201
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Kan S, Hariyadi DM, Grainge C, Knight DA, Bartlett NW, Liang M. Airway epithelial-targeted nanoparticles for asthma therapy. Am J Physiol Lung Cell Mol Physiol 2020; 318:L500-L509. [PMID: 31913649 DOI: 10.1152/ajplung.00237.2019] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Asthma is a common chronic inflammatory disease associated with intermittent airflow obstruction caused by airway inflammation, mucus overproduction, and bronchial hyperresponsiveness. Despite current treatment and management options, a large number of patients with asthma still have poorly controlled disease and are susceptible to acute exacerbations, usually caused by a respiratory virus infection. As a result, there remains a need for novel therapies to achieve better control and prevent/treat exacerbations. Nanoparticles (NPs), including extracellular vesicles (EV) and their synthetic counterparts, have been developed for drug delivery in respiratory diseases. In the case of asthma, where airway epithelium dysfunction, including dysregulated differentiation of epithelial cells, impaired barrier, and immune response, is a driver of disease, targeting airway epithelial cells with NPs may offer opportunities to repair or reverse these dysfunctions with therapeutic interventions. EVs possess multiple advantages for airway epithelial targeting, such as their natural intrinsic cell-targeting properties and low immunogenicity. Synthetic NPs can be coated with muco-inert polymers to overcome biological barriers such as mucus and the phagocytic response of immune cells. Targeting ligands could be also added to enhance targeting specificity to epithelial cells. The review presents current understanding and advances in NP-mediated drug delivery to airway epithelium for asthma therapy. Future perspectives in this therapeutic strategy will also be discussed, including the development of novel formulations and physiologically relevant preclinical models.
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Affiliation(s)
- Stanislav Kan
- School of Biomedical Sciences and Pharmacy, The University of Newcastle, Callaghan, New South Wales, Australia.,Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, The University of Newcastle, New South Wales, Australia
| | | | - Christopher Grainge
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.,Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, The University of Newcastle, New South Wales, Australia
| | - Darryl A Knight
- School of Biomedical Sciences and Pharmacy, The University of Newcastle, Callaghan, New South Wales, Australia.,Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, The University of Newcastle, New South Wales, Australia
| | - Nathan W Bartlett
- School of Biomedical Sciences and Pharmacy, The University of Newcastle, Callaghan, New South Wales, Australia.,Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, The University of Newcastle, New South Wales, Australia
| | - Mingtao Liang
- School of Biomedical Sciences and Pharmacy, The University of Newcastle, Callaghan, New South Wales, Australia.,Faculty of Pharmacy, Universitas Airlangga, Surabaya, Indonesia
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202
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Potaczek DP, Miethe S, Schindler V, Alhamdan F, Garn H. Role of airway epithelial cells in the development of different asthma phenotypes. Cell Signal 2020; 69:109523. [PMID: 31904412 DOI: 10.1016/j.cellsig.2019.109523] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 12/30/2019] [Accepted: 12/31/2019] [Indexed: 01/06/2023]
Abstract
The term (bronchial) asthma describes a disorder syndrome that comprises several disease phenotypes, all characterized by chronic inflammation in the bronchial epithelium, with a variety of subsequent functional consequences. Thus, the epithelium in the conducting airways is the main localization of the complex pathological changes in the disease. In this regard, bronchial epithelial cells are not passively affected by inflammatory mechanisms induced by immunological processes but rather actively involved in all steps of disease development from initiation and perpetuation to chronification. In recent years it turned out that bronchial epithelial cells show a high level of structural and functional diversity and plasticity with epigenetic mechanisms playing a crucial role in the regulation of these processes. Thus, it is quite reasonable that differential functional activities of the bronchial epithelium are involved in the development of different asthma phenotypes and/or stages of disease. The current knowledge on this topic will be discussed in this review article.
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Affiliation(s)
- Daniel P Potaczek
- Institute of Laboratory Medicine and Pathobiochemistry - Molecular Diagnostics, Philipps University of Marburg - Medical Faculty, Universities of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL), Marburg, Germany; John Paul II Hospital, Krakow, Poland
| | - Sarah Miethe
- Institute of Laboratory Medicine and Pathobiochemistry - Molecular Diagnostics, Philipps University of Marburg - Medical Faculty, Universities of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL), Marburg, Germany
| | - Viktoria Schindler
- Institute of Laboratory Medicine and Pathobiochemistry - Molecular Diagnostics, Philipps University of Marburg - Medical Faculty, Universities of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL), Marburg, Germany
| | - Fahd Alhamdan
- Institute of Laboratory Medicine and Pathobiochemistry - Molecular Diagnostics, Philipps University of Marburg - Medical Faculty, Universities of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL), Marburg, Germany
| | - Holger Garn
- Institute of Laboratory Medicine and Pathobiochemistry - Molecular Diagnostics, Philipps University of Marburg - Medical Faculty, Universities of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL), Marburg, Germany.
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203
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Ramsahai JM, Hansbro PM, Wark PAB. Mechanisms and Management of Asthma Exacerbations. Am J Respir Crit Care Med 2020; 199:423-432. [PMID: 30562041 DOI: 10.1164/rccm.201810-1931ci] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Acute asthma remains an important medical emergency, the most frequent cause of acute admissions in children and a major source of morbidity for adults with asthma. In all ages with asthma, the presence of exacerbations is an important defining characteristic of asthma severity. In this review, we assess the epidemiology of acute asthma, the triggers of acute exacerbations, and the mechanisms that underlie these exacerbations. We also assess current treatments that prevent exacerbations, with an emphasis on the role of type 2 airway inflammation in the context of acute exacerbations and the novel treatments that effectively target this. Finally we review current management strategies of the exacerbations themselves.
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Affiliation(s)
- J Michael Ramsahai
- 1 Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales, Australia.,2 Division of Respiratory Medicine, Department of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada; and
| | - Philip M Hansbro
- 1 Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales, Australia.,3 Centre for Inflammation, Centenary Institute and University of Technology Sydney, Sydney, New South Wales, Australia
| | - Peter A B Wark
- 1 Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales, Australia
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204
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Beasley R, Gibson P. Twenty-five years of Respirology: Advances in asthma. Respirology 2019; 25:11-13. [PMID: 31840886 DOI: 10.1111/resp.13735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 09/24/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Richard Beasley
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Peter Gibson
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, University of Newcastle, Newcastle, New South Wales, Australia
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205
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Mihaylova VT, Kong Y, Fedorova O, Sharma L, Dela Cruz CS, Pyle AM, Iwasaki A, Foxman EF. Regional Differences in Airway Epithelial Cells Reveal Tradeoff between Defense against Oxidative Stress and Defense against Rhinovirus. Cell Rep 2019; 24:3000-3007.e3. [PMID: 30208323 PMCID: PMC6190718 DOI: 10.1016/j.celrep.2018.08.033] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 06/22/2018] [Accepted: 08/13/2018] [Indexed: 12/14/2022] Open
Abstract
Rhinovirus is a leading cause of acute respiratory infections and asthma attacks, but infections are also frequently cleared from the nasal mucosa without causing symptoms. We sought to better understand host defense against rhinovirus by investigating antiviral defense in primary human nasal and bronchial airway epithelial cells cultured ex vivo. Surprisingly, upon rhinovirus infection or RIG-I stimulation, nasal-derived epithelial cells exhibited much more robust antiviral responses than bronchial-derived cells. Conversely, RIG-I stimulation triggered more robust activation of the NRF2-dependent oxidative stress response in bronchial cells compared to nasal cells. NRF2 activation dampened epithelial antiviral responses, whereas NRF2 knockdown enhanced antiviral responses and was protective during rhinovirus infection. These findings demonstrate a tradeoff in epithelial defense against distinct types of airway damage, namely, viral versus oxidative, and reveal differential calibration of defense responses in cells derived from different airway microenvironments. Airway epithelial cells form the first line of defense against harmful substances that enter the airway. Mihaylova et al. show that viral RNA detection triggers both the NRF2-mediated oxidative stress response and the antiviral interferon response in epithelial cells and demonstrates a tradeoff between these defense responses.
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Affiliation(s)
- Valia T Mihaylova
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Yong Kong
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Olga Fedorova
- Howard Hughes Medical Institute, New Haven, CT 06520, USA
| | - Lokesh Sharma
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Charles S Dela Cruz
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Anna Marie Pyle
- Department of Molecular, Cellular and Developmental Biology and Department of Chemistry, Yale University, New Haven, CT 06520, USA; Howard Hughes Medical Institute, New Haven, CT 06520, USA
| | - Akiko Iwasaki
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT 06520, USA; Howard Hughes Medical Institute, New Haven, CT 06520, USA
| | - Ellen F Foxman
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT 06520, USA.
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206
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Singanayagam A, Johnston SL. Not just the common cold: Rhinovirus infection in lung allograft recipients. Respirology 2019; 24:1134-1135. [DOI: 10.1111/resp.13571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 04/08/2019] [Indexed: 12/01/2022]
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207
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Menzel M, Ramu S, Calvén J, Olejnicka B, Sverrild A, Porsbjerg C, Tufvesson E, Bjermer L, Akbarshahi H, Uller L. Oxidative Stress Attenuates TLR3 Responsiveness and Impairs Anti-viral Mechanisms in Bronchial Epithelial Cells From COPD and Asthma Patients. Front Immunol 2019; 10:2765. [PMID: 31849956 PMCID: PMC6895140 DOI: 10.3389/fimmu.2019.02765] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 11/12/2019] [Indexed: 12/16/2022] Open
Abstract
COPD and asthma exacerbations are commonly triggered by rhinovirus infection. Potentially promoting exacerbations, impaired anti-viral signaling and attenuated viral clearance have been observed in diseased bronchial epithelium. Oxidative stress is a feature of inflammation in asthma and COPD and is prominent during exacerbations. It is not known whether oxidative stress affects the anti-viral signaling capacity. Bronchial epithelial cells from asthmatic and COPD donors were infected with rhinovirus or treated with the oxidative stressor H2O2 followed by exposure to the synthetic viral replication intermediate poly(I:C). Poly(I:C) was used to ascertain a constant infection-like burden. Gene and protein levels of antioxidants as well as anti-viral responses were measured 3 and 24 h post poly(I:C) exposure. Rhinovirus infection and poly(I:C) stimulation induced protein levels of the antioxidants SOD1 and SOD2. In asthmatic bronchial epithelial cells pre-treatment with H2O2 dose-dependently decreased the antioxidant response to poly(I:C), suggesting exaggerated oxidative stress. Further, poly(I:C)-induced IFNβ gene expression was reduced after pre-treatment with H2O2. This epithelial effect was associated with a reduced expression of the pattern recognition receptors RIG-I, MDA5 and TLR3 both on gene and protein level. Pre-treatment with H2O2 did not alter antioxidant responses in COPD bronchial epithelial cells and, more modestly than in asthma, reduced poly(I:C)-induced IFNβ gene expression. Knockdown of TLR3 but not RIG-I/MDA5 abrogated impairment of poly(I:C)-induced IFNβ gene expression by H2O2. We developed a method by which we could demonstrate that oxidative stress impairs anti-viral signaling in bronchial epithelial cells from asthmatic and COPD patients, most pronounced in asthma. The impairment apparently reflects reduced responsiveness of TLR3. These present findings shed light on molecular mechanisms potentially causing reduced interferon responses to rhinovirus infection at exacerbations in asthma and COPD. Together, our findings suggest a possible self-perpetuating vicious cycle underlying recurrent exacerbations, leading to an impaired anti-viral response, which in turn leads to viral-induced exacerbations, causing more airway inflammation.
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Affiliation(s)
- Mandy Menzel
- Unit of Respiratory Immunopharmacology, Department of Experimental Medical Science, Lund University, Lund, Sweden
| | - Sangeetha Ramu
- Unit of Respiratory Immunopharmacology, Department of Experimental Medical Science, Lund University, Lund, Sweden
| | - Jenny Calvén
- Unit of Respiratory Immunopharmacology, Department of Experimental Medical Science, Lund University, Lund, Sweden.,Department of Internal Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Beata Olejnicka
- Airway Inflammation Unit, Department of Experimental Medical Science, Lund University, Lund, Sweden.,Department of Internal Medicine, Trelleborg Hospital, Trelleborg, Sweden
| | - Asger Sverrild
- Department of Respiratory Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Celeste Porsbjerg
- Department of Respiratory Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Ellen Tufvesson
- Unit of Respiratory Medicine and Allergology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Leif Bjermer
- Unit of Respiratory Medicine and Allergology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Hamid Akbarshahi
- Unit of Respiratory Immunopharmacology, Department of Experimental Medical Science, Lund University, Lund, Sweden.,Unit of Respiratory Medicine and Allergology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Lena Uller
- Unit of Respiratory Immunopharmacology, Department of Experimental Medical Science, Lund University, Lund, Sweden
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208
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Denlinger LC, Heymann P, Lutter R, Gern JE. Exacerbation-Prone Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 8:474-482. [PMID: 31765853 DOI: 10.1016/j.jaip.2019.11.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 10/28/2019] [Accepted: 11/12/2019] [Indexed: 02/07/2023]
Abstract
Patients who are prone to exacerbations of asthma experience significant costs in terms of missed work and school, acute care visits, and hospitalizations. Exacerbations are largely driven by environmental exposures including pollutants, stress, and viral and bacterial pathogens. These exposures are most likely to induce acute severe "asthma attacks" in high-risk patients. These personal risk factors for exacerbations can vary with the phenotype of asthma and age of the patient. In children, allergic sensitization is a strong risk factor, especially for those children who develop sensitization early in life. Airway inflammation is an important risk factor, and biomarkers are under evaluation for utility in detecting eosinophilic and type 2 inflammation and neutrophilic inflammation as indicators of risk for recurrent exacerbations. Insights into inflammatory mechanisms have led to new approaches to prevent exacerbations using mAb-based biologics that target specific type 2 pathways. Challenges remain in developing an evidence base to support precision interventions with these effective yet expensive therapies, and in determining whether these treatments will be safe and effective in young children. Unfortunately, there has been less progress in developing treatments for acute exacerbations. Hopefully, greater understanding of mechanisms relating airway viruses, bacteria, mucin production, and neutrophilic inflammatory responses will lead to additional treatment options for patients experiencing acute exacerbations.
