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Schleich F, Moermans C, Gerday S, Ziant S, Louis G, Bougard N, Paulus V, Guissard F, Henket M, Bachert C, Louis R. Patients With Asthma Only Sensitized to Staphylococcus aureus Enterotoxins Have More Exacerbations, Airflow Limitation, and Higher Levels of Sputum IL-5 and IgE. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:3055-3061.e4. [PMID: 37301436 DOI: 10.1016/j.jaip.2023.05.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 05/25/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Staphylococcus aureus enterotoxins (SE) may act as superantigens and induce an intense T-cell activation, causing local production of polyclonal IgE and resultant eosinophil activation. OBJECTIVE To assess whether asthma with sensitization to SE but not to common aeroallergens (AAs) displays different inflammatory characteristics. METHODS We conducted a prospective study on a series of 110 consecutive patients with asthma recruited from the University Asthma Clinic of Liège. We compared clinical, functional, and inflammatory characteristics of this general population of patients with asthma categorized into 4 groups according to sensitization to AAs and/or SE. We also compared sputum supernatant cytokines in patients sensitized to SE or not. RESULTS Patients with asthma sensitized only to AAs represented 30%, while 29% were sensitized to both AAs and SE. One-fifth of the population had no specific IgE. Sensitization to SE but not to AA (21%) was associated with later onset of disease, higher rate of exacerbations, nasal polyps, and more severe airway obstruction. As for airway type 2 biomarkers, patients presenting with specific IgE against SE displayed higher fractional exhaled nitric oxide, sputum IgE, and sputum IL-5 levels but not IL-4. We confirm that the presence of specific IgE against SE is associated with elevated serum IgE to levels well above those observed in patients sensitized only to AAs. CONCLUSIONS Our study suggests that asthma specialists should measure specific IgE against SE during the phenotyping process because it may allow the identification of a subgroup of patients with more asthma exacerbations, more nasal polyposis and chronic sinusitis, lower lung function, and more intense type 2 inflammation.
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Affiliation(s)
- Florence Schleich
- CHU Liège Sart-Tilman, University of Liège, GIGA I(3), Liège, Belgium.
| | | | - Sara Gerday
- CHU Liège Sart-Tilman, University of Liège, GIGA I(3), Liège, Belgium
| | - Stéphanie Ziant
- CHU Liège Sart-Tilman, University of Liège, GIGA I(3), Liège, Belgium
| | - Gilles Louis
- CHU Liège Sart-Tilman, University of Liège, GIGA I(3), Liège, Belgium
| | - Nicolas Bougard
- CHU Liège Sart-Tilman, University of Liège, GIGA I(3), Liège, Belgium
| | - Virginie Paulus
- CHU Liège Sart-Tilman, University of Liège, GIGA I(3), Liège, Belgium
| | | | - Monique Henket
- CHU Liège Sart-Tilman, University of Liège, GIGA I(3), Liège, Belgium
| | - Claus Bachert
- ENT-Clinic, University Hospital of Münster, Münster, Germany; Division of ENT Diseases, CLINTEC, Karolinska Institute, Stockholm, Sweden; Upper Airway Research Laboratory, Ghent University, Ghent, Belgium
| | - Renaud Louis
- CHU Liège Sart-Tilman, University of Liège, GIGA I(3), Liège, Belgium
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Perioperative Respiratory Outcome of Patients with Eosinophilia: A Cohort Study in a Tertiary Care Hospital. Anesthesiol Res Pract 2023; 2023:8514949. [PMID: 36660020 PMCID: PMC9845031 DOI: 10.1155/2023/8514949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/13/2022] [Accepted: 01/03/2023] [Indexed: 01/12/2023] Open
Abstract
Background A respiratory adverse event is one of the main causes of critical events in the perioperative period. Perioperative distress symptoms like cough and stridor have been reported to occur in patients with hyperreactive airways. Objective This study was conducted to determine the relationship between blood eosinophil count and perioperative adverse respiratory events among different age groups of patients who require general anesthesia for different types of surgeries. Methods A cohort study was conducted on 197 patients of either gender, aged 3 years and above, belonging to ASA classes I-II, who were scheduled to undergo surgery requiring general anesthesia and intubation. Patients were stratified according to absolute eosinophil count into two groups: Group A (AEC 0 to 499/mm3) and Group B (AEC 500 to 1000/mm3). Patients were monitored for 24 hours in the perioperative period for adverse respiratory events such as bronchospasm, laryngospasm, a fall in SPO2 < 95%, and cough and stridor. Results A total of 197 patients were evaluated, with a median age of 37 ± 14.4 years. The percentage range of adverse respiratory events across different age groups was 35% in adults to 60% in children. Major complications noted were a fall in SPO2 < 95% (62.5%) and cough (27.7%) as per CTCAE v5.0 (November 27, 2017). The Naranjo score of adverse respiratory events was categorized as possible with mild level 1 severity. Adverse respiratory events were managed with humidified oxygen, antitussives, and bronchodilators. Conclusions Eosinophilia is seen in one-third of the patients undergoing surgical interventions. Patients with a blood eosinophil count of ≥400/mm3 had an increased risk of exacerbations of respiratory adverse events in the perioperative period.
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Cottin S, Doyen V, Pilette C. Upper airway disease diagnosis as a predictive biomarker of therapeutic response to biologics in severe asthma. Front Med (Lausanne) 2023; 10:1129300. [PMID: 37035303 PMCID: PMC10073432 DOI: 10.3389/fmed.2023.1129300] [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: 12/21/2022] [Accepted: 02/27/2023] [Indexed: 04/11/2023] Open
Abstract
Asthma is a heterogeneous disease sharing airway instability but with different biology, risk factors, and response-to-therapy patterns. Biologics have revolutionized the one-size-fits-to-all approach to personalized medicine in severe asthma (SA), which relies on the identification of biomarkers that define distinct endotypes. Thus, blood eosinophils and, to some extent, exhaled nitric oxide (FeNO) can predict the response to approved anti-type 2 (T2) biologics (anti-IgE, anti-IL-5, and anti-IL-4R alpha), whereas age at onset and comorbidities such as anxiety/depression, obesity, reflux, and upper airway disease (UAD) also influence therapeutic responses in SA. In this article, focusing on the predictive value of biomarkers for the therapeutic response to biologics in SA, we first summarize the level of prediction achieved by T2 biomarkers (blood eosinophils, FeNO) and then review whether data support the predictive value of upper airway diagnosis on such outcomes. Post hoc analysis of most studies with T2 biologics suggests that chronic rhinosinusitis with nasal polyps (CRSwNP) and, to a lower extent, allergic rhinitis may help in predicting clinical response. Considering that T2 biologics are now also approved for the treatment of severe CRSwNP, diagnosis of upper airway disease is a key step in determining eligibility for such therapy.
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Affiliation(s)
- Sophie Cottin
- Department of Pulmonary Medicine, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Virginie Doyen
- Department of Pulmonary Medicine, Centre Hospitalier Universitaire UCL Namur, Université catholique de Louvain, Yvoir, Belgium
| | - Charles Pilette
- Department of Pulmonary Medicine, Cliniques Universitaires Saint-Luc, Brussels, Belgium
- Pole of Pulmonology, ENT and Dermatology, Institute of Experimental and Cliniqal Research, Université catholique de Louvain, Brussels, Belgium
- *Correspondence: Charles Pilette
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Guida G, Bagnasco D, Carriero V, Bertolini F, Ricciardolo FLM, Nicola S, Brussino L, Nappi E, Paoletti G, Canonica GW, Heffler E. Critical evaluation of asthma biomarkers in clinical practice. Front Med (Lausanne) 2022; 9:969243. [PMID: 36300189 PMCID: PMC9588982 DOI: 10.3389/fmed.2022.969243] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/29/2022] [Indexed: 11/13/2022] Open
Abstract
The advent of personalized medicine has revolutionized the whole approach to the management of asthma, representing the essential basis for future developments. The cornerstones of personalized medicine are the highest precision in diagnosis, individualized prediction of disease evolution, and patient-tailored treatment. To this aim, enormous efforts have been established to discover biomarkers able to predict patients' phenotypes according to clinical, functional, and bio-humoral traits. Biomarkers are objectively measured characteristics used as indicators of biological or pathogenic processes or clinical responses to specific therapeutic interventions. The diagnosis of type-2 asthma, prediction of response to type-2 targeted treatments, and evaluation of the risk of exacerbation and lung function impairment have been associated with biomarkers detectable either in peripheral blood or in airway samples. The surrogate nature of serum biomarkers, set up to be less invasive than sputum analysis or bronchial biopsies, has shown several limits concerning their clinical applicability. Routinely used biomarkers, like peripheral eosinophilia, total IgE, or exhaled nitric oxide, result, even when combined, to be not completely satisfactory in segregating different type-2 asthma phenotypes, particularly in the context of severe asthma where the choice among different biologics is compelling. Moreover, the type-2 low fraction of patients is not only an orphan of biological treatments but is at risk of being misdiagnosed due to the low negative predictive value of type-2 high biomarkers. Sputum inflammatory cell analysis, considered the highest specific biomarker in discriminating eosinophilic inflammation in asthma, and therefore elected as the gold standard in clinical trials and research models, demonstrated many limits in clinical applicability. Many factors may influence the measure of these biomarkers, such as corticosteroid intake, comorbidities, and environmental exposures or habits. Not least, biomarkers variability over time is a confounding factor leading to wrong clinical choices. In this narrative review, we try to explore many aspects concerning the role of routinely used biomarkers in asthma, applying a critical view over the "state of the art" and contemporarily offering an overview of the most recent evidence in this field.
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Affiliation(s)
- Giuseppe Guida
- Severe Asthma and Rare Lung Disease Unit, Department of Clinical and Biological Sciences, San Luigi Gonzaga University Hospital, University of Torino, Turin, Italy
| | - Diego Bagnasco
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, Department of Internal Medicine (DIMI), University of Genoa, Genoa, Italy
| | - Vitina Carriero
- Severe Asthma and Rare Lung Disease Unit, Department of Clinical and Biological Sciences, San Luigi Gonzaga University Hospital, University of Torino, Turin, Italy
| | - Francesca Bertolini
- Severe Asthma and Rare Lung Disease Unit, Department of Clinical and Biological Sciences, San Luigi Gonzaga University Hospital, University of Torino, Turin, Italy
| | - Fabio Luigi Massimo Ricciardolo
- Severe Asthma and Rare Lung Disease Unit, Department of Clinical and Biological Sciences, San Luigi Gonzaga University Hospital, University of Torino, Turin, Italy
| | - Stefania Nicola
- Allergy and Immunology, AO Mauriziano Hospital, University of Turin, Turin, Italy
| | - Luisa Brussino
- Allergy and Immunology, AO Mauriziano Hospital, University of Turin, Turin, Italy
| | - Emanuele Nappi
- IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Giovanni Paoletti
- IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Giorgio Walter Canonica
- IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Enrico Heffler
- IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
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Fouka E, Domvri K, Gkakou F, Alevizaki M, Steiropoulos P, Papakosta D, Porpodis K. Recent insights in the role of biomarkers in severe asthma management. Front Med (Lausanne) 2022; 9:992565. [PMID: 36226150 PMCID: PMC9548530 DOI: 10.3389/fmed.2022.992565] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 09/09/2022] [Indexed: 11/28/2022] Open
Abstract
Contemporary asthma management requires a proactive and individualized approach, combining precision diagnosis and personalized treatment. The introduction of biologic therapies for severe asthma to everyday clinical practice, increases the need for specific patient selection, prediction of outcomes and monitoring of these costly and long-lasting therapies. Several biomarkers have been used in asthma in disease identification, prediction of asthma severity and prognosis, and response to treatment. Novel advances in the area of personalized medicine regarding disease phenotyping and endotyping, encompass the development and application of reliable biomarkers, accurately quantified using robust and reproducible methods. The availability of powerful omics technologies, together with integrated and network-based genome data analysis, and microbiota changes quantified in serum, body fluids and exhaled air, will lead to a better classification of distinct phenotypes or endotypes. Herein, in this review we discuss on currently used and novel biomarkers for the diagnosis and treatment of asthma.
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Affiliation(s)
- Evangelia Fouka
- G. Papanikolaou General Hospital, Thessaloniki, Greece
- Pulmonary Department of Aristotle University of Thessaloniki, Thessaloniki, Greece
- *Correspondence: Evangelia Fouka
| | - Kalliopi Domvri
- G. Papanikolaou General Hospital, Thessaloniki, Greece
- Pulmonary Department of Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Foteini Gkakou
- G. Papanikolaou General Hospital, Thessaloniki, Greece
- Pulmonary Department of Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria Alevizaki
- G. Papanikolaou General Hospital, Thessaloniki, Greece
- Pulmonary Department of Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Despoina Papakosta
- G. Papanikolaou General Hospital, Thessaloniki, Greece
- Pulmonary Department of Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Porpodis
- G. Papanikolaou General Hospital, Thessaloniki, Greece
- Pulmonary Department of Aristotle University of Thessaloniki, Thessaloniki, Greece
- Konstantinos Porpodis
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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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7
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de Carvalho-Pinto RM, Cançado JED, Pizzichini MMM, Fiterman J, Rubin AS, Cerci A, Cruz ÁA, Fernandes ALG, Araujo AMS, Blanco DC, Cordeiro G, Caetano LSB, Rabahi MF, de Menezes MB, de Oliveira MA, Lima MA, Pitrez PM. 2021 Brazilian Thoracic Association recommendations for the management of severe asthma. J Bras Pneumol 2021; 47:e20210273. [PMID: 34932721 PMCID: PMC8836628 DOI: 10.36416/1806-3756/e20210273] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 08/05/2021] [Indexed: 12/20/2022] Open
Abstract
Advances in the understanding that severe asthma is a complex and heterogeneous disease and in the knowledge of the pathophysiology of asthma, with the identification of different phenotypes and endotypes, have allowed new approaches for the diagnosis and characterization of the disease and have resulted in relevant changes in pharmacological management. In this context, the definition of severe asthma has been established, being differentiated from difficult-to-control asthma. These recommendations address this topic and review advances in phenotyping, use of biomarkers, and new treatments for severe asthma. Emphasis is given to topics regarding personalized management of the patient and selection of biologicals, as well as the importance of evaluating the response to treatment. These recommendations apply to adults and children with severe asthma and are targeted at physicians involved in asthma treatment. A panel of 17 Brazilian pulmonologists was invited to review recent evidence on the diagnosis and management of severe asthma, adapting it to the Brazilian reality. Each of the experts was responsible for reviewing a topic or question relevant to the topic. In a second phase, four experts discussed and structured the texts produced, and, in the last phase, all experts reviewed and approved the present manuscript and its recommendations.
