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Siddiqui A, Kopas L. Updates on the Management of Severe Asthma. Methodist Debakey Cardiovasc J 2019; 13:82-83. [PMID: 28740590 DOI: 10.14797/mdcj-13-2-82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
| | - Lisa Kopas
- Houston Methodist Hospital, Houston, Texas
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Long non-coding RNA TCF7 contributes to the growth and migration of airway smooth muscle cells in asthma through targeting TIMMDC1/Akt axis. Biochem Biophys Res Commun 2018; 508:749-755. [PMID: 30528236 DOI: 10.1016/j.bbrc.2018.11.187] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 11/28/2018] [Indexed: 01/15/2023]
Abstract
BACKGROUND Long noncoding RNAs (lncRNAs) have been revealed to participate in cellular biological processes in multiple diseases, including asthma. Nevertheless, the role of lncRNA TCF7 (lncTCF7) in airway smooth muscle cells (ASMCs) is still covered. METHODS The expression of lncTCF7 and TIMMDC1 in ASMCs from 12 asthma patients and 12 healthy controls were detected using qRT-PCR. Then MTT assay, EdU assay and transwell assay were conducted respectively to assess the impact of lncTCF7 on ASMCs viability, proliferation and migration. Besides, western blotting was performed to determine the protein levels of TIMMDC1 and AKT/p-AKT. RESULTS We discovered that lncTCF7 and TIMMDC1 were upregulated in asthma groups and lncTCF7 improved ASMCs viability/proliferation and migration. In addition, lncTCF7 regulated TIMMDC1 expression indeed and PDGF-BB treated ASMCs exhibited elevated levels of lncTCF7 and TIMMDC1. Moreover, lncTCF7 suppression diminished both the mRNA and protein levels of TIMMDC1 and markedly reduced p-AKT level which could be enhanced under TIMMDC1 overexpression. Finally, both TIMMDC1 overexpression and AKT activator could restored the inhibitory impacts of lncTCF7 silence on PDGF-BB treated ASMCs. CONCLUSION Our study uncovered that lncTCF7 facilitated human ASMCs growth and migration via targeting TIMMDC1 thus activating AKT signaling, providing a novel possible target for asthma therapy.
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Puente-Maestu L, Llanos Flores M, Benedetti P, Frías Benzant I, Oliva Ramos A, García de Pedro J, Sanz Sanz P, García-López J. Effectiveness and Safety of Bronchial Thermoplasty in Severe Asthma in Clinical Practice in Spain. Biomed Hub 2018; 3:1-9. [PMID: 31988961 PMCID: PMC6945925 DOI: 10.1159/000492075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 07/11/2018] [Indexed: 12/14/2022] Open
Abstract
Background Bronchial thermoplasty (BT) is a minimally invasive procedure consisting of application of thermal energy into the airways to produce ablation of the hypertrophic smooth muscle. It was approved for use in moderate-severe asthma in Spain in 2010. Objectives The aims of the present study are to analyze the effectiveness and the safety of BT in clinical practice in our center. Methods Participants had a confirmed diagnosis of severe asthma and poor control without therapeutic alternative. Effectiveness was measured by comparing exacerbations, admissions rates, asthma control, and medication 1 year prior and 1 year after BT was completed. All complications appearing during the procedure and in the first year were recorded. Results Patients had a mean age of 51 (SD 8) years and were predominantly female (17/23). The average number of activations per patient was 147 (16). The number of severe exacerbations was reduced by 75% (p < 0.001). A 38% reduction in admissions per year was also observed (p = 0.03). The Asthma Control Test improved by 7.1 (3.7) points (p = 0.018). Before BT, the dose of inhaled corticosteroids was 1,621 (1,015) µg of budesonide-equivalent and the dose of oral corticosteroids was 15 (13) mg of prednisone-equivalent. There was a reduction in 430 (731) µg of budesonide-equivalent (p = 0.02) and 4 (11) mg of prednisone (p = 0.094). No changes in lung function were observed. Complications were related mostly to exacerbation of asthma in the days following the procedure. Conclusions BT is effective and safe for severe uncontrolled bronchial asthma in real clinical practice.
