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Gelfand EW, Schedel M. Molecular Endotypes Contribute to the Heterogeneity of Asthma. Immunol Allergy Clin North Am 2018; 38:655-665. [PMID: 30342586 DOI: 10.1016/j.iac.2018.06.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Diagnosis and management of asthma is commonly implemented based on clinical assessment. Although these nonmolecular biomarkers have been useful, limited resolution of the heterogeneity among asthmatic patients and little information regarding the underlying pathobiology of disease in individuals have been provided. Molecular endotying using global transcriptome expression profiling associated with clinical features of asthma has improved our understanding of disease mechanisms, risk assessment of asthma exacerbations, and treatment responses, especially in patients with type 2 inflammation. Further advances in establishing pathobiological subgroups, bioactive pathways, and true disease endotypes hold potential for a more personalized medical approach in asthmatic patients.
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Affiliation(s)
- Erwin W Gelfand
- Division of Cell Biology, Department of Pediatrics, National Jewish Health, 1400 Jackson Street, Denver, CO 80206, USA
| | - Michaela Schedel
- Division of Cell Biology, Department of Pediatrics, National Jewish Health, 1400 Jackson Street, Denver, CO 80206, USA.
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102
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Zissler UM, Ulrich M, Jakwerth CA, Rothkirch S, Guerth F, Weckmann M, Schiemann M, Haller B, Schmidt-Weber CB, Chaker AM. Biomatrix for upper and lower airway biomarkers in patients with allergic asthma. J Allergy Clin Immunol 2018; 142:1980-1983. [PMID: 30121290 DOI: 10.1016/j.jaci.2018.07.027] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 07/04/2018] [Accepted: 07/20/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Ulrich M Zissler
- Center of Allergy & Environment (ZAUM), Technical University of Munich and Helmholtz Center Munich, German Research Center for Environmental Health, Germany, Member of the German Center for Lung Research (DZL), CPC-M, Munich, Germany.
| | - Moritz Ulrich
- Center of Allergy & Environment (ZAUM), Technical University of Munich and Helmholtz Center Munich, German Research Center for Environmental Health, Germany, Member of the German Center for Lung Research (DZL), CPC-M, Munich, Germany; Department of Otorhinolaryngology and Head and Neck Surgery, Medical School, Technical University of Munich, Munich, Germany
| | - Constanze A Jakwerth
- Center of Allergy & Environment (ZAUM), Technical University of Munich and Helmholtz Center Munich, German Research Center for Environmental Health, Germany, Member of the German Center for Lung Research (DZL), CPC-M, Munich, Germany
| | - Sandra Rothkirch
- Center of Allergy & Environment (ZAUM), Technical University of Munich and Helmholtz Center Munich, German Research Center for Environmental Health, Germany, Member of the German Center for Lung Research (DZL), CPC-M, Munich, Germany; Department of Otorhinolaryngology and Head and Neck Surgery, Medical School, Technical University of Munich, Munich, Germany
| | - Ferdinand Guerth
- Center of Allergy & Environment (ZAUM), Technical University of Munich and Helmholtz Center Munich, German Research Center for Environmental Health, Germany, Member of the German Center for Lung Research (DZL), CPC-M, Munich, Germany
| | - Markus Weckmann
- Department of Pediatric Allergy and Pulmonology, Children's Hospital at the University of Luebeck, Luebeck, Germany, and Member of the German Center for Lung Research (DZL), Airway Research Center North (ARCN)
| | - Matthias Schiemann
- Institute for Medical Microbiology, Immunology and Hygiene, Technical University of Munich, Munich, Germany
| | - Bernhard Haller
- Institut für Medizinische Statistik und Epidemiologie, Medical School, Technical University of Munich, Munich, Germany
| | - Carsten B Schmidt-Weber
- Center of Allergy & Environment (ZAUM), Technical University of Munich and Helmholtz Center Munich, German Research Center for Environmental Health, Germany, Member of the German Center for Lung Research (DZL), CPC-M, Munich, Germany
| | - Adam M Chaker
- Center of Allergy & Environment (ZAUM), Technical University of Munich and Helmholtz Center Munich, German Research Center for Environmental Health, Germany, Member of the German Center for Lung Research (DZL), CPC-M, Munich, Germany; Department of Otorhinolaryngology and Head and Neck Surgery, Medical School, Technical University of Munich, Munich, Germany
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103
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Carr TF, Kraft M. Use of biomarkers to identify phenotypes and endotypes of severeasthma. Ann Allergy Asthma Immunol 2018; 121:414-420. [PMID: 30059792 DOI: 10.1016/j.anai.2018.07.029] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 07/19/2018] [Accepted: 07/22/2018] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Severe asthma can be classified into phenotypes and endotypes, which may inform clinicians about inflammatory pathways leading to disease and ultimately guide optimal therapeutic strategy. Biomarkers, objectively measurable characteristics of the disease, are of increasing interest to clinicians and researchers as powerful tools to distinguish among the severe asthma phenotypes and endotypes. The objective of this review is to highlight current knowledge of biomarker applications to identify phenotypes and endotypes of severe asthma. DATA SOURCES Sources used include observational cohorts, clinical trials, translational studies, comprehensive reviews, and expert/taskforce statements. STUDY SELECTIONS Included studies were selected for their relevance to the topic and for strength of data or study design. RESULTS In severe asthma, biomarkers can be used for diagnosis of phenotype or endotype, can also be predictive of clinical outcomes or response to therapy, and may be dynamic with time or therapy. Fully determining phenotype or endotype of severe asthma will require interpretation of combinations of commercially available biomarkers. CONCLUSION Biomarkers have multiple potential clinical applications in severe asthma. Novel biomarkers may add accuracy to this field.
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Affiliation(s)
- Tara F Carr
- Asthma and Airway Disease Research Center, University of Arizona, Tucson, Arizona.
| | - Monica Kraft
- Asthma and Airway Disease Research Center, University of Arizona, Tucson, Arizona
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104
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Towards precision medicine in severe asthma: Treatment algorithms based on treatable traits. Respir Med 2018; 142:15-22. [PMID: 30170796 DOI: 10.1016/j.rmed.2018.07.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 07/14/2018] [Accepted: 07/16/2018] [Indexed: 11/23/2022]
Abstract
Asthma is a common disease, and although its clinical manifestations may be similar among patients, recent research discoveries have shown that it consists of several distinct clinical clusters or phenotypes, each with different underlying molecular pathways yielding different treatment responses. Based on these observations, an alternative approach - known as 'precision medicine' - has been proposed for the management of patients with severe asthma. Precision medicine advocates identification of treatable traits, linking them to therapeutic approaches targeting genetic, immunological, environmental, and/or lifestyle factors in individual patients. The main "goal" of this personalised approach is to enable choosing a treatment which will be more likely to produce a beneficial response in the individual patient rather than a 'one size fits all' approach. The aim of the present review is to discuss different ways of phenotyping asthma and to provide a rationale for treatment algorithms based on principles of precision medicine.
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105
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The MEGA Project: A Study of the Mechanisms Involved in the Genesis and Disease Course of Asthma. Asthma Cohort Creation and Long-Term Follow-Up. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.arbr.2018.05.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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106
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Baos S, Calzada D, Cremades-Jimeno L, Sastre J, Picado C, Quiralte J, Florido F, Lahoz C, Cárdaba B. Nonallergic Asthma and Its Severity: Biomarkers for Its Discrimination in Peripheral Samples. Front Immunol 2018; 9:1416. [PMID: 29977241 PMCID: PMC6021512 DOI: 10.3389/fimmu.2018.01416] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 06/06/2018] [Indexed: 12/12/2022] Open
Abstract
Asthma is a complex and heterogeneous respiratory disorder characterized by chronic airway inflammation. It has generally been associated with allergic mechanisms related to type 2 airway inflammation. Nevertheless, between 10 and 33% of asthmatic individuals have nonallergic asthma (NA). Several targeted treatments are in clinical development for patients with Th2 immune response, but few biomarkers are been defined for low or non-Th2-mediated inflammation asthma. We have recently defined by gene expression a set of genes as potential biomarkers of NA, mainly associated with disease severity: IL10, MSR1, PHLDA1, SERPINB2, CHI3L1, IL8, and PI3. Here, we analyzed their protein expression and specificity using sera and isolated peripheral blood mononuclear cells (PBMCs). First, protein quantification was carried out using ELISA (in sera) or Western blot (proteins extracted from PBMCs by Trizol procedure), depending on the biomarker in 30 healthy controls (C) subjects and 30 NA patients. A receiver operating characteristic curve analysis was performed by using the R program to study the specificity and sensitivity of the candidate biomarkers at a gene- and protein expression level. Four kinds of comparisons were performed: total NA group vs C group, severe NA patients vs C, moderate-mild NA patients vs C, and severe NA patients vs moderate-mild NA patients. We found that all the single genes showed good sensitivity vs specificity for some phenotypic discrimination, with CHI3L1 and PI3 exhibiting the best results for C vs NA: CHI3L1 area under the curve (AUC) (CI 95%): 0.95 (0.84-1.00) and PI3 AUC: 0.99 (0.98-1.00); C vs severe NA: PI3 AUC: 1 (0.99-1.00); and C vs moderate-mild NA: CHI3L1 AUC: 1 (0.99-1.00) and PI3 AUC: 0.99 (0.96-1.00). However, the results for discriminating asthma disease and severity with protein expression were better when two or three biomarkers were combined. In conclusion, individual genes and combinations of proteins have been evaluated as reliable biomarkers for classifying NA subjects and their severity. These new panels could be good diagnostic tests.
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Affiliation(s)
- Selene Baos
- Immunology Department, Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain
- Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - David Calzada
- Immunology Department, Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain
| | - Lucía Cremades-Jimeno
- Immunology Department, Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain
| | - Joaquín Sastre
- Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Allergy Department, Fundación Jiménez Díaz, Madrid, Spain
| | - César Picado
- Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Service of Pneumology, Hospital Clinic, Universitat de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Joaquín Quiralte
- Allergy Department, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Fernando Florido
- Allergy Department, Hospital Universitario San Cecilio, Granada, Spain
| | - Carlos Lahoz
- Immunology Department, Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain
- Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Blanca Cárdaba
- Immunology Department, Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain
- Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Madrid, Spain
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Abstract
PURPOSE OF REVIEW Airway inflammation is considered to be a cardinal feature of asthma. However, the type of airway inflammation is heterogeneous and airway inflammation may even be absent. Biomarkers may help to identify the inflammatory phenotype or endotype, especially now the time has come that targeted therapies enter daily practice. RECENT FINDINGS Sputum biomarkers have increased our insights into the different inflammatory asthma phenotypes, their response to treatment and their association with progression of disease. New endotypes of type 2 driven inflammation were identified using a multidimensional approach. A specific mast cell subtype has been linked with type 2 driven inflammation and response to inhaled corticosteroids. Advances have been made with regard to sputum cytokine analysis and might also help to guide future treatment of severe asthma. SUMMARY Identifying the target population for biological therapies will not be possible without the use of biomarkers. Optimized, easy-to-apply, automated methods for sputum analysis (cellular content or soluble markers) need to be developed for implementation of sputum biomarkers in daily clinical practice.
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Abstract
PURPOSE OF REVIEW Asthma is a heterogeneous disease not only on a clinical but also on a mechanistic level. For a long time, the molecular mechanisms of asthma were considered to be driven by type 2 helper T cells (Th2) and eosinophilic airway inflammation; however, extensive research has revealed that T2-low subtypes that differ from the dominant T2 paradigm are also common. RECENT FINDINGS Research into asthma pathways has led to the recognition that some asthma phenotypes show absence of T2 inflammation or alternate between T2 and non-T2 responses. Moreover, numerous immune response modifiers that block key-molecules such as interleukin (IL)-5, IL-13, and immunoglobulin E (IgE) have been identified. Along the way, these studies pointed that T2-low inflammation may also be responsible for lack of responsiveness to current treatment regimes. SUMMARY Asthma pathogenesis is characterized by two major endotypes, a T2-high featuring increased eosinophilic airway inflammation, and a T2-low endotype presenting with either neutrophilic or paucigranulocytic airway inflammation and showing greater resistance to steroids. This clearly presents an unmet therapeutic challenge. A precise definition and characterization of the mechanisms that drive this T2-low inflammatory response in each patient phenotype is necessary to help identify novel drug targets and design more effective and targeted treatments.
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Muñoz X, Álvarez-Puebla MJ, Arismendi E, Arochena L, Ausín MDP, Barranco P, Bobolea I, Cañas JA, Cardaba B, Crespo A, Del Pozo V, Domínguez-Ortega J, Fernandez-Nieto MDM, Giner J, González-Barcala FJ, Luna JA, Mullol J, Ojanguren I, Olaguibel JM, Picado C, Plaza V, Quirce S, Ramos D, Rial M, Romero-Mesones C, Salgado FJ, San-José ME, Sánchez-Diez S, Sastre B, Sastre J, Soto L, Torrejón M, Urnadoz M, Valdes L, Valero A, Cruz MJ. The MEGA Project: A Study of the Mechanisms Involved in the Genesis and Disease Course of Asthma. Asthma Cohort Creation and Long-Term Follow-Up. Arch Bronconeumol 2018; 54:S0300-2896(18)30009-7. [PMID: 29566971 DOI: 10.1016/j.arbres.2017.12.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 12/11/2017] [Accepted: 12/20/2017] [Indexed: 12/27/2022]
Abstract
The general aim of this study is to create a cohort of asthma patients with varying grades of severity in order to gain greater insight into the mechanisms underlying the genesis and course of this disease. The specific objectives focus on various studies, including imaging, lung function, inflammation, and bronchial hyperresponsiveness, to determine the relevant events that characterize the asthma population, the long-term parameters that can determine changes in the severity of patients, and the treatments that influence disease progression. The study will also seek to identify the causes of exacerbations and how this affects the course of the disease. Patients will be contacted via the outpatient clinics of the 8 participating institutions under the auspices of the Spanish Respiratory Diseases Networking System (CIBER). In the inclusion visit, a standardized clinical history will be obtained, a clinical examination, including blood pressure, body mass index, complete respiratory function tests, and FENO will be performed, and the Asthma Control Test (ACT), Morisky-Green test, Asthma Quality of Life Questionnaire (Mini AQLQ), the Sino-Nasal Outcome Test 22 (SNOT-22), and the Hospital Anxiety and Depression scale (HADS) will be administered. A specific electronic database has been designed for data collection. Exhaled breath condensate, urine and blood samples will also be collected. Non-specific bronchial hyperresponsiveness testing with methacholine will be performed and an induced sputum sample will be collected at the beginning of the study and every 24 months. A skin prick test for airborne allergens and a chest CT will be performed at the beginning of the study and repeated every 5 years.
