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Li Y, Wang J, Zhao Q, Jin F, Liu G, Pan L. The impact of inflammatory cells on lung function in asthmatics in a cross sectional retrospect study. Heliyon 2024; 10:e33691. [PMID: 39071553 PMCID: PMC11283163 DOI: 10.1016/j.heliyon.2024.e33691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 06/20/2024] [Accepted: 06/25/2024] [Indexed: 07/30/2024] Open
Abstract
Background Limited data exists on the impact of inflammatory cells and clinical characteristics on lung function in individuals with asthma. Objective The objective is to examine the correlation between increased inflammatory cells, asthma symptoms, and lung function in patients with asthma in a clinical setting. Methods A retrospective cohort study was conducted on 234 individuals suspected of having asthma in Xian, China between January 2008 and December 2021. Of those, 143 patients with complete clinical feature and lung function data were enrolled to examine the relationship between increased inflammatory cells, asthma symptoms, and lung function. Basic characteristics, blood eosinophil count, blood neutrophil count, blood platelet count, blood C-reactive protein (CRP), and comprehensive lung function analysis were evaluated at each inpatient for the 143 adult asthmatics. The association between inflammatory cells and clinical parameters with pulmonary function was compared. Results The results of the study showed that individuals in the alcohol intake group had elevated blood eosinophil count compared to those in the non-alcohol intake group (P = 0.024). Long-acting inhaled beta 2 agonists and antibiotic therapy were associated with lower blood eosinophil count (P = 0.021 and P = 0.049, respectively) compared to other therapy. There was a independent association between blood eosinophil counts and FEV1 pre- and post-therapy in asthma but there was a markedly correlation between blood eosinophil counts and FEV1/FVC pre-and post-therapy in Asthma (P = 0.007). Blood neutrophil counts were inversely correlated with FEV1/FVC after treatment (P = 0.032). Night onset in asthma was positively correlated with blood neutrophil counts, while fever was negatively correlated with blood CRP (P = 0.028). Platelet counts >300 × 109/L after treatment were significantly associated with a decline in FEV (<0.001) in patients with asthma. Elevated blood eosinophil count was independently associated with clinical features in asthma. Conclusions Based on the study's findings, there is a significant decline in FEV1/FVC among individuals with elevated blood eosinophil count, both pre- and post-bronchodilator while there was a independent relationship between blood eosinophil counts and FEV1 pre-and post-therapy in asthma. This suggests that increased levels of eosinophils may independently associated contribute to reduced lung function in asthma patients.
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Affiliation(s)
- Yujuan Li
- Department of Respiratory and Critical Care Medicine, Tangdu Hospital, Air Force Military Medical University, Xi'an, China
| | - Jingjing Wang
- Department of Obstetrics and Gynecology, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Qi Zhao
- Department of Respiratory and Critical Care Medicine, Tangdu Hospital, Air Force Military Medical University, Xi'an, China
| | - Faguang Jin
- Department of Respiratory and Critical Care Medicine, Tangdu Hospital, Air Force Military Medical University, Xi'an, China
| | - Gang Liu
- Department of Respiratory and Critical Care Medicine, Tangdu Hospital, Air Force Military Medical University, Xi'an, China
| | - Lei Pan
- Department of Respiratory and Critical Care Medicine, Tangdu Hospital, Air Force Military Medical University, Xi'an, China
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Supron AD, Omilabu V, Bailey L, Buchheit KM, Laidlaw TM. Absolute eosinophil counts in aspirin-exacerbated respiratory disease are distinctly elevated and correlate inversely with respiratory function. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:1372-1373. [PMID: 38281584 PMCID: PMC11327898 DOI: 10.1016/j.jaip.2024.01.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/17/2024] [Accepted: 01/18/2024] [Indexed: 01/30/2024]
Affiliation(s)
- Andrew D Supron
- Department of Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Mass.
| | - Victor Omilabu
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass; Jeff and Penny Vinik Center, Boston, Mass
| | - Laura Bailey
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass; Jeff and Penny Vinik Center, Boston, Mass
| | - Kathleen M Buchheit
- Department of Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Mass; Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass; Jeff and Penny Vinik Center, Boston, Mass
| | - Tanya M Laidlaw
- Department of Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Mass; Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass; Jeff and Penny Vinik Center, Boston, Mass
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Nishi K, Nagasaki T, Matsumoto H, Oguma T, Terada S, Nomura N, Kogo M, Tashima N, Sunadome H, Murase K, Matsumoto T, Kawaguchi T, Tabara Y, Matsuda F, Sato S, Chin K, Hirai T. Increased blood eosinophils and airflow obstruction as new-onset asthma predictors in the elderly: The Nagahama study. Allergol Int 2024; 73:236-242. [PMID: 38001017 DOI: 10.1016/j.alit.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 10/23/2023] [Accepted: 11/08/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Asthma in the elderly needs more attention in an aging society. However, it is likely to remain underdiagnosed and undertreated. This study aimed to clarify clinical characteristics of new-onset asthma in the elderly, describing the prevalence, predictive factors, and comorbidities after asthma diagnosis of new-onset asthma in the elderly in the general population. METHODS This community-based prospective cohort study enrolled 9804 generally healthy participants (30-74 years old) in Nagahama City, and conducted a follow-up assessment after 5 years. Elderly participants were those aged ≥65 years at baseline. Patients with new-onset asthma were defined as participants without asthma at baseline assessment and with asthma at the follow-up assessment. RESULTS Among the 7948 participants analyzed in this study, 28 (1.4%) elderly and 130 (2.2%) non-elderly had new-onset asthma. Multiple logistic regression analysis revealed low forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) and high blood eosinophil counts at baseline as predicting factors for new-onset asthma in the elderly. Additionally, subsequent incidence of new-onset asthma was higher in elderly participants with both predictors (high blood eosinophil counts and low FEV1/FVC at baseline) than those with none or one of the predictors before asthma diagnosis. Lastly, elderly patients with new-onset asthma had more frequent comorbidity of moderate to severe sleep disordered breathing than those non-elderly. CONCLUSIONS Eosinophilic inflammation and airflow obstruction may predict subsequent new-onset asthma after the age of 65 years. Revealing the characteristics of new-onset asthma in the elderly can aid in the prevention of underdiagnosed asthma.