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Affiliation(s)
- Loren C Denlinger
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wis.
| | - Peter Heymann
- Department of Pediatrics, University of Virginia, Charlottesville, Va
| | - Rene Lutter
- Departments of Respiratory Medicine and Experimental Immunology, Amsterdam University Centers, University of Amsterdam, Amsterdam Infection and Immunity Institute, Amsterdam, The Netherlands
| | - James E Gern
- Department of Pediatrics, University of Wisconsin-Madison, School of Medicine and Public Health, Madison, Wis
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209
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Affiliation(s)
- Shilpa J Patel
- Division of Emergency Medicine, Children's National Medical Center, Washington, DC
| | - Stephen J Teach
- Division of Emergency Medicine, Children's National Medical Center, Washington, DC
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210
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Ravi A, Chang M, van de Pol M, Yang S, Aliprantis A, Thornton B, Carayannopoulos LN, Bautmans A, Robberechts M, De Lepeleire I, Singh D, Hohlfeld JM, Sterk PJ, Krug N, Lutter R. Rhinovirus-16 induced temporal interferon responses in nasal epithelium links with viral clearance and symptoms. Clin Exp Allergy 2019; 49:1587-1597. [PMID: 31400236 PMCID: PMC6972523 DOI: 10.1111/cea.13481] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 06/27/2019] [Accepted: 07/30/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND The temporal in vivo response of epithelial cells to a viral challenge and its association with viral clearance and clinical outcomes has been largely unexplored in asthma. OBJECTIVE To determine gene expression profiles over time in nasal epithelial cells (NECs) challenged in vivo with rhinovirus-16 (RV16) and compare to nasal symptoms and viral clearance. METHODS Patients with stable mild to moderate asthma (n = 20) were challenged intranasally with RV16. Nasal brush samples for RNA sequencing were taken 7 days prior to infection and 3, 6 and 14 days post-infection, and blood samples 4 days prior to infection and day 6 post-infection. Viral load was measured in nasal lavage fluid at day 3, 6 and 14. RESULTS Top differentially (>2.5-fold increase) expressed gene sets in NECs post-RV16 at days 3 and 6, compared with baseline, were interferon alpha and gamma response genes. Patients clearing the virus within 6 days (early resolvers) had a significantly increased interferon response at day 6, whereas those having cleared the virus by day 14 (late resolvers) had significantly increased responses at day 3, 6 and 14. Interestingly, patients not having cleared the virus by day 14 (non-resolvers) had no enhanced interferon responses at any of these days. The daily Cold Symptom Scores (CSS) peaked at days 3 to 5 and correlated positively with interferon response genes at day 3 (R = 0.48), but not at other time-points. Interferon response genes were also enhanced in blood at day 6 after RV16 challenge. CONCLUSION AND CLINICAL RELEVANCE This study shows that viral load and clearance varies markedly over time in mild to moderate asthma patients exposed to a fixed RV16 dose. The host's nasal interferon response to RV16 at day 3 is associated with upper respiratory tract symptoms. The temporal interferon response in nasal epithelium associates with viral clearance in the nasal compartment.
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Affiliation(s)
- Abilash Ravi
- Amsterdam UMC, Department of Respiratory Medicine, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam UMC, Department of Experimental Immunology, Amsterdam Infection & Immunity Institute, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Marianne van de Pol
- Amsterdam UMC, Department of Respiratory Medicine, University of Amsterdam, Amsterdam, The Netherlands
| | - Shan Yang
- Merck & Co., Inc., Kenilworth, NJ, USA
| | | | | | | | - An Bautmans
- Merck Sharp and Dohme, Europe Inc., Brussels, Belgium
| | | | | | - Dave Singh
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
| | - Jens M Hohlfeld
- Fraunhofer Institute for Toxicology and Experimental Medicine, Hannover, Germany.,German Center for Lung Research (DZL), Hannover, Germany
| | - Peter J Sterk
- Amsterdam UMC, Department of Respiratory Medicine, University of Amsterdam, Amsterdam, The Netherlands
| | - Norbert Krug
- Fraunhofer Institute for Toxicology and Experimental Medicine, Hannover, Germany.,German Center for Lung Research (DZL), Hannover, Germany
| | - René Lutter
- Amsterdam UMC, Department of Respiratory Medicine, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam UMC, Department of Experimental Immunology, Amsterdam Infection & Immunity Institute, University of Amsterdam, Amsterdam, The Netherlands
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211
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Wark PAB. Why are people with asthma more susceptible to influenza? Eur Respir J 2019; 54:54/4/1901748. [PMID: 31649149 DOI: 10.1183/13993003.01748-2019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 09/05/2019] [Indexed: 11/05/2022]
Affiliation(s)
- Peter A B Wark
- Centre for Healthy Lungs, Hunter Medical Research Institute, University of Newcastle, New Lambton, Australia
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212
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Jha A, Dunning J, Tunstall T, Thwaites RS, Hoang LT, Kon OM, Zambon MC, Hansel TT, Openshaw PJ. Patterns of systemic and local inflammation in patients with asthma hospitalised with influenza. Eur Respir J 2019; 54:13993003.00949-2019. [PMID: 31391224 DOI: 10.1183/13993003.00949-2019] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 07/25/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Patients with asthma are at risk of hospitalisation with influenza, but the reasons for this predisposition are unknown. STUDY SETTING A prospective observational study of adults with PCR-confirmed influenza in 11 UK hospitals, measuring nasal, nasopharyngeal and systemic immune mediators and whole-blood gene expression. RESULTS Of 133 admissions, 40 (30%) had previous asthma; these were more often female (70% versus 38.7%, OR 3.69, 95% CI 1.67-8.18; p=0.0012), required less mechanical ventilation (15% versus 37.6%, Chi-squared 6.78; p=0.0338) and had shorter hospital stays (mean 8.3 versus 15.3 days, p=0.0333) than those without. In patients without asthma, severe outcomes were more frequent in those given corticosteroids (OR 2.63, 95% CI 1.02-6.96; p=0.0466) or presenting >4 days after disease onset (OR 5.49, 95% CI 2.28-14.03; p=0.0002). Influenza vaccination in at-risk groups (including asthma) were lower than intended by national policy and the early use of antiviral medications were less than optimal. Mucosal immune responses were equivalent between groups. Those with asthma had higher serum interferon (IFN)-α, but lower serum tumour necrosis factor, interleukin (IL)-5, IL-6, CXCL8, CXCL9, IL-10, IL-17 and CCL2 levels (all p<0.05); both groups had similar serum IL-13, total IgE, periostin and blood eosinophil gene expression levels. Asthma diagnosis was unrelated to viral load, IFN-α, IFN-γ, IL-5 or IL-13 levels. CONCLUSIONS Asthma is common in those hospitalised with influenza, but may not represent classical type 2-driven disease. Those admitted with influenza tend to be female with mild serum inflammatory responses, increased serum IFN-α levels and good clinical outcomes.
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Affiliation(s)
- Akhilesh Jha
- National Heart and Lung Institute, Imperial College London, St Mary's Campus, London, UK.,Dept of Medicine, University of Cambridge, Cambridge, UK
| | - Jake Dunning
- National Heart and Lung Institute, Imperial College London, St Mary's Campus, London, UK.,Public Health England (formerly Health Protection Agency), London, UK
| | - Tanushree Tunstall
- National Heart and Lung Institute, Imperial College London, St Mary's Campus, London, UK
| | - Ryan S Thwaites
- National Heart and Lung Institute, Imperial College London, St Mary's Campus, London, UK
| | - Long T Hoang
- National Heart and Lung Institute, Imperial College London, St Mary's Campus, London, UK
| | | | - Onn Min Kon
- National Heart and Lung Institute, Imperial College London, St Mary's Campus, London, UK
| | - Maria C Zambon
- Public Health England (formerly Health Protection Agency), London, UK
| | - Trevor T Hansel
- National Heart and Lung Institute, Imperial College London, St Mary's Campus, London, UK
| | - Peter J Openshaw
- National Heart and Lung Institute, Imperial College London, St Mary's Campus, London, UK
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213
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Danov O, Lasswitz L, Obernolte H, Hesse C, Braun A, Wronski S, Sewald K. Rupintrivir reduces RV-induced T H-2 cytokine IL-4 in precision-cut lung slices (PCLS) of HDM-sensitized mice ex vivo. Respir Res 2019; 20:228. [PMID: 31640701 PMCID: PMC6805592 DOI: 10.1186/s12931-019-1175-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 08/28/2019] [Indexed: 12/11/2022] Open
Abstract
Background Antiviral drugs such as rupintrivir may have an immune-modulatory effect in experimentally induced allergic asthma with subsequent RV infection. We infected lung slices of house-dust mite (HDM)-sensitized asthmatic mice ex vivo with human rhinovirus (RV) and investigated the effect of the antiviral drug rupintrivir on RV-induced cytokine response in lung tissue of HDM-sensitized mice ex vivo. Methods Mice were sensitized with HDM. Precision-cut lung slices (PCLS) were prepared from HDM-sensitized or non-sensitized mice. Lung slices were infected ex vivo with RV or RV together with rupintrivir. Modulation of immune responses was evaluated by cytokine secretion 48 h post infection. Results In vivo HDM sensitization resulted in a TH-2/TH-17-dominated cytokine response that persisted in PCLS ex vivo. RV infection of PCLS from non-sensitized mice resulted in the induction of an antiviral and pro-inflammatory immune response, as indicated by the secretion of IFN-α, IFN-β, IFN-γ, TNF-α, MCP-1, IP-10, IL-10, and IL-17A. In contrast, PCLS from HDM-sensitized mice showed an attenuated antiviral response, but exaggerated IL-4, IL-6, and IL-10 secretion upon infection. Rupintrivir inhibited exaggerated pro-inflammatory cytokine IL-6 and TH-2 cytokine IL-4 in HDM-sensitized mice. Conclusions In summary, this study demonstrates that treatment with rupintrivir influences virus-induced IL-4 and IL-6 cytokine release under experimental conditions ex vivo. Electronic supplementary material The online version of this article (10.1186/s12931-019-1175-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Olga Danov
- Fraunhofer Institute for Toxicology and Experimental Medicine ITEM, Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Member of Fraunhofer International Consortium for Anti-Infective Research (iCAIR), Nikolai-Fuchs-Strasse 1, 30625, Hannover, Germany
| | - Lisa Lasswitz
- Fraunhofer Institute for Toxicology and Experimental Medicine ITEM, Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Member of Fraunhofer International Consortium for Anti-Infective Research (iCAIR), Nikolai-Fuchs-Strasse 1, 30625, Hannover, Germany
| | - Helena Obernolte
- Fraunhofer Institute for Toxicology and Experimental Medicine ITEM, Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Member of Fraunhofer International Consortium for Anti-Infective Research (iCAIR), Nikolai-Fuchs-Strasse 1, 30625, Hannover, Germany
| | - Christina Hesse
- Fraunhofer Institute for Toxicology and Experimental Medicine ITEM, Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Member of Fraunhofer International Consortium for Anti-Infective Research (iCAIR), Nikolai-Fuchs-Strasse 1, 30625, Hannover, Germany
| | - Armin Braun
- Fraunhofer Institute for Toxicology and Experimental Medicine ITEM, Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Member of Fraunhofer International Consortium for Anti-Infective Research (iCAIR), Nikolai-Fuchs-Strasse 1, 30625, Hannover, Germany.,Institute of Immunology, Hannover Medical School, Carl-Neuberg Strasse 1, 30625, Hannover, Germany
| | - Sabine Wronski
- Fraunhofer Institute for Toxicology and Experimental Medicine ITEM, Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Member of Fraunhofer International Consortium for Anti-Infective Research (iCAIR), Nikolai-Fuchs-Strasse 1, 30625, Hannover, Germany
| | - Katherina Sewald
- Fraunhofer Institute for Toxicology and Experimental Medicine ITEM, Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Member of Fraunhofer International Consortium for Anti-Infective Research (iCAIR), Nikolai-Fuchs-Strasse 1, 30625, Hannover, Germany.
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214
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Kikkert M. Innate Immune Evasion by Human Respiratory RNA Viruses. J Innate Immun 2019; 12:4-20. [PMID: 31610541 PMCID: PMC6959104 DOI: 10.1159/000503030] [Citation(s) in RCA: 238] [Impact Index Per Article: 47.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 08/07/2019] [Indexed: 02/06/2023] Open
Abstract
The impact of respiratory virus infections on the health of children and adults can be very significant. Yet, in contrast to most other childhood infections as well as other viral and bacterial diseases, prophylactic vaccines or effective antiviral treatments against viral respiratory infections are either still not available, or provide only limited protection. Given the widespread prevalence, a general lack of natural sterilizing immunity, and/or high morbidity and lethality rates of diseases caused by influenza, respiratory syncytial virus, coronaviruses, and rhinoviruses, this difficult situation is a genuine societal challenge. A thorough understanding of the virus-host interactions during these respiratory infections will most probably be pivotal to ultimately meet these challenges. This review attempts to provide a comparative overview of the knowledge about an important part of the interaction between respiratory viruses and their host: the arms race between host innate immunity and viral innate immune evasion. Many, if not all, viruses, including the respiratory viruses listed above, suppress innate immune responses to gain a window of opportunity for efficient virus replication and setting-up of the infection. The consequences for the host's immune response are that it is often incomplete, delayed or diminished, or displays overly strong induction (after the delay) that may cause tissue damage. The affected innate immune response also impacts subsequent adaptive responses, and therefore viral innate immune evasion often undermines fully protective immunity. In this review, innate immune responses relevant for respiratory viruses with an RNA genome will briefly be summarized, and viral innate immune evasion based on shielding viral RNA species away from cellular innate immune sensors will be discussed from different angles. Subsequently, viral enzymatic activities that suppress innate immune responses will be discussed, including activities causing host shut-off and manipulation of stress granule formation. Furthermore, viral protease-mediated immune evasion and viral manipulation of the ubiquitin system will be addressed. Finally, perspectives for use of the reviewed knowledge for the development of novel antiviral strategies will be sketched.