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Affiliation(s)
- Luis Puente-Maestu
- Hospital General Universitario "Gregorio Marañón," Servicio de Neumología, Madrid, Spain.,Facultad de Medicina de la Universidad Complutense de Madrid, Madrid, Spain.,Instituto de Investigación Sanitaria "Gregorio Marañón", Madrid, Spain
| | - Milagros Llanos Flores
- Hospital General Universitario "Gregorio Marañón," Servicio de Neumología, Madrid, Spain.,Instituto de Investigación Sanitaria "Gregorio Marañón", Madrid, Spain
| | - Paola Benedetti
- Hospital General Universitario "Gregorio Marañón," Servicio de Neumología, Madrid, Spain.,Instituto de Investigación Sanitaria "Gregorio Marañón", Madrid, Spain
| | - Ingrid Frías Benzant
- Hospital General Universitario "Gregorio Marañón," Servicio de Neumología, Madrid, Spain
| | - Alicia Oliva Ramos
- Hospital General Universitario "Gregorio Marañón," Servicio de Neumología, Madrid, Spain.,Instituto de Investigación Sanitaria "Gregorio Marañón", Madrid, Spain
| | - Julia García de Pedro
- Hospital General Universitario "Gregorio Marañón," Servicio de Neumología, Madrid, Spain.,Facultad de Medicina de la Universidad Complutense de Madrid, Madrid, Spain.,Instituto de Investigación Sanitaria "Gregorio Marañón", Madrid, Spain
| | - Pilar Sanz Sanz
- Hospital General Universitario "Gregorio Marañón," Servicio de Neumología, Madrid, Spain
| | - Javier García-López
- Hospital General Universitario "Gregorio Marañón," Servicio de Neumología, Madrid, Spain.,Facultad de Medicina de la Universidad Complutense de Madrid, Madrid, Spain.,Instituto de Investigación Sanitaria "Gregorio Marañón", Madrid, Spain
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Thomson NC. Bronchial thermoplasty as a treatment for severe asthma: controversies, progress and uncertainties. Expert Rev Respir Med 2018; 12:269-282. [PMID: 29471685 DOI: 10.1080/17476348.2018.1444991] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Bronchial thermoplasty is a licensed non-pharmacological treatment for severe asthma. Area covered: This article considers evidence for the efficacy and safety of bronchial thermoplasty from clinical trials and observational studies in clinical practice. Its place in the management of severe asthma, predictors of response and mechanisms of action are reviewed. Expert commentary: Bronchial thermoplasty improves quality of life and reduces exacerbations in moderate to severe asthma. Morbidity from asthma is increased during treatment. Overall, patients treated in clinical practice have worse baseline characteristics and comparable clinical outcomes to trial data. Follow-up studies provide reassurance on long-term safety. Despite some progress, future research needs to investigate uncertainties about predictors of response, mechanism of action and place in management of asthma.
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Affiliation(s)
- Neil C Thomson
- a Institute of Infection, Immunity & Inflammation , University of Glasgow , Glasgow , UK
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6
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Krmisky W, Sobieszczyk MJ, Sarkar S. Thermal ablation for asthma: current status and technique. J Thorac Dis 2017; 9:S104-S109. [PMID: 28446972 DOI: 10.21037/jtd.2016.11.113] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Bronchial thermoplasty (BT) is a novel technique used in the treatment of severe asthma. A catheter is advanced through the bronchoscope and directed radiofrequency waves are applied to the segmental bronchi to reduce airway smooth muscle mass. Several randomized clinical trials demonstrate improvement in quality of life and reduction in exacerbation rates after treatment. BT is a safe and cost effective treatment option for severe asthma which is refractory to medical treatment. Further studies are needed in order to better describe the mechanism of action and the asthma subphenotype that was best benefit from this treatment.