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Affiliation(s)
- Kenta Nishi
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Tadao Nagasaki
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Respiratory Care and Sleep Control Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Respiratory Medicine and Allergology, Kindai University Nara Hospital, Nara, Japan.
| | - Hisako Matsumoto
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Respiratory Medicine and Allergology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Tsuyoshi Oguma
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Satoru Terada
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Natsuko Nomura
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Mariko Kogo
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Noriyuki Tashima
- Department of Respiratory Medicine, Kishiwada City Hospital, Osaka, Japan
| | - Hironobu Sunadome
- Department of Respiratory Care and Sleep Control Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kimihiko Murase
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Respiratory Care and Sleep Control Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takeshi Matsumoto
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Respiratory Medicine, Saiseikai-Noe Hospital, Osaka, Japan
| | - Takahisa Kawaguchi
- Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yasuharu Tabara
- Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan; Graduate School of Public Health, Shizuoka Graduate University of Public Health, Shizuoka, Japan
| | - Fumihiko Matsuda
- Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Susumu Sato
- Department of Respiratory Care and Sleep Control Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kazuo Chin
- Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Sleep Medicine and Respiratory Care, Division of Sleep Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Toyohiro Hirai
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Warm K, Hedman L, Stridsman C, Lindberg A, Rönmark E, Backman H. Age-related differences in associations between uncontrolled asthma, comorbidities and biomarkers in adult-onset asthma. J Asthma 2023; 60:2224-2232. [PMID: 37405375 DOI: 10.1080/02770903.2023.2231078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 06/25/2023] [Indexed: 07/06/2023]
Abstract
OBJECTIVE Adult-onset asthma is a recognized but heterogeneous phenotype and has been described to associate with poor asthma control. Knowledge about associations between clinical characteristics including comorbidities and control of adult-onset asthma is limited, especially in older populations. We aimed to study how clinical biomarkers and comorbidities are associated with uncontrolled asthma among middle-aged and older individuals with adult-onset asthma. METHODS Clinical examinations including structured interview, asthma control test (ACT), spirometry, skin prick test (SPT), blood sampling, and measurement of exhaled fractional nitric oxide (FeNO) was performed in a population-based adult-onset asthma cohort in 2019-2020 (n = 227, 66.5% female). Analyses were performed among all included, and separately in middle-aged (37-64 years, n = 120) and older (≥65 years, n = 107) participants. RESULTS In bivariate analysis, uncontrolled asthma (ACT ≤ 19) was significantly associated with a blood neutrophil count ≥5/µl, BMI ≥30, and several comorbidities. In multivariable regression analysis, uncontrolled asthma was associated with neutrophils ≥5/µl (OR 2.35; 95% CI 1.11-4.99). In age-stratified analysis, BMI ≥30 (OR 3.04; 1.24-7.50), eosinophils ≥0.3/µl (OR 3.17; 1.20-8.37), neutrophils ≥5/µl (OR 4.39; 1.53-12.62) and allergic rhinitis (OR 5.10; 1.59-16.30) were associated with uncontrolled asthma among the middle-aged. Among the older adults, uncontrolled asthma was only associated with comorbidities: chronic rhinitis (OR 4.08; 1.62-10.31), ischemic heart disease (OR 3.59; 1.17-10.98), malignancy (OR 3.10; 1.10-8.73), and depression/anxiety (OR 16.31; 1.82-146.05). CONCLUSIONS In adult-onset asthma, comorbidities were strongly associated with uncontrolled asthma among older adults, while clinical biomarkers including eosinophils and neutrophils in blood were associated with uncontrolled asthma among middle-aged.
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Affiliation(s)
- Katja Warm
- The OLIN Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Linnea Hedman
- Section of Sustainable Health, The OLIN Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Caroline Stridsman
- The OLIN Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Anne Lindberg
- The OLIN Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Eva Rönmark
- Section of Sustainable Health, The OLIN Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Helena Backman
- Section of Sustainable Health, The OLIN Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Rajanayagam B, Manikandan S, Anand N. Deterioration of lung function and its association with eosinophil count. Bioinformation 2023; 19:644-648. [PMID: 37886149 PMCID: PMC10599662 DOI: 10.6026/97320630019644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 05/31/2023] [Accepted: 05/31/2023] [Indexed: 10/28/2023] Open
Abstract
Exposure to lethal dust particles has a negative impact on human's health. This work investigated the association between respiratory symptoms and eosinophil levels between quarry workers and the controls. A total of 75 workers exposed to quarry dust and 45 age, sex, body mass index-matched unexposed controls participated in this study. Results of this study indicated that the quarry dust particles produced inflammatory responses, increasing the mean eosinophil level (7.56 ± 2.94), causing allergic respiratory symptoms such as rhinitis , chest tightness, wheeze, sputum production thus impairing the lung function with decline in FEV1(80.84 ±108.8) level in workers exposed to quarry dust compared to controls (P≤0.00**) Conclusion: The presence of increased levels of respiratory irritants in quarry sites may explain the higher prevalence of respiratory infections and exacerbated inflammatory reactions found to ascertain the link between increased eosinophil count and the lung impairment in quarry workers.
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Affiliation(s)
- Bama Rajanayagam
- Bharath Institute of Higher Education and Research, Selaiyur, Chennai, India
- Department of Physiology, Indira Medical College and Hospital, Thiruvallur, Tamilnadu, India
| | | | - Nag Anand
- Department of General Medicine, Sree Balaji Medical College and Hospital, Chromepet, Chennai, India
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Association Between Blood Eosinophils and Neutrophils With Clinical Features in Adult-Onset Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:811-821.e5. [PMID: 36473624 DOI: 10.1016/j.jaip.2022.11.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 10/20/2022] [Accepted: 11/14/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Asthma is a disease that can be separated into different phenotypes and endotypes based on the clinical characteristics and the molecular mechanisms of the condition, respectively. OBJECTIVE To assess the association between blood eosinophil and neutrophil counts with clinical and molecular features in patients with adult-onset asthma. METHODS Blood eosinophil and neutrophil counts were measured from 203 patients who took part in the Seinäjoki Adult Asthma Study and attended the 12-year follow-up visit. The patients were then divided into four groups (paucigranulocytic [n = 108], neutrophilic [n = 60], eosinophilic [n = 21], and mixed granulocytic [n = 14]), according to eosinophil and neutrophil levels. The cutoff values used to define the groups were 0.30 × 109 · L-1 for blood eosinophils and 4.4 × 109 · L-1 for blood neutrophils. RESULTS The neutrophilic group had highest body mass index. It was dispensed the highest doses of inhaled corticosteroids during the 12-year follow-up and made the most unplanned respiratory visits. The neutrophilic, eosinophilic, and mixed granulocytic groups had more severe asthma compared with the paucigranulocytic group. The neutrophilic and eosinophilic groups were associated with higher dispensed antibiotics. The eosinophilic group had more nasal polyps, more suspected sinusitis, a greater decline in lung function, and increased levels of periostin, FeNO, and IgE. The neutrophilic group had increased high-sensitivity C-reactive protein, matrix metalloproteinase-9, IL-6, leptin, and soluble urokinase plasminogen activator receptor levels. The mixed granulocytic group showed increased resistin levels together with the neutrophilic group. CONCLUSIONS In addition to blood eosinophils, the blood neutrophil count reflects underlying inflammatory patterns and indicates important differences in asthma clinical features and outcomes.
