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Perret JL, Vicendese D, Simons K, Jarvis DL, Lowe AJ, Lodge CJ, Bui DS, Tan D, Burgess JA, Erbas B, Bickerstaffe A, Hancock K, Thompson BR, Hamilton GS, Adams R, Benke GP, Thomas PS, Frith P, McDonald CF, Blakely T, Abramson MJ, Walters EH, Minelli C, Dharmage SC. Ten-year prediction model for post-bronchodilator airflow obstruction and early detection of COPD: development and validation in two middle-aged population-based cohorts. BMJ Open Respir Res 2021; 8:e001138. [PMID: 34857526 PMCID: PMC8640628 DOI: 10.1136/bmjresp-2021-001138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 11/15/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Classifying individuals at high chronic obstructive pulmonary disease (COPD)-risk creates opportunities for early COPD detection and active intervention. OBJECTIVE To develop and validate a statistical model to predict 10-year probabilities of COPD defined by post-bronchodilator airflow obstruction (post-BD-AO; forced expiratory volume in 1 s/forced vital capacity<5th percentile). SETTING General Caucasian populations from Australia and Europe, 10 and 27 centres, respectively. PARTICIPANTS For the development cohort, questionnaire data on respiratory symptoms, smoking, asthma, occupation and participant sex were from the Tasmanian Longitudinal Health Study (TAHS) participants at age 41-45 years (n=5729) who did not have self-reported COPD/emphysema at baseline but had post-BD spirometry and smoking status at age 51-55 years (n=2407). The validation cohort comprised participants from the European Community Respiratory Health Survey (ECRHS) II and III (n=5970), restricted to those of age 40-49 and 50-59 with complete questionnaire and spirometry/smoking data, respectively (n=1407). STATISTICAL METHOD Risk-prediction models were developed using randomForest then externally validated. RESULTS Area under the receiver operating characteristic curve (AUCROC) of the final model was 80.8% (95% CI 80.0% to 81.6%), sensitivity 80.3% (77.7% to 82.9%), specificity 69.1% (68.7% to 69.5%), positive predictive value (PPV) 11.1% (10.3% to 11.9%) and negative predictive value (NPV) 98.7% (98.5% to 98.9%). The external validation was fair (AUCROC 75.6%), with the PPV increasing to 17.9% and NPV still 97.5% for adults aged 40-49 years with ≥1 respiratory symptom. To illustrate the model output using hypothetical case scenarios, a 43-year-old female unskilled worker who smoked 20 cigarettes/day for 30 years had a 27% predicted probability for post-BD-AO at age 53 if she continued to smoke. The predicted risk was 42% if she had coexistent active asthma, but only 4.5% if she had quit after age 43. CONCLUSION This novel and validated risk-prediction model could identify adults aged in their 40s at high 10-year COPD-risk in the general population with potential to facilitate active monitoring/intervention in predicted 'COPD cases' at a much earlier age.
