1
|
Pinedo Sierra C, Curto Sánchez E, Diaz Campos R, Hermida Valverde T, Sánchez-Cuellar S, Fernández Tena A. [Asthma]. OPEN RESPIRATORY ARCHIVES 2024; 6:100324. [PMID: 38707659 PMCID: PMC11067451 DOI: 10.1016/j.opresp.2024.100324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 03/10/2024] [Indexed: 05/07/2024] Open
Abstract
Asthma is a chronic inflammatory disease that affects about 5% of the world's population and generates high health and social costs. Proper management of the disease requires a correct diagnosis, based on objective measures of functional impairment, as well as symptom control and assessment of the future risk of exacerbations.It has been estimated that 18% of asthma patients in Western Europe have severe asthma and approximately 50% of them have poor control. The severity of asthma is established based on the minimum maintenance treatment needs to achieve control. Asthma clinical practice guidelines recommend classifying severe patients into allergic asthma (T2); eosinophilic asthma (T2) and non-T2 asthma in order to establish the most appropriate treatment.In recent decades, new biological therapies have been developed that can be applied according to the phenotype and endotype of asthma, allowing for selective and personalized treatment. These phenotypes and endotypes can change over time and therefore, the identification of biomarkers capable of predicting the severity, the course of the disease and the response to a given treatment seems essential. A large number of biomarkers have been studied in asthma, but so far only a few can be readily used in routine clinical practice. The application of omics technologies (epigenomics, genomics, transcriptomics, proteomics, metabolomics, lipidomics, etc.) for this purpose is still in the research phase.
Collapse
Affiliation(s)
- Celia Pinedo Sierra
- Servicio de Neumología. Hospital Universitario Clínico San Carlos. Universidad Complutense, Madrid, España
| | - Elena Curto Sánchez
- Servicio de Neumología. Hospital Clínico Universitario de Salamanca, Salamanca, España
| | - Rocio Diaz Campos
- U. de Asma Grave de Alta Complejidad. Servicio de Neumología. Hospital Universitario 12 de Octubre, Madrid, España
| | | | | | - Ana Fernández Tena
- Servicio de Neumología Ocupacional. Instituto Nacional de Silicosis, Oviedo, España
| |
Collapse
|
2
|
Plavsic A, Bonaci-Nikolic B, Milenkovic B, Miskovic R, Kusic N, Dimitrijevic M, Arandjelovic S, Milosevic K, Buha I, Tomic Spiric V. Asthma Inflammatory Phenotypes: How Can We Distinguish Them? J Clin Med 2024; 13:526. [PMID: 38256660 PMCID: PMC10816410 DOI: 10.3390/jcm13020526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 01/07/2024] [Accepted: 01/16/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND AND OBJECTIVES induced sputum is used to assess different inflammatory phenotypes in asthma, but is not used routinely. We aimed to determine the proportion of inflammatory asthma phenotypes based on induced sputum, to find biomarkers that can discriminate between phenotypes, and to evaluate biomarkers in patients with and without biological therapy in different inflammatory asthma phenotypes. MATERIALS AND METHODS this cross-sectional study investigated clinical characteristics, asthma control tests, skin prick test, impulse oscillometry (IOS), spirometry, induced sputum, biomarkers (IgE, eosinophils, fractional exhaled nitric oxide (FeNO), serum periostin, IL-5, IL-6, IL-8, IL-17A, IL-33) in 80 asthmatics. A total of 17/80 patients were treated with biologics (10 with omalizumab, 7 with benralizumab). RESULTS a total of 31% of patients had eosinophilic asthma (EA), 30% had mixed granulocytic asthma (MGA), 24% had paucigranulocytic asthma (PGA), and 15% had neutrophilic asthma (NA). The difference was found in blood eosinophils (p = 0.002), the highest observed in EA. The cut-off ≥ 240/μL eosinophils, with 64% sensitivity and 72.7% specificity, identified EA (AUC = 0.743, p = 0.001). A higher IL-8 level was associated with NA (p = 0.025). In 63 non-biologic asthma group, eosinophils were higher in EA than in NA, MGA, and PGA (p = 0.012, p = 0.028, and p = 0.049, respectively). A higher IL-17A was associated with EA without biologics (p = 0.004). A significantly higher IL-5 was found in EA treated with biologics, in comparison with EA without biologics (p = 0.043). The number of leucocytes and neutrophils was higher in MGA without biologics (p = 0.049, p = 0.019), while IL-5, IL-6, and IL-8 levels were higher in MGA treated with biologics (p = 0.012, p = 0.032, p = 0.038, respectively). CONCLUSIONS EA and MGA were the most prevalent asthma phenotypes. Blood eosinophils can identify EA, both in patients with and without biologics. Apart from the clinical profile, a broad spectrum of biomarkers for assessing inflammatory phenotypes is necessary for an adequate therapy approach to patients with asthma.
Collapse
Affiliation(s)
- Aleksandra Plavsic
- Clinic for Allergy and Immunology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia; (B.B.N.); (R.M.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (B.M.)
| | - Branka Bonaci-Nikolic
- Clinic for Allergy and Immunology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia; (B.B.N.); (R.M.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (B.M.)
| | - Branislava Milenkovic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (B.M.)
- Clinic for Pulmonology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia
| | - Rada Miskovic
- Clinic for Allergy and Immunology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia; (B.B.N.); (R.M.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (B.M.)
| | - Natasa Kusic
- Clinic for Allergy and Immunology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia; (B.B.N.); (R.M.)
| | - Milan Dimitrijevic
- Clinic for Allergy and Immunology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia; (B.B.N.); (R.M.)
| | - Snezana Arandjelovic
- Clinic for Allergy and Immunology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia; (B.B.N.); (R.M.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (B.M.)
| | - Katarina Milosevic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (B.M.)
- Department of Pulmonology and Allergology, University Children’s Hospital, 11000 Belgrade, Serbia
| | - Ivana Buha
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (B.M.)
- Clinic for Pulmonology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia
| | - Vesna Tomic Spiric
- Clinic for Allergy and Immunology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia; (B.B.N.); (R.M.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (B.M.)
| |
Collapse
|
3
|
Armeftis C, Gratziou C, Siafakas N, Katsaounou P, Pana ZD, Bakakos P. An update on asthma diagnosis. J Asthma 2023; 60:2104-2110. [PMID: 37358228 DOI: 10.1080/02770903.2023.2228911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 06/15/2023] [Accepted: 06/20/2023] [Indexed: 06/27/2023]
Abstract
OBJECTIVE Asthma imposes a significant health and socioeconomic burden with an average prevalence impacting 5-10% of the global population. The aim of this narrative review is to update the current literature on topics related to asthma diagnosis. DATA SOURCES Original research articles were identified from PubMed using the search terms "asthma diagnosis" and "asthma misdiagnosis". STUDY SELECTIONS Recently published articles (n = 51) detailing the diagnosis, misdiagnosis of asthma, and the updated recommendations of the European and international asthma guidelines. RESULTS Emerging evidence revealed that asthma might represent a rather heterogenous clinical entity with varying underlying molecular mechanisms. Attempts have been made to unravel these traits to better provide accurate diagnosis and a more efficient patient-based management approach. The lack of a gold standard test for asthma diagnosis has contributed to its over- and underdiagnosis. This is problematic, given that overdiagnosis might lead to delay of both diagnosis and prompt treatment of other diseases, while underdiagnosis might substantially impact quality of life due to progression of asthma by increased rate of exacerbations and airway remodeling. In addition to poor asthma control and potential patient harm, asthma misdiagnosis is also associated with excessive costs. As a result, current international guidelines emphasize the need for a standardized approach to diagnosis, including objective measurements prior to treatment. CONCLUSION Future research is warranted to define the optimal diagnostic and treatable traits approach especially for patients with severe asthma, as they may benefit from the advent of newly targeted asthma management.
