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Giusti D, Guemari A, Perotin JM, Fontaine JF, Tonye Libyh M, Gatouillat G, Tabary T, Pham BN, Vitte J. Molecular allergology: a clinical laboratory tool for precision diagnosis, stratification and follow-up of allergic patients. Clin Chem Lab Med 2024; 0:cclm-2024-0305. [PMID: 38815141 DOI: 10.1515/cclm-2024-0305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 05/15/2024] [Indexed: 06/01/2024]
Abstract
Identification of the molecular culprits of allergic reactions leveraged molecular allergology applications in clinical laboratory medicine. Molecular allergology shifted the focus from complex, heterogeneous allergenic extracts, e.g. pollen, food, or insect venom, towards genetically and immunologically defined proteins available for in vitro diagnosis. Molecular allergology is a precision medicine approach for the diagnosis, stratification, therapeutic management, follow-up and prognostic evaluation of patients within a large range of allergic diseases. Exclusively available for in vitro diagnosis, molecular allergology is nonredundant with any of the current clinical tools for allergy investigation. As an example of a major application, discrimination of genuine sensitization from allergen cross-reactivity at the molecular level allows the proper targeting of the culprit allergen and thus dramatically improves patient management. This review aims at introducing clinical laboratory specialists to molecular allergology, from the biochemical and genetic bases, through immunological concepts, to daily use in the diagnosis and management of allergic diseases.
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Affiliation(s)
- Delphine Giusti
- Immunology Laboratory, Biology and Pathology Department, University Hospital of Reims, Reims, France
- University of Reims Champagne Ardenne, EA7509 IRMAIC, Reims, France
| | - Amir Guemari
- Univ Montpellier, Desbrest Institute of Epidemiology and Public Health (IDESP), INSERM, Montpellier, France
| | - Jeanne-Marie Perotin
- Department of Respiratory Diseases, University Hospital of Reims, Reims, France
- University of Reims Champagne Ardenne, INSERM UMR 1250, Reims, France
| | | | - Marcelle Tonye Libyh
- Immunology Laboratory, Biology and Pathology Department, University Hospital of Reims, Reims, France
| | - Gregory Gatouillat
- Immunology Laboratory, Biology and Pathology Department, University Hospital of Reims, Reims, France
| | - Thierry Tabary
- Immunology Laboratory, Biology and Pathology Department, University Hospital of Reims, Reims, France
| | - Bach-Nga Pham
- Immunology Laboratory, Biology and Pathology Department, University Hospital of Reims, Reims, France
- University of Reims Champagne Ardenne, EA7509 IRMAIC, Reims, France
| | - Joana Vitte
- Immunology Laboratory, Biology and Pathology Department, University Hospital of Reims, Reims, France
- University of Reims Champagne Ardenne, INSERM UMR 1250, Reims, France
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Pfeiffer S, Swoboda I. Problems Encountered Using Fungal Extracts as Test Solutions for Fungal Allergy Diagnosis. J Fungi (Basel) 2023; 9:957. [PMID: 37888213 PMCID: PMC10607634 DOI: 10.3390/jof9100957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 09/15/2023] [Accepted: 09/18/2023] [Indexed: 10/28/2023] Open
Abstract
Fungal allergy is a worldwide public health burden, and problems associated with a reliable allergy diagnosis are far from being solved. Especially, the lack of high-quality standardized fungal extracts contributes to the underdiagnosis of fungal allergy. Compared to the manufacturing processes of extracts from other allergen sources, the processes used to manufacture extracts from fungi show the highest variability. The reasons for the high variability are manifold as the starting material, the growth conditions, the protein extraction methods, and the storage conditions all have an influence on the presence and quantity of individual allergens. Despite the vast variety of studies that have analyzed the impact of the different production steps on the allergenicity of fungal allergen extracts, much remains unknown. This review points to the need for further research in the field of fungal allergology, for standardization and for generally accepted guidelines on the preparation of fungal allergen extracts. In particular, the standardization of fungal extracts has been and will continue to be difficult, but it will be crucial for improving allergy diagnosis and therapy.
