthma UK Centre for Allergic Mechanisms of Asthma, London, UK
| | - Mark H Almond
- Airway Disease Infection Section, National Heart Lung Institute, Imperial College London, London, UK MRC & Asthma UK Centre for Allergic Mechanisms of Asthma, London, UK
| | - Ernie Wong
- Airway Disease Infection Section, National Heart Lung Institute, Imperial College London, London, UK MRC & Asthma UK Centre for Allergic Mechanisms of Asthma, London, UK
| | - Ross P Walton
- Airway Disease Infection Section, National Heart Lung Institute, Imperial College London, London, UK MRC & Asthma UK Centre for Allergic Mechanisms of Asthma, London, UK
| | | | - John Tregoning
- Mucosal Infection and Immunity Group, Section of Virology, Imperial College London, London, UK
| | | | - Sebastian L Johnston
- Airway Disease Infection Section, National Heart Lung Institute, Imperial College London, London, UK MRC & Asthma UK Centre for Allergic Mechanisms of Asthma, London, UK
| | - Michael R Edwards
- Airway Disease Infection Section, National Heart Lung Institute, Imperial College London, London, UK MRC & Asthma UK Centre for Allergic Mechanisms of Asthma, London, UK
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Liu W, Liu S, Verma M, Zafar I, Good JT, Rollins D, Groshong S, Gorska MM, Martin RJ, Alam R. Mechanism of T H2/T H17-predominant and neutrophilic T H2/T H17-low subtypes of asthma. J Allergy Clin Immunol 2016; 139:1548-1558.e4. [PMID: 27702673 DOI: 10.1016/j.jaci.2016.08.032] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 07/25/2016] [Accepted: 08/16/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND The mechanism of TH2/TH17-predominant and TH2/TH17-low asthma is unknown. OBJECTIVE We sought to study the immune mechanism of TH2/TH17-predominant and TH2/TH17-low asthma. METHODS In a previously reported cohort of 60 asthmatic patients, 16 patients were immunophenotyped with TH2/TH17-predominant asthma and 22 patients with TH2/TH17-low asthma. We examined bronchoalveolar lavage (BAL) fluid leukocytes, cytokines, mediators, and epithelial cell function for these asthma subgroups. RESULTS Patients with TH2/TH17-predominant asthma had increased IL-1β, IL-6, IL-23, C3a, and serum amyloid A levels in BAL fluid, and these correlated with IL-1β and C3a levels. TH2/TH17 cells expressed higher levels of the IL-1 receptor and phospho-p38 mitogen-activated protein kinase. Anakinra, an IL-1 receptor antagonist protein, inhibited BAL TH2/TH17 cell counts. TH2/TH17-low asthma had 2 distinct subgroups: neutrophilic asthma (45%) and pauci-inflammatory asthma (55%). This contrasted with patients with TH2/TH17-predominant and TH2-predominant asthma, which included neutrophilic asthma in 6% and 0% of patients, respectively. BAL fluid neutrophils strongly correlated with BAL fluid myeloperoxidase, IL-8, IL-1α, IL-6, granulocyte colony-stimulating factor, and GM-CSF levels. Sixty percent of the patients with neutrophilic asthma had a pathogenic microorganism in BAL culture, which suggested a subclinical infection. CONCLUSION We uncovered a critical role for the IL-1β pathway in patients with TH2/TH17-predminant asthma. A subgroup of patients with TH2/TH17-low asthma had neutrophilic asthma and increased BAL fluid IL-1α, IL-6, IL-8, granulocyte colony-stimulating factor, and GM-CSF levels. IL-1α was directly involved in IL-8 production and likely contributed to neutrophilic asthma. Sixty percent of neutrophilic patients had a subclinical infection.