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Affiliation(s)
- Xavier Muñoz
- Servicio de Neumología, Hospital Vall d'Hebron, Barcelona, España; CIBER de Enfermedades Respiratorias (CIBERES), España; Departamento de Biología Celular, Fisiología e Inmunología, Universitat Autònoma de Barcelona, Barcelona, España.
| | | | - Ebymar Arismendi
- CIBER de Enfermedades Respiratorias (CIBERES), España; Servicio de Neumología, Hospital Clínic, Universitat de Barcelona, IDIBAPS, Barcelona, España
| | - Lourdes Arochena
- CIBER de Enfermedades Respiratorias (CIBERES), España; Departamento de inmunología, Servicio de Neumología, IIS-Fundación Jiménez Díaz, Madrid, España
| | - María Del Pilar Ausín
- CIBER de Enfermedades Respiratorias (CIBERES), España; Servicio de Neumología, Hospital del Mar-IMIM, Barcelona, España
| | - Pilar Barranco
- CIBER de Enfermedades Respiratorias (CIBERES), España; Servicio de Alergia, Instituto de Investigación, Hospital Universitario La Paz (IdiPAZ), Madrid, España
| | - Irina Bobolea
- CIBER de Enfermedades Respiratorias (CIBERES), España; Servicio de Neumología, Hospital Clínic, Universitat de Barcelona, IDIBAPS, Barcelona, España
| | - Jose Antonio Cañas
- CIBER de Enfermedades Respiratorias (CIBERES), España; Departamento de inmunología, Servicio de Neumología, IIS-Fundación Jiménez Díaz, Madrid, España
| | - Blanca Cardaba
- CIBER de Enfermedades Respiratorias (CIBERES), España; Departamento de inmunología, Servicio de Neumología, IIS-Fundación Jiménez Díaz, Madrid, España
| | - Astrid Crespo
- Departamento de Medicina Respiratoria, Hospital de la Santa Creu i Sant Pau, Instituto de investigación biomédica Sant Pau (IIB Snat Pau), Universidad Autonoma de Barcelona. Departamento de Medicina, Barcelona, España
| | - Victora Del Pozo
- CIBER de Enfermedades Respiratorias (CIBERES), España; Departamento de inmunología, Servicio de Neumología, IIS-Fundación Jiménez Díaz, Madrid, España
| | - Javier Domínguez-Ortega
- CIBER de Enfermedades Respiratorias (CIBERES), España; Servicio de Alergia, Instituto de Investigación, Hospital Universitario La Paz (IdiPAZ), Madrid, España
| | - María Del Mar Fernandez-Nieto
- CIBER de Enfermedades Respiratorias (CIBERES), España; Departamento de inmunología, Servicio de Neumología, IIS-Fundación Jiménez Díaz, Madrid, España
| | - Jordi Giner
- Departamento de Medicina Respiratoria, Hospital de la Santa Creu i Sant Pau, Instituto de investigación biomédica Sant Pau (IIB Snat Pau), Universidad Autonoma de Barcelona. Departamento de Medicina, Barcelona, España
| | | | - Juan Alberto Luna
- CIBER de Enfermedades Respiratorias (CIBERES), España; Servicio de Alergia, Instituto de Investigación, Hospital Universitario La Paz (IdiPAZ), Madrid, España
| | - Joaquim Mullol
- CIBER de Enfermedades Respiratorias (CIBERES), España; Servicio de Neumología, Hospital Clínic, Universitat de Barcelona, IDIBAPS, Barcelona, España
| | - Iñigo Ojanguren
- Servicio de Neumología, Hospital Vall d'Hebron, Barcelona, España; CIBER de Enfermedades Respiratorias (CIBERES), España
| | - José María Olaguibel
- Servicio de Alergología, Complejo Hospitalario de Navarra, Pamplona, Navarra, España
| | - César Picado
- CIBER de Enfermedades Respiratorias (CIBERES), España; Servicio de Neumología, Hospital Clínic, Universitat de Barcelona, IDIBAPS, Barcelona, España
| | - Vicente Plaza
- Departamento de Medicina Respiratoria, Hospital de la Santa Creu i Sant Pau, Instituto de investigación biomédica Sant Pau (IIB Snat Pau), Universidad Autonoma de Barcelona. Departamento de Medicina, Barcelona, España
| | - Santiago Quirce
- CIBER de Enfermedades Respiratorias (CIBERES), España; Servicio de Alergia, Instituto de Investigación, Hospital Universitario La Paz (IdiPAZ), Madrid, España
| | - David Ramos
- Departamento de Medicina Respiratoria, Hospital de la Santa Creu i Sant Pau, Instituto de investigación biomédica Sant Pau (IIB Snat Pau), Universidad Autonoma de Barcelona. Departamento de Medicina, Barcelona, España
| | - Manuel Rial
- CIBER de Enfermedades Respiratorias (CIBERES), España; Departamento de inmunología, Servicio de Neumología, IIS-Fundación Jiménez Díaz, Madrid, España
| | - Christian Romero-Mesones
- Servicio de Neumología, Hospital Vall d'Hebron, Barcelona, España; CIBER de Enfermedades Respiratorias (CIBERES), España
| | - Francisco Javier Salgado
- Servicio de Neumología, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, La Coruña, España
| | - María Esther San-José
- Servicio de Neumología, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, La Coruña, España
| | - Silvia Sánchez-Diez
- Servicio de Neumología, Hospital Vall d'Hebron, Barcelona, España; CIBER de Enfermedades Respiratorias (CIBERES), España
| | - Beatriz Sastre
- CIBER de Enfermedades Respiratorias (CIBERES), España; Departamento de inmunología, Servicio de Neumología, IIS-Fundación Jiménez Díaz, Madrid, España
| | - Joaquin Sastre
- CIBER de Enfermedades Respiratorias (CIBERES), España; Departamento de inmunología, Servicio de Neumología, IIS-Fundación Jiménez Díaz, Madrid, España
| | - Lorena Soto
- Departamento de Medicina Respiratoria, Hospital de la Santa Creu i Sant Pau, Instituto de investigación biomédica Sant Pau (IIB Snat Pau), Universidad Autonoma de Barcelona. Departamento de Medicina, Barcelona, España
| | - Montserrat Torrejón
- Departamento de Medicina Respiratoria, Hospital de la Santa Creu i Sant Pau, Instituto de investigación biomédica Sant Pau (IIB Snat Pau), Universidad Autonoma de Barcelona. Departamento de Medicina, Barcelona, España
| | - Marisa Urnadoz
- Servicio de Alergología, Complejo Hospitalario de Navarra, Pamplona, Navarra, España
| | - Luis Valdes
- Servicio de Neumología, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, La Coruña, España
| | - Antonio Valero
- CIBER de Enfermedades Respiratorias (CIBERES), España; Servicio de Neumología, Hospital Clínic, Universitat de Barcelona, IDIBAPS, Barcelona, España
| | - María Jesús Cruz
- Servicio de Neumología, Hospital Vall d'Hebron, Barcelona, España; CIBER de Enfermedades Respiratorias (CIBERES), España
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Peters MC, Kerr S, Dunican EM, Woodruff PG, Fajt ML, Levy BD, Israel E, Phillips BR, Mauger DT, Comhair SA, Erzurum SC, Johansson MW, Jarjour NN, Coverstone AM, Castro M, Hastie AT, Bleecker ER, Wenzel SE, Fahy JV. Refractory airway type 2 inflammation in a large subgroup of asthmatic patients treated with inhaled corticosteroids. J Allergy Clin Immunol 2018. [PMID: 29524537 DOI: 10.1016/j.jaci.2017.12.1009] [Citation(s) in RCA: 117] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Airway type 2 inflammation is usually corticosteroid sensitive, but the role of type 2 inflammation as a mechanism of asthma in patients receiving high-dose inhaled corticosteroids (ICSs) is uncertain. OBJECTIVE We sought to determine whether airway type 2 inflammation persists in patients treated with ICSs and to evaluate the clinical features of patients with steroid-resistant airway type 2 inflammation. METHODS We used quantitative PCR to generate a composite metric of type 2 cytokine gene expression (type 2 gene mean [T2GM]) in induced sputum cells from healthy control subjects, patients with severe asthma receiving ICSs (n = 174), and patients with nonsevere asthma receiving ICSs (n = 85). We explored relationships between asthma outcomes and T2GM values and the utility of noninvasive biomarkers of airway T2GM. RESULTS Sputum cell T2GM values in asthmatic patients were significantly increased and remained high after treatment with intramuscular triamcinolone. We used the median T2GM value as a cutoff to classify steroid-treated type 2-low and steroid-resistant type 2-high (srT2-high) subgroups. Compared with patients with steroid-treated type 2-low asthma, those with srT2-high asthma were older and had more severe asthma. Blood eosinophil cell counts predicted srT2-high asthma when body mass index was less than 40 kg/m2 but not when it was 40 kg/m2 or greater, whereas blood IgE levels strongly predicted srT2-high asthma when age was less than 34 years but not when it was 34 years or greater. CONCLUSION Despite ICS therapy, many asthmatic patients have persistent airway type 2 inflammation (srT2-high asthma), and these patients are older and have more severe disease. Body weight and age modify the performance of blood-based biomarkers of airway type 2 inflammation.
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Affiliation(s)
- Michael C Peters
- Division of Pulmonary and Critical Care Medicine, Department of Medicine and the Cardiovascular Research Institute, University of California San Francisco, San Francisco, Calif
| | - Sheena Kerr
- Division of Pulmonary and Critical Care Medicine, Department of Medicine and the Cardiovascular Research Institute, University of California San Francisco, San Francisco, Calif
| | - Eleanor M Dunican
- Division of Pulmonary and Critical Care Medicine, Department of Medicine and the Cardiovascular Research Institute, University of California San Francisco, San Francisco, Calif
| | - Prescott G Woodruff
- Division of Pulmonary and Critical Care Medicine, Department of Medicine and the Cardiovascular Research Institute, University of California San Francisco, San Francisco, Calif
| | - Merritt L Fajt
- Pulmonary, Allergy and Critical Care Medicine Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pa
| | - Bruce D Levy
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Elliot Israel
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Brenda R Phillips
- Division of Statistics and Bioinformatics, Department of Public Health Sciences, Pennsylvania State University, Hershey, Pa
| | - David T Mauger
- Division of Statistics and Bioinformatics, Department of Public Health Sciences, Pennsylvania State University, Hershey, Pa
| | - Suzy A Comhair
- Department of Pathobiology, Cleveland Clinic Cleveland, Cleveland, Ohio
| | - Serpil C Erzurum
- Department of Pathobiology, Cleveland Clinic Cleveland, Cleveland, Ohio
| | - Mats W Johansson
- Department of Biomolecular Chemistry, University of Wisconsin School of Medicine, Madison, Wis
| | - Nizar N Jarjour
- Section of Pulmonary and Critical Care Medicine, University of Wisconsin School of Medicine, Madison, Wis
| | - Andrea M Coverstone
- Division of Allergy, Immunology and Pulmonary Medicine, Department of Pediatrics, Washington University School of Medicine, St Louis, Mo
| | - Mario Castro
- Division of Pulmonary and Critical Care Medicine, Departments of Medicine and Pediatrics, Washington University, St Louis, Mo
| | - Annette T Hastie
- Center for Genomics and Personalized Medicine Research, School of Medicine, Wake Forest University, Winston-Salem, NC
| | - Eugene R Bleecker
- Center for Genomics and Personalized Medicine Research, School of Medicine, Wake Forest University, Winston-Salem, NC
| | - Sally E Wenzel
- Pulmonary, Allergy and Critical Care Medicine Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pa
| | - John V Fahy
- Division of Pulmonary and Critical Care Medicine, Department of Medicine and the Cardiovascular Research Institute, University of California San Francisco, San Francisco, Calif.
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Uwaezuoke SN, Ayuk AC, Eze JN. Severe bronchial asthma in children: a review of novel biomarkers used as predictors of the disease. J Asthma Allergy 2018; 11:11-18. [PMID: 29398922 PMCID: PMC5774744 DOI: 10.2147/jaa.s149577] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Severe asthma or therapy-resistant asthma in children is a heterogeneous disease that affects all age-groups. Given its heterogeneity, precision in diagnosis and treatment has become imperative, in order to achieve better outcomes. If one is thus able to identify specific patient phenotypes and endotypes using the appropriate biomarkers, it will assist in providing the patient with more personalized and appropriate treatment. However, there appears to be a huge diagnostic gap in severe asthma, as there is no single test yet that accurately determines disease phenotype. In this paper, we review the published literature on some of these biomarkers and their possible role in bridging this diagnostic gap. We also highlight the cellular and molecular mechanisms involved in severe asthma, in order to show the basis for the novel biomarkers. Some markers useful for monitoring therapy and assessing airway remodeling in the disease are also discussed. A review of the literature was conducted with PubMed to gather baseline data on the subject. The literature search extended to articles published within the last 40 years. Although biomarkers specific to different severe asthma phenotypes have been identified, progress in their utility remains slow, because of several disease mechanisms, the variation of biomarkers at different levels of inflammation, changes in relying on one test over time (eg, from sputum eosinophilia to blood eosinophilia), and the degree of invasive tests required to collect biomarkers, which limits their applicability in clinical settings. In conclusion, several biomarkers remain useful in recognizing various asthma phenotypes. However, due to disease heterogeneity, identification and utilization of ideal and defined biomarkers in severe asthma are still inconclusive. The development of novel serum/sputum-based biomarker panels with enhanced sensitivity and specificity may lead to prompt diagnosis of the disease in the future.