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Affiliation(s)
| | - Ines Swoboda
- The Molecular Biotechnology Section, Department Applied Life Sciences, FH Campus Wien, University of Applied Sciences, 1100 Vienna, Austria;
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Abstract
Aspergillus fumigatus is a saprotrophic fungus; its primary habitat is the soil. In its ecological niche, the fungus has learned how to adapt and proliferate in hostile environments. This capacity has helped the fungus to resist and survive against human host defenses and, further, to be responsible for one of the most devastating lung infections in terms of morbidity and mortality. In this review, we will provide (i) a description of the biological cycle of A. fumigatus; (ii) a historical perspective of the spectrum of aspergillus disease and the current epidemiological status of these infections; (iii) an analysis of the modes of immune response against Aspergillus in immunocompetent and immunocompromised patients; (iv) an understanding of the pathways responsible for fungal virulence and their host molecular targets, with a specific focus on the cell wall; (v) the current status of the diagnosis of different clinical syndromes; and (vi) an overview of the available antifungal armamentarium and the therapeutic strategies in the clinical context. In addition, the emergence of new concepts, such as nutritional immunity and the integration and rewiring of multiple fungal metabolic activities occurring during lung invasion, has helped us to redefine the opportunistic pathogenesis of A. fumigatus.
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Affiliation(s)
- Jean-Paul Latgé
- School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Georgios Chamilos
- School of Medicine, University of Crete, Heraklion, Crete, Greece
- Institute of Molecular Biology and Biotechnology, Foundation for Research and Technology, Heraklion, Crete, Greece
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Hayes T, Rumore A, Howard B, He X, Luo M, Wuenschmann S, Chapman M, Kale S, Li L, Kita H, Lawrence CB. Innate Immunity Induced by the Major Allergen Alt a 1 From the Fungus Alternaria Is Dependent Upon Toll-Like Receptors 2/4 in Human Lung Epithelial Cells. Front Immunol 2018; 9:1507. [PMID: 30100902 PMCID: PMC6072870 DOI: 10.3389/fimmu.2018.01507] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 06/18/2018] [Indexed: 12/31/2022] Open
Abstract
Allergens are molecules that elicit a hypersensitive inflammatory response in sensitized individuals and are derived from a variety of sources. Alt a 1 is the most clinically important secreted allergen of the ubiquitous fungus, Alternaria. It has been shown to be a major allergen causing IgE-mediated allergic response in the vast majority of Alternaria-sensitized individuals. However, no studies have been conducted in regards to the innate immune eliciting activities of this clinically relevant protein. In this study, recombinant Alt a 1 was produced, purified, labeled, and incubated with BEAS-2B, NHBE, and DHBE human lung epithelial cells. Alt a 1 elicited strong induction of IL-8, MCP-1, and Gro-a/b/g. Using gene-specific siRNAs, blocking antibodies, and chemical inhibitors such as LPS-RS, it was determined that Alt a 1-induced immune responses were dependent upon toll-like receptors (TLRs) 2 and 4, and the adaptor proteins MYD88 and TIRAP. Studies utilizing human embryonic kidney cells engineered to express single receptors on the cell surface such as TLRs, further confirmed that Alt a 1-induced innate immunity is dependent upon TLR4 and to a lesser extent TLR2.
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Affiliation(s)
- Tristan Hayes
- Department of Biological Sciences, Virginia Tech, Blacksburg, VA, United States
- Department of Pediatrics, School of Medicine, Indiana University Bloomington, Indianapolis, IN, United States
| | - Amanda Rumore
- Department of Biology, Randolph College, Lynchburg, VA, United States
| | - Brad Howard
- Department of Biological Sciences, Virginia Tech, Blacksburg, VA, United States
| | - Xin He
- Department of Biological Sciences, Virginia Tech, Blacksburg, VA, United States
| | - Mengyao Luo
- Department of Biological Sciences, Virginia Tech, Blacksburg, VA, United States
| | | | - Martin Chapman
- Indoor Biotechnologies, Charlottesville, VA, United States
| | - Shiv Kale
- Biocomplexity Institute, Virginia Tech, Blacksburg, VA, United States
| | - Liwu Li
- Department of Biological Sciences, Virginia Tech, Blacksburg, VA, United States
| | - Hirohito Kita
- Division of Allergic Diseases, Internal Medicine, Mayo Clinic, Rochester, MN, United States
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Carsin A, Romain T, Ranque S, Reynaud‐Gaubert M, Dubus J, Mège J, Vitte J. Aspergillus fumigatus in cystic fibrosis: An update on immune interactions and molecular diagnostics in allergic bronchopulmonary aspergillosis. Allergy 2017; 72:1632-1642. [PMID: 28513848 DOI: 10.1111/all.13204] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2017] [Indexed: 12/13/2022]
Abstract
A wide spectrum of pathological conditions may result from the interaction of Aspergillus fumigatus and the immune system of its human host. Allergic bronchopulmonary aspergillosis is one of the most severe A. fumigatus-related diseases due to possible evolution toward pleuropulmonary fibrosis and respiratory failure. Allergic bronchopulmonary aspergillosis occurs almost exclusively in cystic fibrosis or asthmatic patients. An estimated 8%-10% of patients with cystic fibrosis experience this condition. The diagnosis of allergic bronchopulmonary aspergillosis relies on criteria first established in 1977. Progress in the understanding of host-pathogen interactions in A. fumigatus and patients with cystic fibrosis and the ongoing validation of novel laboratory tools concur to update and improve the diagnosis of allergic bronchopulmonary aspergillosis.