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Affiliation(s)
- Regina Maria de Carvalho-Pinto
- . Divisão de Pneumologia, Instituto do Coração − InCor − Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | | | | | - Jussara Fiterman
- . Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul − PUCRS − Porto Alegre (RS) Brasil
| | - Adalberto Sperb Rubin
- . Universidade Federal de Ciências da Saúde de Porto Alegre − UFCSPA − Porto Alegre (RS) Brasil
- . Santa Casa de Misericórdia de Porto Alegre, Porto Alegre (RS) Brasil
| | - Alcindo Cerci
- . Universidade Estadual de Londrina − UEL − Londrina (PR) Brasil
- . Pontifícia Universidade Católica do Paraná − PUCPR − Londrina (PR) Brasil
| | - Álvaro Augusto Cruz
- . Universidade Federal da Bahia − UFBA − Salvador (BA) Brasil
- . Fundação ProAR, Salvador (BA) Brasil
| | | | - Ana Maria Silva Araujo
- . Instituto de Doenças do Tórax, Universidade Federal do Rio de Janeiro − IDT/UFRJ − Rio de Janeiro (RJ) Brasil
| | - Daniela Cavalet Blanco
- . Escola de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul − PUCRS − Porto Alegre (RS), Brasil
| | - Gediel Cordeiro
- . Hospital Júlia Kubitschek, Fundação Hospitalar do Estado de Minas Gerais - FHEMIG - Belo Horizonte (MG) Brasil
- . Hospital Madre Teresa, Belo Horizonte (MG) Brasil
| | | | - Marcelo Fouad Rabahi
- . Faculdade de Medicina, Universidade Federal de Goiás − UFG − Goiânia (GO) Brasil
| | - Marcelo Bezerra de Menezes
- . Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto (SP) Brasil
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Low T, Lin TY, Lin JY, Lai CJ. Airway hyperresponsiveness induced by intermittent hypoxia in rats. Respir Physiol Neurobiol 2021; 295:103787. [PMID: 34537372 DOI: 10.1016/j.resp.2021.103787] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 09/05/2021] [Accepted: 09/13/2021] [Indexed: 11/19/2022]
Abstract
This study investigated whether intermittent hypoxia (IH) induces airway hyperresponsiveness (AHR) and associated with lung inflammation. Male Brown Norway rats were exposed to 14-day IH or room air (RA) for 6 h/day. One day after the last exposure, total lung resistance to various doses of methacholine was measured as an index of bronchoconstrictive responses. Compared with RA controls, methacholine significantly induced an augmented bronchoconstriction in IH-exposed rats. Moreover, IH exposure evoked lung inflammation which was reflected by increased inflammatory cell infiltration, concentrations of interleukin-6 and prostaglandin E2 in bronchoalveolar lavage fluid, and lung lipid peroxidation. IH-induced AHR and lung inflammation were completely abolished by daily intraperitoneal injection of N-acetylcysteine (an antioxidant) or ibuprofen (a cyclooxygenase inhibitor), but not by apocynin (an inhibitor of NADPH oxidase) or vehicle. In conclusion, AHR and lung inflammation occur after 14-day IH exposure, with endogenous reactive oxygen species and cyclooxygenase metabolites being responsible for these responses.
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Affiliation(s)
- Tissot Low
- Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan; Division of Chest Medicine, Department of Internal Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Tsung-Yen Lin
- Department of Physiology, School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Jyun-Yi Lin
- Division of Chest Medicine, Department of Internal Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Ching Jung Lai
- Department of Physiology, School of Medicine, Tzu Chi University, Hualien, Taiwan.
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Rupani H, Fong WCG, Kyyaly A, Kurukulaaratchy RJ. Recent Insights into the Management of Inflammation in Asthma. J Inflamm Res 2021; 14:4371-4397. [PMID: 34511973 PMCID: PMC8421249 DOI: 10.2147/jir.s295038] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 08/17/2021] [Indexed: 12/11/2022] Open
Abstract
The present prevailing inflammatory paradigm in asthma is of T2-high inflammation orchestrated by key inflammatory cells like Type 2 helper lymphocytes, innate lymphoid cells group 2 and associated cytokines. Eosinophils are key components of this T2 inflammatory pathway and have become key therapeutic targets. Real-world evidence on the predominant T2-high nature of severe asthma is emerging. Various inflammatory biomarkers have been adopted in clinical practice to aid asthma characterization including airway measures such as bronchoscopic biopsy and lavage, induced sputum analysis, and fractional exhaled nitric oxide. Blood measures like eosinophil counts have also gained widespread usage and multicomponent algorithms combining different parameters are now appearing. There is also growing interest in potential future biomarkers including exhaled volatile organic compounds, micro RNAs and urinary biomarkers. Additionally, there is a growing realisation that asthma is a heterogeneous state with numerous phenotypes and associated treatable traits. These may show particular inflammatory patterns and merit-specific management approaches that could improve asthma patient outcomes. Inhaled corticosteroids (ICS) remain the mainstay of asthma management but their use earlier in the course of disease is being advocated. Recent evidence suggests potential roles for ICS in combination with long-acting beta-agonists (LABA) for as needed use in mild asthma whilst maintenance and reliever therapy regimes have gained widespread acceptance. Other anti-inflammatory strategies including ultra-fine particle ICS, leukotriene receptor antagonists and macrolide antibiotics may show efficacy in particular phenotypes too. Monoclonal antibody biologic therapies have recently entered clinical practice with significant impacts on asthma outcomes. Understanding of the efficacy and use of those agents is becoming clearer with a growing body of real-world evidence as is their potential applicability to other treatable comorbid traits. In conclusion, the evolving understanding of T2 driven inflammation alongside a treatable traits disease model is enhancing therapeutic approaches to address inflammation in asthma.
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Affiliation(s)
- Hitasha Rupani
- Department of Respiratory Medicine, University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | - Wei Chern Gavin Fong
- Clinical and Experimental Sciences, University of Southampton, Southampton, UK
- David Hide Asthma and Allergy Research Centre, Isle of Wight NHS Trust, Isle of Wight, UK
| | - Aref Kyyaly
- Clinical and Experimental Sciences, University of Southampton, Southampton, UK
- David Hide Asthma and Allergy Research Centre, Isle of Wight NHS Trust, Isle of Wight, UK
| | - Ramesh J Kurukulaaratchy
- Department of Respiratory Medicine, University Hospitals Southampton NHS Foundation Trust, Southampton, UK
- Clinical and Experimental Sciences, University of Southampton, Southampton, UK
- David Hide Asthma and Allergy Research Centre, Isle of Wight NHS Trust, Isle of Wight, UK
- NIHR Biomedical Research Centre, University Hospitals Southampton NHS Foundation Trust, Southampton, UK
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10
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Menzel M, Akbarshahi H, Mahmutovic Persson I, Andersson C, Puthia M, Uller L. NFκB1 Dichotomously Regulates Pro-Inflammatory and Antiviral Responses in Asthma. J Innate Immun 2021; 14:182-191. [PMID: 34350857 DOI: 10.1159/000517847] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 06/13/2021] [Indexed: 11/19/2022] Open
Abstract
Asthma exacerbations are commonly triggered by rhinovirus infections. Viruses can activate the NFκB pathway resulting in airway inflammation and increased Th2 cytokine expression. NFκB signaling is also involved in early activation of IFNβ, which is a central mediator of antiviral responses to rhinovirus infection. Using a mouse model, this study tests our hypothesis that NFκB signaling is involved in impaired IFNβ production at viral-induced asthma exacerbations. C57BL/6 wild-type and NFκB1-/- mice were challenged with house dust mite for 3 weeks and were subsequently stimulated with the rhinoviral mimic poly(I:C). General lung inflammatory parameters and levels of the Th2 upstream cytokine IL-33 were measured after allergen challenge. At exacerbation, production of IFNβ and antiviral proteins as well as gene expression of pattern recognition receptors and IRF3/IRF7 was assessed. In the asthma exacerbation mouse model, lack of NFκB1 resulted in lower levels of IL-33 after allergen challenge alone and was associated with reduced eosinophilia. At exacerbation, mice deficient in NFκB1 exhibited enhanced expression of IFNβ and antiviral proteins. This was accompanied by increased IRF3/IRF7 expression and induction of pattern recognition receptor expression. In a human asthma dataset, a negative correlation between IRF3 and NFκB1 expression was observed. NFκB may impair antiviral responses at exacerbation, possibly by reducing expression of the transcription factors IRF3/IRF7. These findings suggest a therapeutic potential for targeting NFκB pathways at viral infection-induced exacerbations.
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Affiliation(s)
- Mandy Menzel
- Respiratory Immunopharmacology, Department of Experimental Medical Sciences, Lund University, Lund, Sweden
| | - Hamid Akbarshahi
- Respiratory Immunopharmacology, Department of Experimental Medical Sciences, Lund University, Lund, Sweden.,Respiratory Medicine and Allergology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Irma Mahmutovic Persson
- Respiratory Immunopharmacology, Department of Experimental Medical Sciences, Lund University, Lund, Sweden
| | - Cecilia Andersson
- Respiratory Cell Biology, Department of Experimental Medical Sciences, Lund University, Lund, Sweden
| | - Manoj Puthia
- Division of Dermatology and Venerology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Lena Uller
- Respiratory Immunopharmacology, Department of Experimental Medical Sciences, Lund University, Lund, Sweden
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Xu I, Boulay ME, Bertrand M, Côté A, Boulet LP. Comparative features of eosinophilic and non-eosinophilic asthma. Clin Exp Allergy 2021; 52:205-208. [PMID: 34053138 DOI: 10.1111/cea.13959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/29/2021] [Accepted: 04/30/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Isabelle Xu
- Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, Québec, QC, Canada
| | - Marie-Eve Boulay
- Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, Québec, QC, Canada
| | - Mylène Bertrand
- Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, Québec, QC, Canada
| | - Andréanne Côté
- Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, Québec, QC, Canada
| | - Louis-Philippe Boulet
- Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, Québec, QC, Canada
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12
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Shi B, Li W, Hao Y, Dong H, Cao W, Guo J, Gao P. Characteristics of inflammatory phenotypes among patients with asthma: relationships of blood count parameters with sputum cellular phenotypes. Allergy Asthma Clin Immunol 2021; 17:47. [PMID: 33975625 PMCID: PMC8111745 DOI: 10.1186/s13223-021-00548-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 04/27/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND There is a need to identify the asthma inflammatory phenotypes of patients to facilitate personalized asthma treatment. Sputum induction is time-consuming and requires expert clinical technique. This study aimed to assess the distribution and characteristics of asthma inflammatory phenotypes in Jilin Province, China; it also aimed to identify an easier method for characterization of an asthma phenotype, rather than sputum cellular analysis. METHODS In this study, 232 asthma patients underwent sputum induction following clinical assessment and blood collection. Inflammatory cell counts in sputum were used to classify asthma inflammatory phenotypes. Receiver operating characteristic curve and Spearman correlation coefficient analyses were used to identify correlations between clinical parameters. RESULTS Among the included patients, there had 52.1% paucigranulocytic, 38.4% eosinophilic, 4.3% neutrophilic, and 5.2% mixed granulocytic asthma phenotypes, respectively. In total, 129 (55.6%) patients had asthma-chronic obstructive pulmonary disease (COPD) overlap (ACO); these patients had higher proportion of smokers, higher sputum neutrophil count, worse lung function, and worse asthma control, compared with patients who had asthma alone (p < 0.05). Sputum eosinophil/neutrophil counts were positively correlated with blood eosinophil/neutrophil counts (p < 0.01). To identify the presence of sputum eosinophil proportion ≥ 3%, optimal cut-off values for blood eosinophil count and fractional exhaled nitric oxide (FeNO) were 0.2 × 109/L and 30.25 ppd (area under the curve (AUC) = 0.744; AUC = 0.653, p < 0.001). AUCs did not significantly differ between FeNO and blood eosinophil count (p = 0.162), but both exhibited poor specificity (57% and 49%, respectively). To identify the presence of sputum neutrophil proportion ≥ 61%, the optimal cut-off value for blood neutrophil proportion was 69.3% (AUC = 0.691, p = 0.0003); however, this exhibited poor sensitivity (50%). CONCLUSIONS Paucigranulocytic asthma was the most common phenotype, followed by eosinophilic asthma. Higher proportion of smokers, poor patient compliance, insufficient treatment, and poor asthma control may have been the main causes of high ACO proportion among patients in this study. Blood eosinophil/neutrophil counts exhibited poor specificity and sensitivity for prediction of airway eosinophilic/neutrophilic inflammation.
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Affiliation(s)
- Bingqing Shi
- Department of Respiratory Medicine, The Second Hospital of Jilin University, Changchun, 130041, Jilin, China
| | - Wei Li
- Department of Respiratory Medicine, The Second Hospital of Jilin University, Changchun, 130041, Jilin, China
| | - Yuqiu Hao
- Department of Respiratory Medicine, The Second Hospital of Jilin University, Changchun, 130041, Jilin, China
| | - Hongna Dong
- Department of Respiratory Medicine, The Second Hospital of Jilin University, Changchun, 130041, Jilin, China
| | - Wenjing Cao
- Department of Science and Education, Changchun Central Hospital, Changchun, Jilin, China
| | - Jie Guo
- Department of Radiation Oncology, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Peng Gao
- Department of Respiratory Medicine, The Second Hospital of Jilin University, Changchun, 130041, Jilin, China.