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Affiliation(s)
- Jennifer L Perret
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
- Department of Respiratory and Sleep Medicine, The Austin Hospital, Melbourne, VIC, Australia
- Institute for Breathing and Sleep (IBAS), Melbourne, VIC, Australia
| | - Don Vicendese
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
- The Department of Mathematics and Statistics, La Trobe University, Bundoora, VIC, Australia
| | - Koen Simons
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Debbie L Jarvis
- National Heart and Lung Institute (NHLI), Imperial College London, London, UK
| | - Adrian J Lowe
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Caroline J Lodge
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Dinh S Bui
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Daniel Tan
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - John A Burgess
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Bircan Erbas
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Adrian Bickerstaffe
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | | | - Bruce R Thompson
- Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Garun S Hamilton
- Department of Lung, Sleep, Allergy and Immunology, Monash Health, Melbourne, VIC, Australia
- School of Clinical Sciences, Monash University, Melbourne, VIC, Australia
| | - Robert Adams
- Adelaide Institute for Sleep Health (AISH), Flinders University, Adelaide, SA, Australia
| | - Geza P Benke
- School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Paul S Thomas
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Peter Frith
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Christine F McDonald
- Department of Respiratory and Sleep Medicine, The Austin Hospital, Melbourne, VIC, Australia
- Institute for Breathing and Sleep (IBAS), Melbourne, VIC, Australia
| | - Tony Blakely
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Michael J Abramson
- School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - E Haydn Walters
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
- School of Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Cosetta Minelli
- National Heart and Lung Institute (NHLI), Imperial College London, London, UK
| | - Shyamali C Dharmage
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
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2
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Song Y, Walters EH, Abramson MJ, Bowatte G, Bui DS, Perret J, Feather I, Knibbs LD, Wilson R, Nichols DS, Dharmage SC, Zosky GR. Protein levels, air pollution and vitamin D deficiency: links with allergy. ERJ Open Res 2021; 7:00237-2021. [PMID: 34616834 PMCID: PMC8488218 DOI: 10.1183/23120541.00237-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 07/15/2021] [Indexed: 11/05/2022] Open
Abstract
This study provides novel insights into mechanisms of traffic-related air pollution-induced allergy by down-regulation via complement regulators (CFI, PROS1 and PLG) and its interaction with vitamin D deficiency via the complement inhibitor PLG https://bit.ly/3x0jYOw.
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Affiliation(s)
- Yong Song
- Menzies Institute for Medical Research, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - E Haydn Walters
- School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia.,Tasmanian School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Michael J Abramson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Gayan Bowatte
- School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia.,Faculty of Allied Health Sciences, University of Peradeniya, National Institute of Fundamental Studies, Kandy, Sri Lanka.,Department of Basic Sciences, Faculty of Allied Health Sciences, University of Peradeniya, Kandy, Sri Lanka
| | - Dinh S Bui
- School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - Jennifer Perret
- School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - Iain Feather
- Gold Coast Hospital, Southport, Queensland, Australia
| | - Luke D Knibbs
- School of Public Health, The University of Queensland, Herston, Queensland, Australia
| | - Richard Wilson
- Central Science Laboratory, University of Tasmania, Hobart, Tasmania, Australia
| | - David S Nichols
- Central Science Laboratory, University of Tasmania, Hobart, Tasmania, Australia
| | - Shyamali C Dharmage
- School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - Graeme R Zosky
- Menzies Institute for Medical Research, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia.,Tasmanian School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
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3
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Bui DS, Agusti A, Walters H, Lodge C, Perret JL, Lowe A, Bowatte G, Cassim R, Hamilton GS, Frith P, James A, Thomas PS, Jarvis D, Abramson MJ, Faner R, Dharmage SC. Lung function trajectory and biomarkers in the Tasmanian Longitudinal Health Study. ERJ Open Res 2021; 7:00020-2021. [PMID: 34527727 PMCID: PMC8435806 DOI: 10.1183/23120541.00020-2021] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 06/04/2021] [Indexed: 11/05/2022] Open
Abstract
Background and objective Different lung function trajectories through life can lead to COPD in adulthood. This study investigated whether circulating levels of biomarkers can differentiate those with accelerated (AD) from normal decline (ND) trajectories. Methods The Tasmanian Longitudinal Health Study (TAHS) is a general population study that measured spirometry and followed up participants from ages 7 to 53 years. Based on their forced expiratory volume in 1 s (FEV1) trajectories from age 7 to 53 years, this analysis included those with COPD at age 53 years (60 with AD and 94 with ND) and controls (n=720) defined as never-smokers with an average FEV1 trajectory. Circulating levels of selected biomarkers determined at 53 and 45 years of age were compared between trajectories. Results Results showed that CC16 levels (an anti-inflammatory protein) were lower and C-reactive protein (CRP) (a pro-inflammatory marker) higher in the AD than in the ND trajectory. Higher CC16 levels were associated with a decreased risk of belonging to the AD trajectory (OR=0.79 (0.63-0.98) per unit increase) relative to ND trajectory. Higher CRP levels were associated with an increased risk of belonging to the AD trajectory (OR=1.07, 95% CI: 1.00-1.13, per unit increase). Levels of CC16 (area under the curve (AUC)=0.69, 95% CI: 0.56-0.81, p=0.002), CRP (AUC=0.63, 95% CI: 0.53-0.72, p=0.01) and the combination of both (AUC=0.72, 95% CI: 0.60-0.83, p<0.001) were able to discriminate between the AD and ND trajectories. Other quantified biomarkers (interleukin (IL)-4, IL-5, IL-6, IL-10 and tumour necrosis factor-α (TNF-α)) were not significantly different between AD, ND and controls. Conclusions Circulating levels of CRP and CC16 measured in late adulthood identify different lung function trajectories (AD versus ND) leading to COPD at age 53 years.
