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Chen L, Liu S, Xiao L, Chen K, Tang J, Huang C, Luo W, Ferrandon D, Lai K, Li Z. An initial assessment of the involvement of transglutaminase2 in eosinophilic bronchitis using a disease model developed in C57BL/6 mice. Sci Rep 2021; 11:11946. [PMID: 34099759 PMCID: PMC8184915 DOI: 10.1038/s41598-021-90950-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 05/12/2021] [Indexed: 11/09/2022] Open
Abstract
The detailed pathogenesis of eosinophilic bronchitis (EB) remains unclear. Transglutaminase 2 (TG2) has been implicated in many respiratory diseases including asthma. Herein, we aim to assess preliminarily the relationship of TG2 with EB in the context of the development of an appropriate EB model through ovalbumin (OVA) sensitization and challenge in the C57BL/6 mouse strain. Our data lead us to propose a 50 μg dose of OVA challenge as appropriate to establish an EB model in C57BL/6 mice, whereas a challenge with a 400 μg dose of OVA significantly induced asthma. Compared to controls, TG2 is up-regulated in the airway epithelium of EB mice and EB patients. When TG2 activity was inhibited by cystamine treatment, there were no effects on airway responsiveness; in contrast, the lung pathology score and eosinophil counts in bronchoalveolar lavage fluid were significantly increased whereas the cough frequency was significantly decreased. The expression levels of interleukin (IL)-4, IL-13, IL-6, mast cell protease7 and the transient receptor potential (TRP) ankyrin 1 (TRPA1), TRP vanilloid 1 (TRPV1) were significantly decreased. These data open the possibility of an involvement of TG2 in mediating the increased cough frequency in EB through the regulation of TRPA1 and TRPV1 expression. The establishment of an EB model in C57BL/6 mice opens the way for a genetic investigation of the involvement of TG2 and other molecules in this disease using KO mice, which are often generated in the C57BL/6 genetic background.
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Affiliation(s)
- Lan Chen
- Sino-French Hoffmann Institute, Guangzhou, China
| | - Shuyan Liu
- Sino-French Hoffmann Institute, Guangzhou, China
| | - Linzhuo Xiao
- Sino-French Hoffmann Institute, Guangzhou, China
| | - Kanyao Chen
- Sino-French Hoffmann Institute, Guangzhou, China
| | | | - Chuqin Huang
- State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou Medical University, Guangzhou, China
| | - Wei Luo
- State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou Medical University, Guangzhou, China
| | - Dominique Ferrandon
- Sino-French Hoffmann Institute, Guangzhou, China
- State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou Medical University, Guangzhou, China
- Université de Strasbourg, M3I UPR9022 du CNRS, 67000, Strasbourg, France
| | - Kefang Lai
- State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou Medical University, Guangzhou, China.
| | - Zi Li
- Sino-French Hoffmann Institute, Guangzhou, China.
- State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou Medical University, Guangzhou, China.
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Cimino C, Maurel OM, Musumeci T, Bonaccorso A, Drago F, Souto EMB, Pignatello R, Carbone C. Essential Oils: Pharmaceutical Applications and Encapsulation Strategies into Lipid-Based Delivery Systems. Pharmaceutics 2021; 13:pharmaceutics13030327. [PMID: 33802570 PMCID: PMC8001530 DOI: 10.3390/pharmaceutics13030327] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 02/12/2021] [Accepted: 02/24/2021] [Indexed: 12/14/2022] Open
Abstract
Essential oils are being studied for more than 60 years, but a growing interest has emerged in the recent decades due to a desire for a rediscovery of natural remedies. Essential oils are known for millennia and, already in prehistoric times, they were used for medicinal and ritual purposes due to their therapeutic properties. Using a variety of methods refined over the centuries, essential oils are extracted from plant raw materials: the choice of the extraction method is decisive, since it determines the type, quantity, and stereochemical structure of the essential oil molecules. To these components belong all properties that make essential oils so interesting for pharmaceutical uses; the most investigated ones are antioxidant, anti-inflammatory, antimicrobial, wound-healing, and anxiolytic activities. However, the main limitations to their use are their hydrophobicity, instability, high volatility, and risk of toxicity. A successful strategy to overcome these limitations is the encapsulation within delivery systems, which enable the increase of essential oils bioavailability and improve their chemical stability, while reducing their volatility and toxicity. Among all the suitable platforms, our review focused on the lipid-based ones, in particular micro- and nanoemulsions, liposomes, solid lipid nanoparticles, and nanostructured lipid carriers.
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Affiliation(s)
- Cinzia Cimino
- Laboratory of Drug Delivery Technology, Department of Drug and Health Sciences, University of Catania, Viale A. Doria 6, 95125 Catania, Italy; (C.C.); (T.M.); (A.B.); (R.P.)
| | - Oriana Maria Maurel
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95125 Catania, Italy; (O.M.M.); (F.D.)
| | - Teresa Musumeci
- Laboratory of Drug Delivery Technology, Department of Drug and Health Sciences, University of Catania, Viale A. Doria 6, 95125 Catania, Italy; (C.C.); (T.M.); (A.B.); (R.P.)
| | - Angela Bonaccorso
- Laboratory of Drug Delivery Technology, Department of Drug and Health Sciences, University of Catania, Viale A. Doria 6, 95125 Catania, Italy; (C.C.); (T.M.); (A.B.); (R.P.)
| | - Filippo Drago
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95125 Catania, Italy; (O.M.M.); (F.D.)
| | - Eliana Maria Barbosa Souto
- Department of Pharmaceutical Technology, Faculty of Pharmacy, University of Coimbra, 3000-548 Coimbra, Portugal;
- CEB—Centre of Biological Engineering, Campus de Gualtar, University of Minho, 4710-057 Braga, Portugal
| | - Rosario Pignatello
- Laboratory of Drug Delivery Technology, Department of Drug and Health Sciences, University of Catania, Viale A. Doria 6, 95125 Catania, Italy; (C.C.); (T.M.); (A.B.); (R.P.)
| | - Claudia Carbone
- Laboratory of Drug Delivery Technology, Department of Drug and Health Sciences, University of Catania, Viale A. Doria 6, 95125 Catania, Italy; (C.C.); (T.M.); (A.B.); (R.P.)
- Correspondence:
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Diver S, Russell RJ, Brightling CE. Cough and Eosinophilia. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 7:1740-1747. [PMID: 31279462 DOI: 10.1016/j.jaip.2019.04.048] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 04/25/2019] [Accepted: 04/25/2019] [Indexed: 10/26/2022]
Abstract
Eosinophilic airway inflammation is observed in 30% to 50% of chronic cough sufferers. It is a common feature of asthma and upper airway cough syndrome, and it is required in the diagnosis of nonasthmatic eosinophilic bronchitis. Our understanding of the mechanisms underlying allergic and nonallergic eosinophilic inflammation have evolved tremendously in the last 2 decades, but the cause of this inflammation in any individual is often uncertain. Inhaled corticosteroids are the mainstay therapy for cough due to asthma or nonasthmatic eosinophilic bronchitis, and response is related to the presence of biomarkers of eosinophilic airway inflammation. In upper airway cough syndrome, nasal topical corticosteroids are beneficial in allergic rhinitis and chronic rhinosinusitis with polyposis. This review will describe the diagnosis, current and possible future treatments, and prognosis of chronic cough in adults with eosinophilic inflammation.
