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Mastalerz L, Celejewska‐Wójcik N, Ćmiel A, Wójcik K, Szaleniec J, Hydzik‐Sobocińska K, Tomik J, Sanak M. Non‐eosinophilic asthma in nonsteroidal anti‐inflammatory drug exacerbated respiratory disease. Clin Transl Allergy 2023; 13:e12235. [PMID: 36973957 PMCID: PMC10009799 DOI: 10.1002/clt2.12235] [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: 12/06/2022] [Revised: 02/12/2023] [Accepted: 02/24/2023] [Indexed: 03/14/2023] Open
Abstract
Background The cellular inflammatory pattern of nonsteroidal anti‐inflammatory drug–exacerbated respiratory disease (N‐ERD) is heterogeneous. However, data on the heterogeneity of non‐eosinophilic asthma (NEA) with aspirin hypersensitivity are scanty. By examination of N‐ERD patients based on clinical data and eicosanoid biomarkers we aimed to identify NEA endotypes potentially guiding clinical management. Methods Induced sputum was collected from patients with N‐ERD. Sixty six patients (49.6% of 133 N‐ERD) with NEA were included in the hierarchical cluster analysis based on clinical and laboratory data. The quality of clustering was evaluated using internal cluster validation with different indices and a practical decision tree was proposed to simplify stratification of patients. Results The most frequent NEA pattern was paucigranulocytic (PGA; 75.8%), remaining was neutrophilic asthma (NA; 24.2%). Four clusters were identified. Cluster #3 included the highest number of NEA patients (37.9%) with severe asthma and PGA pattern (96.0%). Cluster #1 (24.2%) included severe only asthma, with a higher prevalence of NA (50%). Cluster #2 (25.8%) comprised well‐controlled mild or severe asthma (PGA; 76.5%). Cluster #4 contained only 12.1% patients with well‐controlled moderate asthma (PGA; 62.5%). Sputum prostaglandin D2 levels distinguished cluster #1 from the remaining clusters with an area under the curve of 0.94. Conclusions Among identified four NEA subtypes, clusters #3 and #1 represented N‐ERD patients with severe asthma but a different inflammatory signatures. All the clusters were discriminated by sputum PGD2 levels, asthma severity, and age of patients. The heterogeneity of non‐eosinophilic N‐ERD suggests a need for novel targeted interventions.
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Affiliation(s)
- Lucyna Mastalerz
- 2nd Department of Internal MedicineJagiellonian University Medical CollegeKrakowPoland
| | | | - Adam Ćmiel
- Department of Applied MathematicsAGH University of Science and TechnologyKrakowPoland
| | - Krzysztof Wójcik
- 2nd Department of Internal MedicineJagiellonian University Medical CollegeKrakowPoland
| | - Joanna Szaleniec
- Department of OtolaryngologyFaculty of MedicineJagiellonian University Medical CollegeKrakowPoland
| | | | - Jerzy Tomik
- Department of OtolaryngologyFaculty of MedicineJagiellonian University Medical CollegeKrakowPoland
| | - Marek Sanak
- 2nd Department of Internal MedicineJagiellonian University Medical CollegeKrakowPoland
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Mastalerz L, Kacorzyk R, Jakieła B, Ćmiel A, Sanak M. Sputum transcriptome analysis of co-regulated genes related to arachidonic acid metabolism in N-ERD. Allergy 2023; 78:553-555. [PMID: 36048968 DOI: 10.1111/all.15501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 08/11/2022] [Accepted: 08/29/2022] [Indexed: 02/01/2023]
Affiliation(s)
- Lucyna Mastalerz
- II Department of Internal Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Radosław Kacorzyk
- II Department of Internal Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Bogdan Jakieła
- II Department of Internal Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Adam Ćmiel
- Department of Applied Mathematics, AGH University of Science and Technology, Krakow, Poland
| | - Marek Sanak
- II Department of Internal Medicine, Jagiellonian University Medical College, Krakow, Poland
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Bangert C, Villazala-Merino S, Fahrenberger M, Krausgruber T, Bauer WM, Stanek V, Campion NJ, Bartosik T, Quint T, Regelsberger G, Niederberger-Leppin V, Bock C, Schneider S, Eckl-Dorna J. Comprehensive Analysis of Nasal Polyps Reveals a More Pronounced Type 2 Transcriptomic Profile of Epithelial Cells and Mast Cells in Aspirin-Exacerbated Respiratory Disease. Front Immunol 2022; 13:850494. [PMID: 35418991 PMCID: PMC8996080 DOI: 10.3389/fimmu.2022.850494] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 02/28/2022] [Indexed: 11/28/2022] Open
Abstract
Chronic rhinosinusitis with nasal polyps is affecting up to 3% of Western populations. About 10% of patients with nasal polyps also suffer from asthma and intolerance to aspirin, a syndrome called aspirin-exacerbated respiratory disease. Although eosinophilic inflammation is predominant in polyps of both diseases, phenotypic differences in the tissue-derived microenvironment, elucidating disease-specific characteristics, have not yet been identified. We sought to obtain detailed information about phenotypic and transcriptional differences in epithelial and immune cells in polyps of aspirin-tolerant and intolerant patients. Cytokine profiles in nasal secretions and serum of patients suffering from aspirin-exacerbated respiratory disease (n = 10) or chronic rhinosinusitis with nasal polyps (n = 9) were assessed using a multiplex mesoscale discovery assay. After enrichment for immune cell subsets by flow cytometry, we performed transcriptomic profiling by employing single-cell RNA sequencing. Aspirin-intolerant patients displayed significantly elevated IL-5 and CCL17 levels in nasal secretions corresponding to a more pronounced eosinophilic type 2 inflammation. Transcriptomic profiling revealed that epithelial and mast cells not only complement one another in terms of gene expression associated with the 15-lipoxygenase pathway but also show a clear type 2-associated inflammatory phenotype as identified by the upregulation of POSTN, CCL26, and IL13 in patients with aspirin-exacerbated respiratory disease. Interestingly, we also observed cellular stress responses indicated by an increase of MTRNR2L12, MTRNR2L8, and NEAT1 across all immune cell subsets in this disease entity. In conclusion, our findings support the hypothesis that epithelial and mast cells act in concert as potential drivers of the pathogenesis of the aspirin-exacerbated respiratory disease.
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Affiliation(s)
- Christine Bangert
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | | | - Martin Fahrenberger
- Center for Integrative Bioinformatics Vienna (CIBIV), Max Perutz Labs, University of Vienna and Medical University of Vienna, Vienna, Austria
| | - Thomas Krausgruber
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Wolfgang M Bauer
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Victoria Stanek
- Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria
| | | | - Tina Bartosik
- Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria
| | - Tamara Quint
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Guenther Regelsberger
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | | | - Christoph Bock
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria.,Institute of Artificial Intelligence and Decision Support, Center for Medical Statistics, Informatics, and Intelligence Systems, Medical University of Vienna, Vienna, Austria
| | - Sven Schneider
- Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria
| | - Julia Eckl-Dorna
- Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria
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