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Affiliation(s)
- Dinh S Bui
- Allergy and Lung Health Unit, School of Population and Global Health, The University of Melbourne, Melbourne, Australia.,Co-primary authors
| | - Alvar Agusti
- Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Barcelona, Spain.,Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Respiratory Institute, Hospital Clinic, Barcelona, Spain.,University of Barcelona, Barcelona, Spain.,Co-primary authors
| | - Haydn Walters
- Allergy and Lung Health Unit, School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Caroline Lodge
- Allergy and Lung Health Unit, School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Jennifer L Perret
- Allergy and Lung Health Unit, School of Population and Global Health, The University of Melbourne, Melbourne, Australia.,The Institute for Breathing and Sleep (IBAS), Melbourne, Australia
| | - Adrian Lowe
- Allergy and Lung Health Unit, School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Gayan Bowatte
- Allergy and Lung Health Unit, School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Raisa Cassim
- Allergy and Lung Health Unit, School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Garun S Hamilton
- Lung and Sleep Dept at Monash Health, Melbourne, Australia.,School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Peter Frith
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Alan James
- Dept of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, Australia
| | - Paul S Thomas
- Faculty of Medicine, Inflammation and Infection Research, University of New South Wales, Sydney, Australia
| | - Debbie Jarvis
- Dept of Epidemiology and Biostatistics, MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK.,Respiratory Epidemiology and Public Health Group, National Heart and Lung Institute, Imperial College London, London, UK
| | - Michael J Abramson
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Rosa Faner
- Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Barcelona, Spain.,Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Co-senior authors
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, School of Population and Global Health, The University of Melbourne, Melbourne, Australia.,Co-senior authors
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4
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Tan DJ, Lodge CJ, Lowe AJ, Bui DS, Bowatte G, Johns DP, Hamilton GS, Thomas PS, Abramson MJ, Walters EH, Perret JL, Dharmage SC. Bronchodilator reversibility as a diagnostic test for adult asthma: findings from the population-based Tasmanian Longitudinal Health Study. ERJ Open Res 2021; 7:00042-2020. [PMID: 33585659 PMCID: PMC7869605 DOI: 10.1183/23120541.00042-2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 12/09/2020] [Indexed: 11/23/2022] Open
Abstract
Bronchodilator reversibility (BDR) is often used as a diagnostic test for adult asthma. However, there has been limited assessment of its diagnostic utility. We aimed to determine the discriminatory accuracy of common BDR cut-offs in the context of current asthma and asthma–COPD overlap (ACO) in a middle-aged community sample. The Tasmanian Longitudinal Health Study is a population-based cohort first studied in 1968 (n=8583). In 2012, participants completed respiratory questionnaires and spirometry (n=3609; mean age 53 years). Receiver operating characteristic (ROC) curves were fitted for current asthma and ACO using continuous BDR measurements. Diagnostic parameters were calculated for different categorical cut-offs. Area under the ROC curve (AUC) was highest when BDR was expressed as change in forced expiratory volume in 1 s (FEV1) as a percentage of initial FEV1, as compared with predicted FEV1. The corresponding AUC was 59% (95% CI 54–64%) for current asthma and 87% (95% CI 81–93%) for ACO. Of the categorical cut-offs examined, the European Respiratory Society/American Thoracic Society threshold (≥12% from baseline and ≥200 mL) was assessed as providing the best balance between positive and negative likelihood ratios (LR+ and LR−, respectively), with corresponding sensitivities and specificities of 9% and 97%, respectively, for current asthma (LR+ 3.26, LR− 0.93), and 47% and 97%, respectively, for ACO (LR+ 16.05, LR− 0.55). With a threshold of ≥12% and ≥200 mL from baseline, a positive BDR test provided a clinically meaningful change in the post-test probability of disease, whereas a negative test did not. BDR was more useful as a diagnostic test in those with co-existent post-bronchodilator airflow obstruction (ACO). Using the commonly adopted threshold, a positive BDR test provides a meaningful change in post-test probability of adult asthma, whereas a negative test does not. Discriminatory accuracy is much greater in those with coexistent post-BD airflow obstruction.https://bit.ly/3gPvlm8