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Abstract
Eosinophils are important effector cells in airway inflammation, as pleiotropy and heterogeneity can be linked to various pathophysiologies in asthma and chronic obstructive pulmonary disease (COPD). Sputum eosinophils can reflect the heterogeneity of airway inflammation, and owing to their traits, blood eosinophils can be a surrogate and potential biomarker for managing both conditions. Blood eosinophils are activated via the stimulation of type 2 cytokines, such as interleukin (IL)-5, IL-4/13, granulocyte-macrophage colony-stimulating factor, IL-33, and thymic stromal lymphopoietin. There is sufficient evidence to support the relationship between the blood eosinophil count and clinical outcomes, including pulmonary function decline, exacerbations, all-cause mortality, and treatment response to inhaled corticosteroids and biologics. Thus, there is growing interest in the use of blood eosinophils for the management of these diseases. Compiling recent evidence, we herein review the significance of measuring blood eosinophils in asthma and COPD.
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Affiliation(s)
- Tsunahiko Hirano
- Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, Japan
| | - Kazuto Matsunaga
- Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, Japan
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Senna G, Aliani M, Altieri E, Bracciale P, Brussino L, Caiaffa MF, Cameli P, Canonica GW, Caruso C, D’Amato M, De Michele F, Del Giacco S, Di Marco F, Menzella F, Pelaia G, Rogliani P, Romagnoli M, Schino P, Schroeder JW, Vultaggio A, Rizzoli S, Zullo A, Boarino S, Palmisano M, Rossi A, Vitiello G, Centanni S. Clinical Features and Efficacy of Benralizumab in Patients with Blood Eosinophil Count Between 300 and 450 Cells/mm 3: A Post Hoc Analysis from the ANANKE Study. J Asthma Allergy 2022; 15:1593-1604. [PMID: 36387835 PMCID: PMC9661992 DOI: 10.2147/jaa.s383012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 11/03/2022] [Indexed: 04/23/2024] Open
Abstract
PURPOSE Benralizumab effectively reduces severe eosinophilic asthma (SEA) exacerbations in patients with a wide range of baseline blood eosinophil count (BEC). Patients included in real-world studies are often characterized by high mean/median BEC, while patients with BEC close to 300 cells/mm3 are poorly represented. This post hoc analysis from the Italian study ANANKE aims to define the clinical features and corroborate the efficacy of benralizumab in real world in the BEC 300-450 cells/mm3 subset of patients. PATIENTS AND METHODS Post hoc analysis of the Italian, multicenter, observational, retrospective real-life study ANANKE (NCT04272463). Baseline clinical and laboratory characteristics were collected in the 12 months prior to benralizumab treatment and presented for a BEC 300-450 cells/mm3 subgroup of patients. Change over time of BEC, annualized exacerbation rate (AER), asthma control (ACT), lung function and oral corticosteroid (OCS) use at 16, 24 and 48 weeks after benralizumab introduction were collected. RESULTS A total of 164 patients were analyzed, 34 of whom with a BEC of 300-450 cells/mm3. This subgroup was more likely to be female (64.7%), with lower rates of severe exacerbations at baseline when compared to the total population (0.69 vs 1.01). After 48 weeks of benralizumab treatment, the BEC 300-450 subset showed similar reductions in AER (-94.8% vs -92.2%) and OCS use (median dose reduction of 100% in both groups), as well as improvement in ACT score (median scores 22.5 vs 22) and lung function (pre-BD FEV1: +200 mL vs +300 mL) when compared to the total population. No discontinuations for safety reasons were registered. CONCLUSION At baseline, apart from lower severe exacerbation rate, the BEC 300-450 cells/mm3 subset of patients is comparable to the total population prescribed with benralizumab. In this real-life study, benralizumab is as effective in BEC 300-450 patients as in the total population.
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Affiliation(s)
- Gianenrico Senna
- Department of Medicine, University of Verona, Verona, Italy
- Allergy Unit and Asthma Center, Verona University Hospital, Verona, Italy
| | - Maria Aliani
- UO Pneumologia e Pneumologia Riabilitativa, ICS Maugeri, IRCCS Bari, Bari, Italy
| | - Elena Altieri
- Reparto di Pneumologia, P.O., Garbagnate Milanese, Italy
| | | | - Luisa Brussino
- Dipartimento di Scienze Mediche, SSDDU Allergologia e Immunologia Clinica, Università degli Studi di Torino, AO Ordine Mauriziano Umberto I, Torino, Italy
| | - Maria Filomena Caiaffa
- Cattedra e Scuola di Allergologia e Immunologia Clinica, Dipartimento di Scienze Mediche, Università di Foggia, Foggia, Italy
| | - Paolo Cameli
- Respiratory Diseases and Lung Transplantation, Department of Medical and Surgical Sciences & Neurosciences, Siena University Hospital, Siena, Italy
| | - Giorgio Walter Canonica
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
- Personalized Medicine Center: Asthma and Allergology, Humanitas Research Hospital, Rozzano, MI, Italy
| | - Cristiano Caruso
- Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Maria D’Amato
- UOSD Malattie Respiratorie “Federico II”, Ospedale Monaldi, AO Dei Colli, Napoli, Italy
| | - Fausto De Michele
- UOC Pneumologia e Fisiopatologia Respiratoria, AORN A. Cardarelli, Napoli, Italy
| | - Stefano Del Giacco
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Fabiano Di Marco
- Department of Health Sciences, Università Degli Studi Di Milano, Pneumologia, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Francesco Menzella
- UOC Pneumologia, Ospedale “S. Valentino”, AULSS 2 Marca Trevigiana, Montebelluna, TV, Italy
| | - Girolamo Pelaia
- Dipartimento di Scienze della Salute, Università Magna Graecia, Catanzaro, Italy
| | - Paola Rogliani
- Division of Respiratory Medicine, University Hospital “Tor Vergata”, Roma, Italy
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome “Tor Vergata”, Roma, Italy
| | | | - Pietro Schino
- Fisiopatologia Respiratoria, Ospedale Generale Regionale, Ente Ecclesiastico “F. Miulli”, Acquaviva delle Fonti, BA, Italy
| | - Jan Walter Schroeder
- Allergy and Clinical Immunology, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Alessandra Vultaggio
- Dipartimento di Medicina Sperimentale e Clinica, Università degli Studi di Firenze, Firenze, Italy
| | - Sara Rizzoli
- Medineos Observational Research - An IQVIA Company, Modena, Italy
| | - Alessandro Zullo
- Medineos Observational Research - An IQVIA Company, Modena, Italy
| | | | | | | | | | - Stefano Centanni
- Respiratory Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, Università degli Studi di Milano, Milano, Italy
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Menzella F, Ballarin A, Sartor M, Floriani AF, Corsi L, Dartora C, Tonin S, Romagnoli M. Comparison between clinical trials and real-world evidence studies on biologics for severe asthma. J Int Med Res 2022; 50:3000605221133689. [PMID: 36420737 PMCID: PMC9703569 DOI: 10.1177/03000605221133689] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 09/30/2022] [Indexed: 12/30/2023] Open
Abstract
In recent years, the more widespread availability of biological drugs with specific mechanisms of action has led to significant breakthroughs in the management of severe asthma. Over time, numerous randomised clinical trials have been conducted to evaluate the efficacy and safety of these biologics and define the eligibility criteria of patients suitable for various therapeutic options. These studies were conducted under controlled conditions not always applicable to real life. For this and other reasons, real-world evidence and pragmatic studies are required to provide useful information on the effectiveness of biological drugs and their safety, even in the long term. Because differences in outcomes have sometimes emerged between clinical trials and real-life studies, it is important to clarify the causes of these discrepancies and define the significance of the results of studies conducted in the course of daily clinical practice. Thus, a scientific debate is ongoing, and no consensus has been reached. The purpose of this narrative review is to analyse the differences between randomised trials and real-world evidence studies, focusing on their roles in guiding clinicians among different therapeutic options and understanding the reasons for the large discrepancies often found in the results obtained.