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13
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Baumann R, Untersmayr E, Zissler UM, Eyerich S, Adcock IM, Brockow K, Biedermann T, Ollert M, Chaker AM, Pfaar O, Garn H, Thwaites RS, Togias A, Kowalski ML, Hansel TT, Jakwerth CA, Schmidt‐Weber CB. Noninvasive and minimally invasive techniques for the diagnosis and management of allergic diseases. Allergy 2021; 76:1010-1023. [PMID: 33128851 DOI: 10.1111/all.14645] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/13/2020] [Accepted: 10/25/2020] [Indexed: 12/12/2022]
Abstract
Allergic diseases of the (upper and lower) airways, the skin and the gastrointestinal tract, are on the rise, resulting in impaired quality of life, decreased productivity, and increased healthcare costs. As allergic diseases are mostly tissue-specific, local sampling methods for respective biomarkers offer the potential for increased sensitivity and specificity. Additionally, local sampling using noninvasive or minimally invasive methods can be cost-effective and well tolerated, which may even be suitable for primary or home care sampling. Non- or minimally invasive local sampling and diagnostics may enable a more thorough endotyping, may help to avoid under- or overdiagnosis, and may provide the possibility to approach precision prevention, due to early diagnosis of these local diseases even before they get systemically manifested and detectable. At the same time, dried blood samples may help to facilitate minimal-invasive primary or home care sampling for classical systemic diagnostic approaches. This EAACI position paper contains a thorough review of the various technologies in allergy diagnosis available on the market, which analytes or biomarkers are employed, and which samples or matrices can be used. Based on this assessment, EAACI position is to drive these developments to efficiently identify allergy and possibly later also viral epidemics and take advantage of comprehensive knowledge to initiate preventions and treatments.
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Affiliation(s)
- Ralf Baumann
- Medical Faculty Institute for Molecular Medicine Medical School Hamburg (MSH) – Medical University Hamburg Germany
- RWTH Aachen University Hospital Institute for Occupational, Social and Environmental Medicine Aachen Germany
| | - Eva Untersmayr
- Institute of Pathophysiology and Allergy Research Center of Pathophysiology, Infectiology and Immunology Medical University of Vienna Vienna Austria
| | - Ulrich M. Zissler
- Center of Allergy and Environment (ZAUM) Technical University and Helmholtz Zentrum München München Germany
- Member of the German Center of Lung Research (DZL) and the Helmholtz I&I Initiative Munich Germany
| | - Stefanie Eyerich
- Center of Allergy and Environment (ZAUM) Technical University and Helmholtz Zentrum München München Germany
- Member of the German Center of Lung Research (DZL) and the Helmholtz I&I Initiative Munich Germany
| | - Ian M. Adcock
- National Heart and Lung Institute Imperial College London, and Royal Brompton and Harefield NHS Trust London UK
| | - Knut Brockow
- Department of Dermatology and Allergy Biederstein School of Medicine Technische Universität München Munich Germany
| | - Tilo Biedermann
- Department of Dermatology and Allergy Biederstein School of Medicine Technische Universität München Munich Germany
| | - Markus Ollert
- Department of Infection and Immunity Luxembourg Institute of Health (LIH) Esch‐sur‐Alzette Luxembourg
- Department of Dermatology and Allergy Center Odense Research Centre for Anaphylaxis (ORCA) University of Southern Denmark Odense Denmark
| | - Adam M. Chaker
- Center of Allergy and Environment (ZAUM) Technical University and Helmholtz Zentrum München München Germany
- Member of the German Center of Lung Research (DZL) and the Helmholtz I&I Initiative Munich Germany
- Department of Otolaryngology Allergy Section Klinikum Rechts der Isar Technical University of Munich Munich Germany
| | - Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery University Hospital Marburg Philipps‐Universität Marburg Marburg Germany
| | - Holger Garn
- Biochemical Pharmacological Center (BPC) ‐ Molecular Diagnostics, Translational Inflammation Research Division & Core Facility for Single Cell Multiomics Philipps University of Marburg ‐ Medical Faculty Member of the German Center for Lung Research (DZL) Universities of Giessen and Marburg Lung Center (UGMLC) Marburg Germany
| | - Ryan S. Thwaites
- National Heart and Lung Institute Imperial College London, and Royal Brompton and Harefield NHS Trust London UK
| | - Alkis Togias
- Division of Allergy, Immunology and Transplantation National Institute of Allergy and Infectious Diseases National Institutes of Health Bethesda MD USA
| | - Marek L. Kowalski
- Department of Immunology and Allergy Medical University of Lodz Lodz Poland
| | - Trevor T. Hansel
- National Heart and Lung Institute Imperial College London, and Royal Brompton and Harefield NHS Trust London UK
| | - Constanze A. Jakwerth
- Center of Allergy and Environment (ZAUM) Technical University and Helmholtz Zentrum München München Germany
- Member of the German Center of Lung Research (DZL) and the Helmholtz I&I Initiative Munich Germany
| | - Carsten B. Schmidt‐Weber
- Center of Allergy and Environment (ZAUM) Technical University and Helmholtz Zentrum München München Germany
- Member of the German Center of Lung Research (DZL) and the Helmholtz I&I Initiative Munich Germany
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14
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Schleich F, Graff S, Guissard F, Henket M, Paulus V, Louis R. Asthma in elderly is characterized by increased sputum neutrophils, lower airway caliber variability and air trapping. Respir Res 2021; 22:15. [PMID: 33441106 PMCID: PMC7805110 DOI: 10.1186/s12931-021-01619-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 01/07/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Elderly asthmatics represent an important group that is often excluded from clinical studies. In this study we wanted to present characteristics of asthmatics older than 70 years old as compared to younger patients. METHODS We conducted a retrospective analysis on a series of 758 asthmatics subdivided in three groups: lower than 40, between 40 and 70 and older than 70. All the patients who had a successful sputum induction were included in the study. RESULTS Older patients had a higher Body Mass Index, had less active smokers and were more often treated with Long Acting anti-Muscarinic Agents. We found a significant increase in sputum neutrophil counts with ageing. There was no significant difference in blood inflammatory cell counts whatever the age group. Forced expiratory volume in one second (FEV1) and FEV1/FVC values were significantly lower in elderly who had lower bronchial hyperresponsiveness and signs of air trapping. We found a lower occurrence of the allergic component in advanced ages. Asthmatics older than 70 years old had later onset of the disease and a significant longer disease duration. CONCLUSION Our study highlights that asthmatics older than 70 years old have higher bronchial neutrophilic inflammation, a poorer lung function, signs of air trapping and lower airway variability. The role of immunosenescence inducing chronic low-grade inflammation in this asthma subtype remains to be elucidated.
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Affiliation(s)
- F Schleich
- Respiratory Medicine CHU Sart-Tilman, University of Liege, Sart-Tilman Liege, B35, GIGA I3, Liege, Belgium.
| | - S Graff
- Respiratory Medicine CHU Sart-Tilman, University of Liege, Sart-Tilman Liege, B35, GIGA I3, Liege, Belgium
| | - F Guissard
- Respiratory Medicine CHU Sart-Tilman, University of Liege, Sart-Tilman Liege, B35, GIGA I3, Liege, Belgium
| | - M Henket
- Respiratory Medicine CHU Sart-Tilman, University of Liege, Sart-Tilman Liege, B35, GIGA I3, Liege, Belgium
| | - V Paulus
- Respiratory Medicine CHU Sart-Tilman, University of Liege, Sart-Tilman Liege, B35, GIGA I3, Liege, Belgium
| | - R Louis
- Respiratory Medicine CHU Sart-Tilman, University of Liege, Sart-Tilman Liege, B35, GIGA I3, Liege, Belgium
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15
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Gerday S, Schleich F, Henket M, Guissard F, Paulus V, Louis R. Asthmatics with concordant eosinophilic disease classified according to their serum IgE status. Respir Med Res 2020; 79:100797. [PMID: 33383519 DOI: 10.1016/j.resmer.2020.100797] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 10/14/2020] [Accepted: 11/01/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Eosinophilic inflammation has long been associated with asthma. Looking at systemic and airway eosinophilia, we have recently identified a group of patients exhibiting diffuse eosinophilic inflammation. Among the mechanisms governing eosinophilic inflammation, IgE-mediated mast cell activation is a key event leading to eosinophilia in atopic asthmatics. METHODS We conducted a retrospective study on our asthma clinic database containing more than 1500 patients and identified 205 asthmatics with successful sputum induction and concordant eosinophilic phenotype. This phenotype was defined as a sputum eosinophil count≥3% and a blood eosinophils concentration≥400cells/mm3. IgE-high atopic phenotype was characterized by the presence of at least one positive specific IgE (>0.35kU/L) to common aeroallergens and a raised total serum IgE (≥113kU/L). RESULTS The largest group of asthmatics displaying concordant eosinophilic phenotype had a raised total serum IgE and atopy (45%). IgE-low non-atopic concordant eosinophilic asthma was a predominantly late onset disease, exhibited a more intense airway eosinophilic inflammation (P<0.05), required more often maintenance treatment with oral corticosteroids (P<0.05) but, surprisingly, had a reduced level of bronchial hyperresponsiveness to methacholine (P<0.05) despite similar baseline airway calibre impairment. CONCLUSION The more severe airway eosinophilic inflammation in IgE-low non-atopic asthmatics despite similar treatment with ICS and a higher burden of OCS points to a certain corticosteroid resistance in this asthma phenotype.
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Affiliation(s)
- S Gerday
- Department of Pulmonary Medicine, CHU Sart-Tilman, Liege, GIGA I(3) Research Group, University of Liege, 4000 Liege, Belgium.
| | - F Schleich
- Department of Pulmonary Medicine, CHU Sart-Tilman, Liege, GIGA I(3) Research Group, University of Liege, 4000 Liege, Belgium
| | - M Henket
- Department of Pulmonary Medicine, CHU Sart-Tilman, Liege, GIGA I(3) Research Group, University of Liege, 4000 Liege, Belgium
| | - F Guissard
- Department of Pulmonary Medicine, CHU Sart-Tilman, Liege, GIGA I(3) Research Group, University of Liege, 4000 Liege, Belgium
| | - V Paulus
- Department of Pulmonary Medicine, CHU Sart-Tilman, Liege, GIGA I(3) Research Group, University of Liege, 4000 Liege, Belgium
| | - R Louis
- Department of Pulmonary Medicine, CHU Sart-Tilman, Liege, GIGA I(3) Research Group, University of Liege, 4000 Liege, Belgium
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16
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Graff S, Vanwynsberghe S, Brusselle G, Hanon S, Sohy C, Dupont LJ, Peche R, Michils A, Pilette C, Joos G, Louis RE, Schleich FN. Chronic oral corticosteroids use and persistent eosinophilia in severe asthmatics from the Belgian severe asthma registry. Respir Res 2020; 21:214. [PMID: 32787967 PMCID: PMC7424982 DOI: 10.1186/s12931-020-01460-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 07/17/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Severe asthma (SA) may require frequent courses or chronic use of oral corticosteroids (OCS), inducing many known side effects and complications. Therefore, it is important to identify risk factors of chronic use of OCS in SA, considering the heterogeneity of clinical and inflammatory asthma phenotypes. Another aim of the present analysis is to characterize a subpopulation of severe asthmatics, in whom blood eosinophil counts (BEC) remain elevated despite chronic OCS treatment. METHODS In a cross-sectional analysis of 982 SA patients enrolled in the Belgian Severe Asthma Registry (BSAR) between March 2009 and February 2019, we investigated the characteristics of the OCS treated patients with special attention to their inflammatory profile. RESULTS At enrollment, 211 (21%) SA patients were taking maintenance OCS (median dose: 8 [IQR: 5-10]) mg prednisone equivalent). BEC was high (> 400/mm3) in 44% of the OCS treated population. Multivariable logistic regression analysis showed that risk factors for chronic use of OCS in SA were late-onset asthma (i.e. age of onset > 40 yr), frequent exacerbations (i.e. ≥2 exacerbations in the previous year) and non-atopic asthma. Late-onset asthma was also a predictor for persistently high BEC in OCS treated SA patients. CONCLUSION These data showed a significant association between a persistently high BEC and late-onset asthma in OCS treated SA patients. Whether it is poor compliance to treatment or corticosteroid insensitivity the reasons for this association warrants further investigation.
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Affiliation(s)
- S Graff
- Department of Respiratory Medicine, CHU Sart-Tilman, I3GIGA Research Group, University of Liege, Liege, Belgium.
| | - S Vanwynsberghe
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - G Brusselle
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - S Hanon
- Respiratory Division, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - C Sohy
- Department of Respiratory Medicine, Centre Hospitalier Universitaire UCL Namur, Université Catholique de Louvain, Yvoir, Belgium
| | - L J Dupont
- Department of Respiratory Medicine, Katholieke Universiteit Leuven, Leuven, Belgium
| | - R Peche
- Department of Respiratory Medicine, CHU-Charleroi, A. Vésale Hospital, Charleroi, Belgium
| | - A Michils
- Chest Department, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - C Pilette
- Cliniques Universitaires St-Luc and Institute of Experimental and Clinical Research, Université Catholique de Louvain, Brussels, Belgium
| | - G Joos
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - R E Louis
- Department of Respiratory Medicine, CHU Sart-Tilman, I3GIGA Research Group, University of Liege, Liege, Belgium
| | - F N Schleich
- Department of Respiratory Medicine, CHU Sart-Tilman, I3GIGA Research Group, University of Liege, Liege, Belgium
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17
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Peerboom S, Graff S, Seidel L, Paulus V, Henket M, Sanchez C, Guissard F, Moermans C, Louis R, Schleich F. Predictors of a good response to inhaled corticosteroids in obesity-associated asthma. Biochem Pharmacol 2020; 179:113994. [PMID: 32335139 DOI: 10.1016/j.bcp.2020.113994] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 04/21/2020] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Asthma in obese subjects is poorly understood. According to GINA guidelines, pulmonologists increase ICS in case of poor asthma control but lung volume restriction may also worsen respiratory symptoms in obese asthmatics leading to overtreatment in this subpopulation. METHODS We conducted a retrospective study on 1217 asthmatics recruited from University Hospital of Liege. 92 patients with a BMI ≥30 came at least two times at the asthma clinic (mean interval: 335 days). In this obese population, we identified predictors of good (decrease in ACQ ≥0.5) versus poor response (rise in ACQ ≥0.5) to ICS step-up therapy. RESULTS Obese asthmatics had a poorer asthma control and quality of life as compared to non-obese and exhibited reduced FVC, higher levels of blood leucocytes and markers of systemic inflammation. The proportion of asthma inflammatory phenotypes was similar to that observed in a general population of asthmatics. Among uncontrolled obese asthmatics receiving ICS step-up therapy, 53% improved their asthma control while 31% had a worsening of their asthma. Uncontrolled obese asthmatics showing a good response to increase in ICS had higher ACQ, lower CRP levels, higher sputum eosinophil counts and higher FeNO levels at visit 1. Uncontrolled obese asthmatics that worsened after increasing the dose of ICS had lower FVC, lower sputum eosinophil counts and higher sputum neutrophil counts. CONCLUSION We observed poorer asthma control in obese asthmatics despite similar bronchial inflammation. Managing obese asthmatics according to ACQ alone seems to underestimate asthma control and the contribution of restriction to dyspnea. Increasing the dose of ICS in the absence of sputum eosinophilic inflammation or in the presence of restriction or bronchial neutrophilia led to poorer asthma control. In those patients, management of obesity should be the first choice.