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Affiliation(s)
- Marjolein Kikkert
- Department of Medical Microbiology, Leiden University Medical Center, Molecular Virology Laboratory, Leiden, The Netherlands,
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215
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Merckx J, Kraicer-Melamed H, Gore G, Ducharme FM, Quach C. Respiratory pathogens and clinical outcomes in children with an asthma exacerbation: A systematic review. JOURNAL OF THE ASSOCIATION OF MEDICAL MICROBIOLOGY AND INFECTIOUS DISEASE CANADA = JOURNAL OFFICIEL DE L'ASSOCIATION POUR LA MICROBIOLOGIE MEDICALE ET L'INFECTIOLOGIE CANADA 2019; 4:145-168. [PMID: 36340656 PMCID: PMC9603032 DOI: 10.3138/jammi.2019-0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 04/15/2019] [Indexed: 06/16/2023]
Abstract
BACKGROUND In asthmatic children, respiratory pathogens are identified in 60%-80% of asthma exacerbations, contributing to a significant burden of illness. The role of pathogens in the clinical evolution of exacerbations is unknown. OBJECTIVE We systematically reviewed the association between the presence of pathogens and clinical outcomes in children with an asthma exacerbation. METHOD PubMed, EMBASE, BIOSIS, and the Cochrane Central Register of Controlled Trials were searched up to October 2016 for studies reporting on respiratory pathogen exposure and clinical outcome. The Risk of Bias in Non-Randomized Studies of Interventions tool was used for quality assessment. RESULTS Twenty-eight observational studies (N = 4,224 children) reported on 112 different associations between exposure to any pathogen (n = 45), human rhinovirus (HRV; n = 34), atypical bacteria (n = 21), specific virus (n = 11), or bacteria (n = 1) and outcomes of exacerbation severity (n = 26), health care use (n = 38), treatment response (n = 19), and morbidity (n = 29). Restricting the analysis only to comparisons with a low to moderate risk of bias, we observed an association between HRV and higher exacerbation severity on presentation (regression p = .016) and between the presence of any pathogen and emergency department treatment failure (odds ratio [OR] = 1.57; 95% CI 1.04% to 2.37%). High-quality evidence for effect on morbidity or health care use is lacking. CONCLUSIONS Further research on the role of pathogen-treatment interaction and outcomes is required to inform the need for point-of-care, real-time testing for pathogens. Studies with a sufficiently large sample size that address selection bias, correctly adjust for confounding, and rigorously report core patient-centred outcomes are necessary to improve knowledge.
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Affiliation(s)
- Joanna Merckx
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Québec, Canada
- Division of Infectious Diseases, Department of Pediatrics, Montreal Children’s Hospital, McGill University, Montreal, Québec, Canada
| | - Hannah Kraicer-Melamed
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Québec, Canada
| | - Genevieve Gore
- Life Sciences Library, McGill University, Montreal, Québec, Canada
| | - Francine M Ducharme
- Department of Pediatrics, CHU Sainte-Justine, University of Montreal, Montreal, Québec, Canada
| | - Caroline Quach
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Québec, Canada
- Department of Microbiology, Infectious Disease, and Immunology, University of Montreal, Montreal, Québec, Canada
- Infection Prevention and Control Unit, Division of Infectious Disease and Medical Microbiology, CHU Sainte-Justine, Montreal, Québec, Canada
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216
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Mikhail I, Grayson MH. Asthma and viral infections: An intricate relationship. Ann Allergy Asthma Immunol 2019; 123:352-358. [PMID: 31276807 PMCID: PMC7111180 DOI: 10.1016/j.anai.2019.06.020] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 06/11/2019] [Accepted: 06/24/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To synthesize available data related to the complex associations among viral infections, atopy, and asthma. DATA SOURCES Key historical articles, articles highlighted in our recent review of most significant recent asthma advancements, and findings from several birth cohorts related to asthma and viral infections were reviewed. In addition, PubMed was searched for review articles and original research related to the associations between viral infection and asthma, using the search words asthma, viral infections, atopy, development of asthma, rhinovirus (RV), and respiratory syncytial virus (RSV). STUDY SELECTIONS Articles were selected based on novelty and relevance to our topic of interest, the role of asthma and viral infections, and possible mechanisms to explain the association. RESULTS There is a large body of evidence demonstrating a link between early viral infections (especially RV and RSV) and asthma inception and exacerbations. RV-induced wheezing is an important risk factor for asthma only when atopy is present, with much evidence supporting the idea that sensitization is a risk factor for early RV-induced wheezing, which in turn is a risk factor for asthma. RSV, on the other hand, is a more important risk factor for nonatopic asthma, with severe infections conferring greater risk. CONCLUSION There are important differences in the development of atopic and nonatopic asthma, with several proposed mechanisms explaining the association between viral infections and the development of asthma and asthma exacerbations. Understanding these complex associations is important for developing asthma prevention strategies and targeted asthma therapies.
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Affiliation(s)
- Irene Mikhail
- Division of Allergy and Immunology, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio.
| | - Mitchell H Grayson
- Division of Allergy and Immunology, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
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217
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Adeli M, El-Shareif T, Hendaus MA. Asthma exacerbation related to viral infections: An up to date summary. J Family Med Prim Care 2019; 8:2753-2759. [PMID: 31681638 PMCID: PMC6820381 DOI: 10.4103/jfmpc.jfmpc_86_19] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 02/01/2019] [Accepted: 08/27/2019] [Indexed: 12/21/2022] Open
Abstract
Asthma exacerbation can be a major life threatening event. Viruses have been pinned as the cause behind the vast majority of these exacerbations. The purpose of this short review is to explore the mechanisms behind these exacerbations, focusing mostly on viral infections as triggers. We will also be discussing the phenotypes prone to asthma exacerbation, the pathophysiology of viral induced asthma and ventilation patterns of asthmatic lungs. This manuscript will assist primary care physicians in delineating the proper pathophysiology of the disease as well as the management.
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Affiliation(s)
- Mehdi Adeli
- Department of Pediatrics, Section of Academic General Pediatrics, Sidra Medicine, Doha, Qatar.,Department of Pediatrics, Hamad General Corporation, Doha, Qatar.,Department of Clinical Pediatrics, Weill- Cornell Medicine, Doha, Qatar
| | | | - Mohamed A Hendaus
- Department of Pediatrics, Section of Academic General Pediatrics, Sidra Medicine, Doha, Qatar.,Department of Pediatrics, Hamad General Corporation, Doha, Qatar.,Department of Clinical Pediatrics, Weill- Cornell Medicine, Doha, Qatar
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218
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Bourdin A, Bjermer L, Brightling C, Brusselle GG, Chanez P, Chung KF, Custovic A, Diamant Z, Diver S, Djukanovic R, Hamerlijnck D, Horváth I, Johnston SL, Kanniess F, Papadopoulos N, Papi A, Russell RJ, Ryan D, Samitas K, Tonia T, Zervas E, Gaga M. ERS/EAACI statement on severe exacerbations in asthma in adults: facts, priorities and key research questions. Eur Respir J 2019; 54:13993003.00900-2019. [PMID: 31467120 DOI: 10.1183/13993003.00900-2019] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 07/17/2019] [Indexed: 01/05/2023]
Abstract
Despite the use of effective medications to control asthma, severe exacerbations in asthma are still a major health risk and require urgent action on the part of the patient and physician to prevent serious outcomes such as hospitalisation or death. Moreover, severe exacerbations are associated with substantial healthcare costs and psychological burden, including anxiety and fear for patients and their families. The European Academy of Allergy and Clinical Immunology (EAACI) and the European Respiratory Society (ERS) set up a task force to search for a clear definition of severe exacerbations, and to also define research questions and priorities. The statement includes comments from patients who were members of the task force.
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Affiliation(s)
- Arnaud Bourdin
- Université de Montpellier, CHU Montpellier, PhyMedExp, INSERM, CNRS, Montpellier, France
| | - Leif Bjermer
- Dept of Respiratory Medicine and Allergy, Lung and Allergy research Unit, Lund, Sweden
| | - Christopher Brightling
- Dept of Infection, Immunity and Inflammation, Institute for Lung Health, NIHR BRC Respiratory Medicine, University of Leicester, Leicester, UK
| | - Guy G Brusselle
- Dept of Respiratory Diseases, Ghent University Hospital, Ghent, Belgium
| | | | - Kian Fan Chung
- National Heart and Lung Institute, Imperial College, London, UK
| | - Adnan Custovic
- Dept of Paediatrics, Imperial College London, London, UK
| | - Zuzana Diamant
- Dept of Respiratory Medicine and Allergology, Skane University Hospital, Lund, Sweden.,Respiratory and Allergy Research, QPS Netherlands, The Netherlands
| | - Sarah Diver
- Dept of Respiratory Sciences, College of Life Sciences, Respiratory Biomedical Research Unit, Glenfield Hospital, Leicester, UK
| | - Ratko Djukanovic
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - Ildikó Horváth
- National Koranyi Institute for Pulmonology, and Dept of Public Health, Semmelweis University, Budapest, Hungary
| | | | | | - Nikos Papadopoulos
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK.,Allergy Dept, 2nd Pediatric Clinic, University of Athens, Athens, Greece
| | - Alberto Papi
- Respiratory Medicine, University of Ferrara, Ferrara, Italy
| | - Richard J Russell
- Institute for Lung Health, NIHR Leicester Biomedical Research Centre, Dept of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK
| | - Dermot Ryan
- Allergy and Respiratory Research Group, Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK.,Woodbrook Medical Centre, Loughborough, UK
| | | | - Thomy Tonia
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | | | - Mina Gaga
- 7th Respiratory Medicine Dept, Athens Chest Hospital, Athens, Greece
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219
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Werder RB, Lynch JP, Simpson JC, Zhang V, Hodge NH, Poh M, Forbes-Blom E, Kulis C, Smythe ML, Upham JW, Spann K, Everard ML, Phipps S. PGD2/DP2 receptor activation promotes severe viral bronchiolitis by suppressing IFN- λ production. Sci Transl Med 2019; 10:10/440/eaao0052. [PMID: 29743346 DOI: 10.1126/scitranslmed.aao0052] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 11/17/2017] [Accepted: 03/12/2018] [Indexed: 12/27/2022]
Abstract
Prostaglandin D2 (PGD2) signals through PGD2 receptor 2 (DP2, also known as CRTH2) on type 2 effector cells to promote asthma pathogenesis; however, little is known about its role during respiratory syncytial virus (RSV) bronchiolitis, a major risk factor for asthma development. We show that RSV infection up-regulated hematopoietic prostaglandin D synthase expression and increased PGD2 release by cultured human primary airway epithelial cells (AECs). Moreover, PGD2 production was elevated in nasopharyngeal samples from young infants hospitalized with RSV bronchiolitis compared to healthy controls. In a neonatal mouse model of severe viral bronchiolitis, DP2 antagonism decreased viral load, immunopathology, and morbidity and ablated the predisposition for subsequent asthma onset in later life. This protective response was abolished upon dual DP1/DP2 antagonism and replicated with a specific DP1 agonist. Rather than mediating an effect via type 2 inflammation, the beneficial effects of DP2 blockade or DP1 agonism were associated with increased interferon-λ (IFN-λ) [interleukin-28A/B (IL-28A/B)] expression and were lost upon IL-28A neutralization. In RSV-infected AEC cultures, DP1 activation up-regulated IFN-λ production, which, in turn, increased IFN-stimulated gene expression, accelerating viral clearance. Our findings suggest that DP2 antagonists or DP1 agonists may be useful antivirals for the treatment of viral bronchiolitis and possibly as primary preventatives for asthma.
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Affiliation(s)
- Rhiannon B Werder
- School of Biomedical Sciences, University of Queensland, Queensland 4072, Australia
| | - Jason P Lynch
- School of Biomedical Sciences, University of Queensland, Queensland 4072, Australia
| | - Jennifer C Simpson
- School of Biomedical Sciences, University of Queensland, Queensland 4072, Australia.,Queensland Institute of Medical Research Berghofer Medical Research Institute, Herston 4006, Australia
| | - Vivian Zhang
- Queensland Institute of Medical Research Berghofer Medical Research Institute, Herston 4006, Australia
| | - Nick H Hodge
- School of Biomedical Sciences, University of Queensland, Queensland 4072, Australia
| | - Matthew Poh
- School of Paediatrics and Child Health, University of Western Australia, Western Australia 6840, Australia
| | | | - Christina Kulis
- Institute for Molecular Bioscience, University of Queensland, Queensland 4072, Australia
| | - Mark L Smythe
- Institute for Molecular Bioscience, University of Queensland, Queensland 4072, Australia
| | - John W Upham
- Diamantina Institute, University of Queensland, Translational Research Institute, Princess Alexandra Hospital, Queensland 4102, Australia
| | - Kirsten Spann
- Australian Infectious Diseases Research Centre, University of Queensland, Queensland 4067, Australia.,School of Biomedical Sciences, Queensland University of Technology, Queensland 4001, Australia
| | - Mark L Everard
- School of Paediatrics and Child Health, University of Western Australia, Western Australia 6840, Australia
| | - Simon Phipps
- Queensland Institute of Medical Research Berghofer Medical Research Institute, Herston 4006, Australia. .,Australian Infectious Diseases Research Centre, University of Queensland, Queensland 4067, Australia
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220
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Menzel M, Kosinski J, Uller L, Akbarshahi H. Rhinovirus-induced IFNβ expression is NFκB-dependent and regulated by the macrophage microenvironment. Sci Rep 2019; 9:13394. [PMID: 31527772 PMCID: PMC6746757 DOI: 10.1038/s41598-019-50034-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 09/04/2019] [Indexed: 12/18/2022] Open
Abstract
Macrophages play an important role in asthma pathogenesis both in the inflammatory and resolution phase of the disease. Macrophages can acquire different polarisation states dependent on their microenvironment. It is yet unclear through which mechanism the microenvironment affects the anti-viral response in macrophages. We hypothesized that the macrophage microenvironment regulates rhinovirus-induced IFNβ expression. Murine bone marrow-derived monocytes and human differentiated THP-1 cells were stimulated with M-CSF or GM-CSF and IFNγ or IL-4/IL-13, respectively, to mimic a Th1 or Th2 environment. Macrophages were infected with rhinovirus and gene and protein levels of IFNβ and pattern recognition receptor expression were measured. In subsequent experiments an IκB kinase inhibitor was used to study the involvement of NFκB. Both murine and human M1-like macrophages exhibited higher levels of IFNβ and pattern recognition receptors after rhinovirus infection than M2-like macrophages. Blockage of NFκB resulted in a lower expression of rhinovirus-induced IFNβ in human M1-like macrophages while inducing a higher expression in M2-like macrophages, suggesting that the interferon response towards viral infection was mediated by NFκB. These findings could contribute to a better understanding of mechanisms causing reduced anti-viral responses at viral-induced exacerbations in asthma.