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Affiliation(s)
- William Krmisky
- Interventional Pulmonary and Critical Care Medicine, MedStar Franklin Square Hospital Center, Baltimore, Maryland, USA
| | - Michal J Sobieszczyk
- Pulmonary and Critical Care Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Saiyad Sarkar
- Interventional Pulmonary and Critical Care Medicine, MedStar Franklin Square Hospital Center, Baltimore, Maryland, USA
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Bronchial thermoplasty and biological therapy as targeted treatments for severe uncontrolled asthma. THE LANCET RESPIRATORY MEDICINE 2016; 4:585-592. [PMID: 27230825 DOI: 10.1016/s2213-2600(16)30018-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 03/08/2016] [Accepted: 03/15/2016] [Indexed: 01/08/2023]
Abstract
Although a small proportion of patients with asthma have severe disease, it accounts for the majority of morbidity related to the illness. Severe asthma comprises a heterogeneous group of phenotypes. Targeted treatments for these phenotypes represent a major advancement in the management of severe asthma. Omalizumab, a monoclonal antibody to IgE, improves asthma control in patients with a predominant allergic phenotype. Monoclonal antibodies targeted to interleukin 4α and interleukin 5 have shown substantial benefit in patients with the eosinophilic asthma phenotype; so too have monoclonal antibodies targeted to interleukin 13 in patients with a type 2 allergic phenotype. Bronchial thermoplasty, a new technique to reduce airway smooth muscle mass, improves symptoms and reduces exacerbations in patients with severe uncontrolled asthma and the chronic airflow obstruction phenotype. While awaiting comparative trials, we can now use a targeted approach with these phenotypes, guiding our treatment selection with the best evidence. This Review will focus on the latest developments in these new treatments and inform the clinician on how to select the appropriate patient for these treatments.
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Laxmanan B, Egressy K, Murgu SD, White SR, Hogarth DK. Advances in Bronchial Thermoplasty. Chest 2016; 150:694-704. [PMID: 27006157 DOI: 10.1016/j.chest.2016.03.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 02/02/2016] [Accepted: 03/09/2016] [Indexed: 12/28/2022] Open
Abstract
Bronchial thermoplasty (BT) is a therapeutic intervention that delivers targeted thermal energy to the airway walls with the goal of ablating the smooth muscle in patients with severe persistent asthma. Since the publication of the original preclinical studies, three large randomized clinical trials evaluating its impact on asthma control have been performed. These trials have shown improvements in asthma-related quality of life and a reduction in asthma exacerbations following treatment with BT. However, there remains significant controversy regarding the true efficacy of BT and the interpretation of these studies, particularly the Asthma Intervention Research 2 trial. In this article, we will discuss these controversies and present the latest evidence on the use of BT in asthma, specifically the 5-year longitudinal evaluation of patients. In addition, we will discuss new insights into the histopathologic changes that occur in the airways following BT, as well as the feasibility of performing the procedure in patients with very severe asthma. We also will discuss the ongoing translational and clinical investigations regarding the underlying mechanism of action and methods to improve patient selection for this procedure.
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Affiliation(s)
- Balaji Laxmanan
- Section of Pulmonary and Critical Care Medicine, University of Chicago Medicine, Chicago, IL
| | | | - Septimiu D Murgu
- Section of Pulmonary and Critical Care Medicine, University of Chicago Medicine, Chicago, IL
| | - Steven R White
- Section of Pulmonary and Critical Care Medicine, University of Chicago Medicine, Chicago, IL
| | - D Kyle Hogarth
- Section of Pulmonary and Critical Care Medicine, University of Chicago Medicine, Chicago, IL.