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Affiliation(s)
- Daniel J Tan
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Caroline J Lodge
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Adrian J Lowe
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Dinh S Bui
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Gayan Bowatte
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.,Dept of Basic Sciences, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya, Sri Lanka.,National Institute of Fundamental Studies, Kandy, Sri Lanka
| | - David P Johns
- School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Garun S Hamilton
- Monash Lung and Sleep, Monash Health, Clayton, Victoria, Australia.,School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Paul S Thomas
- Prince of Wales' Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Michael J Abramson
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - E Haydn Walters
- School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Jennifer L Perret
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.,Institute for Breathing and Sleep, Melbourne, Victoria, Australia.,These authors contributed equally
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.,These authors contributed equally
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5
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Perret JL, Bowatte G, Lodge CJ, Knibbs LD, Gurrin LC, Kandane-Rathnayake R, Johns DP, Lowe AJ, Burgess JA, Thompson BR, Thomas PS, Wood-Baker R, Morrison S, Giles GG, Marks G, Markos J, Tang MLK, Abramson MJ, Walters EH, Matheson MC, Dharmage SC. The Dose-Response Association between Nitrogen Dioxide Exposure and Serum Interleukin-6 Concentrations. Int J Mol Sci 2017; 18:ijms18051015. [PMID: 28481326 PMCID: PMC5454928 DOI: 10.3390/ijms18051015] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 04/26/2017] [Accepted: 04/28/2017] [Indexed: 12/04/2022] Open
Abstract
Systemic inflammation is an integral part of chronic obstructive pulmonary disease (COPD), and air pollution is associated with cardiorespiratory mortality, yet the interrelationships are not fully defined. We examined associations between nitrogen dioxide (NO2) exposure (as a marker of traffic-related air pollution) and pro-inflammatory cytokines, and investigated effect modification and mediation by post-bronchodilator airflow obstruction (post-BD-AO) and cardiovascular risk. Data from middle-aged participants in the Tasmanian Longitudinal Health Study (TAHS, n = 1389) were analyzed by multivariable logistic regression, using serum interleukin (IL)-6, IL-8 and tumor necrosis factor-α (TNF-α) as the outcome. Mean annual NO2 exposure was estimated at residential addresses using a validated satellite-based land-use regression model. Post-BD-AO was defined by post-BD forced expiratory ratio (FEV1/FVC) < lower limit of normal, and cardiovascular risk by a history of either cerebrovascular or ischaemic heart disease. We found a positive association with increasing serum IL-6 concentration (geometric mean 1.20 (95% CI: 1.1 to 1.3, p = 0.001) per quartile increase in NO2). This was predominantly a direct relationship, with little evidence for either effect modification or mediation via post-BD-AO, or for the small subgroup who reported cardiovascular events. However, there was some evidence consistent with serum IL-6 being on the causal pathway between NO2 and cardiovascular risk. These findings raise the possibility that the interplay between air pollution and systemic inflammation may differ between post-BD airflow obstruction and cardiovascular diseases.