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Affiliation(s)
- A. Carsin
- Aix‐Marseille Univ APHM Hôpital Timone Enfants Pneumo‐pédiatrie Centre de Ressources et de Compétences en Mucoviscidose Marseille France
- Aix‐Marseille Univ INSERM UMR 1067 CNRS UMR 7333 Marseille France
| | - T. Romain
- Aix‐Marseille Univ APHM Hôpital de La Conception Laboratoire d'Immunologie Marseille France
| | - S. Ranque
- Aix‐Marseille Univ APHM Hôpital Timone Laboratoire de Parasitologie Marseille France
- Aix‐Marseille Univ INSERM U1095 CNRS U7278 IRD 198 URMITE Marseille France
| | - M. Reynaud‐Gaubert
- Aix‐Marseille Univ INSERM U1095 CNRS U7278 IRD 198 URMITE Marseille France
- Aix‐Marseille Univ APHM Hôpital Nord Centre de Ressources et de Compétences en Mucoviscidose Marseille France
| | - J.‐C. Dubus
- Aix‐Marseille Univ APHM Hôpital Timone Enfants Pneumo‐pédiatrie Centre de Ressources et de Compétences en Mucoviscidose Marseille France
- Aix‐Marseille Univ INSERM U1095 CNRS U7278 IRD 198 URMITE Marseille France
| | - J.‐L. Mège
- Aix‐Marseille Univ APHM Hôpital de La Conception Laboratoire d'Immunologie Marseille France
- Aix‐Marseille Univ INSERM U1095 CNRS U7278 IRD 198 URMITE Marseille France
| | - J. Vitte
- Aix‐Marseille Univ INSERM UMR 1067 CNRS UMR 7333 Marseille France
- Aix‐Marseille Univ APHM Hôpital de La Conception Laboratoire d'Immunologie Marseille France
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Dewi IMW, van de Veerdonk FL, Gresnigt MS. The Multifaceted Role of T-Helper Responses in Host Defense against Aspergillus fumigatus. J Fungi (Basel) 2017; 3:E55. [PMID: 29371571 PMCID: PMC5753157 DOI: 10.3390/jof3040055] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 09/28/2017] [Accepted: 09/30/2017] [Indexed: 01/01/2023] Open
Abstract
The ubiquitous opportunistic fungal pathogen Aspergillus fumigatus rarely causes infections in immunocompetent individuals. A healthy functional innate immune system plays a crucial role in preventing Aspergillus-infection. This pivotal role for the innate immune system makes it a main research focus in studying the pathogenesis of aspergillosis. Although sometimes overshadowed by the innate immune response, the adaptive immune response, and in particular T-helper responses, also represents a key player in host defense against Aspergillus. Virtually all T-helper subsets have been described to play a role during aspergillosis, with the Th1 response being crucial for fungal clearance. However; morbidity and mortality of aspergillosis can also be partly attributed to detrimental immune responses resulting from adaptive immune activation. Th2 responses benefit fungal persistence; and are the foundation of allergic forms of aspergillosis. The Th17 response has two sides; although crucial for granulocyte recruitment, it can be involved in detrimental immunopathology. Regulatory T-cells, the endogenous regulators of inflammatory responses, play a key role in controlling detrimental inflammatory responses during aspergillosis. The current knowledge of the adaptive immune response against A. fumigatus is summarized in this review. A better understanding on how T-helper responses facilitate clearance of Aspergillus-infection and control inflammation can be the fundamental basis for understanding the pathogenesis of aspergillosis and for the development of novel host-directed therapies.