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Affiliation(s)
- Weimin Liu
- Department of Medicine, Division of Allergy & Immunology, and Division of Pulmonary and Critical Care Medicine, National Jewish Health, Denver, Colo
| | - Sucai Liu
- Department of Medicine, Division of Allergy & Immunology, and Division of Pulmonary and Critical Care Medicine, National Jewish Health, Denver, Colo
| | - Mukesh Verma
- Department of Medicine, Division of Allergy & Immunology, and Division of Pulmonary and Critical Care Medicine, National Jewish Health, Denver, Colo
| | - Iram Zafar
- Department of Medicine, Division of Allergy & Immunology, and Division of Pulmonary and Critical Care Medicine, National Jewish Health, Denver, Colo
| | - James T Good
- Department of Medicine, Division of Allergy & Immunology, and Division of Pulmonary and Critical Care Medicine, National Jewish Health, Denver, Colo; School of Medicine, University of Colorado Denver, Denver, Colo
| | - Donald Rollins
- Department of Medicine, Division of Allergy & Immunology, and Division of Pulmonary and Critical Care Medicine, National Jewish Health, Denver, Colo; School of Medicine, University of Colorado Denver, Denver, Colo
| | - Stephen Groshong
- Department of Medicine, Division of Allergy & Immunology, and Division of Pulmonary and Critical Care Medicine, National Jewish Health, Denver, Colo; School of Medicine, University of Colorado Denver, Denver, Colo
| | - Magdalena M Gorska
- Department of Medicine, Division of Allergy & Immunology, and Division of Pulmonary and Critical Care Medicine, National Jewish Health, Denver, Colo; School of Medicine, University of Colorado Denver, Denver, Colo
| | - Richard J Martin
- Department of Medicine, Division of Allergy & Immunology, and Division of Pulmonary and Critical Care Medicine, National Jewish Health, Denver, Colo; School of Medicine, University of Colorado Denver, Denver, Colo
| | - Rafeul Alam
- Department of Medicine, Division of Allergy & Immunology, and Division of Pulmonary and Critical Care Medicine, National Jewish Health, Denver, Colo; School of Medicine, University of Colorado Denver, Denver, Colo.
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Soyer O, Ozen C, Cavkaytar O, Senyücel C, Dallar Y. Right middle lobe atelectasis in children with asthma and prognostic factors. Allergol Int 2016; 65:253-8. [PMID: 26806056 DOI: 10.1016/j.alit.2015.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 12/08/2015] [Accepted: 12/09/2015] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Although right middle lobe (RML)-atelectasis of the lungs is a common complication of asthma, the relevant data is limited. The aim of this study is to define the characteristics of RML atelectasis in asthma during childhood. METHODS Children with asthma who had recently developed RML atelectasis were included; anti-inflammatory medications, clarithromycin, and inhaled salbutamol were prescribed, chest-physiotherapy (starting on the sixth day) was applied. Patients were reevaluated on the sixth, fourteenth, thirtieth, and ninetieth days, chest X-rays were taken if the atelectasis had not resolved at the time of the previous visit. RESULTS Twenty-seven patients (6.8 (4.8-8.3) years, 48.1% male) with RML atelectasis were included. Symptoms started 15 (7-30) days before admission. The thickness of the atelectasis was 11.8 ± 5.8 mm; FEV1% was 75.9 ± 14.2 and Childhood Asthma Control Test scores were 11.8 ± 5.6 at the time of admission. The atelectasis had been resolved by the sixth (n = 3), fourteenth (n = 9), thirtieth (n = 10), and ninetieth days (n = 3). The treatment response of the patients whose atelectasis resolved in fourteen days was better on the sixth-day (atelectasis thickness: 4.7 ± 1.7 vs. 11.9 ± 7.3 mm, p = 0.021) compared to those whose atelectasis resolved later. Nearly half (54.5%) of the patients whose atelectasis had resolved by fourteen days were using controller medications at the time of admission. However, only two patients (13.3%) were on controller treatment in the latter group (p = 0.032). Regression analysis didn't reveal any prognostic factors for the early resolution of atelectasis. CONCLUSIONS Early diagnosis and treatment of RML atelectasis prevents complications. Patients who had early resolution of atelectasis had already been on anti-inflammatory medications, and responded better to aggressive treatment within the first week.