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Affiliation(s)
- Mandy Menzel
- Respiratory Immunopharmacology, Department of Experimental Medical Science, Lund University, Lund, Sweden
| | - Joakim Kosinski
- Respiratory Immunopharmacology, Department of Experimental Medical Science, Lund University, Lund, Sweden
| | - Lena Uller
- Respiratory Immunopharmacology, Department of Experimental Medical Science, Lund University, Lund, Sweden
| | - Hamid Akbarshahi
- Respiratory Immunopharmacology, Department of Experimental Medical Science, Lund University, Lund, Sweden. .,Respiratory Medicine and Allergology, Department of Clinical Sciences, Lund, Lund University, Lund, Sweden.
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221
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Lambrecht BN, Hammad H, Fahy JV. The Cytokines of Asthma. Immunity 2019; 50:975-991. [PMID: 30995510 DOI: 10.1016/j.immuni.2019.03.018] [Citation(s) in RCA: 593] [Impact Index Per Article: 118.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 03/15/2019] [Accepted: 03/18/2019] [Indexed: 01/13/2023]
Abstract
Asthma is a chronic inflammatory airway disease associated with type 2 cytokines interleukin-4 (IL-4), IL-5, and IL-13, which promote airway eosinophilia, mucus overproduction, bronchial hyperresponsiveness (BHR), and immunogloubulin E (IgE) synthesis. However, only half of asthma patients exhibit signs of an exacerbated Type 2 response. "Type 2-low" asthma has different immune features: airway neutrophilia, obesity-related systemic inflammation, or in some cases, few signs of immune activation. Here, we review the cytokine networks driving asthma, placing these in cellular context and incorporating insights from cytokine-targeting therapies in the clinic. We discuss established and emerging paradigms in the context of the growing appreciation of disease heterogeneity and argue that the development of new and improved therapeutics will require understanding the diverse mechanisms underlying the spectrum of asthma pathologies.
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Affiliation(s)
- Bart N Lambrecht
- Laboratory of Immunoregulation, VIB Center for Inflammation Research, Ghent, Belgium; Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium; Department of Pulmonary Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands.
| | - Hamida Hammad
- Laboratory of Immunoregulation, VIB Center for Inflammation Research, Ghent, Belgium; Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - John V Fahy
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA; Cardiovascular Research Institute, University of California, San Francisco, San Francisco, USA
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222
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Hiemstra PS, Tetley TD, Janes SM. Airway and alveolar epithelial cells in culture. Eur Respir J 2019; 54:13993003.00742-2019. [DOI: 10.1183/13993003.00742-2019] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 08/13/2019] [Indexed: 12/29/2022]
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223
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Hossain FMA, Choi JY, Uyangaa E, Park SO, Eo SK. The Interplay between Host Immunity and Respiratory Viral Infection in Asthma Exacerbation. Immune Netw 2019; 19:e31. [PMID: 31720042 PMCID: PMC6829071 DOI: 10.4110/in.2019.19.e31] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 08/22/2019] [Accepted: 08/25/2019] [Indexed: 12/16/2022] Open
Abstract
Asthma is one of the most common and chronic diseases characterized by multidimensional immune responses along with poor prognosis and severity. The heterogeneous nature of asthma may be attributed to a complex interplay between risk factors (either intrinsic or extrinsic) and specific pathogens such as respiratory viruses, and even bacteria. The intrinsic risk factors are highly correlated with asthma exacerbation in host, which may be mediated via genetic polymorphisms, enhanced airway epithelial lysis, apoptosis, and exaggerated viral replication in infected cells, resulting in reduced innate immune response and concomitant reduction of interferon (types I, II, and III) synthesis. The canonical features of allergic asthma include strong Th2-related inflammation, sensitivity to non-steroidal anti-inflammatory drugs (NSAIDs), eosinophilia, enhanced levels of Th2 cytokines, goblet cell hyperplasia, airway hyper-responsiveness, and airway remodeling. However, the NSAID-resistant non-Th2 asthma shows a characteristic neutrophilic influx, Th1/Th17 or even mixed (Th17-Th2) immune response and concurrent cytokine streams. Moreover, inhaled corticosteroid-resistant asthma may be associated with multifactorial innate and adaptive responses. In this review, we will discuss the findings of various in vivo and ex vivo models to establish the critical heterogenic asthmatic etiologies, host-pathogen relationships, humoral and cell-mediated immune responses, and subsequent mechanisms underlying asthma exacerbation triggered by respiratory viral infections.
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Affiliation(s)
- Ferdaus Mohd Altaf Hossain
- College of Veterinary Medicine and Bio-Safety Research Institute, Chonbuk National University, Iksan 54596, Korea.,Faculty of Veterinary, Animal and Biomedical Sciences, Sylhet Agricultural University, Sylhet 3100, Bangladesh
| | - Jin Young Choi
- College of Veterinary Medicine and Bio-Safety Research Institute, Chonbuk National University, Iksan 54596, Korea
| | - Erdenebileg Uyangaa
- College of Veterinary Medicine and Bio-Safety Research Institute, Chonbuk National University, Iksan 54596, Korea
| | - Seong Ok Park
- College of Veterinary Medicine and Bio-Safety Research Institute, Chonbuk National University, Iksan 54596, Korea
| | - Seong Kug Eo
- College of Veterinary Medicine and Bio-Safety Research Institute, Chonbuk National University, Iksan 54596, Korea
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224
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Hwang JW, Lee KJ, Choi IH, Han HM, Kim TH, Lee SH. Decreased expression of type I (IFN-β) and type III (IFN-λ) interferons and interferon-stimulated genes in patients with chronic rhinosinusitis with and without nasal polyps. J Allergy Clin Immunol 2019; 144:1551-1565.e2. [PMID: 31449915 PMCID: PMC7111475 DOI: 10.1016/j.jaci.2019.08.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 07/21/2019] [Accepted: 08/02/2019] [Indexed: 12/15/2022]
Abstract
Background Little is known about antiviral responses in the sinonasal mucosal tissue of patients with chronic rhinosinusitis (CRS). Objective we investigated the presence of virus and the expression of Toll-like receptor (TLR) 3, TLR7, and interferon and interferon-stimulated genes (ISGs) in healthy mucosal tissue of control subjects and the inflammatory sinus mucosal tissue of CRS patients, and evaluated whether levels of interferons and ISGs might be affected by CRS-related cytokines and by treatment with macrolides, dexamethasone, or TLR3 and TLR7 agonists. Methods The presence of virus in the sinonasal mucosa was evaluated with real-time PCR. The expression of interferons and ISGs in the sinonasal mucosa and in cultured epithelial cells treated with TH1 and TH2 cytokines, macrolides, dexamethasone, or TLR3 and TLR7 agonists were evaluated with real-time PCR and Western blotting. The expression of TLR3 and TLR7 in the sinonasal mucosa were evaluated with immunohistochemistry. Results Respiratory viruses were detected in 15% of samples. Interferons and ISGs are expressed in normal mucosa, but their levels were decreased in patients with CRS. Interferon and ISG levels were upregulated in cells treated with macrolides, dexamethasone, or TLR3 agonist, but some were decreased in cytokine-treated cells. TLR3 and TLR7 levels showed no significant difference between normal and inflammatory sinus mucosal tissue. Conclusion These results suggest that decreased levels of interferons and ISGs in patients with CRS might contribute to impairment of the antiviral innate response in inflammatory sinonasal epithelial cells. Macrolides and glucocorticoids might provide positive effects on the treatment of CRS by upregulating interferon and ISG expression.
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Affiliation(s)
- Jae Woong Hwang
- Department of Otorhinolaryngology-Head & Neck Surgery, College of Medicine, Korea University, Seoul, Korea
| | - Ki Jeong Lee
- Department of Otorhinolaryngology-Head & Neck Surgery, College of Medicine, Korea University, Seoul, Korea
| | - In Hak Choi
- Department of Otorhinolaryngology-Head & Neck Surgery, College of Medicine, Korea University, Seoul, Korea
| | - Hye Min Han
- Department of Otorhinolaryngology-Head & Neck Surgery, College of Medicine, Korea University, Seoul, Korea
| | - Tae Hoon Kim
- Department of Otorhinolaryngology-Head & Neck Surgery, College of Medicine, Korea University, Seoul, Korea
| | - Sang Hag Lee
- Department of Otorhinolaryngology-Head & Neck Surgery, College of Medicine, Korea University, Seoul, Korea.
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225
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Custovic A, Belgrave D, Lin L, Bakhsoliani E, Telcian AG, Solari R, Murray CS, Walton RP, Curtin J, Edwards MR, Simpson A, Rattray M, Johnston SL. Cytokine Responses to Rhinovirus and Development of Asthma, Allergic Sensitization, and Respiratory Infections during Childhood. Am J Respir Crit Care Med 2019; 197:1265-1274. [PMID: 29466680 DOI: 10.1164/rccm.201708-1762oc] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
RATIONALE Immunophenotypes of antiviral responses, and their relationship with asthma, allergy, and lower respiratory tract infections, are poorly understood. OBJECTIVES We characterized multiple cytokine responses of peripheral blood mononuclear cells to rhinovirus stimulation, and their relationship with clinical outcomes. METHODS In a population-based birth cohort, we measured 28 cytokines after stimulation with rhinovirus-16 in 307 children aged 11 years. We used machine learning to identify patterns of cytokine responses, and related these patterns to clinical outcomes, using longitudinal models. We also ascertained phytohemagglutinin-induced T-helper cell type 2 (Th2)-cytokine responses (PHA-Th2). MEASUREMENTS AND MAIN RESULTS We identified six clusters of children based on their rhinovirus-16 responses, which were differentiated by the expression of four cytokine/chemokine groups: interferon-related (IFN), proinflammatory (Inflam), Th2-chemokine (Th2-chem), and regulatory (Reg). Clusters differed in their clinical characteristics. Children with an IFNmodInflamhighestTh2-chemhighestReghighest rhinovirus-16-induced pattern had a PHA-Th2low response, and a very low asthma risk (odds ratio [OR], 0.08; 95% confidence interval [CI], 0.01-0.81; P = 0.03). Two clusters had a high risk of asthma and allergic sensitization, but with different trajectories from infancy to adolescence. The IFNlowestInflamhighTh2-chemlowRegmod cluster exhibited a PHA-Th2lowest response and was associated with early-onset asthma and sensitization, and the highest risk of asthma exacerbations (OR, 1.37; 95% CI, 1.07-1.76; P = 0.014) and lower respiratory tract infection hospitalizations (OR, 2.40; 95% CI, 1.26-4.58; P = 0.008) throughout childhood. In contrast, the IFNhighestInflammodTh2-chemmodReghigh cluster with a rhinovirus-16-cytokine pattern was characterized by a PHA-Th2highest response, and a low prevalence of asthma/sensitization in infancy that increased sharply to become the highest among all clusters by adolescence (but with a low risk of asthma exacerbations). CONCLUSIONS Early-onset troublesome asthma with early-life sensitization, later-onset milder allergic asthma, and disease protection are each associated with different patterns of rhinovirus-induced immune responses.
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Affiliation(s)
- Adnan Custovic
- 1 Section of Paediatrics, Department of Medicine, Imperial College London, London, United Kingdom.,2 MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom
| | - Danielle Belgrave
- 1 Section of Paediatrics, Department of Medicine, Imperial College London, London, United Kingdom
| | - Lijing Lin
- 3 Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Eteri Bakhsoliani
- 2 MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom.,4 COPD and Asthma Section, National Heart and Lung Institute, Imperial College London, London, United Kingdom; and
| | - Aurica G Telcian
- 2 MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom.,4 COPD and Asthma Section, National Heart and Lung Institute, Imperial College London, London, United Kingdom; and
| | - Roberto Solari
- 2 MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom.,4 COPD and Asthma Section, National Heart and Lung Institute, Imperial College London, London, United Kingdom; and
| | - Clare S Murray
- 5 Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre, University of Manchester and University Hospital of South Manchester NHS Foundation Trust, Manchester, United Kingdom
| | - Ross P Walton
- 2 MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom.,4 COPD and Asthma Section, National Heart and Lung Institute, Imperial College London, London, United Kingdom; and
| | - John Curtin
- 5 Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre, University of Manchester and University Hospital of South Manchester NHS Foundation Trust, Manchester, United Kingdom
| | - Michael R Edwards
- 2 MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom.,4 COPD and Asthma Section, National Heart and Lung Institute, Imperial College London, London, United Kingdom; and
| | - Angela Simpson
- 5 Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre, University of Manchester and University Hospital of South Manchester NHS Foundation Trust, Manchester, United Kingdom
| | - Magnus Rattray
- 3 Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Sebastian L Johnston
- 2 MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom.,4 COPD and Asthma Section, National Heart and Lung Institute, Imperial College London, London, United Kingdom; and
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226
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Han M, Rajput C, Hershenson MB. Rhinovirus Attributes that Contribute to Asthma Development. Immunol Allergy Clin North Am 2019; 39:345-359. [PMID: 31284925 PMCID: PMC6624084 DOI: 10.1016/j.iac.2019.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Early-life wheezing-associated infections with human rhinovirus (HRV) are strongly associated with the inception of asthma. The immune system of immature mice and humans is skewed toward a type 2 cytokine response. Thus, HRV-infected 6-day-old mice but not adult mice develop augmented type 2 cytokine expression, eosinophilic inflammation, mucous metaplasia, and airway hyperresponsiveness. This asthma phenotype depends on interleukin (IL)-13-producing type 2 innate lymphoid cells, the expansion of which in turn depends on release of the innate cytokines IL-25, IL-33, and thymic stromal lymphopoietin from the airway epithelium. In humans, certain genetic variants may predispose to HRV-induced childhood asthma.