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Affiliation(s)
- Samuel N Uwaezuoke
- Department of Pediatrics, University of Nigeria Teaching Hospital, Ituku-Ozalla, Nigeria
| | - Adaeze C Ayuk
- Department of Pediatrics, University of Nigeria Teaching Hospital, Ituku-Ozalla, Nigeria
| | - Joy N Eze
- Department of Pediatrics, University of Nigeria Teaching Hospital, Ituku-Ozalla, Nigeria
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Abstract
Asthma is a heterogeneous disease that can be classified into different clinical endotypes, depending on the type of airway inflammation, clinical severity, and response to treatment. This article focuses on the eosinophilic endotype of asthma, which is defined by the central role that eosinophils play in the pathophysiology of the condition. It is characterized by elevated sputum and/or blood eosinophils on at least 2 occasions and by a significant response to treatments that suppress eosinophilia. Histopathologic demonstration of eosinophils in the airways provides the most direct diagnosis of eosinophilic asthma; but it is invasive, thus, impractical in clinical practice.
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Affiliation(s)
- Fernando Aleman
- Division of Respirology, St Joseph's Healthcare Hamilton, McMaster University, Hamilton, Ontario, Canada
| | - Hui Fang Lim
- Department of Respiratory Medicine, National University of Singapore, Singapore, Singapore
| | - Parameswaran Nair
- Division of Respirology, St Joseph's Healthcare Hamilton, McMaster University, 50 Charlton Avenue East, Hamilton, Ontario L8N 4A6, Canada.
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Pathological Roles of Neutrophil-Mediated Inflammation in Asthma and Its Potential for Therapy as a Target. J Immunol Res 2017; 2017:3743048. [PMID: 29359169 PMCID: PMC5735647 DOI: 10.1155/2017/3743048] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 09/10/2017] [Accepted: 09/27/2017] [Indexed: 12/22/2022] Open
Abstract
Asthma is a chronic inflammatory disease that undermines the airways. It is caused by dysfunction of various types of cells, as well as cellular components, and is characterized by recruitment of inflammatory cells, bronchial hyperreactivity, mucus production, and airway remodelling and narrowing. It has commonly been considered that airway inflammation is caused by the Th2 immune response, or eosinophilia, which is a hallmark of bronchial asthma pathogenesis. Some patients display a neutrophil-dominant presentation and are characterized with low (or even absent) Th2 cytokines. In recent years, increasing evidence has also suggested that neutrophils play a key role in the development of certain subtypes of asthma. This review discusses neutrophils in asthma and potentially related targeted therapies.
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Bachert C, Akdis CA. Phenotypes and Emerging Endotypes of Chronic Rhinosinusitis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017; 4:621-8. [PMID: 27393777 DOI: 10.1016/j.jaip.2016.05.004] [Citation(s) in RCA: 161] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 05/05/2016] [Accepted: 05/06/2016] [Indexed: 02/05/2023]
Abstract
Chronic rhinosinusitis can be differentiated into several phenotypes based on clinical criteria; however, these phenotypes do not teach us much about the underlying inflammatory mechanisms. Thus, the use of nasal endoscopy and CT scanning, and eventually taking a swab or a biopsy, may not be sufficient to fully appreciate the individual patient's pathology. Endotyping of chronic rhinosinusitis on the basis of pathomechanisms, functionally and pathologically different from others by the involvement of specific molecules or cells, may in contrast provide us with information on the risk of disease progression or recurrence and on the best available treatment, and also helps us identifying innovative therapeutic targets for treatment. Endotyping may best be structured around T helper cells and their downstream events, such as tissue eosinophilia or neutrophilia; this approach involves the cytokines and chemokines related to specific T helper cell populations, and related markers such as IgE. Endotyping is of specific interest at the time of the arrival of new biologicals, confronting us with the challenge of the selection of eligible patients for treatment and predicting their therapeutic response; defining suitable biomarkers is therefore an urgent task. Failure to appreciate the underlying mechanisms and endotypes of chronic rhinosinusitis may limit progress in the management of the disease at present.
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Affiliation(s)
- Claus Bachert
- Upper Airways Research Laboratory, Ghent University, Ghent, Belgium; Division of ENT Diseases, CLINTEC, Karolinska Institute, Stockholm, Sweden.
| | - Cezmi A Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
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Svenningsen S, Nair P. Asthma Endotypes and an Overview of Targeted Therapy for Asthma. Front Med (Lausanne) 2017; 4:158. [PMID: 29018800 PMCID: PMC5622943 DOI: 10.3389/fmed.2017.00158] [Citation(s) in RCA: 167] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 09/12/2017] [Indexed: 12/04/2022] Open
Abstract
Guidelines for the management of severe asthma do not emphasize the measurement of the inflammatory component of airway disease to indicate appropriate treatments or to monitor response to treatment. Inflammation is a central component of asthma and contributes to symptoms, physiological, and structural abnormalities. It can be assessed by a number of endotyping strategies based on “omics” technology such as proteomics, transcriptomics, and metabolomics. It can also be assessed using simple cellular responses by quantitative cytometry in sputum. Bronchitis may be eosinophilic, neutrophilic, mixed-granulocytic, or paucigranulocytic (eosinophils and neutrophils not elevated). Eosinophilic bronchitis is usually a Type 2 (T2)-driven process and therefore a sputum eosinophilia of greater than 3% usually indicates a response to treatment with corticosteroids or novel therapies directed against T2 cytokines such as IL-4, IL-5, and IL-13. Neutrophilic bronchitis represents a non-T2-driven disease, which is generally a predictor of response to antibiotics and may be a predictor to therapies targeted at pathways that lead to neutrophil recruitment such as TNF, IL-1, IL-6, IL-8, IL-23, and IL-17. Paucigranulocytic disease may not warrant anti-inflammatory therapy. These patients, whose symptoms may be driven largely by airway hyper-responsiveness may benefit from smooth muscle-directed therapies such as bronchial thermoplasty or mast-cell directed therapies. This review will briefly summarize the current knowledge regarding “omics-based signatures” and cellular endotyping of severe asthma and give an overview of segmentation of asthma therapeutics guided by the endotype.
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Affiliation(s)
| | - Parameswaran Nair
- Department of Medicine, McMaster University, Hamilton, ON, Canada.,St Joseph's Healthcare, Hamilton, ON, Canada
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Abstract
PURPOSE OF REVIEW Asthma is a heterogeneous disease characterized by multiple phenotypes. Treatment of patients with severe disease can be challenging. Predictive biomarkers are measurable characteristics that reflect the underlying pathophysiology of asthma and can identify patients that are likely to respond to a given therapy. This review discusses current knowledge regarding predictive biomarkers in asthma. RECENT FINDINGS Recent trials evaluating biologic therapies targeting IgE, IL-5, IL-13, and IL-4 have utilized predictive biomarkers to identify patients who might benefit from treatment. Other work has suggested that using composite biomarkers may offer enhanced predictive capabilities in tailoring asthma therapy. Multiple biomarkers including sputum eosinophil count, blood eosinophil count, fractional concentration of nitric oxide in exhaled breath (FeNO), and serum periostin have been used to identify which patients will respond to targeted asthma medications. Further work is needed to integrate predictive biomarkers into clinical practice.
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Abstract
PURPOSE OF REVIEW Asthma is heterogeneous with different endotypes/phenotypes. Response to corticosteroids is variable and novel biological therapies are proving useful. Biomarkers allow individualization of treatment. This review provides an update on available data regarding asthma biomarkers with focus on their utility for prediction of response to steroidal and new biological therapies. RECENT FINDINGS Blood eosinophils are a biomarker with acceptable accuracy as a surrogate for sputum eosinophilia, are associated with relevant outcomes, and are more readily measureable. New evidence supports fraction of exhaled nitric oxide (FENO)-based treatment algorithms for cost-effective maintenance of asthma control/quality of life. Serum and sputum-derived periostin are biomarkers of lung function decline and associated with eosinophilic airway inflammation. Transcriptomics show promise for endotyping; their role in management remains to be determined. Biomarker panels may improve predictive value as shown for the combination of FENO/urinary bromotyrosine in prediction of steroid responsiveness. Novel biological therapies are proving effective in biomarker-selected populations. SUMMARY Biomarkers including blood eosinophils and FENO are proving to have utility for the effective administration of steroidal and novel biological therapies in asthma, allowing individualized treatment. Transcriptomics can discriminate subtypes of asthma and may have a role in delivery of individualized therapy.
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Peters MC, Nguyen MLT, Dunican EM. Biomarkers of Airway Type-2 Inflammation and Integrating Complex Phenotypes to Endotypes in Asthma. Curr Allergy Asthma Rep 2017; 16:71. [PMID: 27613654 DOI: 10.1007/s11882-016-0651-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW Over the past decade, the most important advance in the field of asthma has been the widespread recognition that asthma is a heterogeneous disease driven by multiple molecular processes. RECENT FINDINGS The most well-established molecular mechanism in asthma is increased airway type-2 inflammation, and consequently, non-invasive biomarkers of increased airway type-2 inflammation, such as blood eosinophil counts or blood periostin levels, have proven important in stratifying asthma patients in clinical trials of type-2 cytokine inhibitors. However, it remains ambiguous how well these non-invasive biomarkers represent airway measures of type-2 inflammation in asthma. As a result, the utility of these biomarkers to assist with asthma management or as research tools to better understand asthma pathogenesis remains unclear. This article reviews primary data assessing biomarkers of airway type-2 inflammation in asthma and describes how the use of biomarkers can advance a precision medicine approach to asthma treatment.
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Affiliation(s)
- Michael C Peters
- The Airway Clinical Research Center, University of California, Box 0130, 505 Parnassus Avenue, San Francisco, CA, 94143, USA. .,Division of Pulmonary and Critical Care Medicine, University of California, Box 0130, 505 Parnassus Avenue, San Francisco, CA, 94143, USA. .,Cardiovascular Research Institute, University of California, Box 0130, 505 Parnassus Avenue, San Francisco, CA, 94143, USA.
| | | | - Eleanor M Dunican
- The Airway Clinical Research Center, University of California, Box 0130, 505 Parnassus Avenue, San Francisco, CA, 94143, USA.,Division of Pulmonary and Critical Care Medicine, University of California, Box 0130, 505 Parnassus Avenue, San Francisco, CA, 94143, USA.,Cardiovascular Research Institute, University of California, Box 0130, 505 Parnassus Avenue, San Francisco, CA, 94143, USA
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119
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Wenzel SE. Emergence of Biomolecular Pathways to Define Novel Asthma Phenotypes. Type-2 Immunity and Beyond. Am J Respir Cell Mol Biol 2017; 55:1-4. [PMID: 27164162 DOI: 10.1165/rcmb.2016-0141ps] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Asthma is increasingly recognized as a heterogeneous entity, encompassing a variety of different subgroups, or phenotypes, which share clinical and inflammatory characteristics. However, it is only recently that molecular pathways have been both identified and successfully targeted in association with these clinical-inflammatory phenotypes. This integration of clinical-inflammatory and molecular pathways has enabled the broad differentiation of "asthma" into those with and without type-2 inflammation, on the basis of elevations in pathways downstream of type-2 cytokines, such as periostin, exhaled nitric oxide, and blood eosinophils. Although these rather general downstream biomarkers can identify patients more likely to respond to novel type 2-targeted therapies, they may have limited ability to determine which patients respond best to which type 2-targeted therapy, or even who will respond less than optimally, despite elevation in the biomarkers. In addition, new biomarkers and targets are required for the 50% of patients with asthma without elevations in these type-2 biomarkers. The path forward will require integrated 'omics approaches, development of more complex mouse models of asthma, as well as identification and validation of novel biomolecular pathways.
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Affiliation(s)
- Sally E Wenzel
- Pulmonary Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
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120
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Berthon BS, Gibson PG, Wood LG, MacDonald-Wicks LK, Baines KJ. A sputum gene expression signature predicts oral corticosteroid response in asthma. Eur Respir J 2017; 49:49/6/1700180. [PMID: 28663317 DOI: 10.1183/13993003.00180-2017] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 03/21/2017] [Indexed: 11/05/2022]
Abstract
Biomarkers that predict responses to oral corticosteroids (OCS) facilitate patient selection for asthma treatment. We hypothesised that asthma patients would respond differently to OCS therapy, with biomarkers and inflammometry predicting response.Adults with stable asthma underwent a randomised controlled cross-over trial of 50 mg prednisolone daily for 10 days (n=55). A six-gene expression biomarker signature (CLC, CPA3, DNASE1L3, IL1B, ALPL and CXCR2) in induced sputum, and eosinophils in blood and sputum were assessed and predictors of response were investigated (changes in forced expiratory volume in 1 s (ΔFEV1), six-item Asthma Control Questionnaire score (ΔACQ6) or exhaled nitric oxide fraction (ΔFeNO)).At baseline, responders to OCS (n=25) had upregulated mast cell CPA3 gene expression, poorer lung function, and higher sputum and blood eosinophils. Following treatment, CLC and CPA3 gene expression was reduced, whereas DNASE1L3, IL1B, ALPL and CXCR2 expression remained unchanged. Receiver operating characteristic (ROC) analysis showed the six-gene expression biomarker signature as a better predictor of clinically significant responses to OCS than blood and sputum eosinophils.The six-gene expression signature including eosinophil and Th2 related mast cell biomarkers showed greater precision in predicting OCS response in stable asthma. Thus, a novel sputum gene expression signature highlights an additional role of mast cells in asthma, and could be a useful measurement to guide OCS therapy in asthma.
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Affiliation(s)
- Bronwyn S Berthon
- Centre for Healthy Lungs, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
| | - Peter G Gibson
- Centre for Healthy Lungs, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
| | - Lisa G Wood
- Centre for Healthy Lungs, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
| | - Lesley K MacDonald-Wicks
- Discipline of Nutrition and Dietetics, School of Health Sciences, University of Newcastle, Newcastle, NSW, Australia
| | - Katherine J Baines
- Centre for Healthy Lungs, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
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121
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Precision medicine in patients with allergic diseases: Airway diseases and atopic dermatitis-PRACTALL document of the European Academy of Allergy and Clinical Immunology and the American Academy of Allergy, Asthma & Immunology. J Allergy Clin Immunol 2017; 137:1347-58. [PMID: 27155030 DOI: 10.1016/j.jaci.2016.03.010] [Citation(s) in RCA: 214] [Impact Index Per Article: 30.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 03/14/2016] [Accepted: 03/15/2016] [Indexed: 01/01/2023]
Abstract
In this consensus document we summarize the current knowledge on major asthma, rhinitis, and atopic dermatitis endotypes under the auspices of the PRACTALL collaboration platform. PRACTALL is an initiative of the European Academy of Allergy and Clinical Immunology and the American Academy of Allergy, Asthma & Immunology aiming to harmonize the European and American approaches to best allergy practice and science. Precision medicine is of broad relevance for the management of asthma, rhinitis, and atopic dermatitis in the context of a better selection of treatment responders, risk prediction, and design of disease-modifying strategies. Progress has been made in profiling the type 2 immune response-driven asthma. The endotype driven approach for non-type 2 immune response asthma, rhinitis, and atopic dermatitis is lagging behind. Validation and qualification of biomarkers are needed to facilitate their translation into pathway-specific diagnostic tests. Wide consensus between academia, governmental regulators, and industry for further development and application of precision medicine in management of allergic diseases is of utmost importance. Improved knowledge of disease pathogenesis together with defining validated and qualified biomarkers are key approaches to precision medicine.