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Affiliation(s)
- S Peerboom
- Department of Pulmonary Medicine, CHU Sart-Tilman, Liege, I(3) GIGA Research Group, University of Liege, Belgium
| | - S Graff
- Department of Pulmonary Medicine, CHU Sart-Tilman, Liege, I(3) GIGA Research Group, University of Liege, Belgium
| | - L Seidel
- Medical Informatics and Biostatistics, University of Liege, Belgium
| | - V Paulus
- Department of Pulmonary Medicine, CHU Sart-Tilman, Liege, I(3) GIGA Research Group, University of Liege, Belgium
| | - M Henket
- Department of Pulmonary Medicine, CHU Sart-Tilman, Liege, I(3) GIGA Research Group, University of Liege, Belgium
| | - C Sanchez
- Department of Pulmonary Medicine, CHU Sart-Tilman, Liege, I(3) GIGA Research Group, University of Liege, Belgium
| | - F Guissard
- Department of Pulmonary Medicine, CHU Sart-Tilman, Liege, I(3) GIGA Research Group, University of Liege, Belgium
| | - C Moermans
- Department of Pulmonary Medicine, CHU Sart-Tilman, Liege, I(3) GIGA Research Group, University of Liege, Belgium
| | - R Louis
- Department of Pulmonary Medicine, CHU Sart-Tilman, Liege, I(3) GIGA Research Group, University of Liege, Belgium
| | - F Schleich
- Department of Pulmonary Medicine, CHU Sart-Tilman, Liege, I(3) GIGA Research Group, University of Liege, Belgium.
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Bougard N, Nekoee H, Schleich F, Guissard F, Paulus V, Donneau AF, Louis R. Assessment of diagnostic accuracy of lung function indices and FeNO for a positive methacholine challenge. Biochem Pharmacol 2020; 179:113981. [PMID: 32305435 DOI: 10.1016/j.bcp.2020.113981] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 04/14/2020] [Indexed: 01/08/2023]
Abstract
Demonstration of bronchial hyperresponsiveness is a key feature in asthma diagnosis. Methacholine challenge has proved to be a highly sensitive test to diagnose asthma in patients with chronic respiratory symptoms and preserved baseline lung function (FEV1 > 70% pred.) but is time consuming and may sometimes reveal unpleasant to the patient. We conducted a retrospective study on 270 patients recruited from the University Asthma Clinic of Liege. We have compared the values of several lung function indices and fractional exhaled nitric oxide (FeNO) in predicting a provocative methacholine concentration ≤16 mg/ml on a discovery cohort of 129 patients (57 already on ICS) and on a validation cohort of 141 patients (66 already on ICS). In the discovery study (n = 129), 85 patients (66%) had a positive methacholine challenge with PC20M ≤ 16 mg/ml. Those patients had lower baseline % predicted FEV1 (92% vs. 100%; p < 0.01), lower FEV1/FVC ratio (79% vs. 82%; p < 0.05), higher RV/TLC ratio (114% vs. 100%; p < 0,0001), lower SGaw (specific conductance) (0.76 vs. 0.95; p < 0,001) and higher FeNO (29 ppb vs. 19 ppb; p < 0,01). When performing ROC curve the RV/TLC ratio provided the greatest AUC (0.74, p < 0.001), sGAW had intermediate AUC of 0.69 (p < 0.001) while FeNO, FEV1 and FEV1/FVC ratio were modestly predictive (AUC of 0.65 (p < 0.05), 0,67 (p < 0.001) and 0,63 (p < 0.001). These results were confirmed in the validation study (n = 141). Based on a logistic regression analysis, significant variables associated with positive methacholine challenge were FeNO and RV/TLC (% Pred). A combined application of FeNO and RV/TLC (% Pred) for predicting the PC20M had a specificity of 85%, a sensitivity of 59% and an AUC of 0.79. In the validation study, three variables (RV/TLC, FeNO and FEV1) were independently associated with positive methacholine challenge and the combination of these three variables yielded a specificity of 77%, a sensitivity of 39% and an AUC of 0.77. The RV/TLC ratio combined to FeNO may be of interest to predict significant methacholine bronchial hyperresponsiveness.
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Affiliation(s)
- N Bougard
- Pneumology and Public Health Department, University of Liege, CHU Liege, Belgium.
| | - H Nekoee
- Pneumology and Public Health Department, University of Liege, CHU Liege, Belgium
| | - F Schleich
- Pneumology and Public Health Department, University of Liege, CHU Liege, Belgium
| | - F Guissard
- Pneumology and Public Health Department, University of Liege, CHU Liege, Belgium
| | - V Paulus
- Pneumology and Public Health Department, University of Liege, CHU Liege, Belgium
| | - A F Donneau
- Pneumology and Public Health Department, University of Liege, CHU Liege, Belgium
| | - R Louis
- Pneumology and Public Health Department, University of Liege, CHU Liege, Belgium
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Louis R, Bougard N, Guissard F, Paulus V, Henket M, Schleich F. Bronchodilation Test with Inhaled Salbutamol Versus Bronchial Methacholine Challenge to Make an Asthma Diagnosis: Do They Provide the Same Information? THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 8:618-625.e8. [PMID: 31541767 DOI: 10.1016/j.jaip.2019.09.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 08/30/2019] [Accepted: 09/03/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Methacholine bronchial challenge and bronchodilation to salbutamol are key tests in clinical practice to make asthma diagnosis. OBJECTIVE To assess the concordance between the 2 tests and to see whether they actually identify the same population of asthmatics. METHOD We conducted a retrospective study using our asthma clinic database to see how methacholine bronchial challenge compared to bronchodilation to salbutamol in untreated patients with recurrent or chronic symptoms suspicious of asthma. We identified 194 untreated patients with baseline forced expiratory volume in 1 second (FEV1) ≥70% predicted who had both a bronchodilation test with salbutamol and a methacholine bronchial challenge 7 to 14 days apart. A positive bronchial challenge was a provocative concentration of methacholine causing a 20% fall in FEV1 ≤16 mg/mL, whereas a positive bronchodilation test was a reversibility to 400 μg inhaled salbutamol ≥12% from baseline and 200 mL. RESULTS Overall, asthma diagnosis was confirmed in 91% of cases leaving 9% of subjects with double negative tests. Isolated positive methacholine challenge was found in 71% of subjects, double positive tests in 17%, whereas isolated significant bronchodilation to salbutamol was rare (3%). There was no correlation between provocative concentration of methacholine causing a fall in FEV1 of 20% (PC20M) and the magnitude of salbutamol reversibility (P = .10). Baseline FEV1/forced vital capacity ratio inversely correlated with reversibility to salbutamol (P < .001) but not with PC20M (P = .1). No difference was found between the groups regarding demographic and immunoinflammatory features, including the proportion of eosinophilic asthma. CONCLUSION We conclude that methacholine challenge outperforms reversibility to salbutamol to diagnose asthma without selecting patients with distinct inflammatory profile. Baseline airway obstruction predicts magnitude of reversibility but not hyperresponsiveness.
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Affiliation(s)
- Renaud Louis
- Department of Pneumology, CHU Liege, GIGA I(3) Research Group, University of Liege, Liege, Belgium.
| | - Nicolas Bougard
- Department of Pneumology, CHU Liege, GIGA I(3) Research Group, University of Liege, Liege, Belgium
| | - Françoise Guissard
- Department of Pneumology, CHU Liege, GIGA I(3) Research Group, University of Liege, Liege, Belgium
| | - Virginie Paulus
- Department of Pneumology, CHU Liege, GIGA I(3) Research Group, University of Liege, Liege, Belgium
| | - Monique Henket
- Department of Pneumology, CHU Liege, GIGA I(3) Research Group, University of Liege, Liege, Belgium
| | - Florence Schleich
- Department of Pneumology, CHU Liege, GIGA I(3) Research Group, University of Liege, Liege, Belgium
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Garcia-Marcos L, Edwards J, Kennington E, Aurora P, Baraldi E, Carraro S, Gappa M, Louis R, Moreno-Galdo A, Peroni DG, Pijnenburg M, Priftis KN, Sanchez-Solis M, Schuster A, Walker S. Priorities for future research into asthma diagnostic tools: A PAN-EU consensus exercise from the European asthma research innovation partnership (EARIP). Clin Exp Allergy 2019; 48:104-120. [PMID: 29290104 DOI: 10.1111/cea.13080] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The diagnosis of asthma is currently based on clinical history, physical examination and lung function, and to date, there are no accurate objective tests either to confirm the diagnosis or to discriminate between different types of asthma. This consensus exercise reviews the state of the art in asthma diagnosis to identify opportunities for future investment based on the likelihood of their successful development, potential for widespread adoption and their perceived impact on asthma patients. Using a two-stage e-Delphi process and a summarizing workshop, a group of European asthma experts including health professionals, researchers, people with asthma and industry representatives ranked the potential impact of research investment in each technique or tool for asthma diagnosis and monitoring. After a systematic review of the literature, 21 statements were extracted and were subject of the two-stage Delphi process. Eleven statements were scored 3 or more and were further discussed and ranked in a face-to-face workshop. The three most important diagnostic/predictive tools ranked were as follows: "New biological markers of asthma (eg genomics, proteomics and metabolomics) as a tool for diagnosis and/or monitoring," "Prediction of future asthma in preschool children with reasonable accuracy" and "Tools to measure volatile organic compounds (VOCs) in exhaled breath."
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Affiliation(s)
- L Garcia-Marcos
- Respiratory and Allergy Units, Arrixaca University Children's Hospital, University of Murcia & IMIB Research Institute, Murcia, Spain
| | | | | | - P Aurora
- Department of Paediatric Respiratory Medicine, Great Ormond Street Hospital for Children, London, UK.,Department of Respiratory, Critical Care and Anaesthesia Unit, University College London (UCL) Great Ormond Street Institute of Child Health, London, UK
| | - E Baraldi
- Women's and Children's Health Department, University of Padua, Padova, Italy
| | - S Carraro
- Women's and Children's Health Department, University of Padua, Padova, Italy
| | - M Gappa
- Children's Hospital & Research Institute, Marienhospital Wesel, Wesel, Germany
| | - R Louis
- Department of Respiratory Medicine, University of Liege, Liege, Belgium
| | - A Moreno-Galdo
- Paediatric Pulmonology Unit, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - D G Peroni
- Department of Clinical and Experimental Medicine, Section of Paediatrics, University of Pisa, Pisa, Italy
| | - M Pijnenburg
- Paediatrics/Paediatric Respiratory Medicine, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - K N Priftis
- Department of Paediatrics, Athens University Medical School, Attikon General Hospital, Athens, Greece
| | - M Sanchez-Solis
- Respiratory and Allergy Units, Arrixaca University Children's Hospital, University of Murcia & IMIB Research Institute, Murcia, Spain
| | - A Schuster
- Department of Paediatrics, University Hospital, Düsseldorf, Germany
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Demarche SF, Schleich FN, Henket MA, Paulus VA, Van Hees TJ, Louis RE. Effectiveness of inhaled corticosteroids in real life on clinical outcomes, sputum cells and systemic inflammation in asthmatics: a retrospective cohort study in a secondary care centre. BMJ Open 2017; 7:e018186. [PMID: 29183929 PMCID: PMC5719334 DOI: 10.1136/bmjopen-2017-018186] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES The impact of inhaled corticosteroids (ICS) on eosinophilic inflammation in asthma is well established, but their effect in a real-life setting has not been extensively studied. Our purpose was to investigate the effect of ICS on airway and systemic inflammation as well as on clinical outcomes in patients with asthma from clinical practice. DESIGN, SETTING AND PARTICIPANTS We conducted a retrospective analysis on asthmatics from a secondary care centre in whom ICS were initiated/increased (n=101), stopped/decreased (n=60) or remained stable (n=63, used as a control group) between two visits with available sputum and blood cell counts. RESULTS The median time between both visits ranged from 1 to 2 years. Initiating or increasing ICS (median variation (IQR): 800 (400-1200) µg beclomethasone equivalent dose per day) reduced sputum eosinophils and fractional exhaled nitric oxide (P<0.0001) and to a lesser extent blood eosinophils (P<0.0001), while withdrawing or decreasing ICS (median variation (IQR): 900 (500-1200) µg beclomethasone equivalentdose per day) resulted in increased sputum eosinophils (P=0.008). No change was found in patients with a stable dose. The effectiveness of ICS in improving asthma control, quality of life, forced expiratory volume in 1 s (FEV1), bronchial hyper-responsiveness and exacerbation rate was only observed in the eosinophilic phenotype (sputum eosinophils ≥3%, n=79). In non-eosinophilic asthmatics, stepping-down ICS resulted in an improvement in asthma control and quality of life, without any significant change in FEV1 (n=38). CONCLUSIONS Our results confirm the effectiveness of ICS on eosinophilic inflammation in real life and demonstrate that their clinical benefit seems to be restricted to eosinophilic asthmatics. Our data also support a try for stepping-down ICS in non-eosinophilic asthmatics.