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Affiliation(s)
- Sarah Diver
- Institute for Lung Health, NIHR Leicester Biomedical Research Centre, Department of Respiratory Sciences, University of Leicester, Leicester, United Kingdom
| | - Richard J Russell
- Institute for Lung Health, NIHR Leicester Biomedical Research Centre, Department of Respiratory Sciences, University of Leicester, Leicester, United Kingdom
| | - Christopher E Brightling
- Institute for Lung Health, NIHR Leicester Biomedical Research Centre, Department of Respiratory Sciences, University of Leicester, Leicester, United Kingdom.
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Xie J, Zhang J, Zhang X, Zhang Q, Chung KF, Wang C, Lai K. Cough in hypereosinophilic syndrome: case report and literature review. BMC Pulm Med 2020; 20:90. [PMID: 32293378 PMCID: PMC7158094 DOI: 10.1186/s12890-020-1134-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 04/03/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cough and airway eosinophilic inflammation has not been highlighted in hypereosinophilic syndrome (HES). CASE PRESENTATION We report 2 further cases and reviewed the clinical features and treatment of HES present with cough from the literature. Both cases were middle age male, presenting with chronic cough, airway eosinophilic inflammation and hyper eosinophilia who have been previous misdiagnosed as cough-variant asthma and failed anti-asthma treatment. PDGFRA fusion gene was confirmed in one case, but not in the other case. Both had evidence of myeloproliferative features. The tyrosine kinase inhibitor, imatinib, resulted in complete resolution of eosinophilia and cough. By searching PubMed, we found 8 HES cohorts of 411 cases between 1975 and 2013, where the incidence of cough was 23.11%. Sixteen case reports of HES presented with cough as predominant or sole symptom, with nine male patients with positive PDGFRA fusion gene, who responded well to imatinib. Six of seven patients, who tested negative for the PDGFRA, responded to systemic glucocorticoids. CONCLUSIONS Cough and airway eosinophilic inflammation is common in some HES patients. PDGFRA+ HES patients present with chronic cough respond well to imatinib. Our case reports indicate that PDGFRA negative HES patients may respond to imatinib as well.
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Affiliation(s)
- Jiaxing Xie
- Department of Allergy and Clinical Immunology, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jianheng Zhang
- Department of Allergy and Clinical Immunology, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiaoxian Zhang
- Department of Allergy and Clinical Immunology, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Qingling Zhang
- Department of Allergy and Clinical Immunology, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Kian Fan Chung
- National Heart and Lung Institute, Imperial College London & Royal Brompton Biomedical Research Unit at Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Chunyan Wang
- Department of hematology, The First Affiliated Hospital of Guangzhou Medical University, 1 Kangda Road, Guangzhou, 510230, China.
| | - Kefang Lai
- National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang Road, Guangzhou, 510120, China.
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Côté A, Russell RJ, Boulet LP, Gibson PG, Lai K, Irwin RS, Brightling CE. Managing Chronic Cough Due to Asthma and NAEB in Adults and Adolescents: CHEST Guideline and Expert Panel Report. Chest 2020; 158:68-96. [PMID: 31972181 DOI: 10.1016/j.chest.2019.12.021] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 12/11/2019] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Asthma and non-asthmatic eosinophilic bronchitis (NAEB) are among the commonest causes of chronic cough in adults. We sought to determine the role of non-invasive measurements of airway inflammation, including induced sputum and fractional exhaled nitric oxide, in the evaluation of cough associated with asthma, and what the best treatment is for cough due to asthma or NAEB. METHODS We undertook three systematic reviews of randomized controlled trials and observational trials of adults and adolescents > 12 years of age with a chronic cough due to asthma or NAEB. Eligible studies were identified in MEDLINE, CENTRAL, and SCOPUS and assessed for relevance and quality. Guidelines were developed and voted upon using CHEST guideline methodology. RESULTS Of the citations reviewed, 3/1,175, 53/656, and 6/134 were identified as being eligible for inclusion in the three systematic reviews, respectively. In contrast to established guidelines for asthma therapies in general and the inclusion in some guidelines for a role of biomarkers of airway inflammation to guide treatment in severe disease, the evidence of specific benefit related to the use of non-invasive biomarkers in patients with chronic cough due to asthma was weak. The best therapeutic option for cough in asthma or NAEB is inhaled corticosteroids followed by leukotriene receptor antagonism. CONCLUSIONS This guideline offers recommendations on the role of non-invasive measurements of airway inflammation and treatment for cough due to asthma or NAEB based on the available literature, and identifies gaps in knowledge and areas for future research.
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Affiliation(s)
- Andreanne Côté
- Centre de pneumologie, Québec Heart and Lung Institute, Laval University, Québec City, QC, Canada
| | - Richard J Russell
- Department of Respiratory Sciences, Institute for Lung Health, Glenfield Hospital, University of Leicester, Leicester, UK
| | - Louis-Philippe Boulet
- Centre de pneumologie, Québec Heart and Lung Institute, Laval University, Québec City, QC, Canada
| | - Peter G Gibson
- Hunter Medical Research Institute, University of Newcastle, NSW, Australia
| | - Kefang Lai
- State Key Lab of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | | | - Christopher E Brightling
- Department of Respiratory Sciences, Institute for Lung Health, Glenfield Hospital, University of Leicester, Leicester, UK.
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Son JH, Kim JH, Chang HS, Park JS, Park CS. Relationship of Microbial Profile With Airway Immune Response in Eosinophilic or Neutrophilic Inflammation of Asthmatics. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2020; 12:412-429. [PMID: 32141256 PMCID: PMC7061157 DOI: 10.4168/aair.2020.12.3.412] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 11/12/2019] [Accepted: 12/07/2019] [Indexed: 01/24/2023]
Abstract
PURPOSE Different characteristics of airway microbiome in asthmatics may lead to differential immune responses, which in turn cause eosinophilic or neutrophilic airway inflammation. However, the relationships among these factors have yet to be fully elucidated. METHODS Microbes in induced sputum samples were subjected to sequence analysis of 16S rRNA. Airway inflammatory phenotypes were defined as neutrophils (>60%) and eosinophils (>3%), and inflammation endotypes were defined by levels of T helper (Th) 1 (interferon-γ), Th2 (interleukin [IL]-5 and IL-13), Th-17 (IL-17), and innate Th2 (IL-25, IL-33, and thymic stromal lymphopoietin) cytokines, inflammasomes (IL-1β), epithelial activation markers (granulocyte-macrophage colony-stimulating factor and IL-8), and Inflammation (IL-6 and tumor necrosis factor-α) cytokines in sputum supernatants was assessed by enzyme-linked immunosorbent assay. RESULTS The numbers of operational taxonomic units were significantly higher in the mixed (n = 21) and neutrophilic (n = 23) inflammation groups than in the paucigranulocytic inflammation group (n = 19; p < 0.05). At the species level, Granulicatella adiacens, Streptococcus parasanguinis, Streptococcus pneumoniae, Veillonella rogosae, Haemophilus parainfluenzae, and Neisseria perflava levels were significantly higher in the eosinophilic inflammation group (n = 20), whereas JYGU_s levels were significantly higher in the neutrophilic inflammation group compared to the other subtypes (p < 0.05). Additionally, IL-5 and IL-13 concentrations were correlated with the percentage of eosinophils (p < 0.05) and IL-13 levels were positively correlated with the read counts of Porphyromonas pasteri and V. rogosae (p < 0.05). IL-1β concentrations were correlated with the percentage of neutrophils (p < 0.05). had a tendency to be positively correlated with the read count of JYGU_s (p = 0.095), and was negatively correlated with that of S. pneumoniae (p < 0.05). CONCLUSIONS Difference of microbial patterns in airways may induce distinctive endotypes of asthma, which is responsible for the neutrophilic or eosinophilic inflammation in asthma.