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Affiliation(s)
- Intan M W Dewi
- Department of Experimental Internal Medicine and Radboud Center for Infectious diseases (RCI), Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands.
- Faculty of Medicine Universitas Padjadjaran, Jl. Eijkman No. 38, Bandung 40161, Indonesia.
| | - Frank L van de Veerdonk
- Department of Experimental Internal Medicine and Radboud Center for Infectious diseases (RCI), Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands.
| | - Mark S Gresnigt
- Department of Experimental Internal Medicine and Radboud Center for Infectious diseases (RCI), Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands.
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Vitte J, Romain T, Carsin A, Gouitaa M, Stremler-Le Bel N, Baravalle-Einaudi M, Cleach I, Reynaud-Gaubert M, Dubus JC, Mège JL. Aspergillus fumigatus components distinguish IgE but not IgG4 profiles between fungal sensitization and allergic broncho-pulmonary aspergillosis. Allergy 2016; 71:1640-1643. [PMID: 27542151 DOI: 10.1111/all.13031] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2016] [Indexed: 01/11/2023]
Abstract
Aspergillus fumigatus is the causative agent of allergic broncho-pulmonary aspergillosis. Prompt and accurate diagnosis may be difficult to achieve with current clinical and laboratory scores, which do not include immune responses to recombinant A. fumigatus allergens. We measured specific immunoglobulin E and G4 directed to recombinant A. fumigatus allergens in 55 cystic fibrosis patients without allergic broncho-pulmonary aspergillosis but sensitized to A. fumigatus and in nine patients with allergic broncho-pulmonary aspergillosis (two with cystic fibrosis and seven with asthma). IgG4 responses to recombinant A. fumigatus allergens were detected in all patients, but neither prevalence nor levels were different between the two patient groups. On the other hand, both prevalence and levels of IgE responses to Asp f 3, Asp f 4, and Asp f 6 helped distinguish allergic broncho-pulmonary aspergillosis from A. fumigatus sensitization with good negative and positive predictive values.
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Affiliation(s)
- J. Vitte
- Laboratoire d'Immunologie; Hôpital de La Conception; APHM Assistance Publique Hôpitaux de Marseille; Marseille France
- Faculté de Médecine de Marseille; Aix-Marseille University; Marseille France
| | - T. Romain
- Laboratoire d'Immunologie; Hôpital de La Conception; APHM Assistance Publique Hôpitaux de Marseille; Marseille France
| | - A. Carsin
- Faculté de Médecine de Marseille; Aix-Marseille University; Marseille France
- Centre de Ressources et de Compétences en Mucoviscidose; Hôpital Timone Enfants; APHM Assistance Publique Hôpitaux de Marseille; Marseille France
| | - M. Gouitaa
- Service de Pneumologie; Hôpital Nord; APHM Assistance Publique Hôpitaux de Marseille; Marseille France
| | - N. Stremler-Le Bel
- Centre de Ressources et de Compétences en Mucoviscidose; Hôpital Timone Enfants; APHM Assistance Publique Hôpitaux de Marseille; Marseille France
| | - M. Baravalle-Einaudi
- Centre de Ressources et de Compétences en Mucoviscidose; Hôpital Timone Enfants; APHM Assistance Publique Hôpitaux de Marseille; Marseille France
| | - I. Cleach
- Laboratoire d'Immunologie; Hôpital de La Conception; APHM Assistance Publique Hôpitaux de Marseille; Marseille France
| | - M. Reynaud-Gaubert
- Faculté de Médecine de Marseille; Aix-Marseille University; Marseille France
- Centre de Ressources et de Compétences en Mucoviscidose; Hôpital Nord; APHM Assistance Publique Hôpitaux de Marseille; Marseille France
| | - J.-C. Dubus
- Faculté de Médecine de Marseille; Aix-Marseille University; Marseille France
- Centre de Ressources et de Compétences en Mucoviscidose; Hôpital Timone Enfants; APHM Assistance Publique Hôpitaux de Marseille; Marseille France
| | - J.-L. Mège
- Laboratoire d'Immunologie; Hôpital de La Conception; APHM Assistance Publique Hôpitaux de Marseille; Marseille France
- Faculté de Médecine de Marseille; Aix-Marseille University; Marseille France
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