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Affiliation(s)
- Sophie F Demarche
- Department of Respiratory Medicine, CHU Liege, GIGA I³ Research Group, University of Liege, Liège, Belgium
- Department of Clinical Pharmacy, Center for Interdisciplinary Research on Medicines (CIRM), University of Liege, Liege, Belgium
| | - Florence N Schleich
- Department of Respiratory Medicine, CHU Liege, GIGA I³ Research Group, University of Liege, Liège, Belgium
| | - Monique A Henket
- Department of Respiratory Medicine, CHU Liege, GIGA I³ Research Group, University of Liege, Liège, Belgium
| | - Virginie A Paulus
- Department of Respiratory Medicine, CHU Liege, GIGA I³ Research Group, University of Liege, Liège, Belgium
| | - Thierry J Van Hees
- Department of Clinical Pharmacy, Center for Interdisciplinary Research on Medicines (CIRM), University of Liege, Liege, Belgium
| | - Renaud E Louis
- Department of Respiratory Medicine, CHU Liege, GIGA I³ Research Group, University of Liege, Liège, Belgium
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22
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Airway hyperresponsiveness and chronic obstructive pulmonary disease outcomes. J Allergy Clin Immunol 2016; 138:1580-1581. [PMID: 27516214 DOI: 10.1016/j.jaci.2016.06.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 06/24/2016] [Indexed: 11/20/2022]
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Zissler UM, Esser-von Bieren J, Jakwerth CA, Chaker AM, Schmidt-Weber CB. Current and future biomarkers in allergic asthma. Allergy 2016; 71:475-94. [PMID: 26706728 DOI: 10.1111/all.12828] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2015] [Indexed: 12/12/2022]
Abstract
Diagnosis early in life, sensitization, asthma endotypes, monitoring of disease and treatment progression are key motivations for the exploration of biomarkers for allergic rhinitis and allergic asthma. The number of genes related to allergic rhinitis and allergic asthma increases steadily; however, prognostic genes have not yet entered clinical application. We hypothesize that the combination of multiple genes may generate biomarkers with prognostic potential. The current review attempts to group more than 161 different potential biomarkers involved in respiratory inflammation to pave the way for future classifiers. The potential biomarkers are categorized into either epithelial or infiltrate-derived or mixed origin, epithelial biomarkers. Furthermore, surface markers were grouped into cell-type-specific categories. The current literature provides multiple biomarkers for potential asthma endotypes that are related to T-cell phenotypes such as Th1, Th2, Th9, Th17, Th22 and Tregs and their lead cytokines. Eosinophilic and neutrophilic asthma endotypes are also classified by epithelium-derived CCL-26 and osteopontin, respectively. There are currently about 20 epithelium-derived biomarkers exclusively derived from epithelium, which are likely to innovate biomarker panels as they are easy to sample. This article systematically reviews and categorizes genes and collects current evidence that may promote these biomarkers to become part of allergic rhinitis or allergic asthma classifiers with high prognostic value.
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Affiliation(s)
- U. M. Zissler
- Center of Allergy & Environment (ZAUM); Technical University of Munich and Helmholtz Center Munich; German Research Center for Environmental Health member of the German Center for Lung Research (DZL); Munich Germany
| | - J. Esser-von Bieren
- Center of Allergy & Environment (ZAUM); Technical University of Munich and Helmholtz Center Munich; German Research Center for Environmental Health member of the German Center for Lung Research (DZL); Munich Germany
| | - C. A. Jakwerth
- Center of Allergy & Environment (ZAUM); Technical University of Munich and Helmholtz Center Munich; German Research Center for Environmental Health member of the German Center for Lung Research (DZL); Munich Germany
| | - A. M. Chaker
- Center of Allergy & Environment (ZAUM); Technical University of Munich and Helmholtz Center Munich; German Research Center for Environmental Health member of the German Center for Lung Research (DZL); Munich Germany
- Department of Otorhinolaryngology and Head and Neck Surgery; Medical School; Technical University of Munich; Munich Germany
| | - C. B. Schmidt-Weber
- Center of Allergy & Environment (ZAUM); Technical University of Munich and Helmholtz Center Munich; German Research Center for Environmental Health member of the German Center for Lung Research (DZL); Munich Germany
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24
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Abstract
PURPOSE OF REVIEW Severe asthma is a heterogeneous syndrome. Classification of asthma into phenotypes and endotypes can improve understanding and treatment of the disease. Identification and utilization of biomarkers, particularly those linked to T2 inflammation, can help group patients into phenotypes, predict those who will respond to a specific therapy, and assess the response to treatment. RECENT FINDINGS Biomarkers are present in sputum, exhaled breath, and blood of patients with asthma. These include sputum eosinophils and neutrophils, fractional excretion of nitric oxide, blood eosinophilia, IgE, and periostin. Many of these biomarkers are associated with eosinophilic inflammation propagated mainly by T2 cytokines such as IL-5 and IL-13, which are released from Th2 cells and Type 2 innate lymphoid cells. Biomarkers have been utilized in recent trials of novel biologic agents targeted at T2 inflammation and may contribute to the defining population who would respond to these therapies. SUMMARY Despite advances in the identification and utilization of asthma biomarkers, further studies are needed to better clarify the role of biomarkers, individually or in combination, in the diagnosis and treatment of severe asthma. Future therapeutic trials should include the use of biomarkers in their design, which may lead to a more personalized approach to therapy and improved outcomes.
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25
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Dombret MC, Alagha K, Boulet LP, Brillet PY, Joos G, Laviolette M, Louis R, Rochat T, Soccal P, Aubier M, Chanez P. Bronchial thermoplasty: a new therapeutic option for the treatment of severe, uncontrolled asthma in adults. Eur Respir Rev 2015; 23:510-8. [PMID: 25445950 DOI: 10.1183/09059180.00005114] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Bronchial thermoplasty is a young yet promising treatment for severe asthma whose benefit for long-term asthma control outweighs the short-term risk of deterioration and hospitalisation in the days following the treatment. It is an innovative treatment whose clinical efficacy and safety are beginning to be better understood. Since this is a device-based therapy, the overall evaluation of risk-benefit is unlike that of pharmaceutical products; safety aspects, regulatory requirements, study design and effect size assessment may be unfamiliar. The mechanisms of action and optimal patient selection need to be addressed in further rigorous clinical and scientific studies. Bronchial thermoplasty fits in perfectly with the movement to expand personalised medicine in the field of chronic airway disorders. This is a device-based complimentary asthma treatment that must be supported and developed in order to meet the unmet needs of modern severe asthma management. The mechanisms of action and the type of patients that benefit from bronchial thermoplasty are the most important challenges for bronchial thermoplasty in the future.
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Affiliation(s)
- Marie-Christine Dombret
- Dept of Respiratory Medicine, Bichat APHP, U700 INSERM University Hospitals Dept, Diderot University, Paris, France Dept of Respiratory Medicine, APHM, INSERM U1067 CNRS UMR 7333, Aix Marseille University, Marseille, FranceResearch Centre at the Institute of Cardiology and Respiratory Medicine, Laval University, Quebec, QC, CanadaDept of Radiology, Avicenne Public Hospital, Bobigny, France Dept of Respiratory Medicine, Ghent University Hospital, Ghent University, Ghent, BelgiumDept of Respiratory Medicine, Liege University Hospital, GIGAI3 Research Group, University of Liège, Liège, BelgiumDept of Respiratory Medicine, HUG Geneva, SwitzerlandBoth authors contributed equally Dept of Respiratory Medicine, Bichat APHP, U700 INSERM University Hospitals Dept, Diderot University, Paris, France Dept of Respiratory Medicine, APHM, INSERM U1067 CNRS UMR 7333, Aix Marseille University, Marseille, FranceResearch Centre at the Institute of Cardiology and Respiratory Medicine, Laval University, Quebec, QC, CanadaDept of Radiology, Avicenne Public Hospital, Bobigny, France Dept of Respiratory Medicine, Ghent University Hospital, Ghent University, Ghent, BelgiumDept of Respiratory Medicine, Liege University Hospital, GIGAI3 Research Group, University of Liège, Liège, BelgiumDept of Respiratory Medicine, HUG Geneva, SwitzerlandBoth authors contributed equally
| | - Khuder Alagha
- Dept of Respiratory Medicine, Bichat APHP, U700 INSERM University Hospitals Dept, Diderot University, Paris, France Dept of Respiratory Medicine, APHM, INSERM U1067 CNRS UMR 7333, Aix Marseille University, Marseille, FranceResearch Centre at the Institute of Cardiology and Respiratory Medicine, Laval University, Quebec, QC, CanadaDept of Radiology, Avicenne Public Hospital, Bobigny, France Dept of Respiratory Medicine, Ghent University Hospital, Ghent University, Ghent, BelgiumDept of Respiratory Medicine, Liege University Hospital, GIGAI3 Research Group, University of Liège, Liège, BelgiumDept of Respiratory Medicine, HUG Geneva, SwitzerlandBoth authors contributed equally Dept of Respiratory Medicine, Bichat APHP, U700 INSERM University Hospitals Dept, Diderot University, Paris, France Dept of Respiratory Medicine, APHM, INSERM U1067 CNRS UMR 7333, Aix Marseille University, Marseille, FranceResearch Centre at the Institute of Cardiology and Respiratory Medicine, Laval University, Quebec, QC, CanadaDept of Radiology, Avicenne Public Hospital, Bobigny, France Dept of Respiratory Medicine, Ghent University Hospital, Ghent University, Ghent, BelgiumDept of Respiratory Medicine, Liege University Hospital, GIGAI3 Research Group, University of Liège, Liège, BelgiumDept of Respiratory Medicine, HUG Geneva, SwitzerlandBoth authors contributed equally
| | - Louis Philippe Boulet
- Dept of Respiratory Medicine, Bichat APHP, U700 INSERM University Hospitals Dept, Diderot University, Paris, France Dept of Respiratory Medicine, APHM, INSERM U1067 CNRS UMR 7333, Aix Marseille University, Marseille, FranceResearch Centre at the Institute of Cardiology and Respiratory Medicine, Laval University, Quebec, QC, CanadaDept of Radiology, Avicenne Public Hospital, Bobigny, France Dept of Respiratory Medicine, Ghent University Hospital, Ghent University, Ghent, BelgiumDept of Respiratory Medicine, Liege University Hospital, GIGAI3 Research Group, University of Liège, Liège, BelgiumDept of Respiratory Medicine, HUG Geneva, SwitzerlandBoth authors contributed equally
| | - Pierre Yves Brillet
- Dept of Respiratory Medicine, Bichat APHP, U700 INSERM University Hospitals Dept, Diderot University, Paris, France Dept of Respiratory Medicine, APHM, INSERM U1067 CNRS UMR 7333, Aix Marseille University, Marseille, FranceResearch Centre at the Institute of Cardiology and Respiratory Medicine, Laval University, Quebec, QC, CanadaDept of Radiology, Avicenne Public Hospital, Bobigny, France Dept of Respiratory Medicine, Ghent University Hospital, Ghent University, Ghent, BelgiumDept of Respiratory Medicine, Liege University Hospital, GIGAI3 Research Group, University of Liège, Liège, BelgiumDept of Respiratory Medicine, HUG Geneva, SwitzerlandBoth authors contributed equally
| | - Guy Joos
- Dept of Respiratory Medicine, Bichat APHP, U700 INSERM University Hospitals Dept, Diderot University, Paris, France Dept of Respiratory Medicine, APHM, INSERM U1067 CNRS UMR 7333, Aix Marseille University, Marseille, FranceResearch Centre at the Institute of Cardiology and Respiratory Medicine, Laval University, Quebec, QC, CanadaDept of Radiology, Avicenne Public Hospital, Bobigny, France Dept of Respiratory Medicine, Ghent University Hospital, Ghent University, Ghent, BelgiumDept of Respiratory Medicine, Liege University Hospital, GIGAI3 Research Group, University of Liège, Liège, BelgiumDept of Respiratory Medicine, HUG Geneva, SwitzerlandBoth authors contributed equally
| | - Michel Laviolette
- Dept of Respiratory Medicine, Bichat APHP, U700 INSERM University Hospitals Dept, Diderot University, Paris, France Dept of Respiratory Medicine, APHM, INSERM U1067 CNRS UMR 7333, Aix Marseille University, Marseille, FranceResearch Centre at the Institute of Cardiology and Respiratory Medicine, Laval University, Quebec, QC, CanadaDept of Radiology, Avicenne Public Hospital, Bobigny, France Dept of Respiratory Medicine, Ghent University Hospital, Ghent University, Ghent, BelgiumDept of Respiratory Medicine, Liege University Hospital, GIGAI3 Research Group, University of Liège, Liège, BelgiumDept of Respiratory Medicine, HUG Geneva, SwitzerlandBoth authors contributed equally
| | - Renaud Louis
- Dept of Respiratory Medicine, Bichat APHP, U700 INSERM University Hospitals Dept, Diderot University, Paris, France Dept of Respiratory Medicine, APHM, INSERM U1067 CNRS UMR 7333, Aix Marseille University, Marseille, FranceResearch Centre at the Institute of Cardiology and Respiratory Medicine, Laval University, Quebec, QC, CanadaDept of Radiology, Avicenne Public Hospital, Bobigny, France Dept of Respiratory Medicine, Ghent University Hospital, Ghent University, Ghent, BelgiumDept of Respiratory Medicine, Liege University Hospital, GIGAI3 Research Group, University of Liège, Liège, BelgiumDept of Respiratory Medicine, HUG Geneva, SwitzerlandBoth authors contributed equally
| | - Thierry Rochat
- Dept of Respiratory Medicine, Bichat APHP, U700 INSERM University Hospitals Dept, Diderot University, Paris, France Dept of Respiratory Medicine, APHM, INSERM U1067 CNRS UMR 7333, Aix Marseille University, Marseille, FranceResearch Centre at the Institute of Cardiology and Respiratory Medicine, Laval University, Quebec, QC, CanadaDept of Radiology, Avicenne Public Hospital, Bobigny, France Dept of Respiratory Medicine, Ghent University Hospital, Ghent University, Ghent, BelgiumDept of Respiratory Medicine, Liege University Hospital, GIGAI3 Research Group, University of Liège, Liège, BelgiumDept of Respiratory Medicine, HUG Geneva, SwitzerlandBoth authors contributed equally
| | - Paola Soccal
- Dept of Respiratory Medicine, Bichat APHP, U700 INSERM University Hospitals Dept, Diderot University, Paris, France Dept of Respiratory Medicine, APHM, INSERM U1067 CNRS UMR 7333, Aix Marseille University, Marseille, FranceResearch Centre at the Institute of Cardiology and Respiratory Medicine, Laval University, Quebec, QC, CanadaDept of Radiology, Avicenne Public Hospital, Bobigny, France Dept of Respiratory Medicine, Ghent University Hospital, Ghent University, Ghent, BelgiumDept of Respiratory Medicine, Liege University Hospital, GIGAI3 Research Group, University of Liège, Liège, BelgiumDept of Respiratory Medicine, HUG Geneva, SwitzerlandBoth authors contributed equally
| | - Michel Aubier
- Dept of Respiratory Medicine, Bichat APHP, U700 INSERM University Hospitals Dept, Diderot University, Paris, France Dept of Respiratory Medicine, APHM, INSERM U1067 CNRS UMR 7333, Aix Marseille University, Marseille, FranceResearch Centre at the Institute of Cardiology and Respiratory Medicine, Laval University, Quebec, QC, CanadaDept of Radiology, Avicenne Public Hospital, Bobigny, France Dept of Respiratory Medicine, Ghent University Hospital, Ghent University, Ghent, BelgiumDept of Respiratory Medicine, Liege University Hospital, GIGAI3 Research Group, University of Liège, Liège, BelgiumDept of Respiratory Medicine, HUG Geneva, SwitzerlandBoth authors contributed equally
| | - Pascal Chanez
- Dept of Respiratory Medicine, Bichat APHP, U700 INSERM University Hospitals Dept, Diderot University, Paris, France Dept of Respiratory Medicine, APHM, INSERM U1067 CNRS UMR 7333, Aix Marseille University, Marseille, FranceResearch Centre at the Institute of Cardiology and Respiratory Medicine, Laval University, Quebec, QC, CanadaDept of Radiology, Avicenne Public Hospital, Bobigny, France Dept of Respiratory Medicine, Ghent University Hospital, Ghent University, Ghent, BelgiumDept of Respiratory Medicine, Liege University Hospital, GIGAI3 Research Group, University of Liège, Liège, BelgiumDept of Respiratory Medicine, HUG Geneva, SwitzerlandBoth authors contributed equally
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26
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Schleich FN, Louis R. Importance of concomitant local and systemic eosinophilia in uncontrolled asthma. Eur Respir J 2015; 44:1098-9. [PMID: 25271232 DOI: 10.1183/09031936.00118014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Florence N Schleich
- Dept of Pulmonary Medicine, CHU Sart-Tilman, Liege, IGIGA Research Group, University of Liege, Liege, Belgium
| | - Renaud Louis
- Dept of Pulmonary Medicine, CHU Sart-Tilman, Liege, IGIGA Research Group, University of Liege, Liege, Belgium
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27
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Giahi O, Ebrahemzadih M, Khoubi J. Could Sputum Eosinophilia Act as a Predictive Test for Diagnosis of High Risk Bakery Workers to Asthma? Health (London) 2015. [DOI: 10.4236/health.2015.71015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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28
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Chanez P, Boulet LP, Brillet PY, Joos G, Laviolette M, Louis R, Rochat T, Soccal P, Aubier M. [Bronchial thermoplasty in the treatment of severe adult asthma]. Rev Mal Respir 2014; 32:97-109. [PMID: 25534552 DOI: 10.1016/j.rmr.2014.09.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 09/30/2014] [Indexed: 10/24/2022]
Abstract
Bronchial thermoplasty is a recent endoscopic technique for the treatment of severe asthma. It is an innovative treatment whose clinical efficacy and safety are beginning to be better understood. Since this is a device-based treatment, the evaluation procedure of risks and benefits is different that for pharmaceutical products; safety aspects, regulatory requirements, study design and the assessment of the magnitude of effects may all be different. The mechanism of action and optimal patient selection need to be assessed further in rigorous clinical and scientific studies. This technique is in harmony with the development of personalised medicine in the 21st century. It should be developed further in response to the numerous challenges and needs not yet met in the management of severe asthma.