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Affiliation(s)
- Jennifer L Perret
- Allergy and Lung Health Unit, Center for Epidemiology and Biostatistics, the University of Melbourne, Melbourne, Victoria 3010, Australia.
- Institute for Breathing and Sleep (IBAS), Heidelberg, Melbourne, Victoria 3084, Australia.
| | - Gayan Bowatte
- Allergy and Lung Health Unit, Center for Epidemiology and Biostatistics, the University of Melbourne, Melbourne, Victoria 3010, Australia.
| | - Caroline J Lodge
- Allergy and Lung Health Unit, Center for Epidemiology and Biostatistics, the University of Melbourne, Melbourne, Victoria 3010, Australia.
| | - Luke D Knibbs
- School of Public Health, the University of Queensland, Herston, Queensland 4006, Australia.
| | - Lyle C Gurrin
- Allergy and Lung Health Unit, Center for Epidemiology and Biostatistics, the University of Melbourne, Melbourne, Victoria 3010, Australia.
| | - Rangi Kandane-Rathnayake
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria 3004, Australia.
| | - David P Johns
- School of Medicine, University of Tasmania, Hobart, Tasmania 7001, Australia.
- "Breathe Well" Center of Research Excellence for Chronic Respiratory Disease and Lung Ageing, School of Medicine, University of Tasmania, Hobart, Tasmania 7005, Australia.
| | - Adrian J Lowe
- Allergy and Lung Health Unit, Center for Epidemiology and Biostatistics, the University of Melbourne, Melbourne, Victoria 3010, Australia.
| | - John A Burgess
- Allergy and Lung Health Unit, Center for Epidemiology and Biostatistics, the University of Melbourne, Melbourne, Victoria 3010, Australia.
| | - Bruce R Thompson
- Allergy, Immunology and Respiratory Medicine, the Alfred Hospital, Melbourne, Victoria 3004, Australia.
| | - Paul S Thomas
- Prince of Wales' Hospital Clinical School and School of Medicine Sciences, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia.
| | - Richard Wood-Baker
- School of Medicine, University of Tasmania, Hobart, Tasmania 7001, Australia.
| | - Stephen Morrison
- Department of Medicine, University of Queensland, Brisbane, Queensland 4072, Australia.
| | - Graham G Giles
- Cancer Epidemiological Center, Cancer Council Victoria, Melbourne, Victoria 3053, Australia.
| | - Guy Marks
- South West Sydney Clinical School, the University of NSW, Liverpool, NSW 2170, Australia.
| | - James Markos
- Department of Respiratory Medicine, Launceston General Hospital, Launceston, Tasmania 7250, Australia.
| | - Mimi L K Tang
- Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Victoria 3052, Australia.
- Allergy and Immune Disorders, Murdoch Children's Research Institute, Parkville, Victoria 3052, Australia.
- Department of Paediatrics, the University of Melbourne, Victoria 3010, Australia.
| | - Michael J Abramson
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia.
| | - E Haydn Walters
- Allergy and Lung Health Unit, Center for Epidemiology and Biostatistics, the University of Melbourne, Melbourne, Victoria 3010, Australia.
- School of Medicine, University of Tasmania, Hobart, Tasmania 7001, Australia.
- "Breathe Well" Center of Research Excellence for Chronic Respiratory Disease and Lung Ageing, School of Medicine, University of Tasmania, Hobart, Tasmania 7005, Australia.
| | - Melanie C Matheson
- Allergy and Lung Health Unit, Center for Epidemiology and Biostatistics, the University of Melbourne, Melbourne, Victoria 3010, Australia.