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122
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Asthma inflammatory phenotypes show differential microRNA expression in sputum. J Allergy Clin Immunol 2017; 137:1433-46. [PMID: 27155035 DOI: 10.1016/j.jaci.2016.02.018] [Citation(s) in RCA: 142] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 02/10/2016] [Accepted: 02/25/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND Asthma is classified according to severity and inflammatory phenotype and is likely to be distinguished by specific microRNA (miRNA) expression profiles. OBJECTIVE We sought to associate miRNA expression in sputum supernatants with the inflammatory cell profile and disease severity in asthmatic patients. METHODS We investigated miRNA expression in sputum supernatants of 10 healthy subjects, 17 patients with mild-to-moderate asthma, and 9 patients with severe asthma using high-throughput, stem-loop, reverse transcriptase quantitative real-time PCR miRNA expression profiling (screening cohort, n = 36). Differentially expressed miRNAs were validated in an independent cohort (n = 60; 10 healthy subjects and 50 asthmatic patients). Cellular miRNA origin was examined by using in situ hybridization and reverse transcriptase quantitative real-time PCR. The functional role of miRNAs was assessed by using in silico analysis and in vitro transfecting miRNA mimics in human bronchial epithelial cells. RESULTS In 2 independent cohorts expression of miR-629-3p, miR-223-3p, and miR-142-3p was significantly upregulated in sputum of patients with severe asthma compared with that in healthy control subjects and was highest in patients with neutrophilic asthma. Expression of the 3 miRNAs was associated with sputum neutrophilia, and miR-223-3p and miR-142-3p expression was associated also with airway obstruction (FEV1/forced vital capacity). Expression of miR-629-3p was localized in the bronchial epithelium, whereas miR-223-3p and miR-142-3p were expressed in neutrophils, monocytes, and macrophages. Transfecting human bronchial epithelial cells with miR-629-3p mimic induced epithelial IL-8 mRNA and protein expression. IL-1β and IL-8 protein levels were significantly increased in sputum of patients with severe asthma and were positively associated with sputum neutrophilia. CONCLUSIONS Expression of miR-223-3p, miR-142-3p, and miR-629-3p is increased in sputum of patients with severe asthma and is linked to neutrophilic airway inflammation, suggesting that these miRNAs contribute to this asthma inflammatory phenotype.
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Rossios C, Pavlidis S, Hoda U, Kuo CH, Wiegman C, Russell K, Sun K, Loza MJ, Baribaud F, Durham AL, Ojo O, Lutter R, Rowe A, Bansal A, Auffray C, Sousa A, Corfield J, Djukanovic R, Guo Y, Sterk PJ, Chung KF, Adcock IM. Sputum transcriptomics reveal upregulation of IL-1 receptor family members in patients with severe asthma. J Allergy Clin Immunol 2017; 141:560-570. [PMID: 28528200 DOI: 10.1016/j.jaci.2017.02.045] [Citation(s) in RCA: 144] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 01/21/2017] [Accepted: 02/01/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Sputum analysis in asthmatic patients is used to define airway inflammatory processes and might guide therapy. OBJECTIVE We sought to determine differential gene and protein expression in sputum samples from patients with severe asthma (SA) compared with nonsmoking patients with mild/moderate asthma. METHODS Induced sputum was obtained from nonsmoking patients with SA, smokers/ex-smokers with severe asthma, nonsmoking patients with mild/moderate asthma (MMAs), and healthy nonsmoking control subjects. Differential cell counts, microarray analysis of cell pellets, and SOMAscan analysis of sputum analytes were performed. CRID3 was used to inhibit the inflammasome in a mouse model of SA. RESULTS Eosinophilic and mixed neutrophilic/eosinophilic inflammation were more prevalent in patients with SA compared with MMAs. Forty-two genes probes were upregulated (>2-fold) in nonsmoking patients with severe asthma compared with MMAs, including IL-1 receptor (IL-1R) family and nucleotide-binding oligomerization domain, leucine-rich repeat and pyrin domain containing 3 (NRLP3) inflammasome members (false discovery rate < 0.05). The inflammasome proteins nucleotide-binding oligomerization domain, leucine rich repeat and pyrin domain containing 1 (NLRP1), NLRP3, and nucleotide-binding oligomerization domain (NOD)-like receptor C4 (NLRC4) were associated with neutrophilic asthma and with sputum IL-1β protein levels, whereas eosinophilic asthma was associated with an IL-13-induced TH2 signature and IL-1 receptor-like 1 (IL1RL1) mRNA expression. These differences were sputum specific because no activation of NLRP3 or enrichment of IL-1R family genes in bronchial brushings or biopsy specimens in patients with SA was observed. Expression of NLRP3 and of the IL-1R family genes was validated in the Airway Disease Endotyping for Personalized Therapeutics cohort. Inflammasome inhibition using CRID3 prevented airway hyperresponsiveness and airway inflammation (both neutrophilia and eosinophilia) in a mouse model of severe allergic asthma. CONCLUSION IL1RL1 gene expression is associated with eosinophilic SA, whereas NLRP3 inflammasome expression is highest in patients with neutrophilic SA. TH2-driven eosinophilic inflammation and neutrophil-associated inflammasome activation might represent interacting pathways in patients with SA.
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Affiliation(s)
- Christos Rossios
- Airways Disease, National Heart & Lung Institute, Imperial College London, and the Biomedical Research Unit, Royal Brompton & Harefield NHS Trust, London, United Kingdom
| | - Stelios Pavlidis
- Department of Computing & Data Science Institute, Imperial College London, London, United Kingdom; Janssen Research and Development, High Wycombe, United Kingdom
| | - Uruj Hoda
- Airways Disease, National Heart & Lung Institute, Imperial College London, and the Biomedical Research Unit, Royal Brompton & Harefield NHS Trust, London, United Kingdom
| | - Chih-Hsi Kuo
- Department of Computing & Data Science Institute, Imperial College London, London, United Kingdom
| | - Coen Wiegman
- Airways Disease, National Heart & Lung Institute, Imperial College London, and the Biomedical Research Unit, Royal Brompton & Harefield NHS Trust, London, United Kingdom
| | - Kirsty Russell
- Airways Disease, National Heart & Lung Institute, Imperial College London, and the Biomedical Research Unit, Royal Brompton & Harefield NHS Trust, London, United Kingdom
| | - Kai Sun
- Department of Computing & Data Science Institute, Imperial College London, London, United Kingdom
| | - Matthew J Loza
- Janssen Research and Development, High Wycombe, United Kingdom
| | | | - Andrew L Durham
- Airways Disease, National Heart & Lung Institute, Imperial College London, and the Biomedical Research Unit, Royal Brompton & Harefield NHS Trust, London, United Kingdom
| | - Oluwaseun Ojo
- Airways Disease, National Heart & Lung Institute, Imperial College London, and the Biomedical Research Unit, Royal Brompton & Harefield NHS Trust, London, United Kingdom
| | - Rene Lutter
- Faculty of Medicine, University of Amsterdam, Amsterdam, The Netherlands
| | - Anthony Rowe
- Janssen Research and Development, High Wycombe, United Kingdom
| | - Aruna Bansal
- Acclarogen, St John's Innovation Centre, Cambridge, United Kingdom
| | - Charles Auffray
- European Institute for Systems Biology and Medicine, CNRS-ENS-UCBL, Université de Lyon, Lyon, France
| | - Ana Sousa
- Respiratory Therapeutic Unit, GSK, Stockley Park, United Kingdom
| | - Julie Corfield
- AstraZeneca R&D, Molndal, Sweden, and Areteva R&D, Nottingham, United Kingdom
| | - Ratko Djukanovic
- Faculty of Medicine, Southampton University, and the NIHR Southampton Respiratory Biomedical Research Unit, University Hospital Southampton, Southampton, United Kingdom
| | - Yike Guo
- Department of Computing & Data Science Institute, Imperial College London, London, United Kingdom
| | - Peter J Sterk
- Faculty of Medicine, University of Amsterdam, Amsterdam, The Netherlands
| | - Kian Fan Chung
- Airways Disease, National Heart & Lung Institute, Imperial College London, and the Biomedical Research Unit, Royal Brompton & Harefield NHS Trust, London, United Kingdom
| | - Ian M Adcock
- Airways Disease, National Heart & Lung Institute, Imperial College London, and the Biomedical Research Unit, Royal Brompton & Harefield NHS Trust, London, United Kingdom; Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia.
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Lavin J, Min JY, Lidder AK, Huang JH, Kato A, Lam K, Meen E, Chmiel JS, Norton J, Suh L, Mahdavinia M, Hulse KE, Conley DB, Chandra RK, Shintani-Smith S, Kern RC, Schleimer RP, Tan BK. Superior turbinate eosinophilia correlates with olfactory deficit in chronic rhinosinusitis patients. Laryngoscope 2017; 127:2210-2218. [PMID: 28322448 DOI: 10.1002/lary.26555] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 01/02/2017] [Accepted: 01/27/2017] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate if molecular markers of eosinophilia in olfactory-enriched mucosa are associated with olfactory dysfunction. STUDY DESIGN Cross-sectional study of tissue biopsies from 99 patients, and an additional 30 patients who underwent prospective olfactory testing prior to sinonasal procedures. METHODS Tissue biopsies were processed for analysis of inflammatory markers using quantitative real time polymerase chain reaction (qRT-PCR). Ipsilateral olfactory performance was assessed using the Sniffin' Sticks (Burghart, Wedel, Germany) threshold component and the University of Pennsylvania Smell Identification Test (Sensonics, Haddon Heights, NJ). Age-adjusted data was correlated with inflammatory marker expression and clinical measures of obstruction from computed tomography and endoscopy. RESULTS Gene expression of the eosinophil marker CLC (Charcot Leyden crystal protein) was elevated in superior turbinate (ST) tissue in chronic rhinosinusitis (CRS) with nasal polyps (CRSwNP) compared to ST and inferior turbinate tissue in CRS without nasal polyps (CRSsNP) and control patients (all P < 0.001, respectively). CLC in ST tissue was correlated with IL-5 and eotaxin-1 expression (all P < 0.001; P = 0.65, and 0.49, respectively). CLC expression was strongly correlated with eosinophilic cationic protein levels (P < 0.001; r = -0.76), and ST CLC expression was inversely related to olfactory threshold (P = 0.002, r = -0.57) and discrimination scores (P = 0.05, r = -0.42). In multiple linear regression of CLC gene expression, polyp status, and radiographic and endoscopic findings with olfactory threshold, CLC was the only significantly correlated variable (P < 0.05). CONCLUSION Markers of eosinophils are elevated in the ST of patients with CRSwNP and correlate with olfactory loss. These findings support the hypothesis that olfactory dysfunction in CRS correlates local eosinophil influx into the olfactory cleft. LEVEL OF EVIDENCE NA. Laryngoscope, 127:2210-2218, 2017.
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Affiliation(s)
- Jennifer Lavin
- Department of Otolaryngology-Head and Neck SurgeryDivision of Pediatric Otolaryngology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A
| | - Jin-Young Min
- Department of Otolaryngology-Head and Neck SurgeryDivision of Pediatric Otolaryngology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A
| | - Alcina K Lidder
- University of Rochester School of Medicine and Dentistry, Rochester, New York, U.S.A
| | - Julia He Huang
- Department of Otolaryngology-Head and Neck SurgeryDivision of Pediatric Otolaryngology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A
| | - Atsushi Kato
- Division of Allergy and Immunology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A
| | - Kent Lam
- Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, Virginia, U.S.A
| | - Eric Meen
- Department of Otolaryngology-Head and Neck Surgery, University of Manitoba, Winnipeg, Canada
| | - Joan S Chmiel
- Department of Preventive Medicine-Biostatistics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A
| | - James Norton
- Division of Allergy and Immunology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A
| | - Lydia Suh
- Division of Allergy and Immunology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A
| | - Mahboobeh Mahdavinia
- Division of Allergy and Immunology, Rush Medical College, Chicago, Illinois, U.S.A
| | - Kathryn E Hulse
- Division of Allergy and Immunology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A
| | - David B Conley
- Department of Otolaryngology-Head and Neck SurgeryDivision of Pediatric Otolaryngology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A
| | - Rakesh K Chandra
- Department of Otolaryngology, Head and Neck Surgery, Vanderbilt School of Medicine, Nashville, Tennessee, U.S.A
| | - Stephanie Shintani-Smith
- Department of Otolaryngology-Head and Neck SurgeryDivision of Pediatric Otolaryngology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A
| | - Robert C Kern
- Department of Otolaryngology-Head and Neck SurgeryDivision of Pediatric Otolaryngology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A
| | - Robert P Schleimer
- Department of Otolaryngology-Head and Neck SurgeryDivision of Pediatric Otolaryngology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A.,University of Rochester School of Medicine and Dentistry, Rochester, New York, U.S.A
| | - Bruce K Tan
- Department of Otolaryngology-Head and Neck SurgeryDivision of Pediatric Otolaryngology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A
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125
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Seys SF, Scheers H, Van den Brande P, Marijsse G, Dilissen E, Van Den Bergh A, Goeminne PC, Hellings PW, Ceuppens JL, Dupont LJ, Bullens DMA. Cluster analysis of sputum cytokine-high profiles reveals diversity in T(h)2-high asthma patients. Respir Res 2017; 18:39. [PMID: 28231834 PMCID: PMC5324270 DOI: 10.1186/s12931-017-0524-y] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 02/17/2017] [Indexed: 12/17/2022] Open
Abstract
Background Asthma is characterized by a heterogeneous inflammatory profile and can be subdivided into T(h)2-high and T(h)2-low airway inflammation. Profiling of a broader panel of airway cytokines in large unselected patient cohorts is lacking. Methods Patients (n = 205) were defined as being “cytokine-low/high” if sputum mRNA expression of a particular cytokine was outside the respective 10th/90th percentile range of the control group (n = 80). Unsupervised hierarchical clustering was used to determine clusters based on sputum cytokine profiles. Results Half of patients (n = 108; 52.6%) had a classical T(h)2-high (“IL-4-, IL-5- and/or IL-13-high”) sputum cytokine profile. Unsupervised cluster analysis revealed 5 clusters. Patients with an “IL-4- and/or IL-13-high” pattern surprisingly did not cluster but were equally distributed among the 5 clusters. Patients with an “IL-5-, IL-17A-/F- and IL-25- high” profile were restricted to cluster 1 (n = 24) with increased sputum eosinophil as well as neutrophil counts and poor lung function parameters at baseline and 2 years later. Four other clusters were identified: “IL-5-high or IL-10-high” (n = 16), “IL-6-high” (n = 8), “IL-22-high” (n = 25). Cluster 5 (n = 132) consists of patients without “cytokine-high” pattern or patients with only high IL-4 and/or IL-13. Conclusion We identified 5 unique asthma molecular phenotypes by biological clustering. Type 2 cytokines cluster with non-type 2 cytokines in 4 out of 5 clusters. Unsupervised analysis thus not supports a priori type 2 versus non-type 2 molecular phenotypes. www.clinicaltrials.gov NCT01224938. Registered 18 October 2010. Electronic supplementary material The online version of this article (doi:10.1186/s12931-017-0524-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sven F Seys
- Lab of clinical immunology, Department of Microbiology and Immunology, Herestraat 49/811, 3000, Leuven, KU, Belgium. .,Department of Public Health and Primary Care, Environmental Health Unit, Lab of pneumology, Leuven, KU, Belgium.