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Affiliation(s)
- P Chanez
- Inserm U1067 CNRS UMR 7333, service de pneumologie, AP-HM, Aix Marseille université, chemin des Bourrely, 13015 Marseille, France.
| | - L-P Boulet
- Centre de recherche, institut de cardiologie et de pneumologie de l'université Laval Québec, Québec, Canada
| | - P-Y Brillet
- Département de radiologie, AP-HP Avicenne, 93000 Bobigny, France
| | - G Joos
- Département de pneumologie, CHU de Gand, université de Gand, Gand, Belgique
| | - M Laviolette
- Centre de recherche, institut de cardiologie et de pneumologie de l'université Laval Québec, Québec, Canada
| | - R Louis
- Département de pneumologie, CHU de Liège, GIGAI3 groupe de recherche, université de Liège, Liège, Belgique
| | - T Rochat
- Département de pneumologie, hôpitaux universitaires de Genève, Genève, Suisse
| | - P Soccal
- Département de pneumologie, hôpitaux universitaires de Genève, Genève, Suisse
| | - M Aubier
- U700 Inserm DHU, service de pneumologie, AP-HP Bichat, université Diderot Paris, 75018 Paris, France
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29
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Heterogeneity of phenotypes in severe asthmatics. The Belgian Severe Asthma Registry (BSAR). Respir Med 2014; 108:1723-32. [PMID: 25456708 DOI: 10.1016/j.rmed.2014.10.007] [Citation(s) in RCA: 179] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 10/09/2014] [Accepted: 10/17/2014] [Indexed: 11/20/2022]
Abstract
UNLABELLED The Belgian severe asthma registry is a web-based registry encompassing demographic, clinical, functional and inflammatory data of severe asthmatics (SA), aiming at improving awareness, knowledge on its natural history and subphenotypes, and offering tools to optimize care of this asthma population. METHODS The cross-sectional analyses of this registry included 350 SA as defined by the ATS (2000) from 9 Belgian centres, with at least one year follow up. RESULTS Mean age was 55 ± 14 yrs. SA were more frequently female (57%) and atopic (70%). Late-onset asthma (≥40 yr) was observed in 31% of SA. Current smokers represented 12% while 31% were ex-smokers. In addition to high doses ICS + LABA, 65% of patients were receiving LTRA, 27% anti-IgE and 24% maintenance oral corticosteroids (8 mg (Interquartile range-IQR:4-8) methylprednisolone). Despite impaired airflow (median FEV1:67%; IQR: 52-81) only 65% had a post-bronchodilator FEV1/FVC ratio <70%. The median blood eosinophil count was 240/mm³. The median FENO was 26 ppb (IQR: 15-43) and 22% of SA had FENO ≥ 50 ppb. Induced sputum was successful in 86 patients. Eosinophilic asthma (sputum Eos ≥ 3%) was the predominant phenotype (55%) while neutrophilic (sputum Neu ≥ 76%) and paucigranulocytic asthma accounted for 22% and 17% respectively. Comorbidities included rhinitis and chronic rhinosinusitis (49%), nasal polyposis (19%), oesophageal reflux (36%), overweight and obesity (47%) and depression (19%). In addition, 8% had aspirin-induced asthma and 3% ABPA. Asthma was not well-controlled in 83% according to ACT < 20 and 77% with ACQ > 1.5. CONCLUSION In this cohort of patients with severe asthma, the majority displayed indices of persistent airflow limitation and eosinophilic inflammation despite high-dose corticosteroids, suggesting potential for eosinophil-targeted biotherapies.
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30
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Zhang J, Wang X, Chen Y, Yao W. Correlation between levels of exhaled hydrogen sulfide and airway inflammatory phenotype in patients with chronic persistent asthma. Respirology 2014; 19:1165-9. [PMID: 25168466 DOI: 10.1111/resp.12372] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 06/04/2014] [Accepted: 06/05/2014] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND OBJECTIVE Endogenous hydrogen sulfide (H2 S) may be a biomarker of asthma severity and activity. However, the relationship between exhaled H2 S and airway inflammation phenotypes in asthma remains unclear. This study examined associations between endogenous H2 S and chronic airway inflammatory phenotypes in patients with chronic persistent asthma. METHODS One hundred forty-eight patients (47 males, 101 females, 47.4 ± 15.3 years old) with chronic persistent asthma were enrolled. Induced sputum cells were examined, and patients were grouped according to sputum inflammatory cell composition. Baseline demographics, Asthma Control Test (ACT) scores, spirometry data and H₂S levels in exhaled air and plasma were obtained for all patients. RESULTS The eosinophilic, neutrophilic, mixed granulocytic and paucigranulocytic inflammation groups included 57 (38.5%), 28 (18.9%), 23 (15.5%) and 40 (27%) subjects, respectively. The paucigranulocytic group had the best lung function, and patients with eosinophilic inflammation had lower ACT scores than patients with paucigranulocytic findings. In the eosinophilic group, lower exhaled H₂S were found and exhaled H2 S levels were negatively correlated with sputum eosinophil counts (R = -0.428, P < 0.01). Exhaled H2 S levels were positively correlated with percent of predicted forced expiratory volume in 1 s (R = 0.567, P < 0.01) and ACT score (R = 0.519, P < 0.01). CONCLUSIONS Exhaled H2 S may be a useful marker of airway inflammation in asthma.
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Affiliation(s)
- Jing Zhang
- Department of Respiratory Diseases, Peking University Third Hospital, Beijing, China
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Functional proteomics for the characterization of impaired cellular responses to glucocorticoids in asthma. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2014; 795:255-70. [PMID: 24162914 DOI: 10.1007/978-1-4614-8603-9_16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
In chronic airway inflammatory disorders, such as asthma, glucocorticoid (GC) insensitivity is a challenging clinical problem associated with life-threatening disease progression and the potential development of serious side effects. The mechanism of steroid resistance in asthma remains unclear and may be multifactorial. Excluding noncompliance with GC treatment, abnormal steroid pharmacokinetics, and rare genetic defects in the glucocorticoid receptor (GR), the majority of GC insensitivity in asthma can be attributed to secondary defects related to GR function. Airway inflammatory cells obtained from patients with GC-resistant asthma show a number of abnormalities in cell immune responses to GC, which suggests that there is a causative defect in GR signaling in GC-resistant cells that could be further elucidated by a functional and molecular proteomics approach. Since T cells, eosinophils, and monocytes play a major role in the pathogenesis of airway inflammation, most of the work published to date has focused on these cell types as the primary therapeutic targets in GC-insensitive asthma. We herein review several distinct techniques for the assessment of (1) the cellular response to GCs including the effect of GCs on cell viability, adhesion, and mediator release; (2) the functionality of GC receptors, including phosphorylation of the GR, nuclear translocation, and binding activities; and (3) the characterization of proteins differentially expressed in steroid-resistant cells by comparative 2DE-gel electrophoresis-based techniques and mass spectrometry. These comprehensive approaches are expected to reveal novel candidates for biomarkers of steroid insensitivity, which may lead to the development of effective therapeutic interventions for patients with chronic steroid-resistant asthma.
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Fatemi F, Sadroddiny E, Gheibi A, Mohammadi Farsani T, Kardar GA. Biomolecular markers in assessment and treatment of asthma. Respirology 2014; 19:514-23. [DOI: 10.1111/resp.12284] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 11/14/2013] [Accepted: 01/15/2014] [Indexed: 12/20/2022]
Affiliation(s)
- Farnaz Fatemi
- Department of Medical Biotechnology; School of Advanced Technologies in Medicine; Tehran University of Medical Sciences; Tehran Iran
| | - Esmaeil Sadroddiny
- Department of Medical Biotechnology; School of Advanced Technologies in Medicine; Tehran University of Medical Sciences; Tehran Iran
| | - Azam Gheibi
- Department of Medical Biotechnology; School of Advanced Technologies in Medicine; Tehran University of Medical Sciences; Tehran Iran
| | - Taiebeh Mohammadi Farsani
- Department of Medical Biotechnology; School of Advanced Technologies in Medicine; Tehran University of Medical Sciences; Tehran Iran
| | - Gholam Ali Kardar
- Department of Medical Biotechnology; School of Advanced Technologies in Medicine; Tehran University of Medical Sciences; Tehran Iran
- Immunology, Asthma and Allergy Research Institute; Children's Medical Center Hospital; Tehran University of Medical Sciences; Tehran Iran
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The role of inflammation resolution speed in airway smooth muscle mass accumulation in asthma: insight from a theoretical model. PLoS One 2014; 9:e90162. [PMID: 24632688 PMCID: PMC3954558 DOI: 10.1371/journal.pone.0090162] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 01/27/2014] [Indexed: 12/20/2022] Open
Abstract
Despite a large amount of in vitro data, the dynamics of airway smooth muscle (ASM) mass increase in the airways of patients with asthma is not well understood. Here, we present a novel mathematical model that describes qualitatively the growth dynamics of ASM cells over short and long terms in the normal and inflammatory environments typically observed in asthma. The degree of ASM accumulation can be explained by an increase in the rate at which ASM cells switch between non-proliferative and proliferative states, driven by episodic inflammatory events. Our model explores the idea that remodelling due to ASM hyperplasia increases with the frequency and magnitude of these inflammatory events, relative to certain sensitivity thresholds. It highlights the importance of inflammation resolution speed by showing that when resolution is slow, even a series of small exacerbation events can result in significant remodelling, which persists after the inflammatory episodes. In addition, we demonstrate how the uncertainty in long-term outcome may be quantified and used to design an optimal low-risk individual anti-proliferative treatment strategy. The model shows that the rate of clearance of ASM proliferation and recruitment factors after an acute inflammatory event is a potentially important, and hitherto unrecognised, target for anti-remodelling therapy in asthma. It also suggests new ways of quantifying inflammation severity that could improve prediction of the extent of ASM accumulation. This ASM growth model should prove useful for designing new experiments or as a building block of more detailed multi-cellular tissue-level models.