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Affiliation(s)
| | - Andrea Ballarin
- Pulmonology Unit, S. Valentino Hospital, AULSS2 Marca Trevigiana, Italy
| | - Maria Sartor
- Pulmonology Unit, S. Valentino Hospital, AULSS2 Marca Trevigiana, Italy
| | | | - Lorenzo Corsi
- Pulmonology Unit, S. Valentino Hospital, AULSS2 Marca Trevigiana, Italy
| | - Cristina Dartora
- Pulmonology Unit, S. Valentino Hospital, AULSS2 Marca Trevigiana, Italy
| | - Silvia Tonin
- Pulmonology Unit, S. Valentino Hospital, AULSS2 Marca Trevigiana, Italy
| | - Micaela Romagnoli
- Pulmonology Unit, Cà Foncello Hospital, AULSS2 Marca Trevigiana, Italy
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10
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Kimura H, Shimizu K, Tanabe N, Makita H, Taniguchi N, Kimura H, Suzuki M, Abe Y, Matsumoto-Sasaki M, Oguma A, Takimoto-Sato M, Takei N, Matsumoto M, Goudarzi H, Sato S, Ono J, Izuhara K, Hirai T, Nishimura M, Konno S. Further evidence for association of YKL-40 with severe asthma airway remodeling. Ann Allergy Asthma Immunol 2022; 128:682-688.e5. [PMID: 35342020 DOI: 10.1016/j.anai.2022.03.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 02/25/2022] [Accepted: 03/16/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND The chitinase-like protein YKL-40 is associated with airflow limitation on spirometry and airway remodeling in patients with asthma. It remains unclear whether YKL-40 is associated with morphologic changes in the airways and parenchyma or with future progression of airflow limitation in severe asthma. OBJECTIVE To evaluate the association of circulating YKL-40 levels with morphologic changes in the airways and parenchyma and with longitudinal progression of airflow limitation. METHODS The patients were participants in the Hokkaido Severe Asthma Cohort Study (n = 127), including smokers. This study consisted of 2 parts. In analysis 1, we analyzed associations between circulating YKL-40 levels and several asthma-related indices, including computed tomography-derived indices of proximal wall area percentage, the complexity of the airways (airway fractal dimension), and the parenchyma (exponent D) cross-sectionally (n = 97). In analysis 2, we evaluated the impact of circulating YKL-40 levels on forced expiratory volume in 1 second (FEV1) decline longitudinally for a 5-year follow-up (n = 103). RESULTS Circulating YKL-40 levels were significantly associated with proximal wall area percentage and airway fractal dimension (r = 0.25, P = .01; r = -0.22, P = .04, respectively), but not with exponent D. The mean annual change in FEV1 was -33.7 (± 23.3) mL/y, and the circulating YKL-40 level was a significant independent factor associated with annual FEV1 decline (β = -0.24, P = .02), even after controlling for exponent D (β = -0.26, P = .01). CONCLUSION These results provide further evidence for the association of YKL-40 with the pathogenesis of airway remodeling in severe asthma.
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Affiliation(s)
- Hirokazu Kimura
- Faculty of Medicine, Department of Respiratory Medicine, Hokkaido University, Sapporo, Japan.