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Zhou JP, Feng Y, Wang Q, Zhou LN, Wan HY, Li QY. Long-term efficacy and safety of bronchial thermoplasty in patients with moderate-to-severe persistent asthma: a systemic review and meta-analysis. J Asthma 2015; 53:94-100. [PMID: 26383773 DOI: 10.3109/02770903.2015.1065424] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To evaluate the long-term efficacy and safety of bronchial thermoplasty (BT) in the treatment of patients with moderate-to-severe persistent asthma. METHODS We therefore performed a systematic literature review of peer-reviewed studies focusing on BT intervention in asthma control published between January 2000 and June 2014. Three randomized controlled studies and extension studies met the inclusion criteria (n = 6). Outcomes assessed after BT included spirometric data, adverse respiratory events, emergency room (ER) visits and hospitalization for respiratory illness. One-year and 5-year follow-up data were defined as V1 and V5, respectively. RESULTS There were 249 BT-treated subjects in total who had a 1-year follow-up (V1), whereas 216 of them finished a 5-year follow-up (V5). No evidence of significant decline was found in pre-bronchodilator FEV1 (% predicted) (WMD = 0.75; 95% CI: 3.36 to 1.85; p = 0.57), or in post-bronchodilator FEV1 (% predicted) (WMD = 0.62; 95% CI: 3.32 to 2.08; p = 0.65) between V1 and V5. In addition, the frequency of respiratory adverse events was reduced significantly during the follow-up (RR = 3.41, 95% CI: 2.96-3.93, p < 0.00001). The number of ER visits for adverse respiratory events remained unchanged (RR = 1.06, 95% CI: 0.77-1.46, p = 0.71) after BT treatment. There was no statistically significant increase in the incidence of hospitalization for respiratory adverse events (V5 vs. V1, RR = 1.47, 95% CI: 0.69-3.12, p = 0.32). CONCLUSIONS These data demonstrate long-term benefits of BT with regard to both asthma control and safety for moderate-to-severe asthmatic patients.
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Affiliation(s)
- Jian Ping Zhou
- a Department of Respiratory Medicine , Ruijin Hospital, School of Medicine, Shanghai Jiaotong University , Shanghai , P.R. China
| | - Yun Feng
- a Department of Respiratory Medicine , Ruijin Hospital, School of Medicine, Shanghai Jiaotong University , Shanghai , P.R. China
| | - Qiong Wang
- a Department of Respiratory Medicine , Ruijin Hospital, School of Medicine, Shanghai Jiaotong University , Shanghai , P.R. China
| | - Li Na Zhou
- a Department of Respiratory Medicine , Ruijin Hospital, School of Medicine, Shanghai Jiaotong University , Shanghai , P.R. China
| | - Huan Ying Wan
- a Department of Respiratory Medicine , Ruijin Hospital, School of Medicine, Shanghai Jiaotong University , Shanghai , P.R. China
| | - Qing Yun Li
- a Department of Respiratory Medicine , Ruijin Hospital, School of Medicine, Shanghai Jiaotong University , Shanghai , P.R. China
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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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Abstract
Bronchial thermoplasty (BT) is a novel therapy for patients with severe asthma. Using radio frequency thermal energy, it aims to reduce the airway smooth muscle mass. Several clinical trials have demonstrated improvements in asthma-related quality of life and a reduction in the number of exacerbations following treatment with BT. In addition, recent data has demonstrated the long-term safety of the procedure as well as sustained improvements in rates of asthma exacerbations, reduction in health care utilization, and improved quality of life. Further study is needed to elucidate the underlying mechanisms that result in these improvements. In addition, improved characterization of the asthma subphenotypes likely to exhibit the largest clinical benefit is a critical step in determining the precise role of BT in the management of severe asthma.
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Affiliation(s)
- Balaji Laxmanan
- Section of Pulmonary and Critical Care Medicine, University of Chicago Medicine, Chicago, IL, USA
| | - D Kyle Hogarth
- Section of Pulmonary and Critical Care Medicine, University of Chicago Medicine, Chicago, IL, USA
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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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Cangelosi MJ, Ortendahl JD, Meckley LM, Bentley TGK, Anene AM, Shriner KM, Fox J. Cost-effectiveness of bronchial thermoplasty in commercially-insured patients with poorly controlled, severe, persistent asthma. Expert Rev Pharmacoecon Outcomes Res 2014; 15:357-64. [PMID: 25363000 DOI: 10.1586/14737167.2015.978292] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES We examined the cost-effectiveness of treating poorly controlled, severe, persistent asthma patients with bronchial thermoplasty (BT), a novel technology that uses thermal energy to reduce airway smooth muscle mass, with 5-year outcome data demonstrating a durable reduction in asthma exacerbations. STUDY DESIGN We conducted a model-based cost-effectiveness analysis assessing 5-year healthcare utilization, patient quality of life and adverse events. METHODS We utilized Markov modeling to estimate the costs and quality-of-life impact of BT compared with high-dose combination therapy among poorly controlled, severe, persistent asthma patients: those requiring high-dose combination therapy and having experienced an asthma exacerbation-related ER visit in the past year. RESULTS The cost-effectiveness of BT was US$5495 per quality-adjusted life year; and approximately 22% of sensitivity analysis iterations estimated BT to reduce costs and increase quality of life. CONCLUSIONS BT is a cost-effective treatment option for patients with poorly controlled, severe, persistent asthma.