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Calhoun KH. Asthma treatments: new and emerging therapies. Int Forum Allergy Rhinol 2016; 5 Suppl 1:S76-81. [PMID: 26335840 DOI: 10.1002/alr.21611] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 06/25/2015] [Accepted: 06/30/2015] [Indexed: 01/05/2023]
Abstract
BACKGROUND As part of this primer, this article is intended to introduce new and emerging therapies for treating asthma. METHODS A PubMed search was performed for the years 2013 through 2015 for asthma review, asthma treatment, asthma therapy, and asthma new. Subset searches were additionally performed as suggested by information contained in the first round of searches. RESULTS There is continuing work toward the identification of additional cellular and molecular mechanisms of asthma. Many of these suggest additional targets for therapy. New pharmaceuticals, biologics, and procedures are reviewed in greater depth. CONCLUSION This is a summary of new and emerging asthma therapies.
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Affiliation(s)
- Karen H Calhoun
- Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center, University of Ohio, Columbus, OH
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Bronchial thermoplasty and biological therapy as targeted treatments for severe uncontrolled asthma. THE LANCET RESPIRATORY MEDICINE 2016; 4:585-592. [PMID: 27230825 DOI: 10.1016/s2213-2600(16)30018-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 03/08/2016] [Accepted: 03/15/2016] [Indexed: 01/08/2023]
Abstract
Although a small proportion of patients with asthma have severe disease, it accounts for the majority of morbidity related to the illness. Severe asthma comprises a heterogeneous group of phenotypes. Targeted treatments for these phenotypes represent a major advancement in the management of severe asthma. Omalizumab, a monoclonal antibody to IgE, improves asthma control in patients with a predominant allergic phenotype. Monoclonal antibodies targeted to interleukin 4α and interleukin 5 have shown substantial benefit in patients with the eosinophilic asthma phenotype; so too have monoclonal antibodies targeted to interleukin 13 in patients with a type 2 allergic phenotype. Bronchial thermoplasty, a new technique to reduce airway smooth muscle mass, improves symptoms and reduces exacerbations in patients with severe uncontrolled asthma and the chronic airflow obstruction phenotype. While awaiting comparative trials, we can now use a targeted approach with these phenotypes, guiding our treatment selection with the best evidence. This Review will focus on the latest developments in these new treatments and inform the clinician on how to select the appropriate patient for these treatments.
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Postma DS, Weiss ST, van den Berge M, Kerstjens HAM, Koppelman GH. Revisiting the Dutch hypothesis. J Allergy Clin Immunol 2015; 136:521-9. [PMID: 26343936 DOI: 10.1016/j.jaci.2015.06.018] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 06/02/2015] [Accepted: 06/03/2015] [Indexed: 12/20/2022]
Abstract
The Dutch hypothesis was first articulated in 1961, when many novel and advanced scientific techniques were not available, such as genomics techniques for pinpointing genes, gene expression, lipid and protein profiles, and the microbiome. In addition, computed tomographic scans and advanced analysis techniques to dissect (small) airways disease and emphysema were not available. At that time, the group of researchers under the visionary guidance of Professor N. G. M. Orie put forward that both genetic and environmental factors can determine whether one would have airway obstructive diseases, such as asthma and chronic obstructive pulmonary disease (COPD). Moreover, they stipulated that the phenotype of obstructive airway disease could be affected by sex and changes with aging. Orie and colleagues' call to carefully phenotype patients with obstructive airways diseases has been adopted by many current researchers in an attempt to determine the heterogeneity of both asthma and COPD to better define these diseases and optimize their treatment. The founders of the Dutch hypothesis were far ahead of their time, and we can learn from their insights. We should fully characterize all patients in our clinical practice and not just state that they have asthma, COPD, or asthma and COPD overlap syndrome. This detailed phenotyping can help in understanding these obstructive airway diseases and provide guidance for disease management.