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Affiliation(s)
- Mingyuan Han
- Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Medical Sciences Research Building II, 1150 West Medical Center Drive, Ann Arbor, MI, USA
| | - Charu Rajput
- Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Medical Sciences Research Building II, 1150 West Medical Center Drive, Ann Arbor, MI, USA
| | - Marc B Hershenson
- Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Medical Sciences Research Building II, 1150 West Medical Center Drive, Ann Arbor, MI, USA; Department of Molecular and Integrative Physiology, University of Michigan Medical School, Medical Sciences Research Building II, 1150 West Medical Center Drive, Ann Arbor, MI, USA.
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227
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Goggin RK, Bennett CA, Bialasiewicz S, Vediappan RS, Vreugde S, Wormald P, Psaltis AJ. The presence of virus significantly associates with chronic rhinosinusitis disease severity. Allergy 2019; 74:1569-1572. [PMID: 30865307 PMCID: PMC7159483 DOI: 10.1111/all.13772] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Rachel K. Goggin
- Department of Surgery ‐ Otolaryngology University of Adelaide Adelaide South Australia Australia
| | - Catherine A. Bennett
- Department of Surgery ‐ Otolaryngology University of Adelaide Adelaide South Australia Australia
| | - Seweryn Bialasiewicz
- Children's Health Queensland Queensland Paediatric Infectious Diseases Laboratory, and The University of QueenslandChild Health Research Centre Brisbane Queensland Australia
| | - Rajan S. Vediappan
- Department of Surgery ‐ Otolaryngology University of Adelaide Adelaide South Australia Australia
| | - Sarah Vreugde
- Department of Surgery ‐ Otolaryngology University of Adelaide Adelaide South Australia Australia
| | - Peter‐John Wormald
- Department of Surgery ‐ Otolaryngology University of Adelaide Adelaide South Australia Australia
| | - Alkis J. Psaltis
- Department of Surgery ‐ Otolaryngology University of Adelaide Adelaide South Australia Australia
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228
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Efthimiou J, Poll C, Barnes PJ. Dual mechanism of action of T2 inhibitor therapies in virally induced exacerbations of asthma: evidence for a beneficial counter-regulation. Eur Respir J 2019; 54:13993003.02390-2018. [PMID: 31000674 DOI: 10.1183/13993003.02390-2018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 03/29/2019] [Indexed: 01/21/2023]
Abstract
Biological agents such as omalizumab and monoclonal antibodies (mAbs) that inhibit type 2 (T2) immunity significantly reduce exacerbations, which are mainly due to viral infections, when added to inhaled corticosteroids in patients with severe asthma. The mechanisms for the therapeutic benefit of T2 inhibitors in reducing virally induced exacerbations, however, remain to be fully elucidated. Pre-clinical and clinical evidence supports the existence of a close counter-regulation of the high-affinity IgE receptor and interferon (IFN) pathways, and a potential dual mechanism of action and therapeutic benefit for omalizumab and other T2 inhibitors that inhibit IgE activity, which may enhance the prevention and treatment of virally induced asthma exacerbations. Similar evidence regarding some novel T2 inhibitor therapies, including mAbs and small-molecule inhibitors, suggests that such a dual mechanism of action with enhancement of IFN production working through non-IgE pathways might also exist. The specific mechanisms for this dual effect could be related to the close counter-regulation between T2 and T1 immune pathways, and potential key underlying mechanisms are discussed. Further basic research and better understanding of these underlying counter-regulatory mechanisms could provide novel therapeutic targets for the prevention and treatment of virally induced asthma exacerbations, as well as T2- and non-T2-driven asthma. Future clinical research should examine the effects of T2 inhibitors on IFN responses and other T1 immune pathways, in addition to any effects on the frequency and severity of viral and other infections and related exacerbations in patients with asthma as a priority.
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Affiliation(s)
| | - Chris Poll
- Independent Respiratory Scientist, Cambridge, UK
| | - Peter J Barnes
- National Heart and Lung Institute, Imperial College London, London, UK
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229
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Hu M, Schulze KE, Ghildyal R, Henstridge DC, Kolanowski JL, New EJ, Hong Y, Hsu AC, Hansbro PM, Wark PA, Bogoyevitch MA, Jans DA. Respiratory syncytial virus co-opts host mitochondrial function to favour infectious virus production. eLife 2019; 8:42448. [PMID: 31246170 PMCID: PMC6598784 DOI: 10.7554/elife.42448] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Accepted: 06/10/2019] [Indexed: 12/15/2022] Open
Abstract
Although respiratory syncytial virus (RSV) is responsible for more human deaths each year than influenza, its pathogenic mechanisms are poorly understood. Here high-resolution quantitative imaging, bioenergetics measurements and mitochondrial membrane potential- and redox-sensitive dyes are used to define RSV’s impact on host mitochondria for the first time, delineating RSV-induced microtubule/dynein-dependent mitochondrial perinuclear clustering, and translocation towards the microtubule-organizing centre. These changes are concomitant with impaired mitochondrial respiration, loss of mitochondrial membrane potential and increased production of mitochondrial reactive oxygen species (ROS). Strikingly, agents that target microtubule integrity the dynein motor protein, or inhibit mitochondrial ROS production strongly suppresses RSV virus production, including in a mouse model with concomitantly reduced virus-induced lung inflammation. The results establish RSV’s unique ability to co-opt host cell mitochondria to facilitate viral infection, revealing the RSV-mitochondrial interface for the first time as a viable target for therapeutic intervention.
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Affiliation(s)
- MengJie Hu
- Department of Biochemistry and Molecular Biology, University of Melbourne, Melbourne, Australia.,Department of Biochemistry and Molecular Biology, Monash University, Melbourne, Australia
| | - Keith E Schulze
- Monash Micro Imaging, Monash University, Melbourne, Australia
| | - Reena Ghildyal
- Centre for Research in Therapeutic Solutions, Faculty of Science and Technology, University of Canberra, Canberra, Australia
| | | | | | - Elizabeth J New
- School of Chemistry, The University of Sydney, Sydney, Australia
| | - Yuning Hong
- Department of Chemistry and Physics, La Trobe Institute for Molecular Science, La Trobe University, Melbourne, Australia
| | - Alan C Hsu
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute (HMRI) and School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, Australia
| | - Philip M Hansbro
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute (HMRI) and School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, Australia
| | - Peter Ab Wark
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute (HMRI) and School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, Australia
| | - Marie A Bogoyevitch
- Department of Biochemistry and Molecular Biology, University of Melbourne, Melbourne, Australia
| | - David A Jans
- Department of Biochemistry and Molecular Biology, Monash University, Melbourne, Australia
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230
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Gibbs JEM. Essential oils, asthma, thunderstorms, and plant gases: a prospective study of respiratory response to ambient biogenic volatile organic compounds (BVOCs). J Asthma Allergy 2019; 12:169-182. [PMID: 31417289 PMCID: PMC6593190 DOI: 10.2147/jaa.s193211] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 03/25/2019] [Indexed: 01/18/2023] Open
Abstract
Purpose: Prevailing opinion is that wind-pollinated plants affect asthma negatively and that insect- pollinated ones do not. "Thunderstorm" asthma, too, is attributed to bursting grass pollens. Additional biogenic volatile organic compounds (BVOCs) are identified here. Essential oils' BVOCs are inhaled from plants, oil diffusers, candles, room "fresheners", perfumes, and hygiene products. Claims of BVOC "safety" for sensitive respiratory systems are questioned. Methods: Fourteen volunteers, of mixed-age and gender, with seasonal asthma recorded peak expiratory flow (PEF) and 11 symptom scores. BVOCs were collected on Tenax tubes from ambient air in autumn and spring, as were live flower emissions, before and after a thunderstorm. Gas chromatography-mass spectrometry analysis identified frequently occurring BVOCs. Air spora, meteorological, outdoor air pollution variables, and BVOCs predict respiratory symptoms in univariate linear regression models, seasonally. Results: Increased pinene, camphor, linalool, linalyl acetate, benzaldehyde, and benzoic acid predict respiratory symptoms, including reduced PEF, and increased nasal congestion; day length, atmospheric pressure and temperature predict symptoms in both seasons, differently; other variables predict a range of symptoms (0.0001≤p≤0.05). Thunder predicts different BVOC emissions in spring, compared to autumn (p≤0.05). An uncut Grevillea flower emitted linalool and hexenal before a storm; the latter is also emitted from cut grass. Increased nitrogen oxides and pinene in autumn may combine to form harmful oxidation products. Conclusion: This research supports BVOCs as contributors to seasonal asthma and allergic rhinitis, and "thunderstorm" asthma. Pinene emissions from Myrtaceae species (Eucalyptus, Melaleuca, Leptospermum, Callistemon), Brassicaceae (canola), and conifers, worldwide, may induce respiratory inflammation and maintain it, by inhibiting eosinophilic apoptosis. Widely used essential oil products containing BVOCs, like linalool, are associated here with respiratory symptoms. Lagged responses suggest that users' cognitive associations between exposure and response are unlikely, increasing potential for impaired health for vulnerable children.
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Affiliation(s)
- Jane EM Gibbs
- School of Medicine, Griffith University, Gold Coast, Queensland, Australia
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231
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Multi-Method Molecular Characterisation of Human Dust-Mite-associated Allergic Asthma. Sci Rep 2019; 9:8912. [PMID: 31221987 PMCID: PMC6586825 DOI: 10.1038/s41598-019-45257-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 06/04/2019] [Indexed: 12/14/2022] Open
Abstract
Asthma is a chronic inflammatory disorder of the airways. Disease presentation varies greatly in terms of cause, development, severity, and response to medication, and thus the condition has been subdivided into a number of asthma phenotypes. There is still an unmet need for the identification of phenotype-specific markers and accompanying molecular tools that facilitate the classification of asthma phenotype. To this end, we utilised a range of molecular tools to characterise a well-defined group of female adults with poorly controlled atopic asthma associated with house dust mite (HDM) allergy, relative to non-asthmatic control subjects. Circulating messenger RNA (mRNA) and microRNA (miRNA) were sequenced and quantified, and a differential expression analysis of the two RNA populations performed to determine how gene expression and regulation varied in the disease state. Further, a number of circulating proteins (IL-4, 5, 10, 13, 17 A, Eotaxin, GM-CSF, IFNy, MCP-1, TARC, TNFα, Total IgE, and Endotoxin) were quantified to determine whether the protein profiles differed significantly dependent on disease state. Finally, we utilised a previously published assessment of the circulating “blood microbiome” performed using 16S rRNA amplification and sequencing. Asthmatic subjects displayed a range of significant alterations to circulating gene expression and regulation, relative to healthy control subjects, that may influence systemic immune activity. Notably, several circulating mRNAs were detected in just the asthma group or just in the control group, and many more were observed to be expressed at significantly different levels in the asthma group compared to the control group. Proteomic analysis revealed increased levels of inflammatory proteins within the serum, and decreased levels of the bacterial endotoxin protein in the asthmatic state. Comparison of blood microbiome composition revealed a significant increase in the Firmicutes phylum with asthma that was associated with a concomitant reduction in the Proteobacteria phylum. This study provides a valuable insight into the systemic changes evident in the HDM-associated asthma, identifies a range of molecules that are present in the circulation in a condition-specific manner (with clear biomarker potential), and highlights a range of hypotheses for further study.
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232
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Impact of Rhinovirus Infections in Children. Viruses 2019; 11:v11060521. [PMID: 31195744 PMCID: PMC6632063 DOI: 10.3390/v11060521] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 05/22/2019] [Accepted: 06/04/2019] [Indexed: 12/16/2022] Open
Abstract
Rhinovirus (RV) is an RNA virus that causes more than 50% of upper respiratory tract infections in humans worldwide. Together with Respiratory Syncytial Virus, RV is one of the leading causes of viral bronchiolitis in infants and the most common virus associated with wheezing in children aged between one and two years. Because of its tremendous genetic diversity (>150 serotypes), the recurrence of RV infections each year is quite typical. Furthermore, because of its broad clinical spectrum, the clinical variability as well as the pathogenesis of RV infection are nowadays the subjects of an in-depth examination and have been the subject of several studies in the literature. In fact, the virus is responsible for direct cell cytotoxicity in only a small way, and it is now clearer than ever that it may act indirectly by triggering the release of active mediators by structural and inflammatory airway cells, causing the onset and/or the acute exacerbation of asthmatic events in predisposed children. In the present review, we aim to summarize the RV infection's epidemiology, pathogenetic hypotheses, and available treatment options as well as its correlation with respiratory morbidity and mortality in the pediatric population.
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233
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Flores-Torres AS, Salinas-Carmona MC, Salinas E, Rosas-Taraco AG. Eosinophils and Respiratory Viruses. Viral Immunol 2019; 32:198-207. [PMID: 31140942 DOI: 10.1089/vim.2018.0150] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Eosinophils have been mainly associated with parasitic infection and pathologies such as asthma. Some patients with asthma present a high number of eosinophils in their airways. Since respiratory viruses are associated with asthma exacerbations, several studies have evaluated the role of eosinophils against respiratory viruses. Eosinophils contain and produce molecules with antiviral activity, including RNases and reactive nitrogen species. They can also participate in adaptive immunity, serving as antigen-presenting cells. Eosinophil antiviral response has been demonstrated against some respiratory viruses in vitro and in vivo, including respiratory syncytial virus and influenza. Given the implication of respiratory viruses in asthma, the eosinophil antiviral role might be an important factor to consider in this pathology.
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Affiliation(s)
- Armando S Flores-Torres
- 1 Department of Immunology, Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario "Dr. Jose E. Gonzalez," Monterrey, Nuevo León, Mexico
| | - Mario C Salinas-Carmona
- 1 Department of Immunology, Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario "Dr. Jose E. Gonzalez," Monterrey, Nuevo León, Mexico
| | - Eva Salinas
- 2 Department of Microbiology, Centro de Ciencias Básicas, Universidad Autónoma de Aguascalientes, Aguascalientes, Aguascalientes, Mexico
| | - Adrian G Rosas-Taraco
- 1 Department of Immunology, Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario "Dr. Jose E. Gonzalez," Monterrey, Nuevo León, Mexico
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234
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Heinonen S, Rodriguez-Fernandez R, Diaz A, Oliva Rodriguez-Pastor S, Ramilo O, Mejias A. Infant Immune Response to Respiratory Viral Infections. Immunol Allergy Clin North Am 2019; 39:361-376. [PMID: 31284926 DOI: 10.1016/j.iac.2019.03.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Of all respiratory viruses that affect infants, respiratory syncytial virus (RSV) and rhinovirus (RV) represent the leading pathogens causing acute disease (bronchiolitis) and are associated with the development of recurrent wheezing and asthma. The immune system in infants is still developing, and several factors contribute to their increased susceptibility to viral infections. These factors include differences in pathogen detection, weaker interferon responses, lack of immunologic memory toward the invading pathogen, and T-cell responses that are balanced to promote tolerance and restrain inflammation. These aspects are reviewed here with a focus on RSV and RV infections.