Collapse
Affiliation(s)
| | - Christina Gratziou
- Pulmonology, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | | | - Petros Bakakos
- Pulmonology, National and Kapodistrian University of Athens, Athens, Greece
| |
Collapse
|
4
|
Canonica GW, Varricchi G, Paoletti G, Heffler E, Virchow JC. Advancing precision medicine in asthma: Evolution of treatment outcomes. J Allergy Clin Immunol 2023; 152:835-840. [PMID: 37531979 DOI: 10.1016/j.jaci.2023.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 07/17/2023] [Accepted: 07/21/2023] [Indexed: 08/04/2023]
Abstract
The article discusses the historical evolution of asthma treatment and highlights recent advancements in personalized medicine, specifically the use of biologics in severe asthma therapy and its potential combination with allergen immunotherapy (AIT). One of the major breakthroughs of biologics is their potential effect on airway remodeling, a crucial aspect of asthma chronicity. The article introduces the concept of disease-modifying antiasthmatic drugs, which aim to modify the course of asthma and possibly modulate or prevent airway remodeling. Furthermore, the critical importance of patient-centered outcome measures to evaluate the efficacy and effectiveness of asthma treatments is emphasized, with the innovative concept of asthma remission introduced as a potential outcome. Recent studies suggest that AIT can be used as an additional therapy to biologic agents for the treatment of allergic asthma. The combination of these treatments has been shown to induce improved clinical outcomes. However, AIT is actually not recommended for use in patients with severe asthma, but encouraging results from studies investigating the combined use of AIT and biologics indicate a novel approach to exploring these treatment modalities. In conclusion, the introduction of biologics and AIT has changed the scenario of respiratory allergy treatment, from a "one size fits all" approach to embracing "individual treatments."
Collapse
Affiliation(s)
- Giorgio Walter Canonica
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Milan, Italy; Asthma & Allergy Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, Milan, Italy.
| | - Gilda Varricchi
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy; Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, Naples, Italy; World Allergy Organization (WAO) Center of Excellence, Naples, Italy; Institute of Experimental Endocrinology and Oncology (IEOS), National Research Council, Naples, Italy
| | - Giovanni Paoletti
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Milan, Italy; Asthma & Allergy Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, Milan, Italy
| | - Enrico Heffler
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Milan, Italy; Asthma & Allergy Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, Milan, Italy
| | | |
Collapse
|
5
|
Gonzalez-Uribe V, Romero-Tapia SJ, Castro-Rodriguez JA. Asthma Phenotypes in the Era of Personalized Medicine. J Clin Med 2023; 12:6207. [PMID: 37834850 PMCID: PMC10573947 DOI: 10.3390/jcm12196207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/19/2023] [Accepted: 09/22/2023] [Indexed: 10/15/2023] Open
Abstract
Asthma is a widespread disease affecting approximately 300-million people globally. This condition leads to significant morbidity, mortality, and economic strain worldwide. Recent clinical and laboratory research advancements have illuminated the immunological factors contributing to asthma. As of now, asthma is understood to be a heterogeneous disease. Personalized medicine involves categorizing asthma by its endotypes, linking observable characteristics to specific immunological mechanisms. Identifying these endotypic mechanisms is paramount in accurately profiling patients and tailoring therapeutic approaches using innovative biological agents targeting distinct immune pathways. This article presents a synopsis of the key immunological mechanisms implicated in the pathogenesis and manifestation of the disease's phenotypic traits and individualized treatments for severe asthma subtypes.
Collapse
Affiliation(s)
- Victor Gonzalez-Uribe
- Alergia e Inmunología Clínica, Hospital Infantil de México Federico Gómez, Ciudad de Mexico 06720, Mexico;
- Facultad Mexicana de Medicina, Universidad La Salle México, Ciudad de Mexico 14000, Mexico
| | - Sergio J. Romero-Tapia
- Health Sciences Academic Division (DACS), Universidad Juárez Autónoma de Tabasco, Villahermosa 86040, Mexico;
| | - Jose A. Castro-Rodriguez
- Department of Pediatric Pulmonology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago 7820436, Chile
| |
Collapse
|
6
|
Varricchi G, Ferri S, Pepys J, Poto R, Spadaro G, Nappi E, Paoletti G, Virchow JC, Heffler E, Canonica WG. Biologics and airway remodeling in severe asthma. Allergy 2022; 77:3538-3552. [PMID: 35950646 PMCID: PMC10087445 DOI: 10.1111/all.15473] [Citation(s) in RCA: 85] [Impact Index Per Article: 42.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 08/03/2022] [Accepted: 08/05/2022] [Indexed: 01/28/2023]
Abstract
Asthma is a chronic inflammatory airway disease resulting in airflow obstruction, which in part can become irreversible to conventional therapies, defining the concept of airway remodeling. The introduction of biologics in severe asthma has led in some patients to the complete normalization of previously considered irreversible airflow obstruction. This highlights the need to distinguish a "fixed" airflow obstruction due to structural changes unresponsive to current therapies, from a "reversible" one as demonstrated by lung function normalization during biological therapies not previously obtained even with high-dose systemic glucocorticoids. The mechanisms by which exposure to environmental factors initiates the inflammatory responses that trigger airway remodeling are still incompletely understood. Alarmins represent epithelial-derived cytokines that initiate immunologic events leading to inflammatory airway remodeling. Biological therapies can improve airflow obstruction by addressing these airway inflammatory changes. In addition, biologics might prevent and possibly even revert "fixed" remodeling due to structural changes. Hence, it appears clinically important to separate the therapeutic effects (early and late) of biologics as a new paradigm to evaluate the effects of these drugs and future treatments on airway remodeling in severe asthma.