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Affiliation(s)
- Ji Hye Son
- Department of Interdisciplinary Program in Biomedical Science Major, Graduate School, Soonchunhyang University, Asan, Korea
| | - Jung Hyun Kim
- Department of Internal Medicine, Korean Armed Forces Capital Hospital, Seongnam, Korea
| | - Hun Soo Chang
- Department of Interdisciplinary Program in Biomedical Science Major, Graduate School, Soonchunhyang University, Asan, Korea.
| | - Jong Sook Park
- Genome Research Center and Division of Allergy and Respiratory Medicine, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea.
| | - Choon Sik Park
- Genome Research Center and Division of Allergy and Respiratory Medicine, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
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Exhaled nitric oxide in chronic cough: A good tool in a multi-step approach. Respir Med Res 2019; 76:4-9. [PMID: 31254946 DOI: 10.1016/j.resmer.2019.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 04/02/2019] [Accepted: 04/12/2019] [Indexed: 11/21/2022]
Abstract
INTRODUCTION The impact of fractional exhaled nitric oxide (FENO) on the management of chronic cough (CC) is still inconclusive. The aim of the present study was to assess whether FENO is a good tool to predict the response to inhaled corticosteroids (ICS) in patients with CC. METHODS Patients, referred for investigation of CC, had a FENO measurement determined as part of their first-line assessment. A methacholine test was performed as part of a second-line assessement. Patients were assigned to two groups according to their FENO values: a high FENO level group (Ⱕ25 ppb) and a normal FENO level group (<25 ppb). RESULTS One hundred patients were included in the study. High FENO levels were found in 25 patients (25%). The proportion of patients who responded to ICS was significantly greater in the high FENO group compared to the normal FENO level group (86.4% vs 46.3%, P<0.05). FENO is a good tool to predict ICS response in patients with high FENO levels but a response to ICS cannot be ruled out in patients with normal FENO levels. In patients with normal FENO values, a methacholine test could be an interesting tool for a second-line assessment. Among the 13 patients with a positive methacholine test result, 11 responded to ICS whilst 2 did not. Of the patients with a negative methacholine test result, 3 responded to ICS whilst 13 did not. CONCLUSION FENO may be a more reliable predictor of ICS response when used as part of a multi-step assessment procedure.
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Borges RS, Ortiz BLS, Pereira ACM, Keita H, Carvalho JCT. Rosmarinus officinalis essential oil: A review of its phytochemistry, anti-inflammatory activity, and mechanisms of action involved. JOURNAL OF ETHNOPHARMACOLOGY 2019; 229:29-45. [PMID: 30287195 DOI: 10.1016/j.jep.2018.09.038] [Citation(s) in RCA: 120] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 09/27/2018] [Accepted: 09/28/2018] [Indexed: 05/08/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Plant species Rosmarinus officinalis L. (Lamiaceae; Synonyms: Salvia rosmarinus Schleid. and Rosmarinus angustifolius Mill.) is a herb widely used worldwide. In local and traditional medicine, its used for inflammation-related diseases. Currently, studies report anti-inflammatory activity in its essential oil (EORO). However, to better understand EORO's anti-inflammatory activity its necessary to understand its phytochemistry and the signaling pathways affected by it. Hence, this review aimed to describe EORO phytochemical profile, ethnopharmacological uses, some biological activities of EORO will be described but emphasizing its anti-inflammatory potential and possible mechanisms of action involved. MATERIALS AND METHODS The research was performed using the databases Medline, Embase, BVS Regional Portal, Science Direct, CAPES Journals, and Scopus; using the keywords "Rosmarinus officinalis", "anti-inflammatory" and "essential oil". Additional information was gathered from related textbooks, reviews, and documents. RESULTS AND DISCUSSION Until now about 150 chemical compounds were identified in EORO samples, more frequently reported molecules were 1,8-cineole, α-pinene, and camphor. Studies suggest that the anti-inflammatory activity of EORO occur mainly through inhibition of NF-κB transcription and suppression of arachidonic acid cascade. Its antioxidant activity also aids by preventing injury caused by the reactive species of inflammation; its smooth muscle relaxant activity contributes to ameliorating airway inflammatory diseases. Lastly, toxicity assessments indicate low toxicity to EORO. CONCLUSIONS Current evidence indicates anti-inflammatory activity in EORO, supporting its ethnopharmacological uses in inflammatory-related diseases, and potential future applications. However, although considerable acute inflammatory models were tested, more chronic inflammatory models are needed; clinical studies are still absent, this may be due to the high doses needed for essential oils to exert pharmacological effects, but recent studies show this issue can be bypassed using the oil formulated as nanoemulsions to improve its bioavailability.
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Affiliation(s)
- Raphaelle Sousa Borges
- Laboratório de Pesquisa em Fármacos, Departamento de Ciências Biológicas e da Saúde, Universidade Federal do Amapá, Rodovia Juscelino Kubitschek, S/N, Campus Marco Zero, CEP 68903-419 Macapá, AP, Brazil; Programa de Pós-Graduação em Inovação Farmacêutica, Departamento de Ciências Biológicas de da Saúde, Universidade Federal do Amapá, Juscelino Kubitscheck, KM 02, S/N, Jardim Marco Zero, Macapá, AP 68903-419, Brazil
| | - Brenda Lorena Sánchez Ortiz
- Laboratório de Pesquisa em Fármacos, Departamento de Ciências Biológicas e da Saúde, Universidade Federal do Amapá, Rodovia Juscelino Kubitschek, S/N, Campus Marco Zero, CEP 68903-419 Macapá, AP, Brazil
| | - Arlindo César Matias Pereira
- Laboratório de Pesquisa em Fármacos, Departamento de Ciências Biológicas e da Saúde, Universidade Federal do Amapá, Rodovia Juscelino Kubitschek, S/N, Campus Marco Zero, CEP 68903-419 Macapá, AP, Brazil
| | - Hady Keita
- Laboratório de Pesquisa em Fármacos, Departamento de Ciências Biológicas e da Saúde, Universidade Federal do Amapá, Rodovia Juscelino Kubitschek, S/N, Campus Marco Zero, CEP 68903-419 Macapá, AP, Brazil; Division de Pós-Grado, Instituto de Investigación sobre la Salud Publica. Ciudad Universitaria, Universidad de la Sierra Sur, Calle Guillermo Rojas Mijangos S/N, Miahuatlán de Porfirio Díaz, Oaxaca, Mexico
| | - José Carlos Tavares Carvalho
- Laboratório de Pesquisa em Fármacos, Departamento de Ciências Biológicas e da Saúde, Universidade Federal do Amapá, Rodovia Juscelino Kubitschek, S/N, Campus Marco Zero, CEP 68903-419 Macapá, AP, Brazil; Programa de Pós-Graduação em Inovação Farmacêutica, Departamento de Ciências Biológicas de da Saúde, Universidade Federal do Amapá, Juscelino Kubitscheck, KM 02, S/N, Jardim Marco Zero, Macapá, AP 68903-419, Brazil.