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Affiliation(s)
- Santtu Heinonen
- New Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, PO Box 347, Helsinki 00029 HUS, Finland
| | - Rosa Rodriguez-Fernandez
- Department of Pediatrics, Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Hospital Materno-Infantil Gregorio Marañón, Madrid 28009, Spain; Section of General Pediatrics, Hospital Gregorio Marañón, Madrid, Spain
| | - Alejandro Diaz
- Center for Vaccines and Immunity, The Research Institute at Nationwide Children's Hospital, The Ohio State Collage of Medicine, 700 Children's Drive, Columbus, OH 43205, USA; Division of Infectious Diseases, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State Collage of Medicine, 700 Children's Drive, Columbus, OH 43205, USA
| | - Silvia Oliva Rodriguez-Pastor
- Division of Pediatric Emergency Medicine and Critical Care, Hospital Regional Universitario de Malaga, Malaga 29001, Spain; Department of Pharmacology and Pediatrics, Malaga Medical Shool, Malaga University (UMA), Malaga, Spain
| | - Octavio Ramilo
- Center for Vaccines and Immunity, The Research Institute at Nationwide Children's Hospital, The Ohio State Collage of Medicine, 700 Children's Drive, Columbus, OH 43205, USA; Division of Infectious Diseases, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State Collage of Medicine, 700 Children's Drive, Columbus, OH 43205, USA
| | - Asuncion Mejias
- Center for Vaccines and Immunity, The Research Institute at Nationwide Children's Hospital, The Ohio State Collage of Medicine, 700 Children's Drive, Columbus, OH 43205, USA; Division of Infectious Diseases, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State Collage of Medicine, 700 Children's Drive, Columbus, OH 43205, USA; Department of Pharmacology and Pediatrics, Malaga Medical Shool, Malaga University (UMA), Malaga, Spain.
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235
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Altman MC, Gill MA, Whalen E, Babineau DC, Shao B, Liu AH, Jepson B, Gruchalla RS, O'Connor GT, Pongracic JA, Kercsmar CM, Khurana Hershey GK, Zoratti EM, Johnson CC, Teach SJ, Kattan M, Bacharier LB, Beigelman A, Sigelman SM, Presnell S, Gern JE, Gergen PJ, Wheatley LM, Togias A, Busse WW, Jackson DJ. Transcriptome networks identify mechanisms of viral and nonviral asthma exacerbations in children. Nat Immunol 2019; 20:637-651. [PMID: 30962590 PMCID: PMC6472965 DOI: 10.1038/s41590-019-0347-8] [Citation(s) in RCA: 108] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 02/11/2019] [Indexed: 12/14/2022]
Abstract
Respiratory infections are common precursors to asthma exacerbations in children, but molecular immune responses that determine whether and how an infection causes an exacerbation are poorly understood. By using systems-scale network analysis, we identify repertoires of cellular transcriptional pathways that lead to and underlie distinct patterns of asthma exacerbation. Specifically, in both virus-associated and nonviral exacerbations, we demonstrate a set of core exacerbation modules, among which epithelial-associated SMAD3 signaling is upregulated and lymphocyte response pathways are downregulated early in exacerbation, followed by later upregulation of effector pathways including epidermal growth factor receptor signaling, extracellular matrix production, mucus hypersecretion, and eosinophil activation. We show an additional set of multiple inflammatory cell pathways involved in virus-associated exacerbations, in contrast to squamous cell pathways associated with nonviral exacerbations. Our work introduces an in vivo molecular platform to investigate, in a clinical setting, both the mechanisms of disease pathogenesis and therapeutic targets to modify exacerbations.
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Affiliation(s)
- Matthew C Altman
- Department of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA.
- Systems Immunology Program, Benaroya Research Institute, Seattle, WA, USA.
| | - Michelle A Gill
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Elizabeth Whalen
- Systems Immunology Program, Benaroya Research Institute, Seattle, WA, USA
| | | | - Baomei Shao
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Andrew H Liu
- Department of Allergy and Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Rebecca S Gruchalla
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - George T O'Connor
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | | | | | | | | | | | | | - Meyer Kattan
- Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Leonard B Bacharier
- Division of Allergy, Immunology, and Pulmonary Medicine, Washington University, St. Louis, MO, USA
| | - Avraham Beigelman
- Division of Allergy, Immunology, and Pulmonary Medicine, Washington University, St. Louis, MO, USA
| | - Steve M Sigelman
- Division of Allergy, Immunology, and Transplantation, National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA
| | - Scott Presnell
- Systems Immunology Program, Benaroya Research Institute, Seattle, WA, USA
| | - James E Gern
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Peter J Gergen
- Division of Allergy, Immunology, and Transplantation, National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA
| | - Lisa M Wheatley
- Division of Allergy, Immunology, and Transplantation, National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA
| | - Alkis Togias
- Division of Allergy, Immunology, and Transplantation, National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA
| | - William W Busse
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Daniel J Jackson
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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236
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Bhakta NR, Christenson SA, Nerella S, Solberg OD, Nguyen CP, Choy DF, Jung KL, Garudadri S, Bonser LR, Pollack JL, Zlock LT, Erle DJ, Langelier C, Derisi JL, Arron JR, Fahy JV, Woodruff PG. IFN-stimulated Gene Expression, Type 2 Inflammation, and Endoplasmic Reticulum Stress in Asthma. Am J Respir Crit Care Med 2019; 197:313-324. [PMID: 29064281 DOI: 10.1164/rccm.201706-1070oc] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
RATIONALE Quantification of type 2 inflammation provided a molecular basis for heterogeneity in asthma. Non-type 2 pathways that contribute to asthma pathogenesis are not well understood. OBJECTIVES To identify dysregulated pathways beyond type 2 inflammation. METHODS We applied RNA sequencing to airway epithelial brushings obtained from subjects with stable mild asthma not on corticosteroids (n = 19) and healthy control subjects (n = 16). Sequencing reads were mapped to human and viral genomes. In the same cohort, and in a separate group with severe asthma (n = 301), we profiled blood gene expression with microarrays. MEASUREMENTS AND MAIN RESULTS In airway brushings from mild asthma on inhaled corticosteroids, RNA sequencing yielded 1,379 differentially expressed genes (false discovery rate < 0.01). Pathway analysis revealed increased expression of type 2 markers, IFN-stimulated genes (ISGs), and endoplasmic reticulum (ER) stress-related genes. Airway epithelial ISG expression was not associated with type 2 inflammation in asthma or with viral transcripts but was associated with reduced lung function by FEV1 (ρ = -0.72; P = 0.0004). ER stress was confirmed by an increase in XBP1 (X-box binding protein 1) splicing in mild asthma and was associated with both type 2 inflammation and ISG expression. ISGs were also the most activated genes in blood cells in asthma and were correlated with airway ISG expression (ρ = 0.55; P = 0.030). High blood ISG expression in severe asthma was similarly unrelated to type 2 inflammation. CONCLUSIONS ISG activation is prominent in asthma, independent of viral transcripts, orthogonal to type 2 inflammation, and associated with distinct clinical features. ER stress is associated with both type 2 inflammation and ISG expression.
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Affiliation(s)
- Nirav R Bhakta
- 1 Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine
| | | | - Srilaxmi Nerella
- 1 Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine
| | - Owen D Solberg
- 1 Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine
| | - Christine P Nguyen
- 1 Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine
| | - David F Choy
- 2 Genentech, Inc., South San Francisco, California; and
| | - Kyle L Jung
- 1 Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine
| | - Suresh Garudadri
- 1 Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine
| | - Luke R Bonser
- 3 Cardiovascular Research Institute.,4 Lung Biology Center, Department of Medicine
| | | | | | - David J Erle
- 3 Cardiovascular Research Institute.,4 Lung Biology Center, Department of Medicine
| | - Charles Langelier
- 6 Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Joseph L Derisi
- 7 Department of Biochemistry and Biophysics, University of California at San Francisco and Howard Hughes Medical Institute, San Francisco, California
| | | | - John V Fahy
- 1 Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine.,3 Cardiovascular Research Institute
| | - Prescott G Woodruff
- 1 Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine.,3 Cardiovascular Research Institute
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237
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Cai X, Xu Q, Zhou C, Zhou L, Dai W, Ji G. The association of nucleotide-binding oligomerization domain 2 gene polymorphisms with the risk of asthma in the Chinese Han population. Mol Genet Genomic Med 2019; 7:e00675. [PMID: 30950247 PMCID: PMC6565575 DOI: 10.1002/mgg3.675] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 02/17/2019] [Accepted: 03/14/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Genetic background is one of the important risk factors for development of asthma. The nucleotide-binding oligomerization domain 2 (NOD2) has been involved in the pathogenesis of asthma. The purpose of this study was to explore the relationship between NOD2 gene polymorphisms and asthma susceptibility in the Chinese Han population. METHODS Children with asthma (n = 309) and Healthy children (n = 163) were recruited from Yancheng Third People's Hospital, Yancheng, China, between January 2016 and December 2017. The NOD2 gene polymorphisms were measured by the Snapshot SNP genotyping assays. Genotyping was performed for 4 tag SNPs of NOD2. Serum IFN-β levels were measured by ELISA. RESULTS The serum IFN-β levels were significantly lower in Asthmatic children than those in the controls (p < 0.001). Low levels of IFN-β may be related to the susceptibility to severe asthma. The rs3135499 C allele was associated with a significantly increased risk of asthma as compared with the rs3135499 A allele. CONCLUSION The rs3135499 polymorphism of NOD2 gene and IFN-β may play a role in the pathogenesis of asthma.
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Affiliation(s)
- Xulong Cai
- Department of Pediatrics, Yancheng Third People's Hospital, Yancheng, China
| | - Qiaolan Xu
- Department of Pediatrics, Yancheng Third People's Hospital, Yancheng, China
| | - Chenrong Zhou
- Department of Pediatrics, Yancheng Third People's Hospital, Yancheng, China
| | - Li Zhou
- Department of Pediatrics, Yancheng Third People's Hospital, Yancheng, China
| | - Weihua Dai
- Department of Pediatrics, Yancheng Third People's Hospital, Yancheng, China
| | - Guanchi Ji
- Department of Pediatrics, Yancheng Third People's Hospital, Yancheng, China
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238
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Christou EAA, Giardino G, Stefanaki E, Ladomenou F. Asthma: An Undermined State of Immunodeficiency. Int Rev Immunol 2019; 38:70-78. [PMID: 30939053 DOI: 10.1080/08830185.2019.1588267] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Asthma is a heterogeneous chronic respiratory disease characterized by an increased burden of infections. Respiratory tract infections associated with an increased risk for asthma especially when occurring in the first months of life, also represent the most common cause of asthma exacerbations. The association between asthma and the increased frequency of infections and microbiota dysbiosis might be explained by a common mechanism, such as an underlying immune system defect. Apart from the well-established association between primary immunodeficiencies and asthma, several alterations in the immune response following infection have also been observed in asthmatic patients. An impairment in lung epithelial barrier integrity exists and is associated with both an increased susceptibility to infections and the development of asthma. Asthmatic patients are also found to have a deficient interferon (IFN) response upon infection. Additionally, defects in Toll-like receptor (TLR) signaling are observed in asthma and are correlated with both recurrent infections and asthma development. In this review, we summarize the common pathophysiological background of asthma and infections, highlighting the importance of an underlying immune system defect that predispose individuals to recurrent infections and asthma.
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Affiliation(s)
| | - Giuliana Giardino
- b Department of Translational Medical Sciences , University of Naples Federico II , Naples , Italy
| | - Evangelia Stefanaki
- c Department of Pediatrics , Venizeleion General Hospital , Heraklion , Greece
| | - Fani Ladomenou
- c Department of Pediatrics , Venizeleion General Hospital , Heraklion , Greece
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239
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Biological treatments for severe asthma: A major advance in asthma care. Allergol Int 2019; 68:158-166. [PMID: 30792118 DOI: 10.1016/j.alit.2019.01.004] [Citation(s) in RCA: 95] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 01/08/2019] [Accepted: 01/09/2019] [Indexed: 12/16/2022] Open
Abstract
Asthma is a heterogeneous disease with considerable variability noted in disease severity, patterns of airway inflammation, and achievement of disease control on current medications. An absence of disease control is most frequently noted in patients with severe asthma, and is defined as a lack of control while on high dose inhaled corticosteroids (ICS) plus a second controller medication. In part, this lack of control may relate to a diminished effect of current guideline-directed care on the existing pattern of airway inflammation in severe asthma. Airway inflammation in severe asthma has been arbitrarily divided into T (type) 2 high and T2 low. T2 high is characterized by the generation of key cytokines, interleukin (IL)-4, -5 and -13, which generate and regulate airway inflammation. Biomarkers to mark the presence of T2-high inflammation include eosinophils, fractional exhaled nitric oxide (FeNO) and immunoglobulin (Ig) E, whose presence arises from the action of IgE, IL-5, IL-4, and IL-13. In this review, treatment of severe asthma with monoclonal antibodies, i.e. biologics, which are directed against these inflammation generated pathways are reviewed. The available monoclonal antibodies include omalizumab (anti-IgE); mepolizumab, reslizumab and benralizumab (anti-IL-5 pathways), and dupilumab (anti-IL-4/IL-13). The use of these T2-high interventions has led to significant reductions in asthma symptoms, a decreased frequency of exacerbations, and improved lung function in many patients. Not only has the use of these monoclonal antibodies led to improved asthma control in patients with severe disease, their use has provided insight into mechanisms of severe asthma.