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Sol IS, Kim YH, Lee HS, Kim MJ, Han YK, Park YA, Kim KW, Sohn MH, Kim KE. Heterogeneity of asthma according to systemic inflammatory pattern in children. ALLERGY ASTHMA & RESPIRATORY DISEASE 2014. [DOI: 10.4168/aard.2014.2.3.165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- In Suk Sol
- Department of Pediatrics, Institute of Allergy, Severance Biomedical Science Institute, Brain Korea 2 1 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Yoon Hee Kim
- Department of Pediatrics, Institute of Allergy, Severance Biomedical Science Institute, Brain Korea 2 1 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Hee Seon Lee
- Department of Pediatrics, Institute of Allergy, Severance Biomedical Science Institute, Brain Korea 2 1 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Min Jung Kim
- Department of Pediatrics, Institute of Allergy, Severance Biomedical Science Institute, Brain Korea 2 1 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Yoon Ki Han
- Department of Pediatrics, Institute of Allergy, Severance Biomedical Science Institute, Brain Korea 2 1 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Young A Park
- Department of Pediatrics, Institute of Allergy, Severance Biomedical Science Institute, Brain Korea 2 1 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Won Kim
- Department of Pediatrics, Institute of Allergy, Severance Biomedical Science Institute, Brain Korea 2 1 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Myung Hyun Sohn
- Department of Pediatrics, Institute of Allergy, Severance Biomedical Science Institute, Brain Korea 2 1 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Kyu-Earn Kim
- Department of Pediatrics, Institute of Allergy, Severance Biomedical Science Institute, Brain Korea 2 1 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
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Valent P, Klion AD, Rosenwasser LJ, Arock M, Bochner BS, Butterfield JH, Gotlib J, Haferlach T, Hellmann A, Horny HP, Leiferman KM, Metzgeroth G, Matsumoto K, Reiter A, Roufosse F, Rothenberg ME, Simon HU, Sotlar K, Vandenberghe P, Weller PF, Gleich GJ. ICON: Eosinophil Disorders. World Allergy Organ J 2013; 5:174-81. [PMID: 23282419 PMCID: PMC3651188 DOI: 10.1097/wox.0b013e31827f4192] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Peter Valent
- 1Department of Medicine I, Division of Hematology & Hemostaseology, Medical University of Vienna, Austria 2Eosinophil Pathology Unit, Laboratory of Parasitic Diseases, NIH/NIAID, Bethesda, MD 3Children's Mercy Hospital, Kansas City, MO 4LBPA CNRS UMR8113, Ecole Normale Supérieure de Cachan, Cachan, France 5Department of Medicine, Division of Allergy and Clinical Immunology, Johns Hopkins University School of Medicine, Baltimore, MD 6Division of Allergic Diseases, Mayo Clinic, Rochester, MN 7Division of Hematology, Stanford Cancer Center, Stanford, CA 8MLL Münchner Leukämielabor, Munich, Germany 9Department of Hematology, Medical University School of Gdansk, Gdańsk, Poland 10Institute of Pathology, Ludwig-Maximilians-University, Munich, Germany 11Department of Dermatology, University of Utah Health Sciences Center, Salt Lake City, UT 12III. Medizinische Klinik, Universitätsmedizin Mannheim, Universität Heidelberg, Mannheim, Germany 13Department of Allergy and Immunology, National Research Institute for Children's Health and Development, Tokyo, Japan 14Department of Internal Medicine, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium 15Division of Allergy and Immunology, Cincinnati Children's Hospital, Medical Center, Cincinnati, OH 16Institute of Pharmacology, University of Bern, Bern, Switzerland 17Center for Human Genetics, University Hospitals Leuven and Katholieke Universiteit Leuven, Leuven, Belgium 18Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 19Department of Medicine, University of Utah Health Sciences Center, Salt Lake City, UT
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Schleich FN, Manise M, Sele J, Henket M, Seidel L, Louis R. Distribution of sputum cellular phenotype in a large asthma cohort: predicting factors for eosinophilic vs neutrophilic inflammation. BMC Pulm Med 2013; 13:11. [PMID: 23442497 PMCID: PMC3657295 DOI: 10.1186/1471-2466-13-11] [Citation(s) in RCA: 179] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Accepted: 02/22/2013] [Indexed: 11/10/2022] Open
Abstract
Background Phenotyping asthma according to airway inflammation allows identification of responders to targeted therapy. Induced sputum is technically demanding. We aimed to identify predictors of sputum inflammatory phenotypes according to easily available clinical characteristics. Methods This retrospective study was conducted in 508 asthmatics with successful sputum induction recruited from the University Asthma Clinic of Liege. Receiver-operating characteristic (ROC) curve and multiple logistic regression analysis were used to assess the relationship between sputum eosinophil or neutrophil count and a set of covariates. Equations predicting sputum eosinophils and neutrophils were then validated in an independent group of asthmatics. Results Eosinophilic (≥3%) and neutrophilic (≥76%) airway inflammation were observed in 46% and 18% of patients respectively. Predictors of sputum eosinophilia ≥3% were high blood eosinophils, FENO and IgE level and low FEV1/FVC. The derived equation was validated with a Cohen’s kappa coefficient of 0.59 (p < 0.0001). ROC curves showed a cut-off value of 220/mm3 (AUC = 0.79, p < 0.0001) or 3% (AUC = 0.81, p < 0.0001) for blood eosinophils to identify sputum eosinophilia ≥3%. Independent predictors of sputum neutrophilia were advanced age and high FRC but not blood neutrophil count. Conclusion Eosinophilic and paucigranulocytic asthma are the dominant inflammatory phenotypes. Blood eosinophils provide a practical alternative to predict sputum eosinophilia but sputum neutrophil count is poorly related to blood neutrophils.
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Affiliation(s)
- Florence N Schleich
- Department of Respiratory Medicine, CHU Sart-Tilman B35, Liege 4000, Belgium.
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Chronic exposure to sulfur dioxide enhances airway hyperresponsiveness only in ovalbumin-sensitized rats. Toxicol Lett 2012; 214:320-7. [PMID: 23010223 DOI: 10.1016/j.toxlet.2012.09.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Revised: 09/12/2012] [Accepted: 09/14/2012] [Indexed: 11/21/2022]
Abstract
Sulfur dioxide (SO(2)) is a common air pollutant that triggers asthmatic symptoms, but its toxicological mechanisms are not fully understood. Specifically, it is unclear how airborne SO(2) affects airway hyperresponsiveness (AHR) - a hallmark feature of asthma. To this end, we investigated the effects of chronic exposure to SO(2) on AHR, airway inflammation, tissue remodeling, cell stiffness (G') and contractility of the airway smooth muscle cell (ASMC). Newborn Sprague-Dawley (SD) rats sensitized to ovalbumin (OVA) was used as the model to mimic asthmatic symptoms. The experimental results show that exposure to SO(2): (1) significantly increased Penh (an indicator of AHR) in the OVA-sensitized rats (p<0.01) but not in the normal rats (p>0.05), which correlated with the increase of airway smooth muscle mass; (2) increased IL-4 production in BALF of both the normal (p<0.05) and OVA-sensitized rats (p<0.001), but decreased IFN-γ in BALF of only the normal rats, and in serum only increased IL-4 production of the OVA-sensitized rats (p<0.001); (3) increased ASMC stiffness (G') and contractility only in the OVA-sensitized rats (p<0.001, p<0.05, respectively). Taken together, these results demonstrate that SO(2) may be a universal airway inflammatory factor, but more importantly, specific to exacerbating AHR in asthmatics only. These findings uncover a potential mechanism of SO(2)-induced health effects and may provide a basis for therapeutic targets.
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Paulissen G, El Hour M, Rocks N, Guéders MM, Bureau F, Foidart JM, Lopez-Otin C, Noel A, Cataldo DD. Control of allergen-induced inflammation and hyperresponsiveness by the metalloproteinase ADAMTS-12. THE JOURNAL OF IMMUNOLOGY 2012; 189:4135-43. [PMID: 22962682 DOI: 10.4049/jimmunol.1103739] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
A disintegrin and metalloproteinase with thrombospondin motifs (ADAMTS) constitute a family of endopeptidases related to matrix metalloproteinases. These proteinases have been largely implicated in tissue remodeling associated with pathological processes. Among them, ADAMTS12 was identified as an asthma-associated gene in a human genome screening program. However, its functional implication in asthma is not yet documented. The present study aims at investigating potential ADAMTS-12 functions in experimental models of allergic airways disease. Two different in vivo protocols of allergen-induced airways disease were applied to the recently generated Adamts12-deficient mice and corresponding wild-type mice. In this study, we provide evidence for a protective effect of ADAMTS-12 against bronchial inflammation and hyperresponsiveness. In the absence of Adamts12, challenge with different allergens (OVA and house dust mite) led to exacerbated eosinophilic inflammation in the bronchoalveolar lavage fluid and in lung tissue, along with airway dysfunction assessed by increased airway responsiveness following methacholine exposure. Furthermore, mast cell counts and ST2 receptor and IL-33 levels were higher in the lungs of allergen-challenged Adamts12-deficient mice. The present study provides, to our knowledge, the first experimental evidence for a contribution of ADAMTS-12 as a key mediator in airways disease, interfering with immunological processes leading to inflammation and airway hyperresponsiveness.
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Affiliation(s)
- Geneviève Paulissen
- Laboratory of Tumor and Developmental Biology, Interdisciplinary Group of Applied Genoproteomics-Cancer (GIGA-Cancer), University of Liège and University Hospital of Liège, 4000 Liège, Belgium
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Schwartz N, Grossman A, Levy Y, Schwarz Y. Correlation between eosinophil count and methacholine challenge test in asymptomatic subjects. J Asthma 2012; 49:336-41. [PMID: 22715867 DOI: 10.3109/02770903.2012.672613] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Methacholine challenge test is used to identify airway hyperresponsiveness (AHR). Total eosinophil counts in peripheral blood reflect asthmatic activity and are useful for early detection of exacerbations. Correlation between the two is poorly defined, particularly in asymptomatic subjects. OBJECTIVE The aim is to define correlation between methacholine challenge test and peripheral blood eosinophilia. METHODS All flight academy candidates evaluated in the Israeli Air Force Aero Medical Center between the years 2010 and 2011 were included. Candidates were referred to methacholine challenge test based on a personal history of asthma or wheezing in childhood, a first-degree relative with the diagnosis of asthma, or an abnormal spirometry. All methacholine tests were analyzed retrospectively. RESULTS Asymptomatic subjects with a positive methacholine challenge test demonstrated significantly (p < .002) higher levels of absolute eosinophil count compared with the group with a negative methacholine test (0.46 ± 0.21 vs. 0.21 ± 0.01 K/μL). Total white blood cell and neutrophil counts were higher in the group with a positive methacholine test compared with the group with a negative methacholine test, but to a lesser extent (7.1 ± 0.25 vs. 6.6 ± 0.09 K/μL, p = .04 and 3.9 ± 0.24 vs. 3.5 ± 0.07 K/μL, p = .04, respectively). No association was demonstrated between eosinophil count and severity of AHR expressed by the methacholine concentration evoking a response. CONCLUSION There is a strong association between eosinophil count and AHR in asymptomatic subjects.
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Affiliation(s)
- Nofrat Schwartz
- Surgeon General Office Headquarters, The Israeli Air Force, Tel Hashomer, Israel.
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Louis R, Schleich F, Barnes PJ. Corticosteroids: still at the frontline in asthma treatment? Clin Chest Med 2012; 33:531-41. [PMID: 22929100 DOI: 10.1016/j.ccm.2012.05.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Inhaled corticosteroids (ICS) have led to improved asthma control and reduced asthma mortality in the Western world. ICS are effective in combating T-helper type 2-driven inflammation featuring mast cell and eosinophilic airway infiltration. Their effect on innate immunity-driven neutrophilic inflammation is poor and their ability to prevent airway remodeling and accelerated lung decline is controversial. Although ICS remain pivotal drugs in asthma management, research is needed to find drugs complementary to the combination ICS/long-acting β2-agonist in refractory asthma and perhaps a new class of drugs as a first-line treatment in mild to moderate noneosinophilic asthma.
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Affiliation(s)
- Renaud Louis
- Deparment of Pneumology, CHU Liege, GIGAI3 Research Group, University of Liege, Liege, Belgium.
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Schleich FN, Asandei R, Manise M, Sele J, Seidel L, Louis R. Is FENO50 useful diagnostic tool in suspected asthma? Int J Clin Pract 2012; 66:158-65. [PMID: 22257040 DOI: 10.1111/j.1742-1241.2011.02840.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Asthma diagnosis is based on the presence of symptoms and the demonstration of airflow variability. Airway inflammation measured by fractional exhaled nitric oxide, measured at a flow rate of 50 ml/s (FE(NO50)) remains a controversial diagnostic tool. AIM To assess the ability of FE(NO50) to identify bronchial hyperresponsiveness (BHR) to methacholine (provocative concentration of methacholine causing a 20% fall in FEV(1); PC20M ≤ 16 mg/ml) and to establish whether or not symptoms relate to FE(NO50) and PC20M in patients with no demonstrated reversibility to β(2) -agonist. METHODS We conducted a prospective study on 174 steroid naive patients with respiratory symptoms, forced expiratory volume in 1 s (FEV(1) ) ≥ 70% predicted and no demonstrated reversibility to β(2) -agonist. Patients answered to a standardised symptom questionnaire and underwent FE(NO50) and methacholine challenge. Receiver-operating characteristic (ROC) curve and logistic regression analysis assessed the relationship between PC20M and FE(NO50) , taking into account covariates (smoking, atopy, age, gender and FEV(1)). RESULTS A total of 82 patients had a PC20M ≤ 16 mg/ml and had significantly higher FE(NO50) (19 ppb vs. 15 ppb; p < 0.05). By constructing ROC curve, we found that FE(NO50) cut-off value of 34 ppb was able to identify not only BHR with high specificity (95%) and positive predictive value (88%) but low sensitivity (35%) and negative predictive value (62%). When combining all variables into the logistic model, FE(NO50) (p = 0.0011) and FEV(1) (p < 0.0001) were independent predictors of BHR whereas age, gender, smoking and atopy had no influence. The presence of diurnal and nocturnal wheezing was associated with raised FE(NO50) (p < 0.001 and p < 0.05, respectively). CONCLUSION The value of FE(NO50) > 34 ppb has high predictive value of PC20M < 16 in patients with suspected asthma in whom bronchodilating test failed to demonstrate reversibility or was not indicated. However, FE(NO50) ≤ 34 ppb does not rule out BHR and should prompt the clinician to ask for a methacholine challenge.
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Affiliation(s)
- F N Schleich
- Department of Pulmonary Medicine, CHU Sart-Tilman, Liege, I3 GIGA research Group, Belgium.