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Abstract
Asthma is increasingly recognised as a heterogeneous group of diseases with similar clinical presentations rather than a singular disease entity. Asthma was historically categorised by clinical symptoms; however, newer methods of subgrouping, describing and categorising the disease have sub-defined asthma. These sub-definitions are intermittently called phenotypes or endotypes, but the real meanings of these words are poorly understood. Novel treatments are currently and increasingly available, partly in the monoclonal antibody environment, and also some physical therapies (bronchial thermoplasty), but additionally small molecules are not far away from clinical practice. Understanding the disease pathogenesis and the mechanism of action more completely may enable identification of treatable traits, biomarkers, mediators and modifiable therapeutic targets. However, there remains a danger that clinicians become preoccupied with the concept of endotypes and biomarkers, ignoring therapies that are hugely effective but have no companion biomarker. This review discusses our understanding of the concept of phenotypes and endotypes in appreciating and managing the heterogeneous condition that is asthma. We consider the role of functional imaging, physiology, blood-, sputum- and breath-based biomarkers and clinical manifestations that could be used to produce a personalised asthma profile, with implications on prognosis, pathophysiology and most importantly specific therapeutic responses. With the advent of increasing numbers of biological therapies and other interventional options such as bronchial thermoplasty, the importance of targeting expensive therapies to patients with the best chance of clinical response has huge health economic importance.
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Affiliation(s)
- Katrina Dean
- University Hospital South Manchester, Manchester, UK
| | - Robert Niven
- Manchester Academic Health Science Centre, The University of Manchester and University Hospital South Manchester, Manchester, UK.
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10
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Diver S, Russell RJ, Brightling CE. New and emerging drug treatments for severe asthma. Clin Exp Allergy 2018; 48:241-252. [PMID: 29315966 DOI: 10.1111/cea.13086] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Asthma is a common chronic inflammatory condition of the airways affecting over 300 million people world-wide. In 5%-10% of cases, it is severe, with disproportionate healthcare resource utilization including costs associated with frequent exacerbations and the long-term health effects of systemic steroids. Characterization of inflammatory pathways in severe asthma has led to the development of targeted biological and small molecule therapies which aim to achieve disease control while minimizing corticosteroid-associated morbidity. Herein, we review currently licensed agents and those in development, and speculate how drug therapy for severe asthma might evolve and impact on clinical outcomes in the near future.
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Affiliation(s)
- S Diver
- Department of Infection, Immunity and Inflammation, Institute for Lung Health, Leicester NIHR Biomedical Research Centre, University of Leicester, Leicester, UK
| | - R J Russell
- Department of Infection, Immunity and Inflammation, Institute for Lung Health, Leicester NIHR Biomedical Research Centre, University of Leicester, Leicester, UK
| | - C E Brightling
- Department of Infection, Immunity and Inflammation, Institute for Lung Health, Leicester NIHR Biomedical Research Centre, University of Leicester, Leicester, UK
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Terl M, Sedlák V, Cap P, Dvořáková R, Kašák V, Kočí T, Novotna B, Seberova E, Panzner P, Zindr V. Asthma management: A new phenotype-based approach using presence of eosinophilia and allergy. Allergy 2017; 72:1279-1287. [PMID: 28328094 DOI: 10.1111/all.13165] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2017] [Indexed: 12/29/2022]
Abstract
Asthma is a heterogeneous disease. The Czech Pneumology and Allergology Societies commissioned 10 experts to review the literature and create joint national guidelines for managing asthma, reflecting this heterogeneity. The aim was to develop an easy-to-use diagnostic strategy as a rational approach to the widening opportunities for the use of phenotype-targeted therapy. The guidelines were presented on websites for public comments by members of both the societies. The reviewers' comments contributed to creating the final version of the guidelines. The key hallmark of the diagnostic approach is the pragmatic concept, which assesses the presence of allergy and eosinophilia in each asthmatic patient. The guidelines define three clinically relevant asthma phenotypes: eosinophilic allergic asthma, eosinophilic nonallergic asthma and noneosinophilic nonallergic asthma. The resulting multifunctional classification describing the severity, level of control and phenotype is the starting point for a comprehensive treatment strategy. The level of control is constantly confronted with the intensity of the common stepwise pharmacotherapy, and the concurrently included phenotyping is essential for phenotype-specific therapy. The concept of the asthma approach with assessing the presence of eosinophilia and allergy provides a way for more precise diagnosis, which is a prerequisite for using widening options of personalized therapy.
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Affiliation(s)
- M. Terl
- Czech Pneumology and Phthiseology Society; Prague Czech Republic
| | - V. Sedlák
- Czech Pneumology and Phthiseology Society; Prague Czech Republic
| | - P. Cap
- Czech Society of Allergology and Clinical Immunology; Prague Czech Republic
| | - R. Dvořáková
- Czech Pneumology and Phthiseology Society; Prague Czech Republic
| | - V. Kašák
- Czech Pneumology and Phthiseology Society; Prague Czech Republic
| | - T. Kočí
- Czech Society of Allergology and Clinical Immunology; Prague Czech Republic
| | - B. Novotna
- Czech Society of Allergology and Clinical Immunology; Prague Czech Republic
| | - E. Seberova
- Czech Society of Allergology and Clinical Immunology; Prague Czech Republic
| | - P. Panzner
- Czech Society of Allergology and Clinical Immunology; Prague Czech Republic
| | - V. Zindr
- Czech Pneumology and Phthiseology Society; Prague Czech Republic
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12
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Role of S100A9 in the development of neutrophilic inflammation in asthmatics and in a murine model. Clin Immunol 2017; 183:158-166. [PMID: 28847516 DOI: 10.1016/j.clim.2017.08.013] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 07/11/2017] [Accepted: 08/25/2017] [Indexed: 10/19/2022]
Abstract
S100A9 is an endogenous danger signal that promotes and exacerbates the neutrophilic inflammatory response. To investigate the role of S100A9 in neutrophilic asthma, S100A9 levels were measured in sputum from 101 steroid-naïve asthmatics using an ELISA kit and the levels were significantly correlated with percentages of neutrophils in sputum. Intranasal administration of recombinant S100A9 markedly increased neutrophil numbers at 8h and 24h later with concomitant elevation of IL-1β, IL-17, and IFN-γ levels. Treatment with an anti-S100A9 antibody restored the increased numbers of neutrophils and the increased airway resistance in OVA/CFA mice toward the levels of sham-treated mice. Concomitantly, the S100A9 and neutrophil elastase double positive cells were markedly reduced with attenuation of IL-1β, IL-17, and IFN-γ levels by the treatment with the anti-S100A9 antibody. Our data support a role of S100A9 to initiate and amplify the neutrophilic inflammation in asthma, possibly via inducing IL-1β, IL-17 and IFN-γ.
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13
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Pathogenesis of asthma: implications for precision medicine. Clin Sci (Lond) 2017; 131:1723-1735. [PMID: 28667070 DOI: 10.1042/cs20160253] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 05/02/2017] [Accepted: 05/08/2017] [Indexed: 01/03/2023]
Abstract
The pathogenesis of asthma is complex and multi-faceted. Asthma patients have a diverse range of underlying dominant disease processes and pathways despite apparent similarities in clinical expression. Here, we present the current understanding of asthma pathogenesis. We discuss airway inflammation (both T2HIGH and T2LOW), airway hyperresponsiveness (AHR) and airways remodelling as four key factors in asthma pathogenesis, and also outline other contributory factors such as genetics and co-morbidities. Response to current asthma therapies also varies greatly, which is probably related to the inter-patient differences in pathogenesis. Here, we also summarize how our developing understanding of detailed pathological processes potentially translates into the targeted treatment options we require for optimal asthma management in the future.