| | - Kaoruko Shimizu
- Faculty of Medicine, Department of Respiratory Medicine, Hokkaido University, Sapporo, Japan
| | - Naoya Tanabe
- Graduate School of Medicine, Department of Respiratory Medicine, Kyoto University, Kyoto, Japan
| | - Hironi Makita
- Faculty of Medicine, Department of Respiratory Medicine, Hokkaido University, Sapporo, Japan
| | - Natsuko Taniguchi
- Faculty of Medicine, Department of Respiratory Medicine, Hokkaido University, Sapporo, Japan
| | - Hiroki Kimura
- Faculty of Medicine, Department of Respiratory Medicine, Hokkaido University, Sapporo, Japan
| | - Masaru Suzuki
- Faculty of Medicine, Department of Respiratory Medicine, Hokkaido University, Sapporo, Japan
| | - Yuki Abe
- Faculty of Medicine, Department of Respiratory Medicine, Hokkaido University, Sapporo, Japan
| | | | - Akira Oguma
- Faculty of Medicine, Department of Respiratory Medicine, Hokkaido University, Sapporo, Japan
| | - Michiko Takimoto-Sato
- Faculty of Medicine, Department of Respiratory Medicine, Hokkaido University, Sapporo, Japan
| | - Nozomu Takei
- Faculty of Medicine, Department of Respiratory Medicine, Hokkaido University, Sapporo, Japan
| | - Munehiro Matsumoto
- Faculty of Medicine, Department of Respiratory Medicine, Hokkaido University, Sapporo, Japan
| | - Houman Goudarzi
- Faculty of Medicine, Department of Respiratory Medicine, Hokkaido University, Sapporo, Japan
| | - Susumu Sato
- Graduate School of Medicine, Department of Respiratory Medicine, Kyoto University, Kyoto, Japan
| | - Junya Ono
- R&D Center, Shino-Test Corporation, Kanagawa, Japan
| | - Kenji Izuhara
- Division of Medical Biochemistry, Department of Biomolecular Sciences, Saga Medical School, Saga, Japan
| | - Toyohiro Hirai
- Graduate School of Medicine, Department of Respiratory Medicine, Kyoto University, Kyoto, Japan
| | - Masaharu Nishimura
- Faculty of Medicine, Department of Respiratory Medicine, Hokkaido University, Sapporo, Japan; Hokkaido Medical Research Institute for Respiratory Diseases, Sapporo, Japan
| | - Satoshi Konno
- Faculty of Medicine, Department of Respiratory Medicine, Hokkaido University, Sapporo, Japan
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11
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The Role of Smoking in Asthma and Chronic Obstructive Pulmonary Disease Overlap. Immunol Allergy Clin North Am 2022; 42:615-630. [DOI: 10.1016/j.iac.2022.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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12
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Neutrophils and Asthma. Diagnostics (Basel) 2022; 12:diagnostics12051175. [PMID: 35626330 PMCID: PMC9140072 DOI: 10.3390/diagnostics12051175] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/04/2022] [Accepted: 05/05/2022] [Indexed: 02/04/2023] Open
Abstract
Although eosinophilic inflammation is characteristic of asthma pathogenesis, neutrophilic inflammation is also marked, and eosinophils and neutrophils can coexist in some cases. Based on the proportion of sputum cell differentiation, asthma is classified into eosinophilic asthma, neutrophilic asthma, neutrophilic and eosinophilic asthma, and paucigranulocytic asthma. Classification by bronchoalveolar lavage is also performed. Eosinophilic asthma accounts for most severe asthma cases, but neutrophilic asthma or a mixture of the two types can also present a severe phenotype. Biomarkers for the diagnosis of neutrophilic asthma include sputum neutrophils, blood neutrophils, chitinase-3-like protein, and hydrogen sulfide in sputum and serum. Thymic stromal lymphoprotein (TSLP)/T-helper 17 pathways, bacterial colonization/microbiome, neutrophil extracellular traps, and activation of nucleotide-binding oligomerization domain-like receptor family, pyrin domain-containing 3 pathways are involved in the pathophysiology of neutrophilic asthma and coexistence of obesity, gastroesophageal reflux disease, and habitual cigarette smoking have been associated with its pathogenesis. Thus, targeting neutrophilic asthma is important. Smoking cessation, neutrophil-targeting treatments, and biologics have been tested as treatments for severe asthma, but most clinical studies have not focused on neutrophilic asthma. Phosphodiesterase inhibitors, anti-TSLP antibodies, azithromycin, and anti-cholinergic agents are promising drugs for neutrophilic asthma. However, clinical research targeting neutrophilic inflammation is required to elucidate the optimal treatment.
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13
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Nogami K, Nagao M, Takase T, Yasuda Y, Yamada S, Matsunaga M, Hoshi M, Hamada K, Kuwabara Y, Tsugawa T, Fujisawa T. House Dust Mite Subcutaneous Immunotherapy and Lung Function Trajectory in Children and Adolescents with Asthma. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9040487. [PMID: 35455531 PMCID: PMC9028398 DOI: 10.3390/children9040487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/24/2022] [Accepted: 03/28/2022] [Indexed: 11/27/2022]
Abstract
Background: Allergen-specific immunotherapy is currently the only disease-modifying treatment for allergic asthma, and it has been shown to improve control of asthma while reducing both drug use and asthma exacerbations. However, its effects on lung function—especially its long-term effects—remain controversial. We aimed to identify factors associated with a possible beneficial effect of allergen-specific immunotherapy on lung function in asthma by retrospectively evaluating the long-term changes in lung function in children with asthma who received house dust mite subcutaneous immunotherapy (HDM-SCIT). Methods: We enrolled children with asthma who had undergone HDM-SCIT for more than 1 year. Clinical information and lung function measurements were retrieved from the electronic chart system. To characterize the trajectory of lung function change, we performed linear regression analysis to evaluate the maximal expiratory flow at 50% of the forced vital capacity during two periods: before and during HDM-SCIT. Slopes from a least-squares regression line for the two periods, i.e., S1 before HDM-SCIT and S2 during HDM-SCIT, were compared. The subjects were then classified into two groups: an improving group (Group I) defined as S2 − S1 > 0, and a declining group (Group D) defined as S2 − S1 < 0. The clinical factors at the start of HDM-SCIT were compared between the two groups. Results: A total of 16 patients were analyzed. Eight patients were classified into each of Group I and Group D. The mean ages were 10.5 and 11.8 years, and the mean treatment periods were 4.1 and 3.9 years. Group I had a significantly lower blood eosinophil count and a significantly higher HDM-specific IgE level than Group D. Logistic regression showed a strong relationship between those two markers and the lung function trajectory. Conclusion: Control of the blood eosinophil count in highly HDM-sensitized patients may increase the beneficial effect of HDM-SCIT on lung function.
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Affiliation(s)
- Kazutaka Nogami
- Department of Pediatrics, Sapporo Medical University School of Medicine, Sapporo-shi 060-8543, Japan; (K.N.); (T.T.)
- Allergy Center and Department of Clinical Research, Mie National Hospital, Tsu 514-0125, Japan; (M.N.); (T.T.); (Y.Y.); (S.Y.); (M.M.); (M.H.); (K.H.); (Y.K.)
| | - Mizuho Nagao
- Allergy Center and Department of Clinical Research, Mie National Hospital, Tsu 514-0125, Japan; (M.N.); (T.T.); (Y.Y.); (S.Y.); (M.M.); (M.H.); (K.H.); (Y.K.)
| | - Takafumi Takase
- Allergy Center and Department of Clinical Research, Mie National Hospital, Tsu 514-0125, Japan; (M.N.); (T.T.); (Y.Y.); (S.Y.); (M.M.); (M.H.); (K.H.); (Y.K.)
| | - Yasuaki Yasuda
- Allergy Center and Department of Clinical Research, Mie National Hospital, Tsu 514-0125, Japan; (M.N.); (T.T.); (Y.Y.); (S.Y.); (M.M.); (M.H.); (K.H.); (Y.K.)
| | - Shingo Yamada
- Allergy Center and Department of Clinical Research, Mie National Hospital, Tsu 514-0125, Japan; (M.N.); (T.T.); (Y.Y.); (S.Y.); (M.M.); (M.H.); (K.H.); (Y.K.)
