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Roberto G, Barberi S, Marseglia GL, Licari A. What's new in pediatric asthma and rhinitis phenotypes and endotypes? Curr Opin Allergy Clin Immunol 2024; 24:73-78. [PMID: 38295125 DOI: 10.1097/aci.0000000000000970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
PURPOSE OF REVIEW This review explores the evolving landscape of pediatric asthma and rhinitis, focusing on identifying and characterizing different subtypes. RECENT FINDINGS Childhood asthma and rhinitis are prevalent respiratory conditions frequently occurring together. To address the need for a precise definition of these diseases, an unbiased and comprehensive phenotyping approach has been undertaken with hypothesis-free analysis of extensive datasets to uncover new relationships among clinical, environmental, and biological characteristics. On the other hand, the concept of endotype is elaborate and multifaceted, representing distinct pathophysiological mechanisms underlying the clinical presentation and requires the identification of reliable biomarkers. The recognition of multiple inflammatory endotypes underscores the need for in-depth characterization, which could revolutionize the treatment landscape. SUMMARY Comprehending phenotypes and endotypes is crucial for customizing effective and personalized management approaches for children with asthma and rhinitis. More precise and efficient care can be administered through recognition and detailed characterization, ultimately enhancing patients' quality of life.
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Affiliation(s)
- Giulia Roberto
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia
| | - Salvatore Barberi
- Pediatric Unit, Rho and Garbagnate Milanese Hospital, ASST-Rhodense, Milan, Italy
| | - Gian Luigi Marseglia
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia
| | - Amelia Licari
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia
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Foppiano F, Schaub B. Childhood asthma phenotypes and endotypes: a glance into the mosaic. Mol Cell Pediatr 2023; 10:9. [PMID: 37646843 PMCID: PMC10469115 DOI: 10.1186/s40348-023-00159-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 07/10/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Asthma is an inflammatory lung disease that constitutes the most common noncommunicable chronic disease in childhood. Childhood asthma shows large heterogeneity regarding onset of disease, symptoms, severity, prognosis, and response to therapy. MAIN BODY Evidence suggests that this variability is due to distinct pathophysiological mechanisms, which has led to an exhaustive research effort to understand and characterize these distinct entities currently designated as "endotypes." Initially, studies focused on identifying specific groups using clinical variables yielding different "clinical phenotypes." In addition, the identification of specific patterns based on inflammatory cell counts and cytokine data has resulted in "inflammatory endotypes." More recently, an increasing number of molecular data from high-throughput technology ("omics" data) have allowed to investigate more complex "molecular endotypes." CONCLUSION A better definition and comprehension of childhood asthma heterogeneity is key for improving diagnosis and treatment. This review aims at summarizing the current knowledge on this topic and discusses some limitations in their application as well as recommendations for future studies.
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Affiliation(s)
- Francesco Foppiano
- Department of Pulmonary and Allergy, Dr. Von Hauner Children's Hospital, LMU Munich, 80337, Munich, Germany
| | - Bianca Schaub
- Department of Pulmonary and Allergy, Dr. Von Hauner Children's Hospital, LMU Munich, 80337, Munich, Germany.
- German Lung Centre (DZL), CPC-Munich, 80337, Munich, Germany.
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Finn PW, Perkins DL. BORN TO WHEEZE OR LEARNED WHEN WE WERE YOUNG: MATERNAL AND ENVIRONMENTAL FACTORS INFLUENCE ATOPIC RISK. TRANSACTIONS OF THE AMERICAN CLINICAL AND CLIMATOLOGICAL ASSOCIATION 2023; 133:181-192. [PMID: 37701609 PMCID: PMC10493753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
The prevalence of atopic diseases is increasing globally, particularly in children. Heritable genetics can partially explain risk of disease. Evidence also points to acquired genetic material, in the form of the microbiome, as an important factor in disease pathogenesis. The acquisition of the microbiome dynamically changes in response to differences in lifestyle and environmental factors. Also, in utero, maternal and environmental factors influence atopic risk for allergic rhinitis, eczema, asthma, and food allergy. Combining the analytical power of omics, we focus on how the microbiota mediates effects between mother, environment, immunity, and risk of atopic disease. In parallel, we stress that health care disparities impact asthma morbidity and mortality. Efforts to improve asthma outcomes must include multidisciplinary strategies.