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14
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Baldissera L, Squebola-Cola DM, Calixto MC, Lima-Barbosa AP, Rennó AL, Anhê GF, Condino-Neto A, De Nucci G, Antunes E. The soluble guanylyl cyclase activator BAY 60-2770 inhibits murine allergic airways inflammation and human eosinophil chemotaxis. Pulm Pharmacol Ther 2016; 41:86-95. [PMID: 27816773 DOI: 10.1016/j.pupt.2016.11.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 09/21/2016] [Accepted: 11/01/2016] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Activators of soluble guanylyl cyclase (sGC) act preferentially in conditions of enzyme oxidation or haem group removal. This study was designed to investigate the effects of the sGC activator BAY 60-2770 in murine airways inflammation and human eosinophil chemotaxis. METHODS C57Bl/6 mice treated or not with BAY 60-2770 (1 mg/kg/day, 14 days) were intranasally challenged with ovalbumin (OVA). At 48 h, bronchoalveolar lavage fluid (BALF) was performed, and circulating blood, bone marrow and lungs were obtained. Human eosinophils purified from peripheral blood were used to evaluate the cell chemotaxis. RESULTS OVA-challenge promoted marked increases in eosinophil number in BAL, lung tissue, circulating blood and bone marrow, all of which were significantly reduced by BAY 60-2770. The IL-4 and IL-5 levels in BALF were significantly reduced by BAY 60-2770. Increased protein expression of iNOS, along with decreases of expression of sGC (α1 and β1 subunits) and cGMP levels were detected in lung tissue of OVA-challenged mice. BAY 60-2770 fully restored to baseline the iNOS and sGC subunit expressions, and cGMP levels. In human isolated eosinophils, BAY 60-2770 (1-5 μM) had no effects on the cGMP levels and eotaxin-induced chemotaxis; however, prior incubation with ODQ (10 μM) markedly elevated the BAY 60-2770-induced cyclic GMP production, further inhibiting the eosinophil chemotaxis. CONCLUSIONS BAY 60-2770 reduces airway eosinophilic inflammation and rescue the sGC levels. In human eosinophils under oxidized conditions, BAY 60-2770 elevates the cGMP levels causing cell chemotaxis inhibition. BAY 60-2770 may reveal a novel therapeutic target for asthma treatment.
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Affiliation(s)
- Lineu Baldissera
- Department of Pharmacology, Faculty of Medical Science, State University of Campinas (UNICAMP), Campinas, 13084-971, SP, Brazil
| | - Dalize M Squebola-Cola
- Department of Pharmacology, Faculty of Medical Science, State University of Campinas (UNICAMP), Campinas, 13084-971, SP, Brazil
| | - Marina C Calixto
- Department of Pharmacology, Faculty of Medical Science, State University of Campinas (UNICAMP), Campinas, 13084-971, SP, Brazil
| | - Ana P Lima-Barbosa
- Department of Pharmacology, Faculty of Medical Science, State University of Campinas (UNICAMP), Campinas, 13084-971, SP, Brazil
| | - André L Rennó
- Department of Pharmacology, Faculty of Medical Science, State University of Campinas (UNICAMP), Campinas, 13084-971, SP, Brazil
| | - Gabriel F Anhê
- Department of Pharmacology, Faculty of Medical Science, State University of Campinas (UNICAMP), Campinas, 13084-971, SP, Brazil
| | - Antonio Condino-Neto
- Department of Pharmacology, Faculty of Medical Science, State University of Campinas (UNICAMP), Campinas, 13084-971, SP, Brazil
| | - Gilberto De Nucci
- Department of Pharmacology, Faculty of Medical Science, State University of Campinas (UNICAMP), Campinas, 13084-971, SP, Brazil
| | - Edson Antunes
- Department of Pharmacology, Faculty of Medical Science, State University of Campinas (UNICAMP), Campinas, 13084-971, SP, Brazil.
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15
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Wiggans RE, Barber CM. Metalworking fluids: a new cause of occupational non-asthmatic eosinophilic bronchitis. Thorax 2016; 72:579-580. [PMID: 28507075 PMCID: PMC5520278 DOI: 10.1136/thoraxjnl-2016-208827] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 07/20/2016] [Accepted: 07/30/2016] [Indexed: 11/04/2022]
Affiliation(s)
- R E Wiggans
- Department of Infection, Immunity and Cardiovascular Science, University of Sheffield, Sheffield, UK.,Health and Safety Laboratory: HSEs Health and Safety Laboratory, Centre for Workplace Health, Buxton, UK
| | - C M Barber
- Health and Safety Laboratory: HSEs Health and Safety Laboratory, Centre for Workplace Health, Buxton, UK.,Northern General Hospital, Sheffield, UK
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16
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Abstract
INTRODUCTION In asthma, most commonly, 'conventional' anti-inflammatory medications represented by inhaled corticosteroids and leukotriene inhibitors are effective. In some patients however additional inhibition of the airways inflammation is necessary. Such compounds might be molecules inhibiting specifically certain inflammation pathways and lebrikizumab an anti IL-13 molecule might represent a relevant example as a potential asthma therapy. AREAS COVERED Discussion of the rationale for the use of lebrikizumab in asthma. Analysis of the related preclinical and clinical data on lebrikizumab in asthma. EXPERT OPINION Lebrikizumab demonstrated efficacy in an asthma subset characterized by high serum periostin levels and by heavy eosinophilic inflammation. Phase III data are necessary in order to better position this therapy in asthma including as a potential personalized approach.
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Affiliation(s)
- Sabina Antonela Antoniu
- a Department of Surgery II-Palliative Care Nursing , University of Medicine and Pharmacy Gr.T.Popa Iasi , Iasi , Romania
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17
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Gaillard EA, McNamara PS, Murray CS, Pavord ID, Shields MD. Blood eosinophils as a marker of likely corticosteroid response in children with preschool wheeze: time for an eosinophil guided clinical trial? Clin Exp Allergy 2016; 45:1384-95. [PMID: 25809678 DOI: 10.1111/cea.12535] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Childhood wheezing is common particularly in children under the age of 6 years and in this age group is generally referred to as preschool wheezing. Particular diagnostic and treatment uncertainties exist in these young children due to the difficulty in obtaining objective evidence of reversible airways narrowing and inflammation. A diagnosis of asthma depends on the presence of relevant clinical signs and symptoms and the demonstration of reversible airways narrowing on lung function testing, which is difficult to perform in young children. Few treatments are available and inhaled corticosteroids are the recommended preventer treatment in most international asthma guidelines. There is, however, considerable controversy about its effectiveness in children with preschool wheeze and a corticosteroid responder phenotype has not been established. These diagnostic and treatment uncertainties in conjunction with the knowledge of corticosteroid side effects, in particular the reduction of growth velocity, have resulted in a variable approach to inhaled corticosteroid prescribing by medical practitioners and a reluctance in carers to regularly administer the treatment. Identifying children who are likely responders to corticosteroid therapy would be a major benefit in the management of this condition. Eosinophils have emerged as a promising biomarker of corticosteroid responsive airways disease, and evaluation of this biomarker in sputum has successfully been employed to direct management in adults with asthma. Obtaining sputum from young children is time consuming and difficult, and it is hard to justify more invasive procedures such as a bronchoscopy in young children routinely. Recently, in children, interest has shifted to assessing the value of less invasive biomarkers of likely corticosteroid response and the biomarker 'blood eosinophils' has emerged as an attractive candidate. The aim of this review was to summarize the evidence for blood eosinophils as a predictive biomarker for corticosteroid responsive disease with a particular focus on the difficult area of preschool wheeze.