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Dowell ML, Lavoie TL, Solway J, Krishnan R. Airway smooth muscle: a potential target for asthma therapy. Curr Opin Pulm Med 2014; 20:66-72. [PMID: 24247041 DOI: 10.1097/mcp.0000000000000011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Asthma is a major public health problem that afflicts nearly one in 20 people worldwide. Despite available treatments, asthma symptoms remain poorly controlled in a significant minority of asthma patients, especially those with severe disease. Accordingly, much ongoing effort has been directed at developing new therapeutic strategies; these efforts are described in detail below. RECENT FINDINGS Although mucus hypersecretion is an important component of asthma pathobiology, the primary mechanism of morbidity and mortality in asthma is excessive narrowing of the airway. The key end- effector of excessive airway narrowing is airway smooth muscle (ASM) contraction; overcoming ASM contraction is therefore a prominent therapeutic strategy. Here, we review exciting new advances aimed at ASM relaxation. SUMMARY Exciting advances in ASM biology have identified new therapeutic targets for the prevention or reversal of bronchoconstriction in asthma.
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Affiliation(s)
- Maria L Dowell
- aDepartment of Medicine bDepartment of Pediatrics, University of Chicago, Chicago, Illinois, USA cCenter for Vascular Biology Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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Doeing DC, Solway J. Airway smooth muscle in the pathophysiology and treatment of asthma. J Appl Physiol (1985) 2013; 114:834-43. [PMID: 23305987 DOI: 10.1152/japplphysiol.00950.2012] [Citation(s) in RCA: 101] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Airway smooth muscle (ASM) plays an integral part in the pathophysiology of asthma. It is responsible for acute bronchoconstriction, which is potentiated by constrictor hyperresponsiveness, impaired relaxation and length adaptation. ASM also contributes to airway remodeling and inflammation in asthma. In light of this, ASM is an important target in the treatment of asthma.
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Affiliation(s)
- Diana C Doeing
- Department of Medicine, University of Chicago, Chicago, IL, USA.
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Luo L, Gong YQ, Qi X, Lai W, Lan H, Luo Y. Effect of tumor suppressor PTEN gene on apoptosis and cell cycle of human airway smooth muscle cells. Mol Cell Biochem 2012; 375:1-9. [PMID: 23275086 DOI: 10.1007/s11010-012-1484-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Accepted: 10/17/2012] [Indexed: 01/29/2023]
Abstract
It is well established that hyperplasia and decreased apoptosis of airway smooth muscle cells (ASMCs) play an important role in the asthmatic airway remodeling. Tumor suppressor PTEN gene with phosphatase activity plays an important regulatory role in embryonic development, cell proliferation, and apoptosis, cell cycle regulation, migration (invasion) of the cytoskeleton. We hypotheses that PTEN gene could affect the growth and viability of ASMCs through the regulation of PI3K/Akt, MAPK, and cell cycle-related gene expression. We constructed a recombinant adenovirus to transfect ASMCs. Cells were divided into the overexpression of PTEN gene group (Ad-PTEN-GFP), negative control group (Ad-GFP), and blank control group (DMEM). The cell apoptosis of ASMCs were evaluated by Hoechst-33342 staining and PE-7AAD double-labeled flow cytometry. The cell cycle distribution was observed by flow cytometry with PI staining. The expression of PTEN, p-Akt, total-Akt, p-ERK1/2, total-ERK1/2, cleaved-Caspases-3, Caspases-9, p21, and Cyclin D1 were tested by the Western blotting. Our study revealed that overexpression of PTEN gene did not induce apoptosis of human ASMCs cultured in vitro. However, overexpression of PTEN inhibited proliferation of human ASMCs cultured in vitro and was associated with downregulation of Akt phosphorylation levels, while did not affect ERK1/2 phosphorylation levels. Moreover, overexpression of PTEN could induce ASMCs arrested in the G0/G1 phase through the downregulation of Cyclin D1 and upregulation of p21 expressions.