Collapse
Affiliation(s)
- Gilda Varricchi
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy.,Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, Naples, Italy.,World Allergy Organization (WAO) Center of Excellence, Naples, Italy.,Institute of Experimental Endocrinology and Oncology (IEOS), National Research Council, Naples, Italy
| | - Sebastian Ferri
- Personalized Medicine Asthma and Allergy Unit - IRCCS Humanitas Research Hospital, Milan, Italy
| | - Jack Pepys
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Remo Poto
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy.,Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, Naples, Italy.,World Allergy Organization (WAO) Center of Excellence, Naples, Italy
| | - Giuseppe Spadaro
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy.,Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, Naples, Italy.,World Allergy Organization (WAO) Center of Excellence, Naples, Italy
| | - Emanuele Nappi
- Personalized Medicine Asthma and Allergy Unit - IRCCS Humanitas Research Hospital, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Giovanni Paoletti
- Personalized Medicine Asthma and Allergy Unit - IRCCS Humanitas Research Hospital, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | | | - Enrico Heffler
- Personalized Medicine Asthma and Allergy Unit - IRCCS Humanitas Research Hospital, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Walter G Canonica
- Personalized Medicine Asthma and Allergy Unit - IRCCS Humanitas Research Hospital, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| |
Collapse
|
7
|
Guida G, Bagnasco D, Carriero V, Bertolini F, Ricciardolo FLM, Nicola S, Brussino L, Nappi E, Paoletti G, Canonica GW, Heffler E. Critical evaluation of asthma biomarkers in clinical practice. Front Med (Lausanne) 2022; 9:969243. [PMID: 36300189 PMCID: PMC9588982 DOI: 10.3389/fmed.2022.969243] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/29/2022] [Indexed: 11/13/2022] Open
Abstract
The advent of personalized medicine has revolutionized the whole approach to the management of asthma, representing the essential basis for future developments. The cornerstones of personalized medicine are the highest precision in diagnosis, individualized prediction of disease evolution, and patient-tailored treatment. To this aim, enormous efforts have been established to discover biomarkers able to predict patients' phenotypes according to clinical, functional, and bio-humoral traits. Biomarkers are objectively measured characteristics used as indicators of biological or pathogenic processes or clinical responses to specific therapeutic interventions. The diagnosis of type-2 asthma, prediction of response to type-2 targeted treatments, and evaluation of the risk of exacerbation and lung function impairment have been associated with biomarkers detectable either in peripheral blood or in airway samples. The surrogate nature of serum biomarkers, set up to be less invasive than sputum analysis or bronchial biopsies, has shown several limits concerning their clinical applicability. Routinely used biomarkers, like peripheral eosinophilia, total IgE, or exhaled nitric oxide, result, even when combined, to be not completely satisfactory in segregating different type-2 asthma phenotypes, particularly in the context of severe asthma where the choice among different biologics is compelling. Moreover, the type-2 low fraction of patients is not only an orphan of biological treatments but is at risk of being misdiagnosed due to the low negative predictive value of type-2 high biomarkers. Sputum inflammatory cell analysis, considered the highest specific biomarker in discriminating eosinophilic inflammation in asthma, and therefore elected as the gold standard in clinical trials and research models, demonstrated many limits in clinical applicability. Many factors may influence the measure of these biomarkers, such as corticosteroid intake, comorbidities, and environmental exposures or habits. Not least, biomarkers variability over time is a confounding factor leading to wrong clinical choices. In this narrative review, we try to explore many aspects concerning the role of routinely used biomarkers in asthma, applying a critical view over the "state of the art" and contemporarily offering an overview of the most recent evidence in this field.
Collapse
Affiliation(s)
- Giuseppe Guida
- Severe Asthma and Rare Lung Disease Unit, Department of Clinical and Biological Sciences, San Luigi Gonzaga University Hospital, University of Torino, Turin, Italy
| | - Diego Bagnasco
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, Department of Internal Medicine (DIMI), University of Genoa, Genoa, Italy
| | - Vitina Carriero
- Severe Asthma and Rare Lung Disease Unit, Department of Clinical and Biological Sciences, San Luigi Gonzaga University Hospital, University of Torino, Turin, Italy
| | - Francesca Bertolini
- Severe Asthma and Rare Lung Disease Unit, Department of Clinical and Biological Sciences, San Luigi Gonzaga University Hospital, University of Torino, Turin, Italy
| | - Fabio Luigi Massimo Ricciardolo
- Severe Asthma and Rare Lung Disease Unit, Department of Clinical and Biological Sciences, San Luigi Gonzaga University Hospital, University of Torino, Turin, Italy
| | - Stefania Nicola
- Allergy and Immunology, AO Mauriziano Hospital, University of Turin, Turin, Italy
| | - Luisa Brussino
- Allergy and Immunology, AO Mauriziano Hospital, University of Turin, Turin, Italy
| | - Emanuele Nappi
- IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Giovanni Paoletti
- IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Giorgio Walter Canonica
- IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Enrico Heffler
- IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| |
Collapse
|
8
|
Rogliani P, Cavalli F, Ritondo BL, Cazzola M, Calzetta L. Sex differences in adult asthma and COPD therapy: a systematic review. Respir Res 2022; 23:222. [PMID: 36038873 PMCID: PMC9426004 DOI: 10.1186/s12931-022-02140-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 08/04/2022] [Indexed: 11/18/2022] Open
Abstract
Background Although asthma is more prevalent in women and the prevalence of COPD is increasing in women, the current international recommendations for the management and prevention of asthma and COPD provide no sex-related indication for the treatment of these diseases. Therefore, we systematically reviewed the evidence across literature on the sex-related effectiveness of asthma and COPD therapy. Methods This systematic review has been registered in PROSPERO and performed according to PRISMA-P. The PICO framework was applied for the literature search strategy: "patient problem” included adult patients suffering from asthma or COPD, “Intervention” regarded the pharmacological treatments for asthma or COPD, “Comparison” was vs. baseline, active controls, or placebo, “Outcome” was any difference sex-related in the effectiveness of interventions. Results In asthma 44% of the evidence reported that men responded better than women to the therapy, whereas this percentage was 28% in COPD. ICS was generally less effective in women than in men to treat asthma, and consistent evidence suggests that in asthmatic patients ICS/LABA/LAMA combination may be equally effective in both men and women. Due to the inconsistent available evidence, it is not possible to identify specific treatments whose effectiveness is related to sex difference in COPD patients. Conclusions There is a strong need of investigating the sex-related impact of asthma and COPD treatments. Pre-specified analyses in men and women should be planned in future trial protocols, a necessary condition that should be requested also by the regulatory agencies to overcome the anachronistic “one-size-fits-all” approach to therapeutics associated with suboptimal outcomes for patients.
Collapse
Affiliation(s)
- Paola Rogliani
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata", Via Montpellier, 1 - 00133, Rome, Italy. .,Respiratory Medicine, University Hospital Policlinico Tor Vergata, Rome, Italy.
| | - Francesco Cavalli
- Respiratory Medicine, University Hospital Policlinico Tor Vergata, Rome, Italy
| | - Beatrice Ludovica Ritondo
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata", Via Montpellier, 1 - 00133, Rome, Italy
| | - Mario Cazzola
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata", Via Montpellier, 1 - 00133, Rome, Italy
| | - Luigino Calzetta
- Department of Medicine and Surgery, Respiratory Disease and Lung Function Unit, University of Parma, Parma, Italy
| |
Collapse
|
9
|
Impact of Sex on Proper Use of Inhaler Devices in Asthma and COPD: A Systematic Review and Meta-Analysis. Pharmaceutics 2022; 14:pharmaceutics14081565. [PMID: 36015191 PMCID: PMC9414749 DOI: 10.3390/pharmaceutics14081565] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 07/18/2022] [Accepted: 07/24/2022] [Indexed: 01/25/2023] Open
Abstract
Despite females being more often affected by asthma than males and the prevalence of COPD rising in females, conflicting evidence exists as to whether sex may modulate the correct inhaler technique. The aim of this study was to assess the impact of sex on the proper use of inhaler devices in asthma and COPD. A pairwise meta-analysis was performed on studies enrolling adult males and females with asthma or COPD and reporting data of patients making at least one error by inhaler device type (DPI, MDI, and SMI). The data of 6,571 patients with asthma or COPD were extracted from 12 studies. A moderate quality of evidence (GRADE +++) indicated that sex may influence the correct use of inhaler device in both asthma and COPD. The critical error rate was higher in females with asthma (OR 1.31, 95%CI 1.14−1.50) and COPD (OR 1.80, 95%CI 1.22−2.67) using DPI vs. males (p < 0.01). In addition, the use of SMI in COPD was associated with a greater rate of critical errors in females vs. males (OR 5.36, 95%CI 1.48−19.32; p < 0.05). No significant difference resulted for MDI. In conclusion, choosing the right inhaler device in agreement with sex may optimize the pharmacological treatment of asthma and COPD.
Collapse
|
10
|
Paoletti G, Pepys J, Casini M, Di Bona D, Heffler E, Goh CYY, Price DB, Canonica GW. Biologics in severe asthma: the role of real-world evidence from registries. Eur Respir Rev 2022; 31:210278. [PMID: 35675922 PMCID: PMC9489006 DOI: 10.1183/16000617.0278-2021] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 04/20/2022] [Indexed: 11/05/2022] Open
Abstract
Asthma is one of the most common noncommunicable diseases; in the majority of patients it is well controlled with inhaled bronchodilators and inhaled corticosteroids, but the management of severe asthma has been a significant challenge historically. The introduction of novel biologic drugs in the past few decades has revolutionised the field, presenting physicians with a variety of biologic drugs with different mechanisms for the treatment of severe asthma.It is of crucial importance to evaluate the effectiveness of these drugs by following their "real-life" effectiveness rather than relying solely on their efficacy, established in carefully designed clinical trials, which therefore do not necessarily match the profile of the real-life patient. Understanding the actual effectiveness of the specific drugs in real-life patients is a crucial part of tailoring the right drugs to the right patients. Registries serve as an important tool in obtaining real-life evidence, since they are in effect observational studies, following the entire patient population.
Collapse
Affiliation(s)
- Giovanni Paoletti
- IRCCS Humanitas Research Hospital, Milan, Italy
- Dept of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Jack Pepys
- Dept of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Marta Casini
- Dept of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Danilo Di Bona
- School and Chair of Allergology and Clinical Immunology, Dept of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Enrico Heffler
- IRCCS Humanitas Research Hospital, Milan, Italy
- Dept of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Celine Y Y Goh
- Optimum Patient Care Global, Cambridge, UK
- Observational and Pragmatic Research Institute, Singapore, Singapore
| | - David B Price
- Optimum Patient Care Global, Cambridge, UK
- Observational and Pragmatic Research Institute, Singapore, Singapore
- Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Giorgio Walter Canonica
- IRCCS Humanitas Research Hospital, Milan, Italy
- Dept of Biomedical Sciences, Humanitas University, Milan, Italy
| |
Collapse
|
11
|
Rogliani P, Cavalli F, Chetta A, Cazzola M, Calzetta L. Potential Drawbacks of ICS/LABA/LAMA Triple Fixed-Dose Combination Therapy in the Treatment of Asthma: A Quantitative Synthesis of Safety Profile. J Asthma Allergy 2022; 15:565-577. [PMID: 35573127 PMCID: PMC9091690 DOI: 10.2147/jaa.s283489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 04/20/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Methods Results Conclusion
Collapse
Affiliation(s)
- Paola Rogliani
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome “Tor Vergata”, Rome, Italy
- Correspondence: Paola Rogliani, Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome “Tor Vergata”, Rome, Italy, Email
| | - Francesco Cavalli
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome “Tor Vergata”, Rome, Italy
| | - Alfredo Chetta
- Department of Medicine and Surgery, Respiratory Disease and Lung Function Unit, University of Parma, Parma, Italy
| | - Mario Cazzola
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome “Tor Vergata”, Rome, Italy
| | - Luigino Calzetta
- Department of Medicine and Surgery, Respiratory Disease and Lung Function Unit, University of Parma, Parma, Italy
| |
Collapse
|
12
|
Kelly RS, Mendez KM, Huang M, Hobbs BD, Clish CB, Gerszten R, Cho MH, Wheelock CE, McGeachie MJ, Chu SH, Celedón JC, Weiss ST, Lasky-Su J. Metabo-Endotypes of Asthma Reveal Differences in Lung Function: Discovery and Validation in Two TOPMed Cohorts. Am J Respir Crit Care Med 2022; 205:288-299. [PMID: 34767496 PMCID: PMC8886990 DOI: 10.1164/rccm.202105-1268oc] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Rationale: Current guidelines do not sufficiently capture the heterogeneous nature of asthma; a more detailed molecular classification is needed. Metabolomics represents a novel and compelling approach to derive asthma endotypes (i.e., subtypes defined by functional and/or pathobiological mechanisms). Objectives: To validate metabolomic-driven endotypes of asthma and explore their underlying biology. Methods: In the Genetics of Asthma in Costa Rica Study (GACRS), untargeted metabolomic profiling, similarity network fusion, and spectral clustering was used to identify metabo-endotypes of asthma, and differences in asthma-relevant phenotypes across these metabo-endotypes were explored. The metabo-endotypes were recapitulated in the Childhood Asthma Management Program (CAMP), and clinical differences were determined. Metabolomic drivers of metabo-endotype membership were investigated by meta-analyzing findings from GACRS and CAMP. Measurements and Main Results: Five metabo-endotypes were identified in GACRS with significant differences in asthma-relevant phenotypes, including prebronchodilator (p-ANOVA = 8.3 × 10-5) and postbronchodilator (p-ANOVA = 1.8 × 10-5) FEV1/FVC. These differences were validated in the recapitulated metabo-endotypes in CAMP. Cholesterol esters, trigylcerides, and fatty acids were among the most important drivers of metabo-endotype membership. The findings suggest dysregulation of pulmonary surfactant homeostasis may play a role in asthma severity. Conclusions: Clinically meaningful endotypes may be derived and validated using metabolomic data. Interrogating the drivers of these metabo-endotypes has the potential to help understand their pathophysiology.
Collapse
Affiliation(s)
| | | | | | - Brian D. Hobbs
- Channing Division of Network Medicine and,Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Clary B. Clish
- The Broad Institute of MIT and Harvard, Cambridge, Massachusetts
| | - Robert Gerszten
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Michael H. Cho
- Channing Division of Network Medicine and,Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Craig E. Wheelock
- Division of Physiological Chemistry 2, Department of Medical Biochemistry and Biophysics, Karolinska Institute, Stockholm, Sweden;,Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm, Sweden;,Gunma University Initiative for Advanced Research, Gunma University, Gunma, Japan; and
| | | | - Su H. Chu
- Channing Division of Network Medicine and
| | - Juan C. Celedón
- Division of Pediatric Pulmonary Medicine, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | | |
Collapse
|
13
|
Extrafine Beclometasone Dipropionate/Formoterol NEXThaler on Device Usability, Adherence, Asthma Control and Quality of Life. A Panhellenic Prospective, Non-Interventional Observational Study in Patients with Asthma—The NEXT-Step Study. J Pers Med 2022; 12:jpm12020146. [PMID: 35207635 PMCID: PMC8876660 DOI: 10.3390/jpm12020146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/24/2021] [Accepted: 12/16/2021] [Indexed: 02/01/2023] Open
Abstract
Background: The fixed combination of extrafine beclometasone dipropionate 100 μg/formoterol 6 μg (extrafine BDP/F) delivered by NEXThaler has proved to be effective in patients with moderate-to-severe asthma in terms of lung function, symptoms and asthma control. The aim of this study was to investigate the usability/satisfaction of NEXThaler and adherence to treatment in asthma patients not well controlled by low-dose inhaled corticosteroids (ICS). Methods: This was a 6-month prospective, multicenter, open-label, observational study in 661 patients with asthma not well controlled by low-dose ICS according to the physician’s clinical assessment, which have received regular treatment with extrafine BDP/F NEXThaler. Feeling of Satisfaction with Inhaler (FSI), treatment adherence with self-reported Morisky scale, asthma control, lung function and QoL were recorded at baseline, 3 and 6 months after treatment with extrafine BDP/F. Results: The percentage of patients at least “fairly” satisfied with NEXThaler usability (FSI-10 score 40 to 50) was 96.3%. The mean FSI-10 total score was 46.8 ± 4.4 on Visit 2 and increased to 48.1 ± 3.3 on Visit 3 (p < 0.001). Approximately 67% of the patients reported “high adherence” on Visit 2, and 70% of them reported “high adherence” on Visit 3. The percentage of patients with ACQ-6-uncontrolled asthma decreased from 79.1% on Visit 1 to 22.3% on Visit 2 and further decreased to 6.7% on Visit 3. Significant improvements were also observed in the total AQLQ score, predicted FEV1% and reduction in rescue medication use. Conclusions: The NEXThaler device, delivering a combination of BDP/F, achieves satisfaction and high adherence in patients with asthma not well controlled with low-dose ICS. Asthma control, QoL, lung function and rescue medication use were improved in a Greek real-world setting.
Collapse
|
14
|
Lourenço LO, Ribeiro AM, Lopes FDTQDS, Tibério IDFLC, Tavares-de-Lima W, Prado CM. Different Phenotypes in Asthma: Clinical Findings and Experimental Animal Models. Clin Rev Allergy Immunol 2021; 62:240-263. [PMID: 34542807 DOI: 10.1007/s12016-021-08894-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2021] [Indexed: 10/20/2022]
Abstract
Asthma is a respiratory allergic disease presenting a high prevalence worldwide, and it is responsible for several complications throughout life, including death. Fortunately, asthma is no longer recognized as a unique manifestation but as a very heterogenic manifestation. Its phenotypes and endotypes are known, respectively, as pathologic and molecular features that might not be directly associated with each other. The increasing number of studies covering this issue has brought significant insights and knowledge that are constantly expanding. In this review, we intended to summarize this new information obtained from clinical studies, which not only allowed for the creation of patient clusters by means of personalized medicine and a deeper molecular evaluation, but also created a connection with data obtained from experimental models, especially murine models. We gathered information regarding sensitization and trigger and emphasizing the most relevant phenotypes and endotypes, such as Th2-high asthma and Th2-low asthma, which included smoking and obesity-related asthma and mixed and paucigranulocytic asthma, not only in physiopathology and the clinic but also in how these phenotypes can be determined with relative similarity using murine models. We also further investigated how clinical studies have been treating patients using newly developed drugs focusing on specific biomarkers that are more relevant according to the patient's clinical manifestation of the disease.
Collapse
Affiliation(s)
- Luiz Otávio Lourenço
- Department of Biosciences, Federal University of São Paulo, Campus Baixada Santista, Santos, SP, Brazil
| | - Alessandra Mussi Ribeiro
- Department of Biosciences, Federal University of São Paulo, Campus Baixada Santista, Santos, SP, Brazil
| | | | | | - Wothan Tavares-de-Lima
- Department of Pharmacology, Institute of Biomedical Sciences, University of Sao Paulo, Sao Paulo, SP, Brazil
| | - Carla Máximo Prado
- Department of Biosciences, Federal University of São Paulo, Campus Baixada Santista, Santos, SP, Brazil. .,Department of Medicine, School of Medicine, University of São Paulo, São Paulo, SP, Brazil.
| |
Collapse
|
15
|
Zhao J, Zhang J, Tang S, Wang J, Liu T, Zeng R, Zhu W, Zhang K, Wu J. The different functions of short and long thymic stromal lymphopoietin isoforms in autophagy-mediated asthmatic airway inflammation and remodeling. Immunobiology 2021; 226:152124. [PMID: 34333403 DOI: 10.1016/j.imbio.2021.152124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 07/15/2021] [Accepted: 07/18/2021] [Indexed: 11/16/2022]
Abstract
Asthma is a chronic respiratory disease characterized by airway inflammation and remodeling as well as hyper-responsiveness. Thymic stromal lymphopoietin (TSLP), which is a crucial inflammatory cytokine in immune homeostasis, consists of two isoforms, the long isoform lfTSLP and short isoform sfTSLP. The lfTSLP promotes inflammation and plays a pivotal role in asthma pathogenesis, while sfTSLP had been reported to have anti-asthma effects. Experiments have shown that lfTSLP could induce autophagy in hepatocytes. It is unknown whether lfTSLP or sfTSLP could influence autophagy and affect the progression of asthma. Using house dust mite (HDM)-stimulated airway smooth muscle cells as an in vitro model and HDM-induced asthma mice as in vivo model, we found that lfTSLP could induce autophagy and remodeling, while sfTSLP has the reverse effect. Strikingly, sfTSLP treatment in vivo reversed HDM-mediated activation of inflammation and airway remodeling, partly determined by autophagy change. These findings may help us understand the function of TSLP isoforms in the pathogenesis of asthma, and they support the use of drugs targeting sfTSLP and TSLP for asthma treatment.
Collapse
Affiliation(s)
- Jiping Zhao
- Department of Respiratory and Critical Care Medicine, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, China
| | - Jintao Zhang
- Department of Respiratory, Shandong Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250014, China
| | - Shuangmei Tang
- Department of Otolaryngology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, China
| | - Junfei Wang
- Department of Respiratory and Critical Care Medicine, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, China
| | - Tian Liu
- Department of Respiratory and Critical Care Medicine, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, China
| | - Rong Zeng
- Department of Respiratory, Shandong Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250014, China
| | - Weichun Zhu
- Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, China
| | - Kangda Zhang
- Department of Anesthesiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, China
| | - Jinxiang Wu
- Department of Respiratory and Critical Care Medicine, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, China.
| |
Collapse
|
16
|
Haider S, Simpson A, Custovic A. Genetics of Asthma and Allergic Diseases. Handb Exp Pharmacol 2021; 268:313-329. [PMID: 34085121 DOI: 10.1007/164_2021_484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Asthma genes have been identified through a range of approaches, from candidate gene association studies and family-based genome-wide linkage analyses to genome-wide association studies (GWAS). The first GWAS of asthma, reported in 2007, identified multiple markers on chromosome 17q21 as associates of the childhood-onset asthma. This remains the best replicated asthma locus to date. However, notwithstanding undeniable successes, genetic studies have produced relatively heterogeneous results with limited replication, and despite considerable promise, genetics of asthma and allergy has, so far, had limited impact on patient care, our understanding of disease mechanisms, and development of novel therapeutic targets. The paucity of precise replication in genetic studies of asthma is partly explained by the existence of numerous gene-environment interactions. Another important issue which is often overlooked is that of time of the assessment of the primary outcome(s) and the relevant environmental exposures. Most large GWASs use the broadest possible definition of asthma to increase the sample size, but the unwanted consequence of this is increased phenotypic heterogeneity, which dilutes effect sizes. One way of addressing this is to precisely define disease subtypes (e.g. by applying novel mathematical approaches to rich phenotypic data) and use these latent subtypes in genetic studies.
Collapse
Affiliation(s)
- Sadia Haider
- National Heart and Lung Institute, Imperial College London, London, UK
| | | | - Adnan Custovic
- National Heart and Lung Institute, Imperial College London, London, UK.
| |
Collapse
|
17
|
Interferon characterization associates with asthma and is a potential biomarker of predictive diagnosis. Biosci Rep 2021; 41:228038. [PMID: 33682888 PMCID: PMC7982770 DOI: 10.1042/bsr20204210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 03/01/2021] [Accepted: 03/02/2021] [Indexed: 11/17/2022] Open
Abstract
Interferon (IFN) plays a role in immune and inflammation responses. However, the effect of IFN in asthma is still not fully clear. The present study was conducted to better understand the role of IFN signatures in asthma. Blood samples from case–control studies (study 1: 348 asthmas and 39 normal controls and validation study 2: 411 asthmas and 87 normal controls) were enrolled. The single-sample gene set enrichment analysis (ssGSEA) method was used to quantify the levels of 74 IFN signatures. Gene Ontology analysis and pathway function analysis were performed for functional analysis and a protein–protein interaction (PPI) network was constructed. The area under the curve (AUC) value was used to evaluate the diagnostic ability. In our work, IFN-γ response-DN, negative regulation of IFN-γ secretion, IFNG pathway, negative regulation of response to IFN-γ, and type 1 IFN biosynthetic process showed higher levels in asthma. Functional analysis demonstrated that pathway and biological process involved in IFN signaling pathway, regulation of type 1 IFN production and response to IFN-γ. Hub IFN-related genes were identified, and their combination as biomarker exhibited a good diagnostic capacity for asthma (AUC = 0.832). These findings offered more insight into the underlying mechanism of how IFN signatures affected asthma. The use of the easy-to-apply IFN-related genes might serve as a promising blood-based biomarker for early diagnosis of asthma.
Collapse
|
18
|
Elena-Pérez S, Heredero-Jung DH, García-Sánchez A, Estravís M, Martin MJ, Ramos-González J, Triviño JC, Isidoro-García M, Sanz C, Dávila I. Molecular Analysis of IL-5 Receptor Subunit Alpha as a Possible Pharmacogenetic Biomarker in Asthma. Front Med (Lausanne) 2021; 7:624576. [PMID: 33644088 PMCID: PMC7904892 DOI: 10.3389/fmed.2020.624576] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 12/30/2020] [Indexed: 01/17/2023] Open
Abstract
Background: Asthma is a heterogeneous syndrome with a broad clinical spectrum and high drug response variability. The inflammatory response in asthma involves multiple effector cells and mediator molecules. Based on asthma immunopathogenesis, precision medicine can be a promising strategy for identifying biomarkers. Biologic therapies acting on the IL-5/IL-5 receptor axis have been developed. IL-5 promotes proliferation, differentiation and activation of eosinophils by binding to the IL-5 receptor, located on the surface of eosinophils and basophils. This study aimed to investigate the expression of IL5RA in patients with several types of asthma and its expression after treatment with benralizumab, a biologic directed against IL-5 receptor subunit alpha. Methods: Sixty peripheral blood samples, 30 from healthy controls and 30 from asthmatic patients, were selected for a transcriptomic RNAseq study. Differential expression analysis was performed by statistical assessment of fold changes and P-values. A validation study of IL5RA expression was developed using qPCR in 100 controls and 187 asthmatic patients. The effect of benralizumab on IL5RA expression was evaluated in five patients by comparing expression levels between pretreatment and after 3 months of treatment. The IL5RA mRNA levels were normalized to GAPDH and TBP expression values for each sample. Calculations were made by the comparative ΔΔCt method. All procedures followed the MIQE guidelines. Results:IL5RA was one of the most differentially overexpressed coding transcripts in the peripheral blood of asthmatic patients (P = 8.63E-08 and fold change of 2.22). In the qPCR validation study, IL5RA expression levels were significantly higher in asthmatic patients than in controls (P < 0.001). Significant expression differences were present in different asthmatic types. In the biological drug study, patients treated with benralizumab showed a significant decrease in IL5RA expression and blood eosinophil counts. A notable improvement in ACT and lung function was also observed in these patients. Conclusions: These results indicate that IL5RA is overexpressed in patients with different types of asthma. It could help identify which asthmatic patients will respond more efficiently to benralizumab, moving toward a more personalized asthma management. Although further studies are required, IL5RA could play a role as a biomarker and pharmacogenetic factor in asthma.
Collapse
Affiliation(s)
- Sandra Elena-Pérez
- Department of Clinical Biochemistry, University Hospital of Salamanca, Salamanca, Spain
| | | | - Asunción García-Sánchez
- Allergic Disease Research Group IIMD-01, Institute for Biomedical Research of Salamanca, Salamanca, Spain.,Department of Biomedical Sciences and Diagnostics, University of Salamanca, Salamanca, Spain.,Network for Cooperative Research in Health - RETICS ARADyAL, Carlos III Health Institute, Madrid, Spain
| | - Miguel Estravís
- Allergic Disease Research Group IIMD-01, Institute for Biomedical Research of Salamanca, Salamanca, Spain.,Department of Biomedical Sciences and Diagnostics, University of Salamanca, Salamanca, Spain.,Network for Cooperative Research in Health - RETICS ARADyAL, Carlos III Health Institute, Madrid, Spain
| | - Maria J Martin
- Allergic Disease Research Group IIMD-01, Institute for Biomedical Research of Salamanca, Salamanca, Spain.,Network for Cooperative Research in Health - RETICS ARADyAL, Carlos III Health Institute, Madrid, Spain
| | | | | | - María Isidoro-García
- Department of Clinical Biochemistry, University Hospital of Salamanca, Salamanca, Spain.,Allergic Disease Research Group IIMD-01, Institute for Biomedical Research of Salamanca, Salamanca, Spain.,Network for Cooperative Research in Health - RETICS ARADyAL, Carlos III Health Institute, Madrid, Spain.,Department of Medicine, University of Salamanca, Salamanca, Spain
| | - Catalina Sanz
- Allergic Disease Research Group IIMD-01, Institute for Biomedical Research of Salamanca, Salamanca, Spain.,Network for Cooperative Research in Health - RETICS ARADyAL, Carlos III Health Institute, Madrid, Spain.,Department of Microbiology and Genetics, University of Salamanca, Salamanca, Spain
| | - Ignacio Dávila
- Allergic Disease Research Group IIMD-01, Institute for Biomedical Research of Salamanca, Salamanca, Spain.,Department of Biomedical Sciences and Diagnostics, University of Salamanca, Salamanca, Spain.,Network for Cooperative Research in Health - RETICS ARADyAL, Carlos III Health Institute, Madrid, Spain.,Department of Allergy, University Hospital of Salamanca, Salamanca, Spain
| |
Collapse
|
19
|
Abstract
Asthma is a complex disease with a variable course. Efforts to identify biomarkers to predict asthma severity, the course of disease and response to treatment have not been very successful so far. Biomarker research has expanded greatly with the advancement of molecular research techniques. An ideal biomarker should be suitable to identify the disease as well the specific endotype/phenotype, useful in the monitoring of the disease and to determine the prognosis, easily to obtain with minimum discomfort or risk to the patient. An ideal biomarker should be suitable to identify the disease as well the specific endotype/phenotype, useful in the monitoring of the disease and to determine the prognosis, easily to obtain with minimum discomfort or risk to the patient - exhaled breath analysis, blood cells and serum biomarkers, sputum cells and mediators and urine metabolites could be potential biomarkers of asthma bronchiale. Unfortunately, at the moment, an ideal biomarker doesn't exist and the overlap between the biomarkers is a reality. Using panels of biomarkers could improve probably the identification of asthma endotypes in the era of precision medicine.
Collapse
Affiliation(s)
- P Kunc
- Clinic of Pediatric Respiratory Diseases and Tuberculosis in National Institute of Pediatric Tuberculosis and Respiratory Diseases in Dolny Smokovec, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Slovak Republic.
| | | | | | | |
Collapse
|
20
|
Paoletti G, Keber E, Heffler E, Malipiero G, Baiardini I, Canonica GW, Giua C. Effect of an educational intervention delivered by pharmacists on adherence to treatment, disease control and lung function in patients with asthma. Respir Med 2020; 174:106199. [PMID: 33120195 DOI: 10.1016/j.rmed.2020.106199] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/03/2020] [Accepted: 10/19/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Lack of therapeutic adherence is a relevant problem in clinical practice and it can be assessed via validated tools such as the Test of Adherence to Inhalers (TAI). Education on the correct use of inhaler devices has been associated with improvement in adherence. Many studies highlighted the pivotal role of pharmacists in promoting therapeutic adherence in the management of respiratory diseases. OBJECTIVE To evaluate the effectiveness on adherence and clinical parameters of an educational intervention administered by clinical pharmacists (CPs) to patients with asthma on long-term inhalation therapy. METHODS A prospective comparative study involving 34 community pharmacies in Italy (23 intervention, 11 control). Enrolled subjects were evaluated for adherence to inhalation therapy by TAI, asthma control by "Asthma Control Test" (ACT), and lung function at baseline and after 2 months. The educational intervention at baseline was based on TAI results and administered by specifically trained pharmacists. RESULTS A total of 242 consecutive subjects (167 intervention, 75 control) were enrolled. There was a significant improvement in TAI score, ACT and lung function parameters (p-value<0.001) in the intervention group between baseline and the follow-up visit. Patients with baseline ACT≥20 maintained disease control more frequently in the intervention group compared to the control arm (95% vs 79.5%, p = 0.004). Conclusions through administration of TAI-driven educational interventions addressing both technical and psychological issues, trained CPs can help improve adherence to treatment and asthma control.
Collapse
Affiliation(s)
- Giovanni Paoletti
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Rozzano, MI, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
| | - Enrico Keber
- Società Italiana Farmacia Clinica (SIFAC), Cagliari, Italy
| | - Enrico Heffler
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Rozzano, MI, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy.
| | - Giacomo Malipiero
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Rozzano, MI, Italy
| | - Ilaria Baiardini
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Rozzano, MI, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
| | - Giorgio Walter Canonica
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Rozzano, MI, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
| | - Corrado Giua
- Società Italiana Farmacia Clinica (SIFAC), Cagliari, Italy
| |
Collapse
|
21
|
Zhang J, Dong L. Status and prospects: personalized treatment and biomarker for airway remodeling in asthma. J Thorac Dis 2020; 12:6090-6101. [PMID: 33209441 PMCID: PMC7656354 DOI: 10.21037/jtd-20-1024] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Airway remodeling, as a major characteristic of bronchial asthma, is critical to the progression of this disease, whereas it is of less importance in clinical management. Complying with the current stepwise treatment standard for asthma, the choice of intervention on the clinical status is primarily determined by the patient’s treatment response to airway inflammation. However, a considerable number of asthmatic patients, especially severe asthmatic subjects, remain uncontrolled though they have undergone fortified anti-inflammation treatment. In the past few years, a growing number of biologics specific to asthma phenotypes have emerged, bringing new hope for patients with refractory asthma and severe asthma. While at the same time, the effect of airway remodeling on asthma treatment has become progressively prominent. In the era of personalized treatment, it has become one of the development directions for asthma treatment to find reliable airway remodeling biomarkers to assist in asthma phenotypes classification, and to further combine multiple phenotypes to accurately treat patients. In the present study, the research status of airway remodeling in asthma is reviewed to show the basis for classifying and treating such disease. Besides, several selected airway remodeling biomarkers and possibility to use them in individual treatment are discussed as well. This study considers that continuously optimized mechanisms and emerging biomarkers for airway remodeling in the future may further support individual therapy for asthma patients.
Collapse
Affiliation(s)
- Jintao Zhang
- Department of Respiratory and Critical Care Medicine, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Liang Dong
- Department of Respiratory and Critical Care Medicine, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| |
Collapse
|
22
|
Biologics for Severe Asthma: Treatment-Specific Effects Are Important in Choosing a Specific Agent. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 7:1379-1392. [PMID: 31076056 DOI: 10.1016/j.jaip.2019.03.008] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 02/25/2019] [Accepted: 03/03/2019] [Indexed: 12/19/2022]
Abstract
Patients with uncontrolled severe persistent asthma have greater morbidity, greater use of health care resources, and more impairment in health-related quality of life when compared with their peers with well-controlled disease. Fortunately, since the introduction of biological therapeutics, patients with severe eosinophilic asthma now have beneficial treatment options that they did not have just a few years ago. In addition to anti-IgE therapy for allergic asthma, 3 new biological therapeutics targeting IL-5 and 1 targeting IL-4 and IL-13 signaling have recently been approved by the Food and Drug Administration for the treatment of severe eosinophilic asthma, and approval of more biological therapeutics is on the horizon. These medications decrease the frequency of asthma exacerbations, improve lung function, reduce corticosteroid usage, and improve health-related quality of life. This article reviews the mechanisms of action, specific indications, benefits, and side effects of each of the approved biological therapies for asthma. Furthermore, this article reviews how a clinician could use specific patient characteristics to decide which biologic treatment may be optimal for a given patient.
Collapse
|
23
|
Abstract
PURPOSE OF REVIEW Aim of this review is the description of the medical conditions in which the support of molecular allergy diagnostics (MAD) has an impact on the clinical outcomes, such as laboratory diagnostics, prognosis, and therapy of allergic diseases. RECENT FINDINGS The review of the literature of the last 2 years generated a wide number of results on this topic. As expected, not all were obtained by the use of MAD, but, in general, a clear trend is evident. SUMMARY Within the large number of works available, laboratory allergy diagnostics seems to be the most frequently discussed topic, in particular considering the complexity of the biological environment where these assays are used. Some interesting news arrive from the prognostic potential of MAD, whereas for allergen immunotherapy, waiting for a well-conducted prospective randomized clinical study, data from retrospective studies still confirms the added values of MAD in the management of the allergic patients.
Collapse
|
24
|
Treatable traits in chronic rhinosinusitis with nasal polyps. Curr Opin Allergy Clin Immunol 2020; 19:373-378. [PMID: 31135395 DOI: 10.1097/aci.0000000000000544] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
PURPOSE OF REVIEW Chronic rhinosinusitis with nasal polyps (CRSwNP) is a complex inflammatory sinonasal disease that deserves a multidisciplinary precision medicine approach. In a precision medicine model, a more pragmatic approach taking in consideration disease features that are potentially treatable should be considered. RECENT FINDINGS Several treatable traits in CRSwNP can be identified: from disease-related ones, to extra-ENT features, to behavioral and environmental factors. This review article summarizes primarily the recent findings of CRSwNP-related treatable traits and how they can be modified by given treatments. SUMMARY The advent of biological agents acting directly to the endotype underlying CRSwNP pushes the scientific community to integrate clinical, surgical and immunological evaluations for each single patient; this naturally leads to the identification of specific treatable traits that can serve as possible outcomes for any single biological.
Collapse
|
25
|
Heffler E, Saccheri F, Bartezaghi M, Canonica GW. Effectiveness of omalizumab in patients with severe allergic asthma with and without chronic rhinosinusitis with nasal polyps: a PROXIMA study post hoc analysis. Clin Transl Allergy 2020; 10:25. [PMID: 32607141 PMCID: PMC7318524 DOI: 10.1186/s13601-020-00330-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 06/11/2020] [Indexed: 12/17/2022] Open
Abstract
Background A significant proportion of patients with severe asthma may also suffer from nasal polyposis, which is commonly defined as chronic rhinosinusitis with nasal polyps (CRSwNP), the presence of which may adversely affect asthma treatment outcomes. The biologic agent omalizumab is effective as add-on therapy in patients with severe allergic asthma. The aim of this post hoc analysis of the PROXIMA study was to compare the efficacy of omalizumab between patients with severe allergic asthma, with and without comorbid CRSwNP. Methods PROXIMA was a prospective observational 2-part study conducted in Italy in adult patients with severe allergic asthma, where, in the second part, patients eligible for add-on omalizumab initiated treatment for 12 months. Patient baseline data such as comorbidities and history of exacerbations were collected. Outcomes were asthma control (Asthma Control Questionnaire [ACQ]), lung function (forced expiratory volume in 1 s [FEV1]) and exacerbation rate. The post hoc analysis compared these outcomes between the cohort with comorbid CRSwNP and the cohort without CRSwNP. Results Of 123 patients included in this analysis, 17 (13.8%) were in the CRSwNP cohort. There was no significant difference between cohorts in baseline clinical characteristics or in change from baseline at 12 months in ACQ values, % of predicted FEV1 or annual asthma exacerbation rate, although results were numerically in favor of the CRSwNP cohort versus the non-CRSwNP cohort. The proportion of patients who achieved an improvement in all three outcomes was numerically greater in the CRSwNP cohort (35.7% vs 23.0%). Conclusions In an observational real-world setting, add-on omalizumab for severe allergic asthma was effective in improving asthma control, lung function and in reducing exacerbations, including in those patients with CRSwNP.
Collapse
Affiliation(s)
- Enrico Heffler
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Via Alessandro Manzoni 56, 20089 Rozzano, MI Italy.,Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Mi Italy
| | - Fabiana Saccheri
- Medical & Scientific Department, Novartis Farma SpA, Origgio, Italy
| | - Marta Bartezaghi
- Medical & Scientific Department, Novartis Farma SpA, Origgio, Italy
| | - Giorgio Walter Canonica
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Via Alessandro Manzoni 56, 20089 Rozzano, MI Italy.,Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Mi Italy
| |
Collapse
|
26
|
Wu X, Wang P, Zhang Y, Gao L, Zheng B, Xu Y, Mo J. Toll-Like Receptor Characterization Correlates with Asthma and Is Predictive of Diagnosis. DNA Cell Biol 2020; 39:1313-1321. [PMID: 32543891 DOI: 10.1089/dna.2020.5543] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Toll-like receptors (TLRs) play crucial roles in the recognition of invading pathogens and the immune system. However, the effect of TLRs in asthma is still not fully known. This study was performed to better understand the role of TLR signatures in asthma. Blood samples from case-control studies (study 1: 348 asthmas and 39 normal controls and validation study 2: 411 asthmas and 87 normal controls) were enrolled. The single-sample gene set enrichment analysis method was performed to quantify the abundance of 21 TLR signatures. Gene ontology analysis and pathway function analysis were conducted for functional analysis, and a protein-protein interaction network was constructed. The area under the curve (AUC) value was used to assess the diagnostic capacity. In this study, TLR2/TLR3/TLR4 pathway, MyD88-dependent/independent TLR pathway, positive regulation of TLR4 pathway, and TLR binding signatures were significantly higher in asthma. Functional analysis showed that biological processes and pathways were still involved in TLR cascades and TLR signaling pathway. Eleven hub TLR-related genes were identified, and further validation demonstrated that the combination of TLR-related genes was a good diagnostic biomarker for asthma (AUC = 0.8). Our study provided more insight into the underlying immune mechanism of how TLR signatures affected asthma. The use of the easy-to-apply TLR-related genes might represent a promising blood-based biomarker for early detection of asthma.
Collapse
Affiliation(s)
- Xiaoyu Wu
- Department of Clinical Laboratory, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, Zhejiang, China
| | - Pan Wang
- Department of Clinical Laboratory, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, Zhejiang, China
| | - Yaqiong Zhang
- Department of Clinical Laboratory, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, Zhejiang, China
| | - Lin Gao
- Department of Clinical Laboratory, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, Zhejiang, China
| | - Beijia Zheng
- Department of Clinical Laboratory, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, Zhejiang, China
| | - Youwen Xu
- Department of Clinical Laboratory, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, Zhejiang, China
| | - Jinggang Mo
- The First Clinical College of Wenzhou Medical University, Wenzhou, Zhejiang, China
- Department of Hepatobiliary Surgery, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, Zhejiang, China
| |
Collapse
|
27
|
Crimi C, Ferri S, Campisi R, Crimi N. The Link between Asthma and Bronchiectasis: State of the Art. Respiration 2020; 99:463-476. [PMID: 32464625 DOI: 10.1159/000507228] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 03/09/2020] [Indexed: 11/19/2022] Open
Abstract
The nonrecognition of asthma-associated comorbidities is often responsible for the therapeutic failure and the worsening of symptoms, and it is associated with frequent exacerbations, higher disease severity, and increased health costs. Bronchiectasis, one of the most frequent asthma-associated comorbidities, can increase airways inflammation and exacerbation rates and cause respiratory functional impairment. The aim of this article is to review the interactions between bronchiectasis and asthma, in order to better identify patients in the overlap between the 2 diseases and to select an "ad hoc" therapy. A literature search on PubMed/MEDLINE was performed using the following search terms: bronchiectasis in asthma, the association between asthma and bronchiectasis, comorbidities in asthma, and severe asthma. This review analyzed the following items: incorrect or underestimated diagnosis of asthma and bronchiectasis, prevalence of bronchiectasis in asthma, the impact of bronchiectasis in asthma, radiological imaging features of the 2 diseases, etiopathogenesis, and common causes (such as gastroesophageal reflux disease, immune deficits, chronic rhinosinusitis and allergic bronchopulmonary aspergillosis, and treatment of asthma and bronchiectasis). The concomitant presence of bronchiectasis and asthma should be suspected and investigated in patients with severe asthma, frequent exacerbations, and not responding to standard therapy. This clinical phenotype, characterized by a more severe disease, worse outcomes, and functional decline, must be readily recognized in order to choose the most appropriate therapeutic approach, able to potentially improve the management of bronchial asthma, to prevent the onset of exacerbations as well the functional decline, and to reduce health costs.
Collapse
Affiliation(s)
- Claudia Crimi
- Respiratory Medicine Unit, A.O.U. "Policlinico-Vittorio Emanuele," University of Catania, Catania, Italy,
| | - Sebastian Ferri
- Personalized Medicine, Asthma and Allergy, Humanitas Research Center IRCCS, Rozzano, Italy
| | - Raffaele Campisi
- Respiratory Medicine Unit, A.O.U. "Policlinico-Vittorio Emanuele," University of Catania, Catania, Italy
| | - Nunzio Crimi
- Respiratory Medicine Unit, A.O.U. "Policlinico-Vittorio Emanuele," University of Catania, Catania, Italy.,Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| |
Collapse
|
28
|
A WAO - ARIA - GA 2LEN consensus document on molecular-based allergy diagnosis (PAMD@): Update 2020. World Allergy Organ J 2020; 13:100091. [PMID: 32180890 PMCID: PMC7062937 DOI: 10.1016/j.waojou.2019.100091] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Precision allergy molecular diagnostic applications (PAMD@) is increasingly entering routine care. Currently, more than 130 allergenic molecules from more than 50 allergy sources are commercially available for in vitro specific immunoglobulin E (sIgE) testing. Since the last publication of this consensus document, a great deal of new information has become available regarding this topic, with over 100 publications in the last year alone. It thus seems quite reasonable to publish an update. It is imperative that clinicians and immunologists specifically trained in allergology keep abreast of the new and rapidly evolving evidence available for PAMD@. PAMD@ may initially appear complex to interpret; however, with increasing experience, the information gained provides relevant information for the allergist. This is especially true for food allergy, Hymenoptera allergy, and for the selection of allergen immunotherapy. Nevertheless, all sIgE tests, including PAMD@