| | - Hans Scheers
- Department of Public Health and Primary Care, Environmental Health Unit, Lab of pneumology, Leuven, KU, Belgium
| | | | - Gudrun Marijsse
- Lab of clinical immunology, Department of Microbiology and Immunology, Herestraat 49/811, 3000, Leuven, KU, Belgium
| | - Ellen Dilissen
- Lab of clinical immunology, Department of Microbiology and Immunology, Herestraat 49/811, 3000, Leuven, KU, Belgium
| | | | - Pieter C Goeminne
- Respiratory department, Leuven, UZ, Belgium.,Lab of respiratory disease, and lab of pediatric immunology, Department of Clinical and Experimental Medicine, Leuven, KU, Belgium
| | | | - Jan L Ceuppens
- Lab of clinical immunology, Department of Microbiology and Immunology, Herestraat 49/811, 3000, Leuven, KU, Belgium
| | - Lieven J Dupont
- Respiratory department, Leuven, UZ, Belgium.,Lab of respiratory disease, and lab of pediatric immunology, Department of Clinical and Experimental Medicine, Leuven, KU, Belgium
| | - Dominique M A Bullens
- Paediatric department, Leuven, UZ, Belgium.,Lab of paediatric immunology, Department of Microbiology and Immunology, Leuven, KU, Belgium
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126
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Kuo CHS, Pavlidis S, Loza M, Baribaud F, Rowe A, Pandis I, Sousa A, Corfield J, Djukanovic R, Lutter R, Sterk PJ, Auffray C, Guo Y, Adcock IM, Chung KF. T-helper cell type 2 (Th2) and non-Th2 molecular phenotypes of asthma using sputum transcriptomics in U-BIOPRED. Eur Respir J 2017; 49:49/2/1602135. [PMID: 28179442 DOI: 10.1183/13993003.02135-2016] [Citation(s) in RCA: 241] [Impact Index Per Article: 34.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 11/03/2016] [Indexed: 11/05/2022]
Abstract
Asthma is characterised by heterogeneous clinical phenotypes. Our objective was to determine molecular phenotypes of asthma by analysing sputum cell transcriptomics from 104 moderate-to-severe asthmatic subjects and 16 nonasthmatic subjects.After filtering on the differentially expressed genes between eosinophil- and noneosinophil-associated sputum inflammation, we used unbiased hierarchical clustering on 508 differentially expressed genes and gene set variation analysis of specific gene sets.We defined three transcriptome-associated clusters (TACs): TAC1 (characterised by immune receptors IL33R, CCR3 and TSLPR), TAC2 (characterised by interferon-, tumour necrosis factor-α- and inflammasome-associated genes) and TAC3 (characterised by genes of metabolic pathways, ubiquitination and mitochondrial function). TAC1 showed the highest enrichment of gene signatures for interleukin-13/T-helper cell type 2 (Th2) and innate lymphoid cell type 2. TAC1 had the highest sputum eosinophilia and exhaled nitric oxide fraction, and was restricted to severe asthma with oral corticosteroid dependency, frequent exacerbations and severe airflow obstruction. TAC2 showed the highest sputum neutrophilia, serum C-reactive protein levels and prevalence of eczema. TAC3 had normal to moderately high sputum eosinophils and better preserved forced expiratory volume in 1 s. Gene-protein coexpression networks from TAC1 and TAC2 extended this molecular classification.We defined one Th2-high eosinophilic phenotype TAC1, and two non-Th2 phenotypes TAC2 and TAC3, characterised by inflammasome-associated and metabolic/mitochondrial pathways, respectively.
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Affiliation(s)
- Chih-Hsi Scott Kuo
- Airways Disease, National Heart and Lung Institute, Imperial College London, London, UK.,Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, UK.,Dept of Computing and Data Science Institute, Imperial College London, London, UK
| | | | | | | | | | - Iaonnis Pandis
- Dept of Computing and Data Science Institute, Imperial College London, London, UK
| | - Ana Sousa
- Respiratory Therapeutic Unit, GSK, Stockley Park, UK
| | - Julie Corfield
- AstraZeneca R&D, Mölndal, Sweden.,Areteva R&D, Nottingham, UK
| | | | - Rene Lutter
- Faculty of Medicine, University of Amsterdam, Amsterdam, The Netherlands
| | - Peter J Sterk
- Faculty of Medicine, University of Amsterdam, Amsterdam, The Netherlands
| | - Charles Auffray
- Faculty of Medicine, Southampton University, Southampton, UK.,European Institute for Systems Biology and Medicine, CNRS-ENS-UCBL, Université de Lyon, Lyon, France
| | - Yike Guo
- Dept of Computing and Data Science Institute, Imperial College London, London, UK
| | - Ian M Adcock
- Airways Disease, National Heart and Lung Institute, Imperial College London, London, UK.,Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, UK.,These authors contributed equally to this work
| | - Kian Fan Chung
- Airways Disease, National Heart and Lung Institute, Imperial College London, London, UK .,Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, UK.,These authors contributed equally to this work
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127
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Baines KJ, Fu JJ, McDonald VM, Gibson PG. Airway gene expression of IL-1 pathway mediators predicts exacerbation risk in obstructive airway disease. Int J Chron Obstruct Pulmon Dis 2017; 12:541-550. [PMID: 28223794 PMCID: PMC5308595 DOI: 10.2147/copd.s119443] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background Exacerbations of asthma and COPD are a major cause of morbidity and mortality and are responsible for significant health care costs. This study further investigates interleukin (IL)-1 pathway activation and its relationship with exacerbations of asthma and COPD. Methods In this prospective cohort study, 95 participants with stable asthma (n=35) or COPD (n=60) were recruited and exacerbations recorded over the following 12 months. Gene expressions of IL-1 pathway biomarkers, including the IL-1 receptors (IL1R1, IL1R2, and IL1RN), and signaling molecules (IRAK2, IRAK3, and PELI1), were measured in sputum using real-time quantitative polymerase chain reaction. Mediators were compared between the frequent (≥2 exacerbations in the 12 months) and infrequent exacerbators, and the predictive relationships investigated using receiver operating characteristic curves and area under the curve (AUC) values. Results Of the 95 participants, 89 completed the exacerbation follow-up, where 30 participants (n=22 COPD, n=8 asthma) had two or more exacerbations. At the baseline visit, expressions of IRAK2, IRAK3, PELI1, and IL1R1 were elevated in participants with frequent exacerbations of both asthma and COPD combined and separately. In the combined population, sputum gene expression of IRAK3 (AUC=75.4%; P<0.001) was the best predictor of future frequent exacerbations, followed by IL1R1 (AUC=72.8%; P<0.001), PELI1 (AUC=71.2%; P<0.001), and IRAK2 (AUC=68.6; P=0.004). High IL-1 pathway gene expression was associated with frequent prior year exacerbations and correlated with the number and severity of exacerbations. Conclusion The upregulation of IL-1 pathway mediators is associated with frequent exacerbations of obstructive airway disease. Further studies should investigate these mediators as both potential diagnostic biomarkers predicting at-risk patients and novel treatment targets.
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Affiliation(s)
- Katherine J Baines
- Faculty of Health and Medicine, Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, The University of Newcastle; Department of Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton, NSW, Australia
| | - Juan-Juan Fu
- Respiratory Group, Department of Integrated Traditional Chinese and West Medicine, West China Hospital, Sichuan University, People's Republic of China
| | - Vanessa M McDonald
- Faculty of Health and Medicine, Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, The University of Newcastle; Department of Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton, NSW, Australia
| | - Peter G Gibson
- Faculty of Health and Medicine, Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, The University of Newcastle; Department of Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton, NSW, Australia
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128
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Yao Y, Welp T, Liu Q, Niu N, Wang X, Britto CJ, Krishnaswamy S, Chupp GL, Montgomery RR. Multiparameter Single Cell Profiling of Airway Inflammatory Cells. CYTOMETRY. PART B, CLINICAL CYTOMETRY 2017; 92:12-20. [PMID: 27807928 PMCID: PMC5250532 DOI: 10.1002/cyto.b.21491] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 10/26/2016] [Accepted: 10/27/2016] [Indexed: 12/17/2022]
Abstract
Airway diseases affect over 7% of the U.S. population and millions of patients worldwide. Asthmatic patients have wide variation in clinical severity with different clinical and physiologic manifestations of disease that may be driven by distinct biologic mechanisms. Further, the immunologic underpinnings of this complex trait disease are heterogeneous and treatment success depends on defining subgroups of asthmatics. Because of the limited availability and number of cells from the lung, the active site, in-depth investigation has been challenging. Recent advances in technology support transcriptional analysis of cells from induced sputum. Flow cytometry studies have described cells present in the sputum but a detailed analysis of these subsets is lacking. Mass cytometry or CyTOF (Cytometry by Time-Of-Flight) offers tremendous opportunities for multiparameter single cell analysis. Experiments can now allow detection of up to ∼40 markers to facilitate unprecedented multidimensional cellular analyses. Here we demonstrate the use of CyTOF on primary airway samples obtained from well-characterized patients with asthma and cystic fibrosis. Using this technology, we quantify cellular frequency and functional status of defined cell subsets. Our studies provide a blueprint to define the heterogeneity among subjects and underscore the power of this single cell method to characterize airway immune status. © 2016 International Clinical Cytometry Society.
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Affiliation(s)
- Yi Yao
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Tobias Welp
- Department of Genetics, Yale University School of Medicine, New Haven, CT
| | - Qing Liu
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Naiqian Niu
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Xiaomei Wang
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Clemente J. Britto
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Smita Krishnaswamy
- Department of Genetics, Yale University School of Medicine, New Haven, CT
| | - Geoff L. Chupp
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Ruth R. Montgomery
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
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129
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Iordanidou M, Loukides S, Paraskakis E. Asthma phenotypes in children and stratified pharmacological treatment regimens. Expert Rev Clin Pharmacol 2016; 10:293-303. [PMID: 27936975 DOI: 10.1080/17512433.2017.1271322] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Asthma is the most common inflammatory disease in childhood. The interaction of genetic, environmental and host factors may contribute to the development of childhood asthma and defines its progress, including persistence and severity. Until now, various classifications of childhood asthma phenotypes have been suggested based on patient's age during onset of symptoms, type of inflammatory cells, response to treatment and disease severity. Many efforts have been carried out to identify childhood asthma phenotypes and to clarify which are the risk factors that define asthma prediction and the response to therapy. The identification of asthma phenotypes has not only prognostic but also therapeutic role. However, the classification of asthma phenotypes is complex due to the heterogeneity of the disease. Areas covered: The current childhood asthma phenotypes and the new therapeutic strategies for each phenotype are reviewed. Expert commentary: There are multiple phenotypes in childhood asthma and it is crucial to define them before the initiation of personalized treatment. Both the therapeutic strategy and monitoring should follow the recent guidelines.
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Affiliation(s)
- Maria Iordanidou
- a Paediatric Respiratory Unit, Department of Pediatrics , University Hospital of Alexandroupolis , Alexandroupolis , Greece
| | - Stelios Loukides
- b 2nd Respiratory Medicine Department , National and Kapodistrian University of Athens Medical School, Attiko University Hospital , Athens , Greece
| | - Emmanouil Paraskakis
- a Paediatric Respiratory Unit, Department of Pediatrics , University Hospital of Alexandroupolis , Alexandroupolis , Greece
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130
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Wang AL, Tantisira KG. Personalized management of asthma exacerbations: lessons from genetic studies. EXPERT REVIEW OF PRECISION MEDICINE AND DRUG DEVELOPMENT 2016; 1:487-495. [PMID: 29051920 DOI: 10.1080/23808993.2016.1269600] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION The genetics of severe asthma and asthma exacerbations are distinct from milder forms of asthma. Gene-environmental interactions contribute to the complexity and heterogeneity of severe asthma and asthma exacerbations, and pharmacogenomic studies have also identified genes that affect susceptibility to asthma exacerbations. AREAS COVERED Studies on the genetics, gene-environment interactions, and pharmacogenomics of asthma exacerbations are reviewed. Multiple individual genetic variants have been identified to be associated with asthma exacerbations but each genetic polymorphism explains only a fraction of the disease and by itself is not able to translate into clinical practice. Research is shifting from candidate gene studies and genome wide association studies towards more integrative approaches to translate genetic findings into clinical diagnostic and therapeutic tools. EXPERT COMMENTARY Integrative approaches combining polygenic or genomic data with multi-omics technologies have the potential to discover new biologic mechanisms and biomarkers for severe asthma and asthma exacerbations. Greater understanding of genomics and underlying biologic pathways will also lead to improved prevention and treatment, lowering costs, morbidity, and mortality. The utilization of genomic testing and personalized medicine may revolutionize asthma management, in particular for patients with severe, refractory asthma.