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Affiliation(s)
- Dirkje S Postma
- University of Groningen, Department of Pulmonology, University Medical Center Groningen, Groningen, The Netherlands; University of Groningen, GRIAC Research Institute, University Medical Center Groningen, Groningen, The Netherlands.
| | - Scott T Weiss
- Channing Division of Network Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, Mass
| | - Maarten van den Berge
- University of Groningen, Department of Pulmonology, University Medical Center Groningen, Groningen, The Netherlands; University of Groningen, GRIAC Research Institute, University Medical Center Groningen, Groningen, The Netherlands
| | - Huib A M Kerstjens
- University of Groningen, Department of Pulmonology, University Medical Center Groningen, Groningen, The Netherlands; University of Groningen, GRIAC Research Institute, University Medical Center Groningen, Groningen, The Netherlands
| | - Gerard H Koppelman
- University of Groningen, GRIAC Research Institute, University Medical Center Groningen, Groningen, The Netherlands; University of Groningen, University Medical Center Groningen, and the Department of Pediatric Pulmonology and Pediatric Allergology, Beatrix Children's Hospital, Groningen, The Netherlands
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Saglani S, Lloyd CM. Novel concepts in airway inflammation and remodelling in asthma. Eur Respir J 2015; 46:1796-804. [PMID: 26541520 DOI: 10.1183/13993003.01196-2014] [Citation(s) in RCA: 114] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 08/25/2015] [Indexed: 02/03/2023]
Abstract
The hallmark pathological features of asthma include airway eosinophilic inflammation and structural changes (remodelling) which are associated with an irreversible loss in lung function that tracks from childhood to adulthood. In parallel with changes in function, pathological abnormalities occur early, during the pre-school years, are established by school age and subsequently remain (even though symptoms may remit for periods during adulthood). Given the equal importance of inflammation and remodelling in asthma pathogenesis, there is a significant disparity in studies undertaken to investigate the contribution of each. The majority focus on the role of inflammation, and although novel therapeutics such as those targeted against T-helper cell type 2 (Th2) mediators have arisen, it is apparent that targeting inflammation alone has not allowed disease modification. Therefore, unless airway remodelling is addressed for future therapeutic strategies, it is unlikely that we will progress towards a cure for asthma. Having acknowledged these limitations, the focus of this review is to highlight the gaps in our current knowledge about the mechanisms underlying airway remodelling, the relationships between remodelling, inflammation and function, remodelling and clinical phenotypes, and the importance of utilising innovative and realistic pre-clinical models to uncover effective, disease-modifying therapeutic strategies.
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Affiliation(s)
- Sejal Saglani
- Inflammation, Repair and Development Section, National Heart & Lung Institute, Imperial College London, London, UK Dept of Respiratory Paediatrics, Royal Brompton Hospital, London, UK
| | - Clare M Lloyd
- Inflammation, Repair and Development Section, National Heart & Lung Institute, Imperial College London, London, UK
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Čikoš A, Ćaleta I, Žiher D, Vine MB, Elenkov IJ, Dukši M, Gembarovski D, Ilijaš M, Dragojević S, Malnar I, Alihodžić S. Structure and conformational analysis of spiroketals from 6-O-methyl-9(E)-hydroxyiminoerythronolide A. Beilstein J Org Chem 2015; 11:1447-57. [PMID: 26425201 PMCID: PMC4578343 DOI: 10.3762/bjoc.11.157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 07/23/2015] [Indexed: 11/23/2022] Open
Abstract
Three novel spiroketals were prepared by a one-pot transformation of 6-O-methyl-9(E)-hydroxyiminoerythronolide A. We present the formation of a [4.5]spiroketal moiety within the macrolide lactone ring, but also the unexpected formation of a 10-C=11-C double bond and spontaneous change of stereochemistry at position 8-C. As a result, a thermodynamically stable structure was obtained. The structures of two new diastereomeric, unsaturated spiroketals, their configurations and conformations, were determined by means of NMR spectroscopy and molecular modelling. The reaction kinetics and mechanistic aspects of this transformation are discussed. These rearrangements provide a facile synthesis of novel macrolide scaffolds.