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Affiliation(s)
- E A Gaillard
- Department of Infection Immunity and Inflammation, NIHR Leicester Respiratory Biomedical Research Unit, Institute for Lung Health, University of Leicester, Leicester, Leicestershire, UK
| | - P S McNamara
- Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Alder Hey Children's Hospital, Liverpool, Merseyside, UK
| | - C S Murray
- Respiratory and Allergy Centre, Institute of Inflammation and Repair, University of Manchester and University Hospital of South Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
| | - I D Pavord
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - M D Shields
- Centre for Infection and Immunity, Health Sciences, Queen's University Belfast, Belfast, UK
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18
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Guo Z, Wang Y, Xing G, Wang X. Diagnostic accuracy of fractional exhaled nitric oxide in asthma: a systematic review and meta-analysis of prospective studies. J Asthma 2016; 53:404-12. [PMID: 26796787 DOI: 10.3109/02770903.2015.1101132] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Fractional exhaled nitric oxide (FeNO) has been proposed as a non-invasive measure of airway inflammation in asthma. However, its accuracy for the diagnosis of asthma in different populations is not completely clear. The aim of this study was to investigate the accuracy of FeNO measurement for the diagnosis of asthma through a systematic review and meta-analysis of prospective studies. METHODS A systematic search current to July 2014 was performed in Pubmed, EMBASE, Medline, the Cochrane databases, CNKI, Wanfang and Weipu to find relevant studies. All prospective studies on the use of FeNO for the diagnosis of asthma were included. RESULTS Twenty-five studies including 3983 subjects were analyzed. The pooled sensitivity, specificity and diagnostic odds ratio (DOR) for the entire population was 72% (95% CI, 70-74%), 78% (95% CI, 76-80%) and 15.92 (95% CI, 10.70-23.68), respectively. The area under the summary receiver operating characteristic (sROC) curves revealed a receiver-operating characteristic of 0.88. In subgroup analysis, the DOR for patients using corticosteroids, as well as those for steroid-naïve, non-smoking, smoking, chronic cough and allergic rhinitis patients were 4.47 (95% CI, 3.39-5.90), 21.40 (95% CI, 15.38-29.76), 19.84 (95% CI, 15.63-25.19), 5.41 (95% CI, 2.97-9.86), 35.36 (95% CI, 23.90-52.29), and 2.99 (95% CI, 0.85-10.45), respectively. CONCLUSION FeNO is accurate for the diagnosis of asthma in steroid-naive or non-smoking patients, particularly in chronic cough patients.
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Affiliation(s)
- Zhi Guo
- a Department of Pulmonary Diseases , Jinan Military General Hospital , Jinan , Shandong , China
| | - Ying Wang
- a Department of Pulmonary Diseases , Jinan Military General Hospital , Jinan , Shandong , China
| | - Guohong Xing
- a Department of Pulmonary Diseases , Jinan Military General Hospital , Jinan , Shandong , China
| | - Xin Wang
- a Department of Pulmonary Diseases , Jinan Military General Hospital , Jinan , Shandong , China
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19
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Postma DS, Weiss ST, van den Berge M, Kerstjens HAM, Koppelman GH. Revisiting the Dutch hypothesis. J Allergy Clin Immunol 2015; 136:521-9. [PMID: 26343936 DOI: 10.1016/j.jaci.2015.06.018] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 06/02/2015] [Accepted: 06/03/2015] [Indexed: 12/20/2022]
Abstract
The Dutch hypothesis was first articulated in 1961, when many novel and advanced scientific techniques were not available, such as genomics techniques for pinpointing genes, gene expression, lipid and protein profiles, and the microbiome. In addition, computed tomographic scans and advanced analysis techniques to dissect (small) airways disease and emphysema were not available. At that time, the group of researchers under the visionary guidance of Professor N. G. M. Orie put forward that both genetic and environmental factors can determine whether one would have airway obstructive diseases, such as asthma and chronic obstructive pulmonary disease (COPD). Moreover, they stipulated that the phenotype of obstructive airway disease could be affected by sex and changes with aging. Orie and colleagues' call to carefully phenotype patients with obstructive airways diseases has been adopted by many current researchers in an attempt to determine the heterogeneity of both asthma and COPD to better define these diseases and optimize their treatment. The founders of the Dutch hypothesis were far ahead of their time, and we can learn from their insights. We should fully characterize all patients in our clinical practice and not just state that they have asthma, COPD, or asthma and COPD overlap syndrome. This detailed phenotyping can help in understanding these obstructive airway diseases and provide guidance for disease management.
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Affiliation(s)
- Dirkje S Postma
- University of Groningen, Department of Pulmonology, University Medical Center Groningen, Groningen, The Netherlands; University of Groningen, GRIAC Research Institute, University Medical Center Groningen, Groningen, The Netherlands.
| | - Scott T Weiss
- Channing Division of Network Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, Mass
| | - Maarten van den Berge
- University of Groningen, Department of Pulmonology, University Medical Center Groningen, Groningen, The Netherlands; University of Groningen, GRIAC Research Institute, University Medical Center Groningen, Groningen, The Netherlands
| | - Huib A M Kerstjens
- University of Groningen, Department of Pulmonology, University Medical Center Groningen, Groningen, The Netherlands; University of Groningen, GRIAC Research Institute, University Medical Center Groningen, Groningen, The Netherlands
| | - Gerard H Koppelman
- University of Groningen, GRIAC Research Institute, University Medical Center Groningen, Groningen, The Netherlands; University of Groningen, University Medical Center Groningen, and the Department of Pediatric Pulmonology and Pediatric Allergology, Beatrix Children's Hospital, Groningen, The Netherlands
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20
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Acupuncture Attenuated Inflammation and Inhibited Th17 and Treg Activity in Experimental Asthma. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2015; 2015:340126. [PMID: 26612993 PMCID: PMC4646989 DOI: 10.1155/2015/340126] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 09/21/2015] [Indexed: 12/14/2022]
Abstract
Acupuncture is an effective therapeutic method in asthma treatment in traditional Chinese medicine. Here, we evaluated the effect of acupuncture on airway hyperresponsiveness (AHR) and the associated inflammatory changes as well as Th17 and Treg activity in ovalbumin- (OVA-) induced experimental asthma. Our results revealed that acupuncture treatment significantly inhibited AHR, lung inflammation, and mucus secretion of experimental asthma mice. Furthermore, a decrease in lymphocytes and eosinophils as well as neutrophils was observed in bronchoalveolar lavage fluid (BALF) of mice treated with acupuncture. Acupuncture reduced the OVA specific IgE level as well as the Th17 cytokine levels including IL-17A, IL-17F, and IL-22 in the serum of the experimental asthma mice. Acupuncture treatment group also had reduced CD4+IL-17A+ cell numbers and increased CD4+Foxp3+ cell numbers in BALF. In addition, acupuncture could inhibit IL-17R, RORγt, p65, and the inhibitor of NF-κB kinase-α (IKKα) protein expression. Our results indicated that acupuncture was effective in inhibiting AHR and inflammation in OVA-induced experimental asthma, which may be associated with the regulation of Th17 and Treg activity and NF-κB pathway.