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Affiliation(s)
- Alberta L Wang
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States.,Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Kelan G Tantisira
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
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131
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Chang HS, Lee TH, Jun JA, Baek AR, Park JS, Koo SM, Kim YK, Lee HS, Park CS. Neutrophilic inflammation in asthma: mechanisms and therapeutic considerations. Expert Rev Respir Med 2016; 11:29-40. [PMID: 27918221 DOI: 10.1080/17476348.2017.1268919] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Neutrophilic airway inflammation represents a pathologically distinct form of asthma and frequently appears in symptomatic adulthood asthmatics. However, clinical impacts and mechanisms of the neutrophilic inflammation have not been thoroughly evaluated up to date. Areas covered: Currently, distinct clinical manifestations, triggers, and molecular mechanisms of the neutrophilic inflammation (namely Toll-like receptor, Th1, Th17, inflammasome) are under investigation in asthma. Furthermore, possible role of the neutrophilic inflammation is being investigated in respect to the airway remodeling. We searched the related literatures published during the past 10 years on the website of Pub Med under the title of asthma and neutrophilic inflammation in human. Expert commentary: Epidemiologic and experimental studies have revealed that the neutrophilic airway inflammation is induced by a wide variety of stimuli including ozone, particulate matters, cigarette smoke, occupational irritants, endotoxins, microbial infection and colonization, and aeroallergens. These triggers provoke diverse immune and inflammatory responses leading to progressive and sometimes irreversible airway obstruction. Clinically, neutrophilic airway inflammation is frequently associated with severe asthma and poor response to glucocorticoid therapy, indicating the need for other treatment strategies. Accordingly, therapeutics will be targeted against the main mediators behind the underlying molecular mechanisms of the neutrophilic inflammation.
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Affiliation(s)
- Hun Soo Chang
- a Department of Interdisciplinary Program in Biomedical Science Major , Soonchunhyang Graduate School , Bucheon , Gyeonggi-do , Republic of Korea
| | - Tae-Hyeong Lee
- a Department of Interdisciplinary Program in Biomedical Science Major , Soonchunhyang Graduate School , Bucheon , Gyeonggi-do , Republic of Korea
| | - Ji Ae Jun
- a Department of Interdisciplinary Program in Biomedical Science Major , Soonchunhyang Graduate School , Bucheon , Gyeonggi-do , Republic of Korea
| | - Ae Rin Baek
- b Division of Allergy and Respiratory Disease , Soonchunhyang University Bucheon Hospital , Bucheon , Gyeonggi-do , Republic of Korea
| | - Jong-Sook Park
- b Division of Allergy and Respiratory Disease , Soonchunhyang University Bucheon Hospital , Bucheon , Gyeonggi-do , Republic of Korea
| | - So-My Koo
- c Division of Allergy and Respiratory Medicine , Soonchunhyang University Seoul Hospital , Seoul , Republic of Korea
| | - Yang-Ki Kim
- c Division of Allergy and Respiratory Medicine , Soonchunhyang University Seoul Hospital , Seoul , Republic of Korea
| | - Ho Sung Lee
- d Division of Respiratory Medicine , Soonchunhyang University CheonAn Hospital , Cheonan , Chungcheongnam-do , Republic of Korea
| | - Choon-Sik Park
- b Division of Allergy and Respiratory Disease , Soonchunhyang University Bucheon Hospital , Bucheon , Gyeonggi-do , Republic of Korea
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Abstract
PURPOSE OF REVIEW This review describes the literature over the past 18 months that evaluated childhood asthma phenotypes, highlighting the key aspects of these studies, and comparing these studies to previous ones in this area. RECENT FINDINGS Recent studies on asthma phenotypes have identified new phenotypes on the basis of statistical analyses (using cluster analysis and latent class analysis methodology) and have evaluated the outcomes and associated risk factors of previously established early childhood asthma phenotypes that are based on asthma onset and patterns of wheezing illness. There have also been investigations focusing on immunologic, physiologic, and genetic correlates of various phenotypes, as well as identification of subphenotypes of severe childhood asthma. SUMMARY Childhood asthma remains a heterogeneous condition, and investigations into these various presentations, risk factors, and outcomes are important since they can offer therapeutic and prognostic relevance. Further investigation into the immunopathology and genetic basis underlying childhood phenotypes is important so therapy can be tailored accordingly.
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133
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da Silva J, Hilzendeger C, Moermans C, Schleich F, Henket M, Kebadze T, Mallia P, Edwards MR, Johnston SL, Louis R. Raised interferon-β, type 3 interferon and interferon-stimulated genes - evidence of innate immune activation in neutrophilic asthma. Clin Exp Allergy 2016; 47:313-323. [PMID: 27622317 DOI: 10.1111/cea.12809] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 05/30/2016] [Accepted: 06/26/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Interferons play an important role in innate immunity. Previous studies report deficiency in virus induction of interferon (IFN)-α, IFN-β and IFN-λ in bronchial epithelial and bronchial lavage cells in atopic asthmatics. It is now recognized that asthma is a heterogeneous disease comprising different inflammatory phenotypes, some of which may involve innate immune activation in the absence of overt infection. OBJECTIVE The aim of this study was to investigate whether the severity of asthma or a specific cellular sputum pattern may be linked to evidence of innate immune activation. METHODS Here we investigate the expression of IFN-β, IFN-λ1 (IL-29), IFN-λ2/3 (IL-28A/B) and the interferon-stimulated genes (ISGs) such as myxovirus resistance 1 (Mx1), oligoadenylate synthetase (OAS) and viperin in unstimulated sputum cells in 57 asthmatics (including 16 mild, 19 moderate and 22 severe asthma patients) and compared them with 19 healthy subjects. RESULTS We observed increased expression of IFN-β, IFN-λ1/IL-29, OAS and viperin in asthmatics compared with healthy subjects, while IL-28 was not expressed in any group. The overexpression was restricted to neutrophilic asthmatics (sputum neutrophils ≥ 76%), while eosinophilic asthmatics (sputum eosinophils ≥ 3%) did not differ from healthy subjects or even showed a lower expression of Mx1. No difference in interferon or ISG expression was observed according to clinical asthma severity. CONCLUSION AND CLINICAL RELEVANCE Neutrophilic, but not eosinophilic, asthmatics display overexpression of IFN-β, IFN-λ1/IL-29 and ISGs in their sputum cells that may reflect ongoing innate immune activation.
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Affiliation(s)
- J da Silva
- Department of Respiratory Medicine, CHU Liege, GIGA I3 University of Liege, Liege, Belgium.,Allergy Service, University Hospital Professor Polydoro Ernani de São Thiago, Federal University of Santa Catarina (HU-UFSC), Florianopolis, SC, Brazil
| | - C Hilzendeger
- Department of Respiratory Medicine, CHU Liege, GIGA I3 University of Liege, Liege, Belgium.,Airway Disease Infection Section, National Heart and Lung Institute, Imperial College London, London, UK
| | - C Moermans
- Department of Respiratory Medicine, CHU Liege, GIGA I3 University of Liege, Liege, Belgium
| | - F Schleich
- Department of Respiratory Medicine, CHU Liege, GIGA I3 University of Liege, Liege, Belgium
| | - M Henket
- Department of Respiratory Medicine, CHU Liege, GIGA I3 University of Liege, Liege, Belgium
| | - T Kebadze
- Airway Disease Infection Section, National Heart and Lung Institute, Imperial College London, London, UK
| | - P Mallia
- Airway Disease Infection Section, National Heart and Lung Institute, Imperial College London, London, UK
| | - M R Edwards
- Airway Disease Infection Section, National Heart and Lung Institute, Imperial College London, London, UK
| | - S L Johnston
- Airway Disease Infection Section, National Heart and Lung Institute, Imperial College London, London, UK
| | - R Louis
- Department of Respiratory Medicine, CHU Liege, GIGA I3 University of Liege, Liege, Belgium
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Todd CM, Salter BM, Murphy DM, Watson RM, Howie KJ, Milot J, Sadeh J, Boulet LP, O'Byrne PM, Gauvreau GM. The effects of a CXCR1/CXCR2 antagonist on neutrophil migration in mild atopic asthmatic subjects. Pulm Pharmacol Ther 2016; 41:34-39. [PMID: 27640067 DOI: 10.1016/j.pupt.2016.09.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Revised: 09/01/2016] [Accepted: 09/13/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Neutrophils are effector cells recruited to airways in patients with asthma. Migration of neutrophils occurs predominantly through activation of the CXCR1 and CXCR2 receptors by CXC chemokines, including IL-8 and Gro-α. The dual CXCR1/CXCR2 antagonist SCH 527123 has been developed to target neutrophil migration to alleviate airway neutrophilia. This study investigated the effects of SCH 527123 on neutrophil levels within the bone marrow, peripheral blood and airways, and on isolated bone marrow and peripheral blood neutrophil migration from mild allergic asthmatics. METHODS Thirteen subjects with mild allergic asthma completed a double blind, placebo-controlled, multi-center crossover study and were randomized to daily dosing of 30 mg SCH 527123 and placebo for 8 days. Subjects provided bone marrow, peripheral blood and sputum samples pre-dosing and on the last day of dosing. Neutrophil numbers were quantified in all samples and chemotaxis assays were performed on neutrophils purified from bone marrow and peripheral blood. RESULTS Neutrophil numbers fell significantly in the peripheral blood and sputum following treatment with SCH 527123 compared to placebo treatment. No change in neutrophil numbers was observed in bone marrow. SCH 527123 reduced IL-8-induced migration of purified peripheral blood neutrophils (p < 0.05), but had limited effects on migration of neutrophils purified from bone marrow. CONCLUSIONS The results from this study demonstrate that oral administration of the dual CXCR1/CXCR2 antagonist SCH 527123 reduces neutrophil levels in the circulation and airways through inhibition of migration. There were no toxic effects of SCH 527123 on granulocytic progenitor cells in the bone marrow.
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Affiliation(s)
| | | | - Desmond M Murphy
- McMaster University, Hamilton, ON, Canada; Cork University Hospital, Cork, Ireland
| | | | | | - Joanne Milot
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, QC, Canada
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Chawla LS, Toma I, Davison D, Vaziri K, Lee J, Lucas R, Seneff MG, Nyhan A, McCaffrey TA. Acute appendicitis: transcript profiling of blood identifies promising biomarkers and potential underlying processes. BMC Med Genomics 2016; 9:40. [PMID: 27417541 PMCID: PMC4946184 DOI: 10.1186/s12920-016-0200-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 06/09/2016] [Indexed: 12/31/2022] Open
Abstract
Background The diagnosis of acute appendicitis can be surprisingly difficult without computed tomography, which carries significant radiation exposure. Circulating blood cells may carry informative changes in their RNA expression profile that would signal internal infection or inflammation of the appendix. Methods Genome-wide expression profiling was applied to whole blood RNA of acute appendicitis patients versus patients with other abdominal disorders, in order to identify biomarkers of appendicitis. From a large cohort of emergency patients, a discovery set of patients with surgically confirmed appendicitis, or abdominal pain from other causes, was identified. RNA from whole blood was profiled by microarrays, and RNA levels were filtered by a combined fold-change (>2) and p value (<0.05). A separate set of patients, including patients with respiratory infections, was used to validate a partial least squares discriminant (PLSD) prediction model. Results Transcript profiling identified 37 differentially expressed genes (DEG) in appendicitis versus abdominal pain patients. The DEG list contained 3 major ontologies: infection-related, inflammation-related, and ribosomal processing. Appendicitis patients had lower level of neutrophil defensin mRNA (DEFA1,3), but higher levels of alkaline phosphatase (ALPL) and interleukin-8 receptor-ß (CXCR2/IL8RB), which was confirmed in a larger cohort of 60 patients using droplet digital PCR (ddPCR). Conclusions Patients with acute appendicitis have detectable changes in the mRNA expression levels of factors related to neutrophil innate defense systems. The low defensin mRNA levels suggest that appendicitis patient’s immune cells are not directly activated by pathogens, but are primed by diffusible factors in the microenvironment of the infection. The detected biomarkers are consistent with prior evidence that biofilm-forming bacteria in the appendix may be an important factor in appendicitis. Electronic supplementary material The online version of this article (doi:10.1186/s12920-016-0200-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lakhmir S Chawla
- Department of Anesthesiology and Critical Care Medicine, The George Washington University Medical Center, 2300 I Street, NW Ross 443, Washington, DC, 20037, USA.,The Department of Medicine, Veterans Affairs Medical Center, The George Washington University Medical Center, 2300 I Street, NW Ross 443, Washington, DC, 20037, USA
| | - Ian Toma
- Department of Medicine, Division of Genomic Medicine, The George Washington University Medical Center, 2300 I Street, NW Ross 443, Washington, DC, 20037, USA
| | - Danielle Davison
- Department of Anesthesiology and Critical Care Medicine, The George Washington University Medical Center, 2300 I Street, NW Ross 443, Washington, DC, 20037, USA
| | - Khashayar Vaziri
- Department of Surgery, The George Washington University Medical Center, 2300 I Street, NW Ross 443, Washington, DC, 20037, USA
| | - Juliet Lee
- Department of Anesthesiology and Critical Care Medicine, The George Washington University Medical Center, 2300 I Street, NW Ross 443, Washington, DC, 20037, USA.,Department of Surgery, The George Washington University Medical Center, 2300 I Street, NW Ross 443, Washington, DC, 20037, USA
| | - Raymond Lucas
- Department of Emergency Medicine, The George Washington University Medical School and GW Medical Faculty Associates, Washington, DC, USA
| | - Michael G Seneff
- Department of Emergency Medicine, The George Washington University Medical School and GW Medical Faculty Associates, Washington, DC, USA
| | - Aoibhinn Nyhan
- Department of Medicine, Division of Genomic Medicine, The George Washington University Medical Center, 2300 I Street, NW Ross 443, Washington, DC, 20037, USA
| | - Timothy A McCaffrey
- Department of Medicine, Division of Genomic Medicine, The George Washington University Medical Center, 2300 I Street, NW Ross 443, Washington, DC, 20037, USA. .,Department of Microbiology, Immunology, and Tropical Medicine, The George Washington University Medical Center, 2300 I Street, NW Ross 443, Washington, DC, 20037, USA.