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Affiliation(s)
- Liang Luo
- Department of Medical Intensive Care Unit, The First Affiliated Hospital of Sun Yat-sen University, No. 58, Zhong Shan Er Road, Guangzhou, People's Republic of China
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Abstract
PURPOSE OF REVIEW Bronchial thermoplasty, which involves the delivery of radio frequency energy to the airways to reduce airway smooth muscle mass, has been recently introduced for the treatment of severe asthma. This review summarizes the preclinical development, efficacy and adverse effects of bronchial thermoplasty. In addition, the potential mechanisms of action and place in management of severe asthma are discussed. RECENT FINDINGS The efficacy and adverse profile of bronchial thermoplasty has been assessed in three randomized controlled trials, the first two of which showed clinical benefits of bronchial thermoplasty compared with usual care in patients with moderate or severe asthma. The third trial reports the results of a comparison with sham bronchial thermoplasty in 288 adults with severe asthma. Bronchial thermoplasty improved asthma quality of life questionnaire scores compared with sham bronchial thermoplasty; in the posttreatment period, there were fewer severe exacerbations and emergency department visits. Bronchial thermoplasty causes short-term increases in asthma-related morbidity. Follow-up data to date support the long-term safety of the procedure. SUMMARY Bronchial thermoplasty has a role in the management of patients with severe asthma who have uncontrolled symptoms despite current therapies. Future studies need to identify factors that predict a beneficial clinical response.
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Banerjee A, Trivedi CM, Damera G, Jiang M, Jester W, Hoshi T, Epstein JA, Panettieri RA. Trichostatin A abrogates airway constriction, but not inflammation, in murine and human asthma models. Am J Respir Cell Mol Biol 2012; 46:132-8. [PMID: 22298527 DOI: 10.1165/rcmb.2010-0276oc] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Histone deacetylase (HDAC) inhibitors may offer novel approaches in the treatment of asthma. We postulate that trichostatin A (TSA), a Class 1 and 2 inhibitor of HDAC, inhibits airway hyperresponsiveness in antigen-challenged mice. Mice were sensitized and challenged with Aspergillus fumigatus antigen (AF) and treated with TSA, dexamethasone, or vehicle. Lung resistance (R(L)) and dynamic compliance were measured, and bronchial alveolar lavage fluid (BALF) was analyzed for numbers of leukocytes and concentrations of cytokines. Human precision-cut lung slices (PCLS) were treated with TSA and their agonist-induced bronchoconstriction was measured, and TSA-treated human airway smooth muscle (ASM) cells were evaluated for the agonist-induced activation of Rho and intracellular release of Ca(2+). The activity of HDAC in murine lungs was enhanced by antigen and abrogated by TSA. TSA also inhibited methacholine (Mch)-induced increases in R(L) and decreases in dynamic compliance in naive control mice and in AF-sensitized and -challenged mice. Total cell counts, concentrations of IL-4, and numbers of eosinophils in BALF were unchanged in mice treated with TSA or vehicle, whereas dexamethasone inhibited the numbers of eosinophils in BALF and concentrations of IL-4. TSA inhibited the carbachol-induced contraction of PCLS. Treatment with TSA inhibited the intracellular release of Ca(2+) in ASM cells in response to histamine, without affecting the activation of Rho. The inhibition of HDAC abrogates airway hyperresponsiveness to Mch in both naive and antigen-challenged mice. TSA inhibits the agonist-induced contraction of PCLS and mobilization of Ca(2+) in ASM cells. Thus, HDAC inhibitors demonstrate a mechanism of action distinct from that of anti-inflammatory agents such as steroids, and represent a promising therapeutic agent for airway disease.
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Affiliation(s)
- Audreesh Banerjee
- Translational Research Laboratories, Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pennsylvania Medical Center, 125 South 31st St., Translational Research Laboratories, Philadelphia, PA 19104-3403, USA.