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21
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Marshall L, Beardsmore CS, Pescatore AM, Kuehni CE, Gaillard EA. Airway eosinophils in older teenagers with outgrown preschool wheeze: a pilot study. Eur Respir J 2015; 46:1486-9. [PMID: 26453631 DOI: 10.1183/13993003.00174-2015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 07/15/2015] [Indexed: 11/05/2022]
Affiliation(s)
- Lucy Marshall
- Institute for Lung Health, NIHR Leicester Respiratory Biomedical Research Unit and Dept of Infection Immunity and Inflammation, University of Leicester, Leicester, UK
| | - Caroline S Beardsmore
- Institute for Lung Health, NIHR Leicester Respiratory Biomedical Research Unit and Dept of Infection Immunity and Inflammation, University of Leicester, Leicester, UK University Hospitals Leicester, Children's Hospital, Leicester UK
| | - Anina M Pescatore
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Claudia E Kuehni
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Erol A Gaillard
- Institute for Lung Health, NIHR Leicester Respiratory Biomedical Research Unit and Dept of Infection Immunity and Inflammation, University of Leicester, Leicester, UK University Hospitals Leicester, Children's Hospital, Leicester UK
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22
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Martin MJ, Harrison TW. Causes of chronic productive cough: An approach to management. Respir Med 2015; 109:1105-13. [PMID: 26184784 DOI: 10.1016/j.rmed.2015.05.020] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 04/13/2015] [Accepted: 05/24/2015] [Indexed: 02/04/2023]
Abstract
A chronic 'productive' or 'wet' cough is a common presenting complaint for patients attending the adult respiratory clinic. Most reviews and guidelines suggest that the causes of a productive cough are the same as those of a non-productive cough and as such the same diagnostic pathway should be followed. We suggest a different diagnostic approach for patients with a productive cough, focussing on the conditions that are the most likely causes of this problem. This review is intended to briefly summarise the epidemiology, clinical features, pathophysiology and treatment of a number of conditions which are often associated with chronic productive cough to aid decision making when encountering a patient with this often distressing symptom. The conditions discussed include bronchiectasis, chronic bronchitis, asthma, eosinophilic bronchitis and immunodeficiency. We also propose an adult version of the paediatric diagnosis of protracted bacterial bronchitis (PBB) in patients with idiopathic chronic productive cough who appear to respond well to low dose macrolide therapy.
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Affiliation(s)
- Matthew J Martin
- Nottingham Respiratory Research Unit, University of Nottingham, Nottingham City Hospital, Nottingham, UK.
| | - Tim W Harrison
- Nottingham Respiratory Research Unit, University of Nottingham, Nottingham City Hospital, Nottingham, UK
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23
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Lim HB, Kim SH. Inhallation of e-Cigarette Cartridge Solution Aggravates Allergen-induced Airway Inflammation and Hyper-responsiveness in Mice. Toxicol Res 2014; 30:13-8. [PMID: 24795794 PMCID: PMC4007038 DOI: 10.5487/tr.2014.30.1.013] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Revised: 03/19/2014] [Accepted: 03/22/2014] [Indexed: 11/20/2022] Open
Abstract
Electronic cigarettes (e-cigarettes) are becoming increasingly popular worldwide and their cellular effects warrant further evaluation. In this study, we investigated the effects of an e-cigarette cartridge solution on allergen related asthmatic airway inflammation (AI) and airway hyperresponsiveness (AHR), when it is delivered by intratracheal route in mice. Asthmatic AI and AHR were induced by systemic sensitization to ovalbumin (OVA) followed by intratracheal, intraperitoneal, and aerosol allergen challenges in BALB/c mice. The cartridge solution of e-cigarette (containing 16 mg/ml nicotine) was diluted 50 times and 100 μl of the diluted solution was intratracheally instilled to OVA-sensitized (OVA-S) mice two times a week for 10 weeks. Long-term e-cigarette inhalation elicited no remarkable changes in the activities of alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase enzymes in serum, however, increased infiltration of inflammatory cells including eosinophils, into airways from blood, aggravated the asthmatic AI and AHR, and stimulated the production of cytokines such as interleukin (IL)-4, IL-5 and IL-13, and OVA-specific IgE production. Our data suggest that the inhalation of e-cigarette solutions can function as an important factor to exacerbate the allergy-induced asthma symptoms. Further studies are needed to address the effects of e-cigarette solutions on human health.
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Affiliation(s)
- Heung Bin Lim
- Department of Industrial Crop Science and Technology, Chungbuk National University, Cheongju, Chungbuk, Korea
| | - Seung Hyung Kim
- Institute of Traditional Medicine and Bioscience, Daejeon University, Daejeon, Korea
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24
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Moscato G, Pala G, Cullinan P, Folletti I, Gerth van Wijk R, Pignatti P, Quirce S, Sastre J, Toskala E, Vandenplas O, Walusiak-Skorupa J, Malo JL. EAACI Position Paper on assessment of cough in the workplace. Allergy 2014; 69:292-304. [PMID: 24428394 DOI: 10.1111/all.12352] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2013] [Indexed: 12/13/2022]
Abstract
Cough is a nonspecific and relatively common symptom that can present difficulties in diagnosis and management, particularly when it is reported to be associated with the workplace. The present consensus document, prepared by a taskforce of the Interest Group on Occupational Allergy of the European Academy of Allergy and Clinical Immunology by means of a nonsystematic review of the current literature, is intended to provide a definition and classification of work-related chronic cough (WRCC) to assist the daily practice of physicians facing with this symptom. The review demonstrates that several upper and lower airway work-related diseases may present with chronic cough; hence, the possible link with the workplace should always be considered. Due to the broad spectrum of underlying diseases, a multidisciplinary approach is necessary to achieve a definite diagnosis. Nevertheless, more epidemiological studies are necessary to estimate the real prevalence and risk factors for WRCC, the role of exposure to environmental and occupational sensitizers and irritants in its pathogenesis and the interaction with both upper and lower airways. Finally, the best management option should be evaluated in order to achieve the best outcome without adverse social and financial consequences for the worker.