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Affiliation(s)
- Ana Čikoš
- GlaxoSmithKline Research Centre Zagreb Ltd, Prilaz baruna Filipovića 29, 10000 Zagreb, Croatia
| | - Irena Ćaleta
- GlaxoSmithKline Research Centre Zagreb Ltd, Prilaz baruna Filipovića 29, 10000 Zagreb, Croatia
| | - Dinko Žiher
- GlaxoSmithKline Research Centre Zagreb Ltd, Prilaz baruna Filipovića 29, 10000 Zagreb, Croatia
| | - Mark B Vine
- GlaxoSmithKline, New Frontiers Science Park, Harlow, CM19 5AW, United Kingdom
| | - Ivaylo J Elenkov
- GlaxoSmithKline Research Centre Zagreb Ltd, Prilaz baruna Filipovića 29, 10000 Zagreb, Croatia
| | - Marko Dukši
- GlaxoSmithKline Research Centre Zagreb Ltd, Prilaz baruna Filipovića 29, 10000 Zagreb, Croatia
| | - Dubravka Gembarovski
- GlaxoSmithKline Research Centre Zagreb Ltd, Prilaz baruna Filipovića 29, 10000 Zagreb, Croatia
| | - Marina Ilijaš
- GlaxoSmithKline Research Centre Zagreb Ltd, Prilaz baruna Filipovića 29, 10000 Zagreb, Croatia
| | - Snježana Dragojević
- GlaxoSmithKline Research Centre Zagreb Ltd, Prilaz baruna Filipovića 29, 10000 Zagreb, Croatia
| | - Ivica Malnar
- GlaxoSmithKline Research Centre Zagreb Ltd, Prilaz baruna Filipovića 29, 10000 Zagreb, Croatia
| | - Sulejman Alihodžić
- GlaxoSmithKline Research Centre Zagreb Ltd, Prilaz baruna Filipovića 29, 10000 Zagreb, Croatia
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van Buul AR, Taube C. Treatment of severe asthma: entering the era of targeted therapy. Expert Opin Biol Ther 2015; 15:1713-25. [PMID: 26331583 DOI: 10.1517/14712598.2015.1084283] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION It is estimated that 5 - 10% of asthma patients suffer from severe asthma. Severe asthma is associated with increased morbidity and mortality. These patients are not controlled with currently available treatments and therefore additional treatment options are needed. Asthma is a heterogeneous disease, and different asthma patient groups probably have different underlying pathophysiology. Novel therapies with, for example, monoclonal antibodies that target certain immunological pathways have become available. These novel treatments are not effective in all patients but only in certain phenotypes. AREAS COVERED This review covers the current evidence and novel developments in treatment with monoclonal antibodies in different asthma phenotypes. This includes monoclonal antibodies against IgE, against interleukin (IL)-5 and antibodies targeting IL-13 pathways. Although there is a certain overlap between patient groups benefiting from these treatments, a more detailed identification of responder profiles for these therapies is needed for personalized therapy. EXPERT OPINION In recent years, novel monoclonal antibodies have been developed, which are a promising addition to existing therapy in the treatment of severe asthma with eosinophilic inflammation and Th2-driven disease. We expect that several of the new antibodies will become available for clinical practice. In addition, it must be acknowledged that so far no effective strategies are available for patients with non-eosinophilic asthma and further research and development is necessary for this patient group.