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Jiang H, Abel PW, Toews ML, Deng C, Casale TB, Xie Y, Tu Y. Phosphoinositide 3-kinase gamma regulates airway smooth muscle contraction by modulating calcium oscillations. J Pharmacol Exp Ther 2010; 334:703-9. [PMID: 20501633 DOI: 10.1124/jpet.110.168518] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Phosphoinositide 3-kinase gamma (PI3Kgamma) has been implicated in the pathogenesis of asthma, but its mechanism has been considered indirect, through release of inflammatory cell mediators. Because airway smooth muscle (ASM) contractile hyper-responsiveness plays a critical role in asthma, the aim of the present study was to determine whether PI3Kgamma can directly regulate contractility of ASM. Immunohistochemistry staining indicated expression of PI3Kgamma protein in ASM cells of mouse trachea and lung, which was confirmed by Western blot analysis in isolated mouse tracheal ASM cells. PI3Kgamma inhibitor II inhibited acetylcholine (ACh)-stimulated airway contraction of cultured precision-cut mouse lung slices in a dose-dependent manner with 75% inhibition at 10 muM. In contrast, inhibitors of PI3Kalpha, PI3Kbeta, or PI3Kdelta, at concentrations 40-fold higher than their reported IC(50) values for their primary targets, had no effect. It is noteworthy that airways in lung slices pretreated with PI3Kgamma inhibitor II still exhibited an ACh-induced initial contraction, but the sustained contraction was significantly reduced. Furthermore, the PI3Kgamma-selective inhibitor had a small inhibitory effect on the ACh-stimulated initial Ca(2+) transient in ASM cells of mouse lung slices or isolated mouse ASM cells but significantly attenuated the sustained Ca(2+) oscillations that are critical for sustained airway contraction. This report is the first to show that PI3Kgamma directly controls contractility of airways through regulation of Ca(2+) oscillations in ASM cells. Thus, in addition to effects on airway inflammation, PI3Kgamma inhibitors may also exert direct effects on the airway contraction that contribute to pathologic airway hyper-responsiveness.
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Affiliation(s)
- Haihong Jiang
- Department of Pharmacology, Creighton University School of Medicine, Omaha, Nebraska 68178, USA
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Interventional bronchoscopy from bench to bedside: new techniques for central and peripheral airway obstruction. Clin Chest Med 2010; 31:101-15, Table of Contents. [PMID: 20172436 DOI: 10.1016/j.ccm.2009.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
This article discusses how basic scientific concepts, based on a greater understanding of airway physiology, support the development and dissemination of multidimensional classification systems for tracheal stenosis, expiratory central airway collapse, and innovative interventional bronchoscopic procedures for patients with asthma and chronic obstructive pulmonary disease.
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Halayko AJ, Ghavami S. S100A8/A9: a mediator of severe asthma pathogenesis and morbidity? Can J Physiol Pharmacol 2010; 87:743-55. [PMID: 19898558 DOI: 10.1139/y09-054] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Nearly 12% of children and 6% of adults in Canada have been diagnosed with asthma. Although in most patients symptoms are controlled by inhaled steroids, a subpopulation (approximately 10%) characterized by excessive airway neutrophilia, is refractory to treatment; these patients exhibit severe disease, and account for more than 50% of asthma health care costs. These numbers underscore the need to better understand the biology of severe asthma and identify pro-asthma mediators released by cells, such as neutrophils, that are unresponsive to common steroid therapy. This review focuses on a unique protein complex consisting of S100A8 and S100A9. These subunits belong to the large Ca2+-binding S100 protein family and are some of the most abundant proteins in neutrophils and macrophages. S100A8/A9 is a damage-associated molecular pattern (DAMP) protein complex released in abundance in rheumatoid arthritis, inflammatory bowel disease, and cancer, but there are no definitive studies on its role in inflammation and obstructive airways disease. Two receptors for S100A8/A9, the multiligand receptor for advanced glycation end products (RAGE) and Toll-like receptor 4 (TLR4), are expressed in lung. TLR4 is linked with innate immunity that programs local airway inflammation, and RAGE participates in mediating fibroproliferative remodeling in idiopathic pulmonary fibrosis. S100A8/A9 can induce cell proliferation, or apoptosis, inflammation, collagen synthesis, and cell migration. We hypothesize that this capacity suggests S100A8/A9 could underpin chronic airway inflammation and airway remodeling in asthma by inducing effector responses of resident and infiltrating airway cells. This review highlights some key issues related to this hypothesis and provides a template for future research.