| | - Mayumi Matsunaga
- Allergy Center and Department of Clinical Research, Mie National Hospital, Tsu 514-0125, Japan; (M.N.); (T.T.); (Y.Y.); (S.Y.); (M.M.); (M.H.); (K.H.); (Y.K.)
| | - Miyuki Hoshi
- Allergy Center and Department of Clinical Research, Mie National Hospital, Tsu 514-0125, Japan; (M.N.); (T.T.); (Y.Y.); (S.Y.); (M.M.); (M.H.); (K.H.); (Y.K.)
| | - Kana Hamada
- Allergy Center and Department of Clinical Research, Mie National Hospital, Tsu 514-0125, Japan; (M.N.); (T.T.); (Y.Y.); (S.Y.); (M.M.); (M.H.); (K.H.); (Y.K.)
| | - Yu Kuwabara
- Allergy Center and Department of Clinical Research, Mie National Hospital, Tsu 514-0125, Japan; (M.N.); (T.T.); (Y.Y.); (S.Y.); (M.M.); (M.H.); (K.H.); (Y.K.)
- Department of Pediatrics, Ehime University Graduate School of Medicine, Toon 791-0295, Japan
| | - Takeshi Tsugawa
- Department of Pediatrics, Sapporo Medical University School of Medicine, Sapporo-shi 060-8543, Japan; (K.N.); (T.T.)
| | - Takao Fujisawa
- Allergy Center and Department of Clinical Research, Mie National Hospital, Tsu 514-0125, Japan; (M.N.); (T.T.); (Y.Y.); (S.Y.); (M.M.); (M.H.); (K.H.); (Y.K.)
- Correspondence: ; Tel.: +81-59-232-2531
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14
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Tsiavia T, Henny J, Goldberg M, Zins M, Roche N, Orsi L, Nadif R. Blood inflammatory phenotypes were associated with distinct clinical expressions of asthma in adults from a large population-based cohort. EBioMedicine 2022; 76:103875. [PMID: 35152149 PMCID: PMC8844864 DOI: 10.1016/j.ebiom.2022.103875] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/25/2022] [Accepted: 01/25/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Asthma is an inflammatory heterogeneous disease. Asthma inflammatory phenotypes based on blood eosinophil and neutrophil counts have never been identified and characterized in population-based studies. METHODS Adults with current asthma and available blood eosinophil and neutrophil counts from the French population-based CONSTANCES cohort were included. Current asthma was defined by reports of asthma attacks, symptoms or treatments in the last 12 months. Inflammatory phenotypes were based on low (L) and high (H) blood (B) eosinophil (E) (LBE/HBE: ⩾0·25 × 109/L, respectively) and neutrophil (N) (LBN/HBN: ⩾5 × 109/L, respectively) cut-offs. Associations between inflammatory phenotypes and the clinical expressions of asthma were studied using logistic models adjusted for age, sex, smoking status, body mass index, education level, French deprivation index and treatment. Other cut-offs were applied. Stratified analyses according to age or sex were performed. FINDINGS Among 15,019 adults with asthma (56% women, 59%≥40 years), the LBE/LBN (reference), LBE/HBN, HBE/LBN and HBE/HBN phenotypes accounted for 57%, 6%, 33% and 4% respectively. The LBE/HBN phenotype was associated with being awaken by an attack of coughing, chronic bronchitis, and dyspnoea (adjusted(a)OR ranging from 1·21 to 1·42). The HBE/LBN and HBE/HBN phenotypes were associated with asthma attacks (aOR=1·31[1·20-1·42], 1·25[1·02-1·53]) and asthma symptom score (p for trend<0·0001, p for trend=0·001, respectively). The HBE/LBN phenotype was also associated with being awaken with chest tightness (aOR=1·30[1·20-1·40]). Results were unchanged whatever the cut-offs used. No statistically significant heterogeneity was observed according to age or sex. INTERPRETATION Differences in the clinical expressions of asthma were found between the phenotypes, reproducible whatever the cut-offs used, and similar to those observed in case-control and clinical studies. Such phenotypes are of interest to improve asthma management and study its environmental risk factors. FUNDING The CONSTANCES cohort receives grants from ANR (ANR-11-INBS-0002), the Caisse nationale d'assurance maladie-CNAM and the Ministry of research. CONSTANCES also receives funding from MSD, AstraZeneca, Lundbeck and L'Oréal, managed by INSERM-Transfert. T.Tsiavia is supported by a PhD grant from the Fondation pour le Recherche Médicale (ECO202006011654).
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Affiliation(s)
- Tajidine Tsiavia
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie Respiratoire Int´grative, CESP, 94807, Villejuif, France.
| | - Joseph Henny
- Université Paris-Saclay, UVSQ, Inserm, Cohortes Epidémiologiques en population, 94807, Villejuif, France
| | - Marcel Goldberg
- Université Paris-Saclay, UVSQ, Inserm, Cohortes Epidémiologiques en population, 94807, Villejuif, France; Faculté de Médecine, Univ. de Paris, Paris, France
| | - Marie Zins
- Université Paris-Saclay, UVSQ, Inserm, Cohortes Epidémiologiques en population, 94807, Villejuif, France; Faculté de Médecine, Univ. de Paris, Paris, France
| | - Nicolas Roche
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie Respiratoire Int´grative, CESP, 94807, Villejuif, France; Respiratory Medicine, Pneumologie et Soins Intensifs Respiratoires, APHP Centre, Cochin Hospital, Université de Paris (Descartes), Institut Cochin (UMR 1016), Paris, France
| | - Laurent Orsi
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie Respiratoire Int´grative, CESP, 94807, Villejuif, France
| | - Rachel Nadif
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie Respiratoire Int´grative, CESP, 94807, Villejuif, France
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15
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Bermúdez Barón N, Lindberg A, Stridsman C, Andersson M, Hedman L, Vikjord SA, Kankaanranta H, Lundbäck B, Rönmark E, Backman H. Among respiratory symptoms, wheeze associates most strongly with impaired lung function in adults with asthma: a long-term prospective cohort study. BMJ Open Respir Res 2021; 8:e000981. [PMID: 34281917 PMCID: PMC8291305 DOI: 10.1136/bmjresp-2021-000981] [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: 05/17/2021] [Accepted: 06/19/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Asthma is a common disease and a major public health concern. Respiratory symptoms are related to its prognosis, which in turn associates with lung function. Still this association on a long-term basis is not entirely understood. AIM To study the association of the type and number of respiratory symptoms with FEV1 and FEV1 decline in women and men with asthma. METHOD A population-based cohort of adults with asthma was examined at study entry between 1986 and 2001 and at follow-up between 2012 and 2014, and n=977 had valid measurements of FEV1 on both occasions. Data regarding respiratory symptoms at study entry (recurrent wheeze, dyspnoea, longstanding cough and productive cough) were analysed in relation to FEV1 and annual decline in FEV1, both unadjusted and adjusted for other potentially associated factors by linear regression. RESULTS For both sexes recurrent wheeze and dyspnoea were associated with lower FEV1 at study entry and follow-up, while productive cough was associated with lower FEV1 only at follow-up. No associations were found between the type of symptoms and annual decline in FEV1. In adjusted analyses, the association between recurrent wheeze and lower FEV1 both at study entry and follow-up remained significant among women. Also, the association between a higher number of symptoms with lower FEV1 both at study entry and follow-up were present for both sexes and remained after adjustment. CONCLUSIONS Particularly recurrent wheeze and a higher number of respiratory symptoms may predict lower lung function also in the long run among women and men with asthma.