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Affiliation(s)
- Amanda R van Buul
- a Leiden University Medical Center, Department of Pulmonology , Leiden, The Netherlands +31 7 15 26 29 50 ; +31 7 15 26 69 27 ;
| | - Christian Taube
- a Leiden University Medical Center, Department of Pulmonology , Leiden, The Netherlands +31 7 15 26 29 50 ; +31 7 15 26 69 27 ;
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Kazama I, Tamada T, Tachi M. Usefulness of targeting lymphocyte Kv1.3-channels in the treatment of respiratory diseases. Inflamm Res 2015. [PMID: 26206235 DOI: 10.1007/s00011-015-0855-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
T lymphocytes predominantly express delayed rectifier K(+)-channels (Kv1.3) in their plasma membranes. Patch-clamp studies revealed that the channels play crucial roles in facilitating the calcium influx necessary to trigger lymphocyte activation and proliferation. Using selective channel inhibitors in experimental animal models, in vivo studies further revealed the clinically relevant relationship between the channel expression and the development of chronic respiratory diseases, in which chronic inflammation or the overstimulation of cellular immunity in the airways is responsible for the pathogenesis. In chronic respiratory diseases, such as chronic obstructive pulmonary disease, asthma, diffuse panbronchiolitis and cystic fibrosis, in addition to the supportive management for the symptoms, the anti-inflammatory effects of macrolide antibiotics were shown to be effective against the over-activation or proliferation of T lymphocytes. Recently, we provided physiological and pharmacological evidence that macrolide antibiotics, together with calcium channel blockers, HMG-CoA reductase inhibitors, and nonsteroidal anti-inflammatory drugs, effectively suppress the Kv1.3-channel currents in lymphocytes, and thus exert anti-inflammatory or immunomodulatory effects. In this review article, based on the findings obtained from recent in vivo and in vitro studies, we address the novel therapeutic implications of targeting the lymphocyte Kv1.3-channels for the treatment of chronic or acute respiratory diseases.
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Affiliation(s)
- Itsuro Kazama
- Department of Physiology I, Tohoku University Graduate School of Medicine, Seiryo-cho, Aoba-ku, Sendai, Miyagi, Japan.
| | - Tsutomu Tamada
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Masahiro Tachi
- Department of Plastic and Reconstructive Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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Earl CS, An SQ, Ryan RP. The changing face of asthma and its relation with microbes. Trends Microbiol 2015; 23:408-18. [PMID: 25840766 PMCID: PMC4710578 DOI: 10.1016/j.tim.2015.03.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 02/27/2015] [Accepted: 03/09/2015] [Indexed: 12/21/2022]
Abstract
During the past 50 years, the prevalence of asthma has increased and this has coincided with our changing relation with microorganisms. Asthma is a complex disease associated with local tissue inflammation of the airway that is determined by environmental, immunological, and host genetic factors. In a subgroup of sufferers, respiratory infections are associated with the development of chronic disease and more frequent inflammatory exacerbations. Recent studies suggest that these infections are polymicrobial in nature. Furthermore, there is increasing evidence that the recently discovered asthma airway microbiota may play a critical role in pathophysiological processes associated with the disease. Here, we discuss the current data regarding a possible role for infection in chronic asthma with a particular focus on the role bacteria may play. We discuss recent advances that are beginning to elucidate the complex relations between the microbiota and the immune response in asthma patients. We also highlight the clinical implications of these recent findings in regards to the development of novel therapeutic strategies.
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Affiliation(s)
- Chris S Earl
- Division of Molecular Microbiology, College of Life Sciences, University of Dundee, Dundee, UK
| | - Shi-qi An
- Division of Molecular Microbiology, College of Life Sciences, University of Dundee, Dundee, UK
| | - Robert P Ryan
- Division of Molecular Microbiology, College of Life Sciences, University of Dundee, Dundee, UK.
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Abstract
Azithromycin is a broad-spectrum macrolide antibiotic with a long half-life and excellent tissue penetration. It is primarily used for the treatment of respiratory, enteric and genitourinary infections and may be used in preference to other macrolides for some sexually transmitted and enteric infections. Azithromycin has additional immunomodulatory effects and has been used in chronic respiratory inflammatory diseases for this purpose. Potential major adverse effects include cardiovascular arrhythmias and hearing loss. Macrolide resistance is also a problem, as are interactions with commonly prescribed drugs.
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The microbiome in asthma. J Allergy Clin Immunol 2015; 135:25-30. [PMID: 25567040 DOI: 10.1016/j.jaci.2014.11.011] [Citation(s) in RCA: 187] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 10/31/2014] [Accepted: 11/04/2014] [Indexed: 12/27/2022]
Abstract
The application of recently developed sensitive, specific, culture-independent tools for identification of microbes is transforming concepts of microbial ecology, including concepts of the relationships between the vast complex populations of microbes associated with ourselves and with states of health and disease. Although most work initially focused on the community of microbes (microbiome) in the gastrointestinal tract and its relationship to gastrointestinal disease, interest has expanded to include study of the relationships of the airway microbiome to asthma and its phenotypes and to the relationships between the gastrointestinal microbiome, development of immune function, and predisposition to allergic sensitization and asthma. Here we provide our perspective on the findings of studies of differences in the airway microbiome between asthmatic patients and healthy subjects and of studies of relationships between environmental microbiota, gut microbiota, immune function, and asthma development. In addition, we provide our perspective on how these findings suggest the broad outline of a rationale for approaches involving directed manipulation of the gut and airway microbiome for the treatment and prevention of allergic asthma.