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136
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Agache I, Akdis CA. Endotypes of allergic diseases and asthma: An important step in building blocks for the future of precision medicine. Allergol Int 2016; 65:243-52. [PMID: 27282212 DOI: 10.1016/j.alit.2016.04.011] [Citation(s) in RCA: 127] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Accepted: 04/25/2016] [Indexed: 02/07/2023] Open
Abstract
Discoveries from basic science research in the last decade have brought significant progress in knowledge of pathophysiologic processes of allergic diseases, with a compelling impact on understanding of the natural history, risk prediction, treatment selection or mechanism-specific prevention strategies. The view of the pathophysiology of allergic diseases developed from a mechanistic approach, with a focus on symptoms and organ function, to the recognition of a complex network of immunological pathways. Several subtypes of inflammation and complex immune-regulatory networks and the reasons for their failure are now described, that open the way for the development of new diagnostic tools and innovative targeted-treatments. An endotype is a subtype of a disease condition, which is defined by a distinct pathophysiological mechanism, whereas a disease phenotype defines any observable characteristic of a disease without any implication of a mechanism. Another key word linked to disease endotyping is biomarker that is measured and evaluated to examine any biological or pathogenic processes, including response to a therapeutic intervention. These three keywords will be discussed more and more in the future with the upcoming efforts to revolutionize patient care in the direction of precision medicine and precision health. The understanding of disease endotypes based on pathophysiological principles and their validation across clinically meaningful outcomes in asthma, allergic rhinitis, chronic rhinosinusitis, atopic dermatitis and food allergy will be crucial for the success of precision medicine as a new approach to patient management.
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137
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Carr TF, Berdnikovs S, Simon HU, Bochner BS, Rosenwasser LJ. Eosinophilic bioactivities in severe asthma. World Allergy Organ J 2016; 9:21. [PMID: 27386041 PMCID: PMC4924237 DOI: 10.1186/s40413-016-0112-5] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 06/15/2016] [Indexed: 12/17/2022] Open
Abstract
Asthma is clearly related to airway or blood eosinophilia, and asthmatics with significant eosinophilia are at higher risk for more severe disease. Eosinophils actively contribute to innate and adaptive immune responses and inflammatory cascades through the production and release of diverse chemokines, cytokines, lipid mediators and other growth factors. Eosinophils may persist in the blood and airways despite guidelines-based treatment. This review details eosinophil effector mechanisms, surface markers, and clinical outcomes associated with eosinophilia and asthma severity. There is interest in the potential of eosinophils or their products to predict treatment response with biotherapeutics and their usefulness as biomarkers. This is important as monoclonal antibodies are targeting cytokines and eosinophils in different lung environments for treating severe asthma. Identifying disease state-specific eosinophil biomarkers would help to refine these strategies and choose likely responders to biotherapeutics.
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Affiliation(s)
| | - Sergejs Berdnikovs
- />Northwestern University Feinberg School of Medicine, Chicago, Illinois USA
| | - Hans-Uwe Simon
- />Institute of Pharmacology, University of Bern, Bern, Switzerland
| | - Bruce S. Bochner
- />Northwestern University Feinberg School of Medicine, Chicago, Illinois USA
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Abstract
Noneosinophilic airway inflammation occurs in approximately 50% of patients with asthma. It is subdivided into neutrophilic or paucigranulocytic inflammation, although the proportion of each subtype is uncertain because of variable cut-off points used to define neutrophilia. This article reviews the evidence for noneosinophilic inflammation being a target for therapy in asthma and assesses clinical trials of licensed drugs, novel small molecules and biologics agents in noneosinophilic inflammation. Current symptoms, rate of exacerbations and decline in lung function are generally less in noneosinophilic asthma than eosinophilic asthma. Noneosinophilic inflammation is associated with corticosteroid insensitivity. Neutrophil activation in the airways and systemic inflammation is reported in neutrophilic asthma. Neutrophilia in asthma may be due to corticosteroids, associated chronic pulmonary infection, altered airway microbiome or delayed neutrophil apoptosis. The cause of poorly controlled noneosinophilic asthma may differ between patients and involve several mechanism including neutrophilic inflammation, T helper 2 (Th2)-low or other subtypes of airway inflammation or corticosteroid insensitivity as well as noninflammatory pathways such as airway hyperreactivity and remodelling. Smoking cessation in asthmatic smokers and removal from exposure to some occupational agents reduces neutrophilic inflammation. Preliminary studies of 'off-label' use of licensed drugs suggest that macrolides show efficacy in nonsmokers with noneosinophilic severe asthma and statins, low-dose theophylline and peroxisome proliferator-activated receptor gamma (PPARγ) agonists may benefit asthmatic smokers with noneosinophilic inflammation. Novel small molecules targeting neutrophilic inflammation, such as chemokine (CXC) receptor 2 (CXCR2) antagonists reduce neutrophils, but do not improve clinical outcomes in studies to date. Inhaled phosphodiesterase (PDE)4 inhibitors, dual PDE3 and PDE4 inhibitors, p38MAPK (mitogen-activated protein kinase) inhibitors, tyrosine kinase inhibitors and PI (phosphoinositide) 3kinase inhibitors are under development and these compounds may be of benefit in noneosinophilic inflammation. The results of clinical trials of biological agents targeting mediators associated with noneosinophilic inflammation, such as interleukin (IL)-17 and tumor necrosis factor (TNF)-α are disappointing. Greater understanding of the mechanisms of noneosinophilic inflammation in asthma should lead to improved therapies.
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Affiliation(s)
- Neil C Thomson
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow G12 0YN, UK
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139
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Clinically relevant outcome measures for new therapies of asthma using pharmaceutical and biologic agents. Curr Opin Allergy Clin Immunol 2016; 15:213-9. [PMID: 25899693 DOI: 10.1097/aci.0000000000000165] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW To determine the benefits of new asthma drugs or therapies, they should be assessed with regard to their effects on relevant clinical outcomes. RECENT FINDINGS The most frequently used outcomes have been symptoms, rescue medication needs and pulmonary function tests, although others such as quality of life, exacerbations and impairment of activities have also been identified as important ones. Improvements in our understanding of basic mechanisms of asthma have led to the development of new sets of outcomes including inflammatory markers and a rapidly increasing number of biomarkers, which however require validation, and assessment of their clinical usefulness. Many studies have not only looked at induced sputum cell differentials or FENO to phenotype asthma but also as treatment efficacy markers. Periostin is considered a marker of TH2-induced airway inflammation and a predictor of response to drugs such as anti-IL13 and omalizumab, although at the individual level, such prediction remains imperfect. SUMMARY There is a need to develop new markers of activity of the disease, with a prognostic value with regard to the benefits of new treatments.
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140
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Zissler UM, Esser-von Bieren J, Jakwerth CA, Chaker AM, Schmidt-Weber CB. Current and future biomarkers in allergic asthma. Allergy 2016; 71:475-94. [PMID: 26706728 DOI: 10.1111/all.12828] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2015] [Indexed: 12/12/2022]
Abstract
Diagnosis early in life, sensitization, asthma endotypes, monitoring of disease and treatment progression are key motivations for the exploration of biomarkers for allergic rhinitis and allergic asthma. The number of genes related to allergic rhinitis and allergic asthma increases steadily; however, prognostic genes have not yet entered clinical application. We hypothesize that the combination of multiple genes may generate biomarkers with prognostic potential. The current review attempts to group more than 161 different potential biomarkers involved in respiratory inflammation to pave the way for future classifiers. The potential biomarkers are categorized into either epithelial or infiltrate-derived or mixed origin, epithelial biomarkers. Furthermore, surface markers were grouped into cell-type-specific categories. The current literature provides multiple biomarkers for potential asthma endotypes that are related to T-cell phenotypes such as Th1, Th2, Th9, Th17, Th22 and Tregs and their lead cytokines. Eosinophilic and neutrophilic asthma endotypes are also classified by epithelium-derived CCL-26 and osteopontin, respectively. There are currently about 20 epithelium-derived biomarkers exclusively derived from epithelium, which are likely to innovate biomarker panels as they are easy to sample. This article systematically reviews and categorizes genes and collects current evidence that may promote these biomarkers to become part of allergic rhinitis or allergic asthma classifiers with high prognostic value.
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Affiliation(s)
- U. M. Zissler
- Center of Allergy & Environment (ZAUM); Technical University of Munich and Helmholtz Center Munich; German Research Center for Environmental Health member of the German Center for Lung Research (DZL); Munich Germany
| | - J. Esser-von Bieren
- Center of Allergy & Environment (ZAUM); Technical University of Munich and Helmholtz Center Munich; German Research Center for Environmental Health member of the German Center for Lung Research (DZL); Munich Germany
| | - C. A. Jakwerth
- Center of Allergy & Environment (ZAUM); Technical University of Munich and Helmholtz Center Munich; German Research Center for Environmental Health member of the German Center for Lung Research (DZL); Munich Germany
| | - A. M. Chaker
- Center of Allergy & Environment (ZAUM); Technical University of Munich and Helmholtz Center Munich; German Research Center for Environmental Health member of the German Center for Lung Research (DZL); Munich Germany
- Department of Otorhinolaryngology and Head and Neck Surgery; Medical School; Technical University of Munich; Munich Germany
| | - C. B. Schmidt-Weber
- Center of Allergy & Environment (ZAUM); Technical University of Munich and Helmholtz Center Munich; German Research Center for Environmental Health member of the German Center for Lung Research (DZL); Munich Germany
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141
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Airway molecular endotypes of asthma: dissecting the heterogeneity. Curr Opin Allergy Clin Immunol 2016; 15:163-8. [PMID: 25961390 DOI: 10.1097/aci.0000000000000148] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW This review will cover advances over the past year in defining airway endotypes in asthma by gene expression and the relationship between these endotypes and clinical traits. RECENT FINDINGS Expression profiling studies of asthmatic airway samples continue to reveal significant heterogeneity in airway inflammation and dysfunction. Recent studies have indicated multiple distinct, but related Th2 inflammatory asthma endotypes. Moreover, novel biomarkers of Th2 inflammation are being identified in more accessible nasal brushing and induced sputum cell samples. New data suggest the presence of multiple non-Th2-driven asthma molecular endotypes, including ones related to neutrophilic inflammation, airway remodeling, and chemosensory dysfunction. Many of these endotypes are associated with clinical disease features and treatment response. SUMMARY Molecular endotyping of asthmatic patients using gene expression profiling of airway samples is helping to uncover disease mechanisms and potential novel treatment targets. The advancement of endotyping methods holds the promise of future personalized treatment for asthma.
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142
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Landolina N, Levi-Schaffer F. Monoclonal antibodies: the new magic bullets for allergy: IUPHAR Review 17. Br J Pharmacol 2016; 173:793-803. [PMID: 26620589 DOI: 10.1111/bph.13396] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 11/08/2015] [Accepted: 11/22/2015] [Indexed: 12/18/2022] Open
Abstract
Allergic diseases and conditions are widespread and their incidence is on the increase. They are characterized by the activation of mast cells resident in tissues and the consequent infiltration and stimulation of several inflammatory cells, predominantly eosinophils. Cell-cell cross-talk and the release of mediators are responsible for the symptoms and for the modulation of the response. The gold standard of therapeutic intervention is still glucocorticosteroids, although they are not effective in all patients and may cause numerous side effects. Symptomatic medications are also widespread. As research has led to deeper insights into the mechanisms governing the diseases, new avenues have been opened resulting in recent years in the development of monoclonal antibodies (mAbs) such as anti-IgE mAbs (omalizumab) and others still undergoing clinical trials aimed to specifically target molecules involved in the migration and stimulation of inflammatory cells. In this review, we summarize new developments in the field of anti-allergic mAbs with special emphasis on the treatment of asthma, particularly severe forms of this condition, and atopic dermatitis, which are two unmet clinical needs.
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Affiliation(s)
- N Landolina
- Pharmacology and Experimental Therapeutics Unit, The Institute for Drug Research, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - F Levi-Schaffer
- Pharmacology and Experimental Therapeutics Unit, The Institute for Drug Research, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
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143
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Sverrild A, Bergqvist A, Baines KJ, Porsbjerg C, Andersson CK, Thomsen SF, Hoffmann HJ, Gibson P, Erjefält JS, Backer V. Airway responsiveness to mannitol in asthma is associated with chymase-positive mast cells and eosinophilic airway inflammation. Clin Exp Allergy 2016; 46:288-97. [DOI: 10.1111/cea.12609] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 06/16/2015] [Accepted: 07/24/2015] [Indexed: 12/23/2022]
Affiliation(s)
- A. Sverrild
- University Hospital Bispebjerg; Copenhagen Denmark
| | - A. Bergqvist
- Respiratory Medicine and Allergology and Experimental Medical Science; Lund University; Lund Sweden
| | - K. J. Baines
- Centre for Asthma and Respiratory Disease; The University of Newcastle; Newcastle NSW Australia
| | - C. Porsbjerg
- University Hospital Bispebjerg; Copenhagen Denmark
| | - C. K. Andersson
- Respiratory Medicine and Allergology and Experimental Medical Science; Lund University; Lund Sweden
| | - S. F. Thomsen
- Department of Dermatology; Bispebjerg Hospital; Copenhagen Denmark
| | - H. J. Hoffmann
- Department of Pulmonary Medicine B; Institute for Clinical Medicine; Aarhus University; Aarhus Denmark
| | - P. Gibson
- Centre for Asthma and Respiratory Disease; The University of Newcastle; Newcastle NSW Australia
| | - J. S. Erjefält
- Respiratory Medicine and Allergology and Experimental Medical Science; Lund University; Lund Sweden
| | - V. Backer
- University Hospital Bispebjerg; Copenhagen Denmark
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144
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Durham AL, Caramori G, Chung KF, Adcock IM. Targeted anti-inflammatory therapeutics in asthma and chronic obstructive lung disease. Transl Res 2016; 167:192-203. [PMID: 26334389 PMCID: PMC4728194 DOI: 10.1016/j.trsl.2015.08.004] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 08/11/2015] [Accepted: 08/12/2015] [Indexed: 11/29/2022]
Abstract
Asthma and chronic obstructive pulmonary disease (COPD) are chronic inflammatory diseases of the airway, although the drivers and site of the inflammation differ between diseases. Asthmatics with a neutrophilic airway inflammation are associated with a poor response to corticosteroids, whereas asthmatics with eosinophilic inflammation respond better to corticosteroids. Biologicals targeting the Th2-eosinophil nexus such as anti-interleukin (IL)-4, anti-IL-5, and anti-IL-13 are ineffective in asthma as a whole but are more effective if patients are selected using cellular (eg, eosinophils) or molecular (eg, periostin) biomarkers. This highlights the key role of individual inflammatory mediators in driving the inflammatory response and for accurate disease phenotyping to allow greater understanding of disease and development of patient-oriented antiasthma therapies. In contrast to asthmatic patients, corticosteroids are relatively ineffective in COPD patients. Despite stratification of COPD patients, the results of targeted therapy have proved disappointing with the exception of recent studies using CXC chemokine receptor (CXCR)2 antagonists. Currently, several other novel mediator-targeted drugs are undergoing clinical trials. As with asthma specifically targeted treatments may be of most benefit in specific COPD patient endotypes. The use of novel inflammatory mediator-targeted therapeutic agents in selected patients with asthma or COPD and the detection of markers of responsiveness or nonresponsiveness will allow a link between clinical phenotypes and pathophysiological mechanisms to be delineated reaching the goal of endotyping patients.
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Key Words
- ahr, airway hyperresponsiveness
- acq, asthma control questionnaire
- acos, asthma-copd overlap syndrome
- bal, bronchoalveolar lavage
- clca1, chloride channel regulator 1
- copd, chronic obstructive lung disease
- cs, corticosteroids
- cxcr, cxc chemokine receptor
- egf, epidermal growth factor
- egfr, epidermal growth factor receptor
- fkbp51, fk506-binding protein 51
- fp, fluticasone propionate
- fev1, forced expiratory volume in 1 second
- feno, fraction of exhaled nitric oxide
- gr, glucocorticoid receptor
- gm-csf, granulocyte-macrophage colony-stimulating factor
- hdacs, histone deacetylases
- hne, human neutrophil elastase
- ige, immunoglobulin e
- ics, inhaled corticosteroids
- labas, long-acting beta-adrenoceptor agonists
- mrna, messenger rna
- mabs, monoclonal antibodies
- pde, phosphodiesterase
- pi3k, phosphoinositide-3-kinase
- rt-qpcr, real time quantative polymerase chain reaction
- sal, salmeterol
- serpinb2, serpin peptidase inhibitor
- clade b, member 2
- sil-4r, soluble il-4 receptor
- gold, the global initiative for chronic obstructive lung disease
- tslp, thymic stromal lymphopoietin
- torch, towards a revolution in copd health
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Affiliation(s)
- Andrew L Durham
- Airway Diseases Section, National Heart and Lung Institute, Imperial College London, London, UK; Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, UK.
| | - Gaetano Caramori
- Section of Respiratory Diseases, Centro per lo Studio delle Malattie Infiammatorie Croniche delle Vie Aeree e Patologie Fumo Correlate dell'Apparato Respiratorio (CEMICEF; ex Centro di Ricerca su Asma e BPCO), Sezione di Medicina Interna e Cardiorespiratoria, Università di Ferrara, Ferrara, Italy
| | - Kian F Chung
- Airway Diseases Section, National Heart and Lung Institute, Imperial College London, London, UK; Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, UK
| | - Ian M Adcock
- Airway Diseases Section, National Heart and Lung Institute, Imperial College London, London, UK; Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, UK
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145
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Wang G, Baines KJ, Fu JJ, Wood LG, Simpson JL, McDonald VM, Cowan DC, Taylor DR, Cowan JO, Gibson PG. Sputum mast cell subtypes relate to eosinophilia and corticosteroid response in asthma. Eur Respir J 2015; 47:1123-33. [PMID: 26699720 DOI: 10.1183/13993003.01098-2015] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 10/31/2015] [Indexed: 02/05/2023]
Abstract
Mast cells are a resident inflammatory cell of the airways, involved in both the innate and adaptive immune response. The relationship between mast cells and inflammatory phenotypes and treatment response of asthma is not clear.Clinical characteristics of subjects with stable asthma (n=55), inflammatory cell counts and gene expression microarrays in induced sputum were analysed. Sputum mast cell subtypes were determined by molecular phenotyping based on expression of mast cell biomarkers (tryptase (TPSAB1), chymase (CMA1) and carboxypeptidase A3 (CPA3)). Effects of mast cell subtypes on steroid response were observed in a prospective cohort study (n=50).MCT(n=18) and MCT/CPA3(mRNA expression of TPSAB1 and CPA3; n=29) subtypes were identified, as well as a group without mast cell gene expression (n=8). The MCT/CPA3 subtype had elevated exhaled nitric oxide fraction, sputum eosinophils, bronchial sensitivity and reactivity, and poorer asthma control. This was accompanied by upregulation of 13 genes. Multivariable logistic regression identified CPA3(OR 1.21, p=0.004) rather than TPSAB1(OR 0.92, p=0.502) as a determinant of eosinophilic asthma. The MCT/CPA3 subtype had a better clinical response and reduced signature gene expression with corticosteroid treatment.Sputum mast cell subtypes of asthma can be defined by a molecular phenotyping approach. The MCT/CPA3 subtype demonstrated increased bronchial sensitivity and reactivity, and signature gene expression, which was associated with airway eosinophilia and greater corticosteroid responsiveness.
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Affiliation(s)
- Gang Wang
- Pneumology Group, Dept of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, and Collaborative Innovation Center for Biotherapy, Chengdu, P.R. China Center for Asthma and Respiratory Diseases, Dept of Respiratory and Sleep Medicine, John Hunter Hospital, Hunter Medical Research Institute, University of Newcastle, New Lambton, NSW, Australia
| | - Katherine J Baines
- Center for Asthma and Respiratory Diseases, Dept of Respiratory and Sleep Medicine, John Hunter Hospital, Hunter Medical Research Institute, University of Newcastle, New Lambton, NSW, Australia
| | - Juan Juan Fu
- Pneumology Group, Dept of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, and Collaborative Innovation Center for Biotherapy, Chengdu, P.R. China
| | - Lisa G Wood
- Center for Asthma and Respiratory Diseases, Dept of Respiratory and Sleep Medicine, John Hunter Hospital, Hunter Medical Research Institute, University of Newcastle, New Lambton, NSW, Australia
| | - Jodie L Simpson
- Center for Asthma and Respiratory Diseases, Dept of Respiratory and Sleep Medicine, John Hunter Hospital, Hunter Medical Research Institute, University of Newcastle, New Lambton, NSW, Australia
| | - Vanessa M McDonald
- Center for Asthma and Respiratory Diseases, Dept of Respiratory and Sleep Medicine, John Hunter Hospital, Hunter Medical Research Institute, University of Newcastle, New Lambton, NSW, Australia
| | - Douglas C Cowan
- The Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - D Robin Taylor
- The Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Jan O Cowan
- The Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Peter G Gibson
- Pneumology Group, Dept of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, and Collaborative Innovation Center for Biotherapy, Chengdu, P.R. China Center for Asthma and Respiratory Diseases, Dept of Respiratory and Sleep Medicine, John Hunter Hospital, Hunter Medical Research Institute, University of Newcastle, New Lambton, NSW, Australia
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146
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Abstract
Our understanding of asthma has evolved over time from a singular disease to a complex of various phenotypes, with varied natural histories, physiologies, and responses to treatment. Early therapies treated most patients with asthma similarly, with bronchodilators and corticosteroids, but these therapies had varying degrees of success. Similarly, despite initial studies that identified an underlying type 2 inflammation in the airways of patients with asthma, biologic therapies targeted toward these type 2 pathways were unsuccessful in all patients. These observations led to increased interest in phenotyping asthma. Clinical approaches, both biased and later unbiased/statistical approaches to large asthma patient cohorts, identified a variety of patient characteristics, but they also consistently identified the importance of age of onset of disease and the presence of eosinophils in determining clinically relevant phenotypes. These paralleled molecular approaches to phenotyping that developed an understanding that not all patients share a type 2 inflammatory pattern. Using biomarkers to select patients with type 2 inflammation, repeated trials of biologics directed toward type 2 cytokine pathways saw newfound success, confirming the importance of phenotyping in asthma. Further research is needed to clarify additional clinical and molecular phenotypes, validate predictive biomarkers, and identify new areas for possible interventions.
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Affiliation(s)
- Marc Gauthier
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Asthma Institute at UPMC, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Anuradha Ray
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Asthma Institute at UPMC, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Sally E Wenzel
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Asthma Institute at UPMC, University of Pittsburgh, Pittsburgh, Pennsylvania
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147
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Affiliation(s)
- Tara F Carr
- Department of Internal Medicine, University of Arizona College of Medicine, Tucson, Arizona
| | - Monica Kraft
- Department of Internal Medicine, University of Arizona College of Medicine, Tucson, Arizona
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148
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Agache I, Sugita K, Morita H, Akdis M, Akdis CA. The Complex Type 2 Endotype in Allergy and Asthma: From Laboratory to Bedside. Curr Allergy Asthma Rep 2015; 15:29. [PMID: 26141574 DOI: 10.1007/s11882-015-0529-x] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Better management of allergic diseases needs a sharpened understanding of disease heterogeneity and mechanisms in relation to clinically significant outcomes. Phenotypes describing observable clinical and morphologic characteristics and unique responses to treatment have been developed; however, they do not relate to disease mechanisms. Recently, extended heterogeneous and disease-related metabolic, inflammatory, immunological, and remodeling pathways have been described, and reproducible patterns are defined as disease endotypes. An endotype might consist of several intricated mechanisms that cannot be clearly separated into "pure single molecular mechanism" thus being a "complex endotype." The description of an endotype may rely on biomarkers, which can be the signature of a complex underlying pathway or a key molecule associated with or directly playing a role in a particular disease endotype. The Th2 type inflammation can be defined as a complex endotype in asthma and linked to mechanisms of disease development and response to treatment and to disease outcomes such as exacerbations and remodeling. The type 2 complex endotype in allergies and asthma includes innate lymphoid cells, T helper 2 cells, tissue eosinophilia, and IgE production. Currently, emerging endotype-driven strategies in asthma, particularly the development of biologicals that target a single molecular pathway, are being focused for solving individualized clinical problems on disease outcomes. Progress is also being made for endotyping rhinitis, chronic rhinosinusitis, and atopic dermatitis.
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Affiliation(s)
- Ioana Agache
- Department of Allergy and Clinical Immunology, Faculty of Medicine, Transylvania University of Brasov, Brasov, Romania,
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Chiappori A, De Ferrari L, Folli C, Mauri P, Riccio AM, Canonica GW. Biomarkers and severe asthma: a critical appraisal. Clin Mol Allergy 2015; 13:20. [PMID: 26430389 PMCID: PMC4590266 DOI: 10.1186/s12948-015-0027-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 08/04/2015] [Indexed: 01/17/2023] Open
Abstract
Severe asthma (SA) is a clinically and etiologically heterogeneous respiratory disease which affects among 5–10 % of asthmatic patients. Despite high-dose therapy, a large patients percentage is not fully controlled and has a poor quality of life. In this review, we describe the biomarkers actually known in scientific literature and used in clinical practice for SA assessment and management: neutrophils, eosinophils, periostin, fractional exhaled nitric oxide, exhaled breath condensate and galectins. Moreover, we give an overview on clinical and biological features characterizing severe asthma, paying special attention to the potential use of these ones as reliable markers. We finally underline the need to define different biomarkers panels to select patients affected by severe asthma for specific and personalized therapeutic approach.
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Affiliation(s)
- Alessandra Chiappori
- DIMI-Department of Internal Medicine, Respiratory Diseases and Allergy Clinic, University of Genoa, IRCCS AOU S.Martino-IST, Genoa, Italy
| | - Laura De Ferrari
- DIMI-Department of Internal Medicine, Respiratory Diseases and Allergy Clinic, University of Genoa, IRCCS AOU S.Martino-IST, Genoa, Italy
| | - Chiara Folli
- DIMI-Department of Internal Medicine, Respiratory Diseases and Allergy Clinic, University of Genoa, IRCCS AOU S.Martino-IST, Genoa, Italy
| | - Pierluigi Mauri
- Institute for Biomedical Technologies, CNR, Segrate, Milan, Italy
| | - Anna Maria Riccio
- DIMI-Department of Internal Medicine, Respiratory Diseases and Allergy Clinic, University of Genoa, IRCCS AOU S.Martino-IST, Genoa, Italy
| | - Giorgio Walter Canonica
- DIMI-Department of Internal Medicine, Respiratory Diseases and Allergy Clinic, University of Genoa, IRCCS AOU S.Martino-IST, Genoa, Italy
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150
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Peripheral blood IRF1 expression as a marker for glucocorticoid sensitivity. Pharmacogenet Genomics 2015; 25:126-33. [PMID: 25564375 DOI: 10.1097/fpc.0000000000000116] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Despite of the common usage of glucocorticoids (GCs), a significant portion of asthma patients exhibit GC insensitivity. This could be mediated by diverse mechanisms, including genomics. Recent work has suggested that measuring changes in gene expression may provide more predictive information about GC insensitivity than baseline gene expression alone, and that expression changes in peripheral blood may be reflective of those in the airway. METHODS We performed in silico discovery using gene expression omnibus (GEO) data that evaluated GC effect on gene expression in multiple tissue types. Subsequently, candidate genes whose expression levels are affected by GC were examined in cell lines and in primary cells derived from human airway and blood. RESULTS Through gene expression omnibus analysis, we identified interferon regulator factor 1 (IRF1), whose expression is affected by GC treatment in airway smooth muscle cells, normal human bronchial epithelial (NHBE) cells, and lymphoblastoid cell lines (LCLs). Significant IRF1 downregulation post GC exposure was confirmed in two cultured airway epithelial cell lines and primary NHBE cells (P<0.05). We observed large interindividual variation in GC-induced IRF1 expression changes among primary NHBE cells tested. Significant downregulation of IRF1 was also observed in six randomly selected LCLs (P<0.05), with variable degrees of downregulation among different samples. In peripheral blood mononuclear cells obtained from healthy volunteers, variable downregulation of IRF1 by GC was also shown. NFKB1, a gene whose expression is known to be downregulated by GC and the degree of downregulation of which is reflective of GC response, was used as a control in our study. IRF1 shows more consistent downregulation across tissue types when compared with NFKB1. CONCLUSION Our results suggest that GC-induced IRF1 gene expression changes in peripheral blood could be used as a marker to reflect GC response in the airway.
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