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240
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Liu H, Tan J, Liu J, Feng H, Pan D. Altered mast cell activity in response to rhinovirus infection provides novel insight into asthma. J Asthma 2019; 57:459-467. [PMID: 30882256 DOI: 10.1080/02770903.2019.1585870] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: Human rhinoviruses (RVs) are a type of common respiratory virus capable of inducing an asthma attack. Although mast cells are important effector cells involved in allergic disease, little is known about the direct effects of an RV infection on mast cells. The aim of this study is to investigate mast cell behavior in response to RV infection and gain insight into the effects of RVs on mast cells. Methods: Viral replication, cell viability, apoptosis and cytokine release were quantified in Human mast cell-1 (HMC-1) cells following RV16 infection. Results: The results revealed that the viral RNA copy number increased substantially over time. Intercellular cell adhesion molecule-1 (ICAM-1) transcripts were significantly upregulated from 1.79 to 6.37 times following RV16 infection compared to the controls (p ≤ 0.05). Lactate dehydrogenase (LDH) activity was significantly increased, whereas the cell viability decreased following RV16 infection. Examination of the early cellular response to infection revealed that RV16 increased caspase 3 activity and aggravated apoptotic responses. Furthermore, detection of the innate immune response to RV infection revealed that the release of IL-6, IL-8, TNF-α, and IFN-α by HMC-1 cells increased significantly compared to the control groups. Conclusions: RV infection influences mast cell functionality and promotes the innate immune response of mast cells following viral infection. These results provide a novel insight which mast cells have the potential to be involved in the pathogenesis of RV-induced exacerbations of asthma.
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Affiliation(s)
- Haiwen Liu
- Department of Respiratory Medicine, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Jingyu Tan
- Department of Stomatology, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Jingfang Liu
- Department of Respiratory Medicine, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Huiquan Feng
- Department of Respiratory Medicine, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Dianzhu Pan
- Department of Respiratory Medicine, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
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241
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Greenawald L, Strang A, Froehlich C, Chidekel A. Status asthmaticus requiring extracorporeal membrane oxygenation associated with rhinovirus infection. J Asthma 2019; 57:343-346. [PMID: 30882258 DOI: 10.1080/02770903.2019.1565826] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: Evolving research links human rhinovirus (HRV) with status asthmaticus (SA) as well as severe respiratory illness in patients with atopy and asthma. This case series reviews five episodes of HRV-associated SA that required extracorporeal membrane oxygenation (ECMO). Methods: Charts of four patients, five total episodes of ECMO, with SA secondary to HRV were reviewed in this IRB-approved case series. Outcomes included demographic information, past medical history, clinical parameters and spirometry. Results: Patients (three male, one female), mean age 9 years (range 7-12 years) at the time of admission, were African American, on Medicaid, carried a diagnosis of persistent asthma, and had documented non-adherence to prescribed, daily controller medications. One patient had passive smoke exposure. All patients had a mean IgE of 734 (range 12-2497) with seasonal allergic rhinitis was diagnosed in three patients. Cases occurred in spring (3/5) and fall (2/5). Venous/venous ECMO (4/5) or venous/arterial ECMO (1/5) was continued for a mean duration of 4.2 days (range 3-7 days). Spirometry after hospitalization had a mean FEV1 of 1.59 L (81% predicted, range 69%-91%), and an FEF25%-75% 1.13 L (47.5% predicted, range 41%-65%) at an average of 16.7 weeks post ECMO. Conclusions: This case series highlights the association between persistent, poorly controlled asthma and severe SA with HRV infection resulting in ECMO. Despite life-threatening illness, these patients did not demonstrate significant large-airway obstruction following infection. However, patients showed persistently abnormal small airway function, which could be a risk factor or early evidence of vulnerability to infection.
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Affiliation(s)
- Lauren Greenawald
- Division of Pulmonology, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| | - Abigail Strang
- Division of Pulmonology, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| | - Curtis Froehlich
- Pediatric Critical Care Medicine, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| | - Aaron Chidekel
- Division of Pulmonology, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
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242
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Zhang Y, Mao D, Keeler SP, Wang X, Wu K, Gerovac BJ, Shornick LL, Agapov EV, Holtzman MJ. Respiratory Enterovirus (like Parainfluenza Virus) Can Cause Chronic Lung Disease if Protection by Airway Epithelial STAT1 Is Lost. THE JOURNAL OF IMMUNOLOGY 2019; 202:2332-2347. [PMID: 30804041 DOI: 10.4049/jimmunol.1801491] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 02/11/2019] [Indexed: 12/11/2022]
Abstract
Epithelial barrier cells are proposed to be critical for host defense, and airway epithelial cell capacity for IFN signal transduction is presumed to protect against respiratory viral infection. However, it has been difficult to fully test these concepts given the absence of tools to analyze IFN signaling specific to airway epithelial cells in vivo. To address these issues, we generated a new line of transgenic mice with Cre-driver genes (Foxj1 and Scgb1a1) for a floxed-Stat1 allele (designated Foxj1-Scgb1a1-Cre-Stat1f/f mice) to target the master IFN signal regulator STAT1 in airway epithelial cells and tested these mice for control of infection because of mouse parainfluenza (Sendai) virus and human enterovirus D68 (EV-D68). Indeed, both types of infections showed increases in viral titers and severity of acute illness in Foxj1-Scgb1a1-Cre-Stat1f/f mice and conventional Stat1-/- mice compared with wild-type mice. In concert, the chronic lung disease that develops after Sendai virus infection was also increased in Foxj1-Scgb1a1-Cre-Stat1f/f and Stat1-/ - mice, marked by airway and adjacent parenchymal immune cell infiltration and mucus production for at least 7 wk postinfection. Unexpectedly, relatively mild EV-D68 infection also progressed to chronic lung disease in Foxj1-Scgb1a1-Cre-Stat1f/f and Stat1 -/- mice but was limited (like viral replication) to airways. The results thereby provide proof-of-concept for a critical role of barrier epithelial cells in protection from acute illness and chronic disease after viral infection and suggest a specific role for airway epithelial cells given the limitation of EV-D68 replication and acute and chronic manifestations of disease primarily to airway tissue.
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Affiliation(s)
- Yong Zhang
- Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, MO 63110
| | - Dailing Mao
- Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, MO 63110
| | - Shamus P Keeler
- Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, MO 63110
| | - Xinyu Wang
- Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, MO 63110
| | - Kangyun Wu
- Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, MO 63110
| | - Benjamin J Gerovac
- Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, MO 63110
| | - Laurie L Shornick
- Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, MO 63110
| | - Eugene V Agapov
- Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, MO 63110
| | - Michael J Holtzman
- Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, MO 63110
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243
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Brasier AR. Mechanisms how mucosal innate immunity affects progression of allergic airway disease. Expert Rev Respir Med 2019; 13:349-356. [PMID: 30712413 DOI: 10.1080/17476348.2019.1578211] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Activation of antigen-independent inflammation (a.k.a. the 'innate' immune response (IIR)) plays a complex role in allergic asthma (AA). Although activation of the pulmonary IIR by aerosolized bacterial lipopolysaccharide early in life may be protective of AA, respiratory viral infections promote AA. The mechanisms how the mucosal IIR promotes allergic sensitization, remodeling, and altered epithelial signaling are not understood. Areas covered: This manuscript overviews: 1. Mechanistic studies identifying how allergens and viral patterns activate the mucosal IIR; 2. Research that reveals a major role played by specialized epithelial cells in the bronchiolar-alveolar junction in triggering inflammation and remodeling; 3. Reports linking the mucosal IIR with epithelial cell-state change and barrier disruption; and, 4. Observations relating mesenchymal transition with the expansion of the myofibroblast population. Expert commentary: Luminal allergens and viruses activate TLR signaling in key sentinel cells producing epithelial cell state transition, disrupting epithelial barrier function, and expanding the pulmonary myofibroblast population. These signals are transduced through a common NFκB/RelA -bromodomain containing four (BRD4) pathway, an epigenetic remodeling complex reprogramming the genome. Through this pathway, the mucosal IIR is a major modifier of adaptive immunity, AA and acute exacerbation-induced remodeling.
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Affiliation(s)
- Allan R Brasier
- a Institute for Clinical and Translational Research , University of Wisconsin-Madison School of Medicine and Public Health , Madison , WI , USA
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244
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Murrison LB, Brandt EB, Myers JB, Hershey GKK. Environmental exposures and mechanisms in allergy and asthma development. J Clin Invest 2019; 129:1504-1515. [PMID: 30741719 DOI: 10.1172/jci124612] [Citation(s) in RCA: 177] [Impact Index Per Article: 35.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Environmental exposures interplay with human host factors to promote the development and progression of allergic diseases. The worldwide prevalence of allergic disease is rising as a result of complex gene-environment interactions that shape the immune system and host response. Research shows an association between the rise of allergic diseases and increasingly modern Westernized lifestyles, which are characterized by increased urbanization, time spent indoors, and antibiotic usage. These environmental changes result in increased exposure to air and traffic pollution, fungi, infectious agents, tobacco smoke, and other early-life and lifelong risk factors for the development and exacerbation of asthma and allergic diseases. It is increasingly recognized that the timing, load, and route of allergen exposure affect allergic disease phenotypes and development. Still, our ability to prevent allergic diseases is hindered by gaps in understanding of the underlying mechanisms and interaction of environmental, viral, and allergen exposures with immune pathways that impact disease development. This Review highlights epidemiologic and mechanistic evidence linking environmental exposures to the development and exacerbation of allergic airway responses.
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Affiliation(s)
- Liza Bronner Murrison
- Division of Asthma Research, Cincinnati Children's Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Eric B Brandt
- Division of Asthma Research, Cincinnati Children's Medical Center, Cincinnati, Ohio, USA
| | - Jocelyn Biagini Myers
- Division of Asthma Research, Cincinnati Children's Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Gurjit K Khurana Hershey
- Division of Asthma Research, Cincinnati Children's Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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245
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Khoo SK, Read J, Franks K, Zhang G, Bizzintino J, Coleman L, McCrae C, Öberg L, Troy NM, Prastanti F, Everard J, Oo S, Borland ML, Maciewicz RA, Le Souëf PN, Laing IA, Bosco A. Upper Airway Cell Transcriptomics Identify a Major New Immunological Phenotype with Strong Clinical Correlates in Young Children with Acute Wheezing. THE JOURNAL OF IMMUNOLOGY 2019; 202:1845-1858. [PMID: 30745463 DOI: 10.4049/jimmunol.1800178] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 01/08/2019] [Indexed: 01/10/2023]
Abstract
Asthma exacerbations are triggered by rhinovirus infections. We employed a systems biology approach to delineate upper-airway gene network patterns underlying asthma exacerbation phenotypes in children. Cluster analysis unveiled distinct IRF7hi versus IRF7lo molecular phenotypes, the former exhibiting robust upregulation of Th1/type I IFN responses and the latter an alternative signature marked by upregulation of cytokine and growth factor signaling and downregulation of IFN-γ. The two phenotypes also produced distinct clinical phenotypes. For IRF7lo children, symptom duration prior to hospital presentation was more than twice as long from initial symptoms (p = 0.011) and nearly three times as long for cough (p < 0.001), the odds ratio of admission to hospital was increased more than 4-fold (p = 0.018), and time to recurrence was shorter (p = 0.015). In summary, our findings demonstrate that asthma exacerbations in children can be divided into IRF7hi versus IRF7lo phenotypes with associated differences in clinical phenotypes.
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Affiliation(s)
- Siew-Kim Khoo
- Division of Cardiovascular and Respiratory Sciences, The University of Western Australia, Perth, Western Australia 6009, Australia.,Telethon Kids Institute, The University of Western Australia, Perth, Western Australia 6008, Australia
| | - James Read
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia 6008, Australia
| | - Kimberley Franks
- Division of Cardiovascular and Respiratory Sciences, The University of Western Australia, Perth, Western Australia 6009, Australia.,Telethon Kids Institute, The University of Western Australia, Perth, Western Australia 6008, Australia
| | - Guicheng Zhang
- Division of Cardiovascular and Respiratory Sciences, The University of Western Australia, Perth, Western Australia 6009, Australia.,School of Public Health, Curtin University, Perth, Western Australia 6102, Australia.,Centre for Genetic Origins of Health and Disease, The University of Western Australia, Perth, Western Australia 6009, Australia and Curtin University, Perth, Western Australia 6102, Australia
| | - Joelene Bizzintino
- Division of Cardiovascular and Respiratory Sciences, The University of Western Australia, Perth, Western Australia 6009, Australia.,Telethon Kids Institute, The University of Western Australia, Perth, Western Australia 6008, Australia
| | - Laura Coleman
- Division of Cardiovascular and Respiratory Sciences, The University of Western Australia, Perth, Western Australia 6009, Australia.,Telethon Kids Institute, The University of Western Australia, Perth, Western Australia 6008, Australia
| | - Christopher McCrae
- Respiratory Inflammation and Autoimmunity, IMED Biotech Unit, AstraZeneca, Gothenburg, 431 53 Mölndal, Sweden
| | - Lisa Öberg
- Respiratory Inflammation and Autoimmunity, IMED Biotech Unit, AstraZeneca, Gothenburg, 431 53 Mölndal, Sweden
| | - Niamh M Troy
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia 6008, Australia
| | - Franciska Prastanti
- Division of Cardiovascular and Respiratory Sciences, The University of Western Australia, Perth, Western Australia 6009, Australia.,Telethon Kids Institute, The University of Western Australia, Perth, Western Australia 6008, Australia
| | - Janet Everard
- Division of Cardiovascular and Respiratory Sciences, The University of Western Australia, Perth, Western Australia 6009, Australia.,Telethon Kids Institute, The University of Western Australia, Perth, Western Australia 6008, Australia
| | - Stephen Oo
- Division of Paediatrics, School of Medicine, The University of Western Australia, Perth, Western Australia 6009, Australia
| | - Meredith L Borland
- Division of Paediatrics, School of Medicine, The University of Western Australia, Perth, Western Australia 6009, Australia.,Perth Children's Hospital, Perth, Western Australia 6009, Australia; and.,Division of Emergency Medicine, School of Medicine, The University of Western Australia, Perth, Western Australia 6009, Australia
| | - Rose A Maciewicz
- Respiratory Inflammation and Autoimmunity, IMED Biotech Unit, AstraZeneca, Gothenburg, 431 53 Mölndal, Sweden
| | - Peter N Le Souëf
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia 6008, Australia.,Division of Paediatrics, School of Medicine, The University of Western Australia, Perth, Western Australia 6009, Australia
| | - Ingrid A Laing
- Division of Cardiovascular and Respiratory Sciences, The University of Western Australia, Perth, Western Australia 6009, Australia.,Telethon Kids Institute, The University of Western Australia, Perth, Western Australia 6008, Australia
| | - Anthony Bosco
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia 6008, Australia;
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246
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Allergic asthma is associated with increased risk of infections requiring antibiotics. Ann Allergy Asthma Immunol 2019; 120:169-176.e1. [PMID: 29413341 DOI: 10.1016/j.anai.2017.11.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 11/07/2017] [Accepted: 11/20/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Viral infection and allergy have been identified as major risk factors for exacerbation in asthma, especially in the presence of both. However, whether patients with allergic asthma are more susceptible to respiratory infections requiring antibiotics remains unknown. OBJECTIVE To investigate allergy as a risk factor for respiratory infections requiring antibiotics based on register data from a nationwide population of patients with asthma. METHODS A register-based prospective follow-up study was performed using the Danish prescription database. In the inclusion period from 2010 through 2011, we identified patients with allergic asthma 18 to 44 years old. Patients were investigated during the follow-up period from 2012 through 2013, depending on their prescription drug use of antiallergic medication and antibiotics. Odds ratios were adjusted for age, sex, asthma severity, education, and urban vs rural residence. RESULTS In a nationwide population we identified 60,415 patients with asthma. Based on prescriptions fillings for antiallergic medication, patients were subdivided into (1) nonallergic asthma (n = 35,334, 51.5%) and (2) allergic asthma (n = 25,081, 48.5%). Allergic asthma was associated with an increased risk of filling at least 2 antibiotic prescriptions per year compared with nonallergic asthma (odds ratio 1.28, 95% confidence interval 1.24-1.33, P < .0001). Interestingly, a subgroup analysis showed a protective effect of immunotherapy against the risk of requiring antibiotics (odds ratio 0.76, 95% confidence interval 0.66-0.87, P = .0001). CONCLUSION Patients with allergic asthma have an increased risk of being prescribed antibiotics for respiratory infections compared with those with nonallergic asthma. Treatment with allergen immunotherapy appears to have a protective effect against this risk.