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Manise M, Schleich F, Quaedvlieg V, Moermans C, Henket M, Sele J, Corhay JL, Louis R. Disturbed cytokine production at the systemic level in difficult-to-control atopic asthma: evidence for raised interleukin-4 and decreased interferon-γ release following lipopolysaccharide stimulation. Int Arch Allergy Immunol 2011; 158:1-8. [PMID: 22205180 DOI: 10.1159/000329858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Accepted: 05/30/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Disturbed cytokine production is thought to govern inflammation in asthma, which, in its turn, may lead to uncontrolled disease. The aim of this study was to assess the relationship between cytokine production from blood leucocytes and the level of asthma control. METHODS We compared the production of interleukin (IL)-4, IL-6, IL-10, interferon (IFN)-γ and tumour necrosis factor-α from peripheral blood leucocytes in non-atopic healthy subjects (n = 22), atopic non-asthmatics (n = 10), well-controlled asthmatics [Juniper asthma control questionnaire (ACQ) score <1.5; n = 20] and patients with uncontrolled asthma despite inhaled or oral corticoids (ACQ score ≥1.5; n = 20). Fifty microlitres of peripheral blood was incubated for 24 h with RPMIc, lipopolysaccharide (LPS; 1 ng/ml) or phytohaemagglutinin (1 μg/ml), and cytokines were measured by immunotrapping (ELISA). RESULTS Both controlled and uncontrolled asthmatics as well as atopic non-asthmatics spontaneously produced more IL-4 than non-atopic healthy subjects (p < 0.001). IL-4 production induced by LPS was significantly greater (p < 0.05) in both asthma groups compared to atopic non-asthmatics and non-atopic healthy subjects. By contrast, IFN-γ release induced by LPS was lower in uncontrolled asthmatics than in non-atopic healthy subjects (p < 0.05) and controlled asthmatics (p < 0.05). IL-10 release after LPS was greater in uncontrolled asthmatics than in atopic non-asthmatics (p < 0.05). No difference was observed regarding other cytokines. CONCLUSION Blood cells from patients with difficult-to-control atopic asthma display highly skewed Th2 cytokine release following LPS stimulation.
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Affiliation(s)
- M Manise
- Department of Respiratory Medicine, CHU Sart-Tilman, GIGA Research Group i(3), Liège, Belgium.
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Imaoka H, Gauvreau GM, Watson RM, Strinich T, Obminksi GL, Howie K, Killian KJ, O'Byrne PM. Sputum inflammatory cells and allergen-induced airway responses in allergic asthmatic subjects. Allergy 2011; 66:1075-80. [PMID: 21447082 DOI: 10.1111/j.1398-9995.2011.02588.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Allergen inhalation causes early and late bronchoconstrictor responses, airway hyperresponsiveness and airway inflammation in allergic asthmatics. The role of airway inflammatory cells in causing allergen-induced bronchoconstriction and airway hyperresponsiveness is controversial. The objective of this study was to examine the relationships between allergen-induced increases in airway inflammatory cells, early and late bronchoconstrictor responses and methacholine airway hyperresponsiveness. METHODS Allergen inhalation challenge was conducted in 50 allergic asthmatics. Changes in the forced expired volume in 1 s (FEV(1%) ) were followed for 7 h, induced sputum was obtained at 7 and 24 h, and the provocative concentration of methacholine causing a 20% fall in FEV(1) (MCh PC(20) ) was measured at 24 h. RESULTS There was a significant negative correlation between the baseline methacholine PC(20) and baseline sputum eosinophils (r = -0.512, P = 0.0001). Allergen-induced changes in methacholine PC(20) were also significantly negatively correlated to allergen-induced change in sputum eosinophils at 24 h (r = -0.434, P = 0.002), but not to changes in any other inflammatory cells. There were no significant correlations between sputum eosinophils or other inflammatory cells and the allergen-induced early or late asthmatic responses. CONCLUSION Allergen-induced increases in airway eosinophils in asthmatic dual responders may contribute to allergen-induced changes in methacholine PC(20) , but not the late asthmatic responses.
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Affiliation(s)
- H Imaoka
- Department of Medicine, Michael G DeGroot School of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
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Biomarkers in asthma and allergic rhinitis. Pulm Pharmacol Ther 2010; 23:468-81. [PMID: 20601050 DOI: 10.1016/j.pupt.2010.06.006] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2010] [Accepted: 06/23/2010] [Indexed: 11/20/2022]
Abstract
A biological marker (biomarker) is a physical sign or laboratory measurement that can serve as an indicator of biological or pathophysiological processes or as a response to a therapeutic intervention. An applicable biomarker possesses the characteristics of clinical relevance (sensitivity and specificity for the disease) and is responsive to treatment effects, in combination with simplicity, reliability and repeatability of the sampling technique. Presently, there are several biomarkers for asthma and allergic rhinitis that can be obtained by non-invasive or semi-invasive airway sampling methods meeting at least some of these criteria. In clinical practice, such biomarkers can provide complementary information to conventional disease markers, including clinical signs, spirometry and PC(20)methacholine or histamine. Consequently, biomarkers can aid to establish the diagnosis, in staging and monitoring of the disease activity/progression or in predicting or monitoring of a treatment response. Especially in (young) children, reliable, non-invasive biomarkers would be valuable. Apart from diagnostic purposes, biomarkers can also be used as (surrogate) markers to predict a (novel) drug's efficacy in target populations. Therefore, biomarkers are increasingly applied in early drug development. When implementing biomarkers in clinical practice or trials of asthma and allergic rhinitis, it is important to consider the heterogeneous nature of the inflammatory response which should direct the selection of adequate biomarkers. Some biomarker sampling techniques await further development and/or validation, and should therefore be applied as a "back up" of established biomarkers or methods. In addition, some biomarkers or sampling techniques are less suitable for (very young) children. Hence, on a case by case basis, a decision needs to be made what biomarker is adequate for the target population or purpose pursued. Future development of more sophisticated sampling methods and quantification techniques, such as--omics and biomedical imaging, will enable detection of adequate biomarkers for both clinical and research applications.
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Subbarao P, Becker A, Brook JR, Daley D, Mandhane PJ, Miller GE, Turvey SE, Sears MR. Epidemiology of asthma: risk factors for development. Expert Rev Clin Immunol 2010; 5:77-95. [PMID: 20476901 DOI: 10.1586/1744666x.5.1.77] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
This comprehensive review of the recent literature was undertaken to determine the current state of knowledge of the risk factors involved in the development of asthma in order to focus investigations in a proposed new longitudinal birth cohort study. The origins of asthma appear to lie in the prenatal and early postnatal period, and renewed investigations in this period with long-term close follow-up and objective phenotypic characterization will help to unravel the role of the multiple putative environmental factors in the development of asthma. It is only after understanding these effects that one can hope to design rational prevention studies for asthma.
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Affiliation(s)
- Padmaja Subbarao
- Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Gueders MM, Hirst SJ, Quesada-Calvo F, Paulissen G, Hacha J, Gilles C, Gosset P, Louis R, Foidart JM, Lopez-Otin C, Noël A, Cataldo DD. Matrix metalloproteinase-19 deficiency promotes tenascin-C accumulation and allergen-induced airway inflammation. Am J Respir Cell Mol Biol 2009; 43:286-95. [PMID: 19843707 DOI: 10.1165/rcmb.2008-0426oc] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Matrix metalloproteinases (MMPs) recently appeared as key regulators of inflammation, allowing the recruitment and clearance of inflammatory cells and modifying the biological activity of many peptide mediators by cleavage. MMP-19 is newly described, and it preferentially cleaves matrix proteins such as collagens and tenascin-C. The role of MMP-19 in asthma has not been described to date. The present study sought to assess the expression of MMP-19 in a murine asthma model, and to address the biological effects of MMP-19 deficiency in mice. Allergen-exposed, wild-type mice displayed increased expression of MMP-19 mRNA and an increased number of MMP-19-positive cells in the lungs, as detected by immunohistochemistry. After an allergen challenge of MMP-19 knockout (MMP-19(-/-)) mice, exacerbated eosinophilic inflammation was detected in bronchoalveolar lavage fluid and bronchial tissue, along with increased airway responsiveness to methacholine. A shift toward increased T helper-2 lymphocyte (Th2)-driven inflammation in MMP-19(-/-) mice was demonstrated by (1) increased numbers of cells expressing the IL-33 receptor T(1)/ST(2) in lung parenchyma, (2) increased IgG(1) levels in serum, and (3) higher levels of IL-13 and eotaxin-1 in lung extracts. Tenascin-C was found to accumulate in peribronchial areas of MMP-19(-/-) after allergen challenges, as assessed by Western blot and immunohistochemistry analyses. We conclude that MMP-19 is a new mediator in asthma, preventing tenascin-C accumulation and directly or indirectly controlling Th2-driven airway eosinophilia and airway hyperreactivity. Our data suggest that MMP-19 may act on Th2 inflammation homeostasis by preventing the accumulation of tenascin protein.
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Affiliation(s)
- Maud M Gueders
- Department of Respiratory Diseases, University of Liege and Centre Hospitalier Universitaire, Belgium
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Quaedvlieg V, Sele J, Henket M, Louis R. Association between asthma control and bronchial hyperresponsiveness and airways inflammation: a cross-sectional study in daily practice. Clin Exp Allergy 2009; 39:1822-9. [PMID: 19817755 DOI: 10.1111/j.1365-2222.2009.03332.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND The primary end-point in the management of asthma is to obtain optimal control. The aim of this study was to assess the relationships between the markers of airway inflammation (sputum eosinophilia and exhaled nitric oxide), bronchial hyperresponsiveness (BHR) and asthma control. METHODS One hundred and thirty-four patients were recruited from our asthma clinic between January 2004 and September 2005 [mean age: 42 years, mean forced expiratory volume in 1 s (FEV(1)): 86% predicted]. Eighty-six of them were treated by inhaled corticosteroids, 99 were atopic and 23 were current smokers. They all underwent detailed investigations including fractional-exhaled nitric oxide (FE(NO)) measurement, sputum induction and methacholine challenge when FEV(1) was >70% predicted, and filled in a validated asthma control questionnaire (ACQ6 Juniper). RESULTS When dividing patients into the three groups according to their level of asthma control determined by ACQ [well-controlled asthma (ACQ score <or=0.75), borderline (0.75<ACQ score <1.5) and uncontrolled asthma (ACQ score >or=1.5)], it appeared that uncontrolled asthmatics had a greater BHR to methacholine and sputum eosinophilia than controlled asthma (P<0.05, P<0.001, respectively). By contrast, we failed to show significant differences in the FE(NO) levels between the groups. With receiver-operating characteristic curves for differentiating uncontrolled (ACQ>or=1.5) from controlled and borderline (ACQ<1.5) asthma, sputum eosinophilia and methacholine responsiveness were found to be more accurate than FE(NO) (area under the curve: 0.72, 0.72 and 0.59, respectively). CONCLUSION In a broad spectrum of asthmatics encountered in clinical practice, sputum eosinophilia and methacholine bronchial hyperresponsiveness, but not FE(NO), are associated with uncontrolled asthma.
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Affiliation(s)
- V Quaedvlieg
- Department of Respiratory Medicine, GIGA Research Center, CHU Liege, I Group, University of Liege, Liege, Belgium.
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Mouse models of asthma: a comparison between C57BL/6 and BALB/c strains regarding bronchial responsiveness, inflammation, and cytokine production. Inflamm Res 2009; 58:845-54. [PMID: 19506803 DOI: 10.1007/s00011-009-0054-2] [Citation(s) in RCA: 149] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2008] [Revised: 05/19/2009] [Accepted: 05/21/2009] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE Animal models of asthma mimic major features of human disease. Since the genetic background of experimental animals might affect hyperresponsiveness and inflammation, we studied its potential influence and the mechanisms leading to differences in strains. METHODS We applied a mouse model of allergic asthma to BALB/c and C57BL/6 mice. RESULTS BALB/c mice displayed greater levels of airway reactivity to methacholine than C57BL/6 mice. Moreover, BALB/c mice exhibited higher numbers of mast cells in lung tissue when compared to C57BL/6. On the contrary, eosinophil and neutrophil counts in bronchoalveolar lavage fluid (BALF) as well as peribronchial eosinophilia were greater in C57BL/6. IL (Interleukin)-4, IL-5, IL-13, and CCL11 levels measured in whole-lung extracts were higher in BALB/c, while, in sharp contrast, CCL11 and CCL5 levels were higher in BALF of C57BL/6 mice. CONCLUSIONS We observed phenotypic differences between C57BL/6 and BALB/c mice in an asthma model with different distributions of pro-inflammatory cytokines and inflammatory cells.
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O'Byrne PM, Gauvreau GM, Brannan JD. Provoked models of asthma: what have we learnt? Clin Exp Allergy 2009; 39:181-92. [PMID: 19187330 DOI: 10.1111/j.1365-2222.2008.03172.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Asthma is a chronic inflammatory disease of the airways characterized by physiological abnormalities of variable airflow obstruction and airway hyperresponsiveness (AHR) to a wide variety of physical and inhaled chemical stimuli and the presence of symptoms. AHR is measured by challenging the airways with a variety of agonists and naturally occurring stimuli, which results in constriction of the airway smooth muscle, leading to airway narrowing and airflow limitation. There are two distinct mechanisms by which the airways can narrow to a constrictor stimulus and these are defined by the pathways they take to induce AHR. Direct stimuli are pharmacological agents administered exogenously (such as histamine or methacholine) that act 'directly' on specific receptors on the bronchial smooth muscle to cause constriction. The other mechanism by which the airway can narrow is via the inhalation of indirect stimuli, which include natural stimuli, such as allergen or exercise, and pharmacological agents such as adenosine monophosphate and hyper-osmotic agents (e.g. hypertonic saline or dry powder mannitol). These stimuli induce airway narrowing 'indirectly' by causing the endogenous release of mediators of bronchoconstriction from airway inflammatory cells. Provoked models of asthma have been extremely valuable in understanding the pathobiology of asthma, in aiding diagnosis, in helping to clarify the mechanisms of actions of effective drugs and in the development of new entities to treat asthma. Some provoked models are valuable clinically, particularly those that measure direct AHR, while others, particularly allergen challenge, have been used in animal models and in humans to study the mechanisms of allergen-induced airway inflammation and the associated physiological changes, as well in the development of new drugs for asthma. An emerging role for measurements of AHR is in the evaluation of the optimal treatment for patients with asthma.
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Affiliation(s)
- P M O'Byrne
- Firestone Institute for Respiratory Health, St Joseph's Hospital, Hamilton, ON, Canada.
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[Analysis of induced sputum in refractory asthma]. Presse Med 2007; 37:155-9. [PMID: 18061391 DOI: 10.1016/j.lpm.2007.05.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2007] [Accepted: 05/10/2007] [Indexed: 11/20/2022] Open
Abstract
Induction of sputum by inhalation of hypertonic or isotonic fluid makes possible the safe and noninvasive harvesting of airway cells from patients with asthma, regardless of disease severity. Analysis of sputum cells has helped to identify different phenotypes of refractory asthma and shown that such asthma can be eosinophilic, neutrophilic, or both. Elevated eosinophil levels in sputum indicate a risk of exacerbation if the corticosteroid dose is reduced in stabilized patients. Surveillance of eosinophilia levels as an indicator for corticosteroid adjustment in refractory asthma makes it possible to reduce the frequency of severe exacerbations.
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