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Affiliation(s)
- Andrew J Halayko
- Department of Physiology, University of Manitoba, Respiratory Hospital, Winnipeg, MB R3A 1R8, Canada.
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Woods B, Sladen R. Perioperative considerations for the patient with asthma and bronchospasm. Br J Anaesth 2009; 103 Suppl 1:i57-65. [DOI: 10.1093/bja/aep271] [Citation(s) in RCA: 99] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Thomas L. Petty Aspen Lung Conference: Asthma: Insights and Expectations. Conference summary. Ann Am Thorac Soc 2009; 6:316-20. [PMID: 19387037 DOI: 10.1513/pats.200808-086rm] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Lavoie TL, Dowell ML, Lakser OJ, Gerthoffer WT, Fredberg JJ, Seow CY, Mitchell RW, Solway J. Disrupting actin-myosin-actin connectivity in airway smooth muscle as a treatment for asthma? PROCEEDINGS OF THE AMERICAN THORACIC SOCIETY 2009; 6:295-300. [PMID: 19387033 PMCID: PMC2677405 DOI: 10.1513/pats.200808-078rm] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2008] [Accepted: 01/27/2009] [Indexed: 11/20/2022]
Abstract
Breathing is known to functionally antagonize bronchoconstriction caused by airway muscle contraction. During breathing, tidal lung inflation generates force fluctuations that are transmitted to the contracted airway muscle. In vitro, experimental application of force fluctuations to contracted airway smooth muscle strips causes them to relengthen. Such force fluctuation-induced relengthening (FFIR) likely represents the mechanism by which breathing antagonizes bronchoconstriction. Thus, understanding the mechanisms that regulate FFIR of contracted airway muscle could suggest novel therapeutic interventions to increase FFIR, and so to enhance the beneficial effects of breathing in suppressing bronchoconstriction. Here we propose that the connectivity between actin filaments in contracting airway myocytes is a key determinant of FFIR, and suggest that disrupting actin-myosin-actin connectivity by interfering with actin polymerization or with myosin polymerization merits further evaluation as a potential novel approach for preventing prolonged bronchoconstriction in asthma.
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Affiliation(s)
- Tera L Lavoie
- Department of Medicine, University of Chicago, MC6026, 5841 S. Maryland Ave., Chicago, IL 60637, USA
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Bates JHT. How should airway smooth muscle be punished for causing asthma? J Appl Physiol (1985) 2008; 104:575-6. [PMID: 18174388 DOI: 10.1152/japplphysiol.01365.2007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Bates JHT, Cojocaru A, Haverkamp HC, Rinaldi LM, Irvin CG. The synergistic interactions of allergic lung inflammation and intratracheal cationic protein. Am J Respir Crit Care Med 2007; 177:261-8. [PMID: 17962637 DOI: 10.1164/rccm.200706-832oc] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
RATIONALE Airways hyperresponsiveness (AHR) is a hallmark feature of asthma, and can be caused by various disparate mechanisms. Mouse models of AHR have been useful for studying these mechanisms in isolation, but such models still typically do not exhibit the same degree of AHR as seen in severe human asthma. We hypothesized that more severe AHR in mice could be achieved by imbuing them with more than one mechanism of AHR. OBJECTIVES We sought to determine if the airway wall thickening accompanying allergic inflammation and the exaggerated smooth muscle shortening induced by intratracheal cationic protein could act together to produce a severe form of AHR. METHODS We used the forced oscillation technique to measure methacholine responsiveness in BALB/c mice that had been sensitized and challenged with ovalbumin followed by an intratracheal instillation of poly-l-lysine. MEASUREMENTS AND MAIN RESULTS We found that both ovalbumin and poly-l-lysine treatment alone caused moderate levels of AHR. When the two treatments were combined, however, they synergized in terms of their effect on lung stiffness to an extent that could even be fatal, reflecting a significantly enhanced level of airway closure. CONCLUSIONS Our results suggest that mechanistic synergy between airway wall thickening and exaggerated smooth muscle shortening produces a more germane mouse model of asthma that may have particular relevance to the pathophysiology of the acute severe asthma exacerbation.
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