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Affiliation(s)
- Nicolás Bermúdez Barón
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN Unit, Umeå University, Umeå, Sweden
| | - Anne Lindberg
- Department of Public Health and Clinical Medicine, Section of Medicine, The OLIN Unit, Umeå University, Umeå, Sweden
| | - Caroline Stridsman
- Department of Public Health and Clinical Medicine, Section of Medicine, The OLIN Unit, Umeå University, Umeå, Sweden
| | - Martin Andersson
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN Unit, Umeå University, Umeå, Sweden
| | - Linnea Hedman
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN Unit, Umeå University, Umeå, Sweden
- Department of Health Sciences, Division of Nursing, Luleå University of Technology, Luleå, Sweden
| | - Sigrid Anna Vikjord
- HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Hannu Kankaanranta
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Bo Lundbäck
- Department of Public Health and Clinical Medicine, Section of Medicine, The OLIN Unit, Umeå University, Umeå, Sweden
- Department of Internal Medicine and Clinical Nutrition, Krefting Research Centre, University of Gothenburg Institute of Medicine, Goteborg, Sweden
| | - Eva Rönmark
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN Unit, Umeå University, Umeå, Sweden
| | - Helena Backman
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN Unit, Umeå University, Umeå, Sweden
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16
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Bronchodilator response and lung function decline: Associations with exhaled nitric oxide with regard to sex and smoking status. World Allergy Organ J 2021; 14:100544. [PMID: 34093956 PMCID: PMC8142084 DOI: 10.1016/j.waojou.2021.100544] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 03/29/2021] [Accepted: 04/14/2021] [Indexed: 11/23/2022] Open
Abstract
Background Fractional exhaled nitric oxide (FeNO) is a marker of type-2 inflammation used both to support diagnosis of asthma and follow up asthma patients. The associations of FeNO with lung function decline and bronchodilator (BD) response have been studied only scarcely in large populations. Objectives To study the association between FeNO and a) retrospective lung function decline over 20 years, and b) lung function response to BD among asthmatic subjects compared with non-asthmatic subjects and with regards to current smoking and sex. Methods Longitudinal analyses of previous lung function decline and FeNO level at follow-up and cross-sectional analyses of BD response and FeNO levels in 4257 participants (651 asthmatics) from the European Community Respiratory Health Survey. Results Among asthmatic subjects, higher percentage declines of FEV1 and FEV1/FVC were associated with higher FeNO levels (p = 0.001 for both) at follow-up. These correlations were found mainly among non-smoking individuals (p = 0.001) and females (p = 0.001) in stratified analyses. Percentage increase in FEV1 after BD was positively associated with FeNO levels in non-asthmatic subjects. Further, after stratified for sex and smoking separately, a positive association was seen between FEV1 and FeNO levels in non-smokers and women, regardless of asthma status. Conclusions We found a relationship between elevated FeNO and larger FEV1 decline over 20 years among subjects with asthma who were non-smokers or women. The association between elevated FeNO levels and larger BD response was found in both non-asthmatic and asthmatic subjects, mainly in women and non-smoking subjects.
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17
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Sposato B, Scalese M, Ricci A, Rogliani P, Paggiaro P. Persistence of both reversible airway obstruction and higher blood eosinophils may predict lung function decline in severe asthma. CLINICAL RESPIRATORY JOURNAL 2021; 15:237-243. [PMID: 33400385 DOI: 10.1111/crj.13325] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 12/31/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE This study analysed whether the persistence of both reversible airway obstruction (RAO) and elevated BE counts was associated to reduced asthma control and accelerated lung function decline in treated severe asthmatics. METHODS About 202 severe asthmatics were studied after 12-120 months of step-5 treatment associated to anti-IgE therapy. Following treatments, reversibility tests, after inhaling 400 mcg of Salbutamol, were performed. FEV1 > 12% or ≤12% changes differentiated RAO+ from RAO- subjects. Blood eosinophil (BE) counts after treatment were considered. RESULTS Pre-/post-treatment bronchodilator FEV1 % and ACT were lower (61% [50-71], 74.4% [62.5-83.7] and 20[18-22]), whereas BE were higher (380 cells/µl [170-590]) in RAO+ compared to RAO- subjects (77% [64-88], p = 0.0001, 81.8% [66.1-94.3], p = 0.0001, 21[18-23], p = 0.045 and 230 cells/µl [80-360], p = 0.003). A negative relationship between SABA-induced FEV1 % changes and pre-bronchodilator FEV1 % (β = -0.551%; p = 0.0001) and ACT (β = -0.059; p = 0.038) was found. Conversely, post-treatment BE levels were positively related (β = 145.565 cells/µl; p = 0.003) to FEV1 > 12% increases. A rising trend of pre-/post-bronchodilator FEV1 % in time was observed in RAO- subjects with BE < 300 cells/µl. Conversely, we highlighted significant declining tendencies of pre/post-bronchodilator FEV1 % in RAO+ patients with BE > 300 cells/µl reaching lower values after more than 36 months of step-5 treatment (59.6% [39.9-72.1] vs 74[66.5-89.2] of RAO+ individuals with BE < 300 cells/µl [p = 0.026] and 81.6% [66.1-91.8] of RAO-subjects with BE > 300 cells/µl [p = 0.009]). CONCLUSION Persistent SABA-induced FEV1 > 12%, especially when associated to BE > 300 cells/ml, may be a marker of accelerated lung function decline in severe asthmatics despite maximal step-5 treatment. The highest bronchodilation associated to the lowest BE levels should be the main goal of asthma treatment to prevent such decline.