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247
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Zhu J, Message SD, Mallia P, Kebadze T, Contoli M, Ward CK, Barnathan ES, Mascelli MA, Kon OM, Papi A, Stanciu LA, Edwards MR, Jeffery PK, Johnston SL. Bronchial mucosal IFN-α/β and pattern recognition receptor expression in patients with experimental rhinovirus-induced asthma exacerbations. J Allergy Clin Immunol 2019; 143:114-125.e4. [PMID: 29698627 PMCID: PMC6320262 DOI: 10.1016/j.jaci.2018.04.003] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 03/12/2018] [Accepted: 04/03/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND The innate immune system senses viral infection through pattern recognition receptors (PRRs), leading to type I interferon production. The role of type I interferon and PPRs in rhinovirus-induced asthma exacerbations in vivo are uncertain. OBJECTIVES We sought to compare bronchial mucosal type I interferon and PRR expression at baseline and after rhinovirus infection in atopic asthmatic patients and control subjects. METHODS Immunohistochemistry was used to detect expression of IFN-α, IFN-β, and the PRRs: Toll-like receptor 3, melanoma differentiation-associated gene 5, and retinoic acid-inducible protein I in bronchial biopsy specimens from 10 atopic asthmatic patients and 15 nonasthmatic nonatopic control subjects at baseline and on day 4 and 6 weeks after rhinovirus infection. RESULTS We observed IFN-α/β deficiency in the bronchial epithelium at 3 time points in asthmatic patients in vivo. Lower epithelial IFN-α/β expression was related to greater viral load, worse airway symptoms, airway hyperresponsiveness, and reductions in lung function during rhinovirus infection. We found lower frequencies of bronchial subepithelial monocytes/macrophages expressing IFN-α/β in asthmatic patients during infection. Interferon deficiency at baseline was not accompanied by deficient PRR expression in asthmatic patients. Both epithelial and subepithelial PRR expression were induced during rhinovirus infection. Rhinovirus infection-increased numbers of subepithelial interferon/PRR-expressing inflammatory cells were related to greater viral load, airway hyperresponsiveness, and reductions in lung function. CONCLUSIONS Bronchial epithelial IFN-α/β expression and numbers of subepithelial IFN-α/β-expressing monocytes/macrophages during infection were both deficient in asthmatic patients. Lower epithelial IFN-α/β expression was associated with adverse clinical outcomes after rhinovirus infection in vivo. Increases in numbers of subepithelial cells expressing interferon/PRRs during infection were also related to greater viral load/illness severity.
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Affiliation(s)
- Jie Zhu
- Airway Disease Infection, National Heart and Lung Institute, Medical Research Council and Asthma UK Centre in Allergic Mechanisms of Asthma, Imperial College London, London, United Kingdom
| | - Simon D Message
- Airway Disease Infection, National Heart and Lung Institute, Medical Research Council and Asthma UK Centre in Allergic Mechanisms of Asthma, Imperial College London, London, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Patrick Mallia
- Airway Disease Infection, National Heart and Lung Institute, Medical Research Council and Asthma UK Centre in Allergic Mechanisms of Asthma, Imperial College London, London, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Tatiana Kebadze
- Airway Disease Infection, National Heart and Lung Institute, Medical Research Council and Asthma UK Centre in Allergic Mechanisms of Asthma, Imperial College London, London, United Kingdom
| | - Marco Contoli
- Airway Disease Infection, National Heart and Lung Institute, Medical Research Council and Asthma UK Centre in Allergic Mechanisms of Asthma, Imperial College London, London, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; Research Centre on Asthma and COPD, University of Ferrara, Ferrara, Italy
| | | | | | | | - Onn M Kon
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Alberto Papi
- Research Centre on Asthma and COPD, University of Ferrara, Ferrara, Italy
| | - Luminita A Stanciu
- Airway Disease Infection, National Heart and Lung Institute, Medical Research Council and Asthma UK Centre in Allergic Mechanisms of Asthma, Imperial College London, London, United Kingdom
| | - Michael R Edwards
- Airway Disease Infection, National Heart and Lung Institute, Medical Research Council and Asthma UK Centre in Allergic Mechanisms of Asthma, Imperial College London, London, United Kingdom
| | - Peter K Jeffery
- Airway Disease Infection, National Heart and Lung Institute, Medical Research Council and Asthma UK Centre in Allergic Mechanisms of Asthma, Imperial College London, London, United Kingdom
| | - Sebastian L Johnston
- Airway Disease Infection, National Heart and Lung Institute, Medical Research Council and Asthma UK Centre in Allergic Mechanisms of Asthma, Imperial College London, London, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom.
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248
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Jartti T, Smits HH, Bønnelykke K, Bircan O, Elenius V, Konradsen JR, Maggina P, Makrinioti H, Stokholm J, Hedlin G, Papadopoulos N, Ruszczynski M, Ryczaj K, Schaub B, Schwarze J, Skevaki C, Stenberg‐Hammar K, Feleszko W. Bronchiolitis needs a revisit: Distinguishing between virus entities and their treatments. Allergy 2019; 74:40-52. [PMID: 30276826 PMCID: PMC6587559 DOI: 10.1111/all.13624] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 09/07/2018] [Accepted: 09/15/2018] [Indexed: 12/13/2022]
Abstract
Current data indicate that the “bronchiolitis” diagnosis comprises more than one condition. Clinically, pathophysiologically, and even genetically three main clusters of patients can be identified among children suffering from severe bronchiolitis (or first wheezing episode): (a) respiratory syncytial virus (RSV)‐induced bronchiolitis, characterized by young age of the patient, mechanical obstruction of the airways due to mucus and cell debris, and increased risk of recurrent wheezing. For this illness, an effective prophylactic RSV‐specific monoclonal antibody is available; (b) rhinovirus‐induced wheezing, associated with atopic predisposition of the patient and high risk of subsequent asthma development, which may, however, be reversed with systemic corticosteroids in those with severe illness; and (c) wheeze due to other viruses, characteristically likely to be less frequent and severe. Clinically, it is important to distinguish between these partially overlapping patient groups as they are likely to respond to different treatments. It appears that the first episode of severe bronchiolitis in under 2‐year‐old children is a critical event and an important opportunity for designing secondary prevention strategies for asthma. As data have shown bronchiolitis cannot simply be diagnosed using a certain cutoff age, but instead, as we suggest, using the viral etiology as the differentiating factor.
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Affiliation(s)
- Tuomas Jartti
- Department of Pediatrics Turku University Hospital and University of Turku Turku Finland
| | - Hermelijn H. Smits
- Department of Parasitology Leiden University Medical Center Leiden The Netherlands
| | - Klaus Bønnelykke
- COPSAC Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital University of Copenhagen Copenhagen Denmark
| | - Ozlem Bircan
- Department of Pediatric Allergy Istanbul Medeniyet University Göztepe Training and Research Hospital Istanbul Turkey
| | - Varpu Elenius
- Department of Pediatrics Turku University Hospital and University of Turku Turku Finland
| | - Jon R. Konradsen
- Astrid Lindgren Children's Hospital Karolinska University Hospital Stockholm Sweden
- Department of Women's and Children's Health Karolinska Institutet Stockholm Sweden
- Department of Medicine Solna Immunology and Allergy Unit Karolinska Institutet Karolinska University Hospital Stockholm Sweden
| | - Paraskevi Maggina
- Allergy Department 2nd Pediatric Clinic University of Athens Athens Greece
| | | | - Jakob Stokholm
- COPSAC Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital University of Copenhagen Copenhagen Denmark
| | - Gunilla Hedlin
- Astrid Lindgren Children's Hospital Karolinska University Hospital Stockholm Sweden
- Department of Women's and Children's Health Karolinska Institutet Stockholm Sweden
| | - Nikolaos Papadopoulos
- Allergy Department 2nd Pediatric Clinic University of Athens Athens Greece
- Division of Infection Immunity & Respiratory Medicine University of Manchester Manchester UK
| | | | - Klaudia Ryczaj
- Department of Pediatric Pneumonology and Allergy Medical University of Warsaw Warsaw Poland
| | - Bianca Schaub
- Pediatric Allergology Department of Pediatrics Dr. von Hauner Children′s Hospital University Hospital German Center for Lung Research (DZL) LMU Munich Munich Germany
| | - Jürgen Schwarze
- Centre for Inflammation Research Queen's Medical Research Institute and Child Life and Health University of Edinburgh Edinburgh UK
| | - Chrysanthi Skevaki
- Institute of Laboratory Medicine Philipps Universität Marburg Marburg Germany
- Universities of Giessen and Marburg Lung Center (UGMLC) Philipps Universität, Marburg German Center for Lung Research (DZL) Marburg Germany
| | - Katarina Stenberg‐Hammar
- Astrid Lindgren Children's Hospital Karolinska University Hospital Stockholm Sweden
- Department of Women's and Children's Health Karolinska Institutet Stockholm Sweden
| | - Wojciech Feleszko
- Department of Pediatric Pneumonology and Allergy Medical University of Warsaw Warsaw Poland
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249
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Abstract
Respiratory viral infections including human rhinovirus (RV) infection have been identified as the most important environmental trigger of exacerbations of chronic lung diseases. While well established as the most common viral infections associated with exacerbations of asthma and chronic obstructive pulmonary disease, RVs and other respiratory viruses are also now thought to be important in triggering exacerbations of cystic fibrosis and the interstitial lung diseases. Here, we summarize the epidemiological evidence the supports respiratory viruses including RV as triggers of exacerbations of chronic lung diseases. We propose that certain characteristics of RVs may explain why they are the most common trigger of exacerbations of chronic lung diseases. We further highlight the latest mechanistic evidence supporting how and why common respiratory viral infections may enhance and promote disease triggering exacerbation events, through their interactions with the host immune system, and may be affected by ongoing treatments. We also provide a commentary on how new treatments may better manage the disease burden associated with respiratory viral infections and the exacerbation events that they trigger.
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250
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Abstract
Antenatal and preschool factors are key in determining the progression to pre-school wheeze and eosinophilic school age asthma. The conventional view of eosinophilic asthma is that airway inflammation is the fundamental underlying abnormality, and airway inflammation and hyper-responsiveness are secondary; in fact, these three are parallel processes. Very early structural changes, independent of inflammation and infection, are associated with early airway hyper-responsiveness and later adverse respiratory outcomes. There is a bidirectional relationship between structural airway wall changes and airway inflammation, with airway contraction per se leading to the release of growth factors, and inflammatory pathways promoting airway remodeling. Early viral infection (and increasingly being appreciated, bacterial infection) is important in wheeze outcomes. There is evidence of abnormal immune function including cytokine release before the onset of viral infections. However, viral infections may also have prolonged effects on the host immune system, and the evidence for beneficial and adverse effects of viral infection is conflicting. In older children and adults, asthmatic epithelial cells show impaired interferon responses to viral infection, but only in the presence of uncontrolled type 2 inflammation, implying these are secondary phenomena. There are also compelling data relating the innate immune system to later asthma and atopy, and animal studies suggest that the effects of a high endotoxin, microbiologically diverse environment may be modulated via the epithelial alarmin IL-33. Whereas, previously only viral infection was thought to be important, early bacterial colonization of the upper airway is coming to the fore, associated with a mixed pattern of TH1/TH2/TH17 cytokine secretion, and adverse long term outcomes. Bacterial colonization is probably a marker of a subtle immune deficiency, rather than directly causal. The airway and gut microbiome critically impacts the development of Type 2 inflammatory responses. However, Type 2 inflammatory cytokines, which are critical both to progression from pre-school wheeze to eosinophilic asthma, and sustaining the eosinophilic asthmatic state, are not implicated in the very early development of the disease. Taken together, the evidence is that the earliest cytokine and chemokine signals will come from the study of bronchial epithelial cell function and their interactions with viruses and the microbiome.
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Affiliation(s)
- Andrew Bush
- Departments of Paediatrics and Paediatric Respiratory Medicine, Royal Brompton Harefield NHS Foundation Trust and Imperial College, London, United Kingdom
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