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, Center for Epidemiology and Biostatistics, the University of Melbourne, Melbourne, Victoria 3010, Australia.
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Lau MYZ, Dharmage SC, Burgess JA, Win AK, Lowe AJ, Lodge C, Perret J, Hui J, Thomas PS, Morrison S, Giles GG, Hopper J, Abramson MJ, Walters EH, Matheson MC. The interaction between farming/rural environment and TLR2, TLR4, TLR6 and CD14 genetic polymorphisms in relation to early- and late-onset asthma. Sci Rep 2017; 7:43681. [PMID: 28262750 PMCID: PMC5337969 DOI: 10.1038/srep43681] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 01/24/2017] [Indexed: 12/22/2022] Open
Abstract
Asthma phenotypes based on age-of-onset may be differently influenced by the interaction between variation in toll-like receptor (TLR)/CD14 genes and environmental microbes. We examined the associations between single-nucleotide polymorphisms (SNP) in the TLR/CD14 genes and asthma, and their interaction with proxies of microbial exposure (childhood farm exposure and childhood rural environment). Ten SNPs in four genes (TLR2, TLR4, TLR6, CD14) were genotyped for 1,116 participants from the Tasmanian Longitudinal Health Study (TAHS). Using prospectively collected information, asthma was classified as never, early- (before 13 years) or late-onset (after 13 years). Information on childhood farm exposure/childhood rural environment was collected at baseline. Those with early-onset asthma were more likely to be males, had a family history of allergy and a personal history of childhood atopy. We found significant interaction between TLR6 SNPs and childhood farm exposure. For those with childhood farm exposure, carriers of the TLR6-rs1039559 T-allele (p-interaction = 0.009) and TLR6-rs5743810 C-allele (p-interaction = 0.02) were associated with lower risk of early-onset asthma. We suggest the findings to be interpreted as hypothesis-generating as the interaction effect did not withstand correction for multiple testing. In this large, population-based longitudinal study, we found that the risk of early- and late-onset asthma is differently influenced by the interaction between childhood farming exposure and genetic variations.
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Affiliation(s)
- Melisa Y Z Lau
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, the University of Melbourne, Victoria, Australia
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, the University of Melbourne, Victoria, Australia.,Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - John A Burgess
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, the University of Melbourne, Victoria, Australia
| | - Aung K Win
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, the University of Melbourne, Victoria, Australia
| | - Adrian J Lowe
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, the University of Melbourne, Victoria, Australia.,Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Caroline Lodge
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, the University of Melbourne, Victoria, Australia.,Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Jennifer Perret
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, the University of Melbourne, Victoria, Australia
| | - Jennie Hui
- School of Population Health, the University of Western Australia, Perth, Australia
| | - Paul S Thomas
- Inflammation and Infection Research Centre, University of New South Wales, Australia
| | - Stephen Morrison
- Department of Medicine, the University of Queensland, Queensland, Australia
| | - Graham G Giles
- Cancer Epidemiology Centre, Cancer Council Victoria, Victoria, Australia.,School of Public Health &Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - John Hopper
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, the University of Melbourne, Victoria, Australia
| | - Michael J Abramson
- School of Public Health &Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - E Haydn Walters
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, the University of Melbourne, Victoria, Australia.,School of Medicine, University of Tasmania, Tasmania, Australia
| | - Melanie C Matheson
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, the University of Melbourne, Victoria, Australia.,Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
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7