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Abstract
Although the symptom complex we call asthma has been well described since antiquity, our understanding of the causes and therapy of asthma has evolved. Even with this evolution in our understanding, there are persistent myths (widely held but false beliefs) and dogma (entrenched beliefs) regarding the causes, classification, and therapy of asthma. It is sobering that some of the knowledge we hold dear today, will become the mythology of tomorrow.
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Affiliation(s)
- Bruce K Rubin
- Department of Pediatrics, Virginia Commonwealth University School of Medicine, Children's Hospital of Richmond at VCU, Virginia, United States.
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Patel M, Shaw D. A review of standard pharmacological therapy for adult asthma – Steps 1 to 5. Chron Respir Dis 2015; 12:165-76. [PMID: 25711467 DOI: 10.1177/1479972315573529] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The aim of pharmacological therapy for asthma is to improve symptoms and lung function and minimize the risk of asthma attacks. The intensity of treatment is based on the level of asthma control and the potential risk of future deterioration. In the British asthma guidelines, treatments are divided into steps 1 to 5, with each step signifying a need for an increase in therapy in response to symptoms or to prevent exacerbations. Treatments comprise of inhaled or systemic medications. Inhaled therapy includes short-acting and long-acting medication to improve symptoms and inhaled corticosteroids that reduce airway inflammation. Systemic treatments include medications that act on specific biological pathways, such as the leukotriene or immunoglobulin E pathways, or systemic corticosteroids. In choosing a particular therapy, treatment benefits are balanced by the potential risks of medication-related adverse effects. This review will provide a practical guide to the key pharmacological therapies for adult asthma at steps 1 to 5 based on British guidelines and consider future options for new treatments.
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Affiliation(s)
- Mitesh Patel
- Nottingham Respiratory Research Unit, Division of Respiratory Medicine, School of Medicine, University of Nottingham, Nottingham City Hospital, Nottingham, UK
| | - Dominick Shaw
- Nottingham Respiratory Research Unit, Division of Respiratory Medicine, School of Medicine, University of Nottingham, Nottingham City Hospital, Nottingham, UK
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Guidelines for severe uncontrolled asthma. Arch Bronconeumol 2015; 51:235-46. [PMID: 25677358 DOI: 10.1016/j.arbres.2014.12.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Revised: 12/02/2014] [Accepted: 12/06/2014] [Indexed: 01/29/2023]
Abstract
Since the publication, 9 years ago, of the latest SEPAR (Spanish Society of Pulmonology and Thoracic Surgery) Guidelines on Difficult-to-Control Asthma (DCA), much progress has been made in the understanding of asthmatic disease. These new data need to be reviewed, analyzed and incorporated into the guidelines according to their level of evidence and recommendation. Recently, consensus documents and clinical practice guidelines (CPG) addressing this issue have been published. In these guidelines, specific mention will be made of what the previous DCA guidelines defined as "true difficult-to-control asthma". This is asthma that remains uncontrolled after diagnosis and a systematic evaluation to rule out factors unrelated to the disease itself that lead to poor control ("false difficult-to-control asthma"), and despite an appropriate treatment strategy (Spanish Guidelines for the Management of Asthma [GEMA] steps 5 and 6): severe uncontrolled asthma. In this respect, the guidelines propose a revised definition, an attempt to classify the various manifestations of this type of asthma, a proposal for a stepwise diagnostic procedure, and phenotype-targeted treatment. A specific section has also been included on DCA in childhood, aimed at assisting healthcare professionals to improve the care of these patients.
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