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Affiliation(s)
- Bruno Sposato
- Azienda USL Toscana Sud-Est Pneumology Department, "Misericordia" Hospital, Grosseto, Italy.,Experimental Medicine and Systems, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Marco Scalese
- Clinic Physiology Institute, National Research Centre, Pisa, Italy
| | - Alberto Ricci
- Division of Pneumology, Department of Clinical and Molecular Medicine, Sapienza University of Rome, AOU Sant'Andrea, Rome, Italy
| | - Paola Rogliani
- Respiratory Unit, department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Pierluigi Paggiaro
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy
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18
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Guo Q, Yan J, Song T, Zhong C, Kuang J, Mo Y, Tan J, Li D, Sui Z, Cai K, Zhang J. microRNA-130b-3p Contained in MSC-Derived EVs Promotes Lung Cancer Progression by Regulating the FOXO3/NFE2L2/TXNRD1 Axis. MOLECULAR THERAPY-ONCOLYTICS 2020; 20:132-146. [PMID: 33575477 PMCID: PMC7851484 DOI: 10.1016/j.omto.2020.09.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 09/16/2020] [Indexed: 02/08/2023]
Abstract
This study aimed to explore the molecular mechanism by which mesenchymal stem cells (MSCs) mediate lung cancer progression. Extracellular vesicles (EVs) were isolated from transfected or untransfected MSCs, and were co-cultured with lung cancer cells with/without microRNA-130b-3p (miR-130b-3p) inhibitor, mimic, overexpression plasmids of FOXO3/NFE2L2, or shRNAs. CCK-8 assay, colony formation, transwell assay, and flow cytometry were carried out to determine the biological functioning of lung cancer cells. Furthermore, FOXO3, Keap1, NFE2L2, and TXNRD1 expression was determined by qRT-PCR and western blot analysis. A tumor xenograft mouse model was used to determine role of EVs-miR-130b-3p and its target FOXO3 in lung cancer progression in vivo. miR-130b-3p was highly expressed in lung cancer tissues and MSC-derived EVs. Moreover, the MSC-derived EVs transferred miR-130b-3p to lung cancer cells to promote cell proliferation, migration, and invasion while repress cell apoptosis. miR-130b-3p directly targeted FOXO3, and FOXO3 elevated Keap1 expression to downregulate NFE2L2, thus inhibiting TXNRD1. FOXO3 overexpression or silencing of NFE2L2 or TXNRD1 diminished lung cancer cell proliferation, invasion, and migration but enhanced apoptosis. EV-delivered miR-130b-3p or FOXO3 silencing promoted lung cancer progression in vivo. In summary, MSC-derived EVs with upregulated miR-130b-3p suppressed FOXO3 to block the NFE2L2/TXNRD1 pathway, thus playing an oncogenic role in lung cancer progression.
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Affiliation(s)
- Quanwei Guo
- Department of Thoracic Surgery, Shenzhen Hospital, Southern Medical University, Shenzhen 518101, P.R. China.,Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, P.R. China.,The First School of Clinical Medicine, Southern Medical University, Guangzhou 510515, P.R. China
| | - Jun Yan
- Department of Thoracic Surgery, Shenzhen Hospital, Southern Medical University, Shenzhen 518101, P.R. China
| | - Tieniu Song
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu 610041, P.R. China
| | - Chenghua Zhong
- Department of Thoracic Surgery, Shenzhen Hospital, Southern Medical University, Shenzhen 518101, P.R. China
| | - Jun Kuang
- Department of Thoracic Surgery, Shenzhen Hospital, Southern Medical University, Shenzhen 518101, P.R. China
| | - Yijun Mo
- Department of Thoracic Surgery, Shenzhen Hospital, Southern Medical University, Shenzhen 518101, P.R. China
| | - Jianfeng Tan
- Department of Thoracic Surgery, Shenzhen Hospital, Southern Medical University, Shenzhen 518101, P.R. China
| | - Dongfang Li
- Department of Thoracic Surgery, Shenzhen Hospital, Southern Medical University, Shenzhen 518101, P.R. China
| | - Zesen Sui
- Department of Thoracic Surgery, Shenzhen Hospital, Southern Medical University, Shenzhen 518101, P.R. China
| | - Kaican Cai
- Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, P.R. China.,The First School of Clinical Medicine, Southern Medical University, Guangzhou 510515, P.R. China
| | - Jianhua Zhang
- Department of Thoracic Surgery, Shenzhen Hospital, Southern Medical University, Shenzhen 518101, P.R. China
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19
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Pandey R, Prakash V. mRNA expression analysis of interleukins 17A and 17F in bronchial asthmatic patients from Northern Indian population. J Family Med Prim Care 2020; 9:2258-2263. [PMID: 32754484 PMCID: PMC7380788 DOI: 10.4103/jfmpc.jfmpc_35_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 03/12/2020] [Accepted: 04/08/2020] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Asthma being a chronic inflammatory disease concerning to the airways involves genetic and environmental factors. It is known to develop a clinical condition of airway hyper-responsiveness, which induces frequent symptoms in patients such as breathlessness, chest congestion, coughing, and wheezing, particularly during night hours or during early morning hours. The cytokine, Interleukin 17F (IL17F), is important in mediating allergic reactions in the body and regulating the pathophysiology and pathogenesis of asthmatic attacks, as well as airway inflammation, respectively. The Interleukin 17A (IL17A) is involved in increasing the biosynthesis of interleukins IL-6 and IL11. In contrast, IL17F enhances the expression of interleukin IL11 and tumor growth factor, TGF-β. METHODOLOGY Standard procedures were followed for collection and processing of blood samples from the subjects (controls and patients, 104 each), isolation of mRNA and to determine the quantities of IgE, and the interlukins (IL17A and IL17F) in the serum. The Real-time PCR and ELISA techniques were employed for synthesis of cDNA and determination of interleukins, respectively, using standard protocols. Early diagnosis of asthma is still a challenge to meet. RESULTS The statistical analysis of the data reflected a positive correlation between each of the interleukins (IL-17A and IL17F) and IgE (p = 0.001 and r = 0.41), (p = 0.004 and r = 0.077). The results indicated the upregulation of expression of IL17A and IL17F genes in the patients suffering from asthma. CONCLUSIONS This study has indicated that the blood levels of IL-17A and IL17F could be utilized as viable clinical markers for early diagnosis, timely treatment, and proper management of asthma.
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Affiliation(s)
- Rashmi Pandey
- Department of Pulmonary and Critical Care Medicine, KGMU, Lucknow, Uttar Pradesh, India
| | - Ved Prakash
- Department of Pulmonary and Critical Care Medicine, KGMU, Lucknow, Uttar Pradesh, India
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