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Affiliation(s)
- G. Moscato
- Allergology and Immunology Unit; Fondazione ‘Salvatore Maugeri’; Institute of Care and Research; Scientific Institute of Pavia; Pavia Italy
| | - G. Pala
- Allergology and Immunology Unit; Fondazione ‘Salvatore Maugeri’; Institute of Care and Research; Scientific Institute of Pavia; Pavia Italy
| | - P. Cullinan
- Department of Occupational and Environmental Medicine; Imperial College; London UK
| | - I. Folletti
- Department of Clinical and Experimental Medicine; Occupational Allergy Unit; Terni Hospital; University of Perugia; Terni Italy
| | - R. Gerth van Wijk
- Section of Allergology; Department of Internal Medicine; Erasmus MC; Rotterdam the Netherlands
| | - P. Pignatti
- Allergology and Immunology Unit; Fondazione ‘Salvatore Maugeri’; Institute of Care and Research; Scientific Institute of Pavia; Pavia Italy
| | - S. Quirce
- Department of Allergy; Hospital La Paz Institute for Health Research (IdiPAZ), and CIBER de Enfermedades Respiratorias CIBERES; Madrid Spain
| | - J. Sastre
- Department of Allergy; Fundación Jiménez Díaz, and CIBER de Enfermedades Respiratorias CIBERES; Madrid Spain
| | - E. Toskala
- Department of Otolaryngology, Head and Neck Surgery; School of Medicine; Temple University; Philadelphia PA USA
| | - O. Vandenplas
- Department of Chest Medicine; Centre Hospitalier Universitaire de Mont-Godinne; Université Catholique de Louvain; Yvoir Belgium
| | - J. Walusiak-Skorupa
- Department of Occupational Diseases; Nofer Institute of Occupational Medicine; Lodz Poland
| | - J. L. Malo
- Department of Chest Medicine; Hôpital du Sacré-Coeur de Montréal; Université de Montréal; Montreal Canada
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25
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Chronic Cough and OSA: An Underappreciated Relationship. Lung 2013; 192:21-5. [DOI: 10.1007/s00408-013-9534-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Accepted: 10/22/2013] [Indexed: 01/21/2023]
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26
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Possa SS, Leick EA, Prado CM, Martins MA, Tibério IFLC. Eosinophilic inflammation in allergic asthma. Front Pharmacol 2013; 4:46. [PMID: 23616768 PMCID: PMC3627984 DOI: 10.3389/fphar.2013.00046] [Citation(s) in RCA: 124] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2012] [Accepted: 03/28/2013] [Indexed: 01/21/2023] Open
Abstract
Eosinophils are circulating granulocytes involved in pathogenesis of asthma. A cascade of processes directed by Th2 cytokine producing T-cells influence the recruitment of eosinophils into the lungs. Furthermore, multiple elements including interleukin (IL)-5, IL-13, chemoattractants such as eotaxin, Clara cells, and CC chemokine receptor (CCR)3 are already directly involved in recruiting eosinophils to the lung during allergic inflammation. Once recruited, eosinophils participate in the modulation of immune response, induction of airway hyperresponsiveness and remodeling, characteristic features of asthma. Various types of promising treatments for reducing asthmatic response are related to reduction in eosinophil counts both in human and experimental models of pulmonary allergic inflammation, showing that the recruitment of these cells really plays an important role in the pathophysiology of allergic diseases such asthma.
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Affiliation(s)
- Samantha S Possa
- Department of Medicine, School of Medicine, University of São Paulo São Paulo, Brazil
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27
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Abstract
Asthma is increasing in prevalence worldwide. It is characterized by typical symptoms and variable airway obstruction punctuated with episodes of worsening symptoms known as exacerbations. Underlying this clinical expression of disease is airway inflammation and remodeling. Cytokines and their networks are implicated in the innate and adaptive immune responses driving airway inflammation in asthma and are modulated by host-environment interactions. Asthma is a complex heterogeneous disease, and the paradigm of Th2 cytokine-mediated eosinophilic inflammation as a consequence of allergic sensitization has been challenged and probably represents a subgroup of asthma. Indeed, as attention has switched to the importance of severe asthma, which represents the highest burden both to the patient and health care provider, there is an increasing recognition of inflammatory subphenotypes that are likely to be driven by different cytokine networks. Interestingly, these networks may be specific to aspects of clinical expression as well as inflammatory cell profiles and therefore present novel phenotype-specific therapeutic strategies. Here, we review the breadth of cytokines implicated in the pathogenesis of asthma and focus upon the outcomes of early clinical trials conducted using cytokines or cytokine-blocking therapies.
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Affiliation(s)
- Dhananjay Desai
- Department of Infection, Inflammation and Immunity, Institute for Lung Health, University of Leicester, Glenfield Hospital, Leicester, UK
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28
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Abstract
Current definition of asthma involves four cornerstones: inflammation, hyperresponsiveness, bronchoconstriction, and symptoms. In research, the symptoms have had the slightest attention. According to international guidelines, the asthma symptoms are episodic breathlessness, wheeze, cough, tightness of the chest, and shortness of breath. As there are several symptoms, a primary question is how they are related to bronchoconstriction, the main clinical feature of asthma. Symptoms and lung function tests are regularly used for the evaluation of clinical health status and effect of treatment. However, there is no or poor correlation between these two variables, which means that they represent different mechanisms. Reduced lung function, such as a low FEV(1) , represents bronchial constriction, what do the symptoms represent? Some symptoms such as breathlessness and shortness of breath seem not to be evidence-based asthma symptoms. Focusing on bronchial obstruction is important in view of the potential risk of asthma attacks, but nonobstructive symptoms occur frequently and may also cause severe discomfort and poor quality of life. Interpreting all symptoms as signs of bronchoconstriction (asthma) may lead to misinterpretation when assessing health status and effect of treatment. Although a 'soft' variable, the strength of symptoms is that they are representing various mechanisms. The physiological preconditions for control and defense of respiration must be considered in the diagnostic process, regardless of inflammation, allergy, psychology, or other etiological factors. Based on studies on dyspnea in cardiopulmonary diseases, including asthma and asthma-like disorders, there seems to be a continuous spectrum of symptoms and mechanisms integrated in a single asthma syndrome.
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Affiliation(s)
- O. Löwhagen
- Sahlgrenska Academy; Instit Medicine; University of Göteborg; Sweden
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29
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Bezerra-Santos CR, Vieira-de-Abreu A, Vieira GC, Filho JR, Barbosa-Filho JM, Pires AL, Martins MA, Souza HS, Bandeira-Melo C, Bozza PT, Piuvezam MR. Effectiveness of Cissampelos sympodialis and its isolated alkaloid warifteine in airway hyperreactivity and lung remodeling in a mouse model of asthma. Int Immunopharmacol 2012; 13:148-55. [PMID: 22480776 DOI: 10.1016/j.intimp.2012.03.014] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2011] [Revised: 03/08/2012] [Accepted: 03/20/2012] [Indexed: 01/21/2023]
Abstract
BACKGROUND Cissampelos sympodialis Eichl. (Menispermaceae) is a plant found in Northeastern and Southeast of Brazil and hot water infusion of C. sympodialis root bark is largely used in the indigenous and folk medicine to treat several inflammatory disorders, including asthma. Asthma is a chronic inflammatory allergic disease characterized by airway hyperreactivity (AHR), eosinophil tissue infiltration and lung remodeling. The aim of this study was to evaluate the therapeutic effect of C. sympodialis and its isolated alkaloid warifteine on allergen triggered airway hyperreactivity (AHR) and lung remodeling in murine model of asthma. METHODOLOGY/PRINCIPAL FINDINGS The oral pre-treatment with C. sympodialis or warifteine inhibited allergen-induced AHR to inhaled methacholine and IL-13 levels in the bronchoalveolar lavage (BAL). In order to investigate the therapeutic potential of C. sympodialis and warifteine, animals were treated 1h after the last ovalbumin (OVA) challenge in sensitized animals. Similarly to the pre-treatment, post-treatment with warifteine was effective to inhibit significantly AHR to inhaled methacholine and to reduce IL-13 levels in the BAL. In addition, oral pre- or post-treatments with C. sympodialis or warifteine reduced OVA-induced eosinophil tissue infiltration, mucus production and subepithelial fibrosis to values similar to nonallergic controls. CONCLUSIONS Our data show the anti-allergic and immunoregulatory properties of C. sympodialis, acting mostly through the active compound warifteine, to inhibit the airway hyperreactivity and lung remodeling through a mechanism at least partially dependent of IL-13 and eosinophil inhibition. Therefore placing warifteine as an interesting therapeutic candidate in allergic inflammation and corroborating the folk medicine use of C. sympodialis as anti-allergic plant.
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Affiliation(s)
- Claudio R Bezerra-Santos
- Laboratório de Imunofarmacologia, Departamento de Fisiologia e Patologia, Universidade Federal da Paraíba, João Pessoa, 58051-970 Paraíba, Brazil
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