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Chaumette T, Cinotti R, Mollé A, Solomon P, Castain L, Fourgeux C, McWilliam HE, Misme-Aucouturier B, Broquet A, Jacqueline C, Vourc'h M, Fradin D, Bossard C, David L, Montassier E, Braudeau C, Josien R, Villadangos JA, Asehnoune K, Bressollette-Bodin C, Poschmann J, Roquilly A. Monocyte Signature Associated with Herpes Simplex Virus Reactivation and Neurological Recovery After Brain Injury. Am J Respir Crit Care Med 2022; 206:295-310. [PMID: 35486851 DOI: 10.1164/rccm.202110-2324oc] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Brain injury induces systemic immunosuppression increasing the risk of viral reactivations and altering neurological recovery. OBJECTIVES To determine if systemic immune alterations and lung replication of Herpesviridae are associated and can help predict outcomes after brain injury. METHODS We collected peripheral blood mononuclear cells in severely brain-injured patients requiring invasive mechanical ventilation. We systematically searched for respiratory Herpes Simplex Virus (HSV) replications in tracheal aspirates. We also performed CHiP-sequencing, RNA-sequencing and in vitro functional assays of monocytes and CD4 T cells collected on day 1 to characterize immune response to severe acute brain injury. The primary outcome was the Glasgow outcome scale Extended (GOS-E) at 6 months. MEASUREMENTS AND MAIN RESULTS In 344 severe brain-injured patients, lung HSV reactivations were observed in 39% of patients seropositive for HSV, and independently associated with poor neurological recovery at six months (hazard ratio 1.90, 95%CI 1.08-3.57). WGNA analyses of the transcriptomic response of monocytes to brain injury defined a module of 721 genes, including PD-L1 and CD80, enriched for the binding DNA motif of the transcriptional factor Zeb2, and whose ontogenic analyses revealed decreased interferon--mediated and anti-viral response signaling pathways. This monocyte signature was preserved in a validation cohort and predicted the neurological outcome at 6 months with good accuracy (AUC 0.786, 95%CI 0.593-0.978). CONCLUSIONS A specific monocyte signature is associated with HSV reactivation and predicts recovery after brain injury. The alterations of the immune control of Herpesviridae replication are understudied and represent a novel therapeutic target.
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Affiliation(s)
- Tanguy Chaumette
- University of Nantes, 27045, EA3826 Thérapeutiques Anti-Infectieuses, Institut de Recherche en Santé 2 Nantes Biotech, Nantes, France
| | - Raphael Cinotti
- University hospital, Intensive Care Unit, Anesthesia and Critical Care Department, Nantes, France
| | | | | | - Louise Castain
- University Hospital, Departments of Anaesthesiology and Surgical Intensive Care, NANTES, France
| | | | | | - Barbara Misme-Aucouturier
- University of Nantes, 27045, EA3826 Thérapeutiques Anti-Infectieuses, Institut de Recherche en Santé 2 Nantes Biotech, Nantes, France
| | - Alexis Broquet
- University of Nantes, 27045, EA3826 Thérapeutiques Anti-Infectieuses, Institut de Recherche en Santé 2 Nantes Biotech, Nantes, France
| | - Cédric Jacqueline
- University of Nantes, 27045, EA3826 Thérapeutiques Anti-Infectieuses, Institut de Recherche en Santé 2 Nantes Biotech, Nantes, France
| | - Mickael Vourc'h
- University of Nantes, 27045, EA3826 Thérapeutiques Anti-Infectieuses, Institut de Recherche en Santé 2 Nantes Biotech, Nantes, France
| | - Delphine Fradin
- University Hospital, Departments of Anaesthesiology and Surgical Intensive Care, NANTES, France
| | | | | | - Emmanuel Montassier
- Centre Hospitalier Universitaire de Nantes, 26922, Emergency Department, Nantes, France
| | | | | | | | - Karim Asehnoune
- University Hospital, Departments of Anaesthesiology and Surgical Intensive Care, NANTES, France
| | | | - Jeremie Poschmann
- University of Nantes, 27045, Centre de Recherche en Transplantation et Immunologie UMR 1064, Inserm, Nantes, France
| | - Antoine Roquilly
- University Hospital, Departments of Anaesthesiology and Surgical Intensive Care, NANTES, France.,University of Nantes, 27045, EA3826 Thérapeutiques Anti-Infectieuses, Institut de Recherche en Santé 2 Nantes Biotech, Nantes, France;
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