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Matheson MC, Reece JC, Kandane-Rathnayake RK, Tang MLK, Simpson JA, Feather IH, Southey MC, Tsimiklis H, Hopper JL, Morrison SC, Giles GG, Walters EH, Dharmage SC. Mould-sensitized adults have lower Th2 cytokines and a higher prevalence of asthma than those sensitized to other aeroallergens. Allergy 2016; 71:1701-1711. [PMID: 27333124 DOI: 10.1111/all.12964] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Evidence suggests that specific allergen sensitizations are associated with different allergic diseases which may reflect different underlying immune profiles. We aimed to examine the cytokine profiles of individuals sensitized to eight common aeroallergens. METHODS We used data from the Tasmanian Longitudinal Health Study a population-based cohort study of 45-year-olds. Serum cytokines (IL-4, IL-5, IL-6, IL-8, IL-10, TNF-α) were measured in 1157 subjects using the LINCOplex assays. Participants underwent skin prick testing for house dust mite, cat, grasses and moulds. Multivariable linear regression was used to compare serum cytokine levels between sensitized and nonatopic subjects. RESULTS The prevalence of allergic sensitization to any aeroallergen was 51% (95% CI 47-54). Being sensitized to any aeroallergen was strongly associated with current asthma (OR = 3.7, 95% CI 2.6-5.3), and being sensitized to any moulds was associated with a very high risk of current asthma (OR = 6.40, 95% CI 4.06-10.1). The geometric mean (GM) levels of Th2 cytokines (IL-4, IL-5 and IL-6) for adults sensitized to Cladosporium were significantly lower than the levels for nonatopic individuals (IL-4 ratio of GMs = 0.25, 95% CI 0.10-0.62, P = 0.003; IL-5 GM = 0.55, 95% CI 0.30-0.99, P = 0.05; and IL-6 GM = 0.50, 95% CI 0.24-1.07, P = 0.07). Individuals sensitized to other aeroallergens all showed elevated Th2 cytokine levels. CONCLUSION Our study is the first large population-based study to demonstrate reduced Th2 cytokines levels in people sensitized to mould. Underlying biological mechanisms driving allergic inflammatory responses in adults sensitized to moulds may differ from those sensitized to other aeroallergens. These findings suggest that it may be necessary to tailor treatments in individuals sensitized to moulds compared with other aeroallergens in order to optimize outcomes.
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Affiliation(s)
- M. C. Matheson
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics; Melbourne School of Population and Global Health; The University of Melbourne; Melbourne Vic. Australia
- Murdoch Children's Research Institute; Royal Children's Hospital Melbourne; Melbourne Vic. Australia
| | - J. C. Reece
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics; Melbourne School of Population and Global Health; The University of Melbourne; Melbourne Vic. Australia
| | - R. K. Kandane-Rathnayake
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics; Melbourne School of Population and Global Health; The University of Melbourne; Melbourne Vic. Australia
| | - M. L. K. Tang
- Murdoch Children's Research Institute; Royal Children's Hospital Melbourne; Melbourne Vic. Australia
- Department of Paediatrics; The University of Melbourne; Melbourne Vic. Australia
| | - J. A. Simpson
- Biostatistics Unit; Centre for Epidemiology and Biostatistics; Melbourne School of Population and Global Health; The University of Melbourne; Melbourne Vic. Australia
| | - I. H. Feather
- Gold Coast Hospital; Southport Qld Australia
- Bond University; Varsity Lakes Qld Australia
| | - M. C. Southey
- Department of Pathology; University of Melbourne; Melbourne Vic. Australia
| | - H. Tsimiklis
- Department of Pathology; University of Melbourne; Melbourne Vic. Australia
| | - J. L. Hopper
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics; Melbourne School of Population and Global Health; The University of Melbourne; Melbourne Vic. Australia
| | | | - G. G. Giles
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics; Melbourne School of Population and Global Health; The University of Melbourne; Melbourne Vic. Australia
- Cancer Epidemiology Centre; Cancer Council Victoria; Melbourne Vic. Australia
| | - E. H. Walters
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics; Melbourne School of Population and Global Health; The University of Melbourne; Melbourne Vic. Australia
- Menzies Research Institute; Hobart Tas. Australia
| | - S. C. Dharmage
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics; Melbourne School of Population and Global Health; The University of Melbourne; Melbourne Vic. Australia
- Murdoch Children's Research Institute; Royal Children's Hospital Melbourne; Melbourne Vic. Australia
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