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Castanhinha S, Sherburn R, Walker S, Gupta A, Bossley CJ, Buckley J, Ullmann N, Grychtol R, Campbell G, Maglione M, Koo S, Fleming L, Gregory L, Snelgrove RJ, Bush A, Lloyd CM, Saglani S. Pediatric severe asthma with fungal sensitization is mediated by steroid-resistant IL-33. J Allergy Clin Immunol 2015; 136:312-22.e7. [PMID: 25746970 PMCID: PMC4534777 DOI: 10.1016/j.jaci.2015.01.016] [Citation(s) in RCA: 131] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 12/24/2014] [Accepted: 01/05/2015] [Indexed: 11/16/2022]
Abstract
Background The mechanism underlying severe asthma with fungal sensitization (SAFS) is unknown. IL-33 is important in fungus-induced asthma exacerbations, but its role in fungal sensitization is unexplored. Objective We sought to determine whether fungal sensitization in children with severe therapy-resistant asthma is mediated by IL-33. Methods Eighty-two children (median age, 11.7 years; 63% male) with severe therapy-resistant asthma were included. SAFS (n = 38) was defined as specific IgE or skin prick test response positivity to Aspergillus fumigatus, Alternaria alternata, or Cladosporium herbarum. Clinical features and airway immunopathology were assessed. Chronic exposure to house dust mite and A alternata were compared in a neonatal mouse model. Results Children with SAFS had earlier symptom onset (0.5 vs 1.5 years, P = .006), higher total IgE levels (637 vs 177 IU/mL, P = .002), and nonfungal inhalant allergen-specific IgE. Significantly more children with SAFS were prescribed maintenance oral steroids (42% vs 14%, P = .02). SAFS was associated with higher airway IL-33 levels. In neonatal mice A alternata exposure induced higher serum IgE levels, pulmonary IL-33 levels, and IL-13+ innate lymphoid cell (ILC) and TH2 cell numbers but similar airway hyperresponsiveness (AHR) compared with those after house dust mite exposure. Lung IL-33 levels, IL-13+ ILC numbers, TH2 cell numbers, IL-13 levels, and AHR remained increased with inhaled budesonide during A alternata exposure, but all features were significantly reduced in ST2−/− mice lacking a functional receptor for IL-33. Conclusion Pediatric SAFS was associated with more oral steroid therapy and higher IL-33 levels. A alternata exposure resulted in increased IL-33–mediated ILC2 numbers, TH2 cell numbers, and steroid-resistant AHR. IL-33 might be a novel therapeutic target for SAFS.
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Affiliation(s)
- Susana Castanhinha
- Department of Respiratory Paediatrics, Royal Brompton Hospital, London, United Kingdom
| | - Rebekah Sherburn
- Leukocyte Biology, NHLI, Imperial College London, London, United Kingdom
| | - Simone Walker
- Leukocyte Biology, NHLI, Imperial College London, London, United Kingdom
| | - Atul Gupta
- Department of Respiratory Paediatrics, Kings College Hospital, London, United Kingdom
| | - Cara J Bossley
- Department of Respiratory Paediatrics, Kings College Hospital, London, United Kingdom
| | - James Buckley
- Leukocyte Biology, NHLI, Imperial College London, London, United Kingdom
| | - Nicola Ullmann
- Department of Respiratory Paediatrics, Royal Brompton Hospital, London, United Kingdom
| | - Ruth Grychtol
- Leukocyte Biology, NHLI, Imperial College London, London, United Kingdom
| | - Gaynor Campbell
- Leukocyte Biology, NHLI, Imperial College London, London, United Kingdom
| | - Marco Maglione
- Department of Respiratory Paediatrics, Royal Brompton Hospital, London, United Kingdom
| | - Sergio Koo
- Department of Respiratory Paediatrics, Royal Brompton Hospital, London, United Kingdom
| | - Louise Fleming
- Department of Respiratory Paediatrics, Royal Brompton Hospital, London, United Kingdom; Airways Disease, NHLI, Imperial College London, London, United Kingdom
| | - Lisa Gregory
- Leukocyte Biology, NHLI, Imperial College London, London, United Kingdom
| | - Robert J Snelgrove
- Leukocyte Biology, NHLI, Imperial College London, London, United Kingdom
| | - Andrew Bush
- Department of Respiratory Paediatrics, Royal Brompton Hospital, London, United Kingdom; Airways Disease, NHLI, Imperial College London, London, United Kingdom
| | - Clare M Lloyd
- Leukocyte Biology, NHLI, Imperial College London, London, United Kingdom
| | - Sejal Saglani
- Department of Respiratory Paediatrics, Royal Brompton Hospital, London, United Kingdom; Leukocyte Biology, NHLI, Imperial College London, London, United Kingdom.
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Apter AJ. Advances in adult asthma diagnosis and treatment in 2014. J Allergy Clin Immunol 2015; 135:46-53. [PMID: 25567042 DOI: 10.1016/j.jaci.2014.10.050] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 10/30/2014] [Indexed: 12/11/2022]
Abstract
In 2014, new biologic therapies are emerging for severe asthma based on identification of relevant phenotypes. The exploration of nutritional supplements to treat asthma has been less successful.
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Affiliation(s)
- Andrea J Apter
- Division of Pulmonary, Allergy, & Critical Care Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa.
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203
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IL-33: an alarmin cytokine with crucial roles in innate immunity, inflammation and allergy. Curr Opin Immunol 2014; 31:31-7. [PMID: 25278425 DOI: 10.1016/j.coi.2014.09.004] [Citation(s) in RCA: 490] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 09/13/2014] [Indexed: 12/28/2022]
Abstract
IL-33 is a nuclear cytokine from the IL-1 family constitutively expressed in epithelial barrier tissues and lymphoid organs, which plays important roles in type-2 innate immunity and human asthma. Recent studies indicate that IL-33 induces production of large amounts of IL-5 and IL-13 by group 2 innate lymphoid cells (ILC2s), for initiation of allergic inflammation shortly after exposure to allergens or infection with parasites or viruses. IL-33 appears to function as an alarmin (alarm signal) rapidly released from producing cells upon cellular damage or cellular stress. In this review, we discuss the cellular sources, mode of action and regulation of IL-33, and we highlight its crucial roles in vivo with particular emphasis on results obtained using IL33-deficient mice.
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Iijima K, Kobayashi T, Hara K, Kephart GM, Ziegler SF, McKenzie AN, Kita H. IL-33 and thymic stromal lymphopoietin mediate immune pathology in response to chronic airborne allergen exposure. THE JOURNAL OF IMMUNOLOGY 2014; 193:1549-59. [PMID: 25015831 DOI: 10.4049/jimmunol.1302984] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Humans are frequently exposed to various airborne allergens in the atmospheric environment. These allergens may trigger a complex network of immune responses in the airways, resulting in asthma and other chronic airway diseases. In this study, we investigated the immunological mechanisms involved in the pathological changes induced by chronic exposure to multiple airborne allergens. Naive mice were exposed intranasally to a combination of common airborne allergens, including the house dust mite, Alternaria, and Aspergillus, for up to 8 wk. These allergens acted synergistically and induced robust eosinophilic airway inflammation, specific IgE Ab production, type 2 cytokine response, and airway hyperresponsiveness in 4 wk, followed by airway remodeling in 8 wk. Increased lung infiltration of T cells, B cells, and type 2 innate lymphoid cells was observed. CD4(+) T cells and type 2 innate lymphoid cells contributed to the sources of IL-5 and IL-13, suggesting involvement of both innate and adaptive immunity in this model. The lung levels of IL-33 increased quickly within several hours after allergen exposure and continued to rise throughout the chronic phase of inflammation. Mice deficient in IL-33R (Il1rl1(-/-)) and thymic stromal lymphopoietin receptor (Tslpr(-/-)) showed significant reduction in airway inflammation, IgE Ab levels, and airway hyperresponsiveness. In contrast, mice deficient in IL-25R or IL-1R showed minimal differences as compared with wild-type animals. Thus, chronic exposure to natural airborne allergens triggers a network of innate and adaptive type 2 immune responses and airway pathology, and IL-33 and thymic stromal lymphopoietin most likely play key roles in this process.
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Affiliation(s)
- Koji Iijima
- Division of Allergic Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905
| | - Takao Kobayashi
- Division of Allergic Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905
| | - Kenichiro Hara
- Division of Allergic Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905
| | - Gail M Kephart
- Division of Allergic Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905
| | - Steven F Ziegler
- Immunology Program, Benaroya Research Institute, Seattle, WA 98101; and
| | - Andrew N McKenzie
- Medical Research Council Laboratory of Molecular Biology, Cambridge CB2 0QH, United Kingdom
| | - Hirohito Kita
- Division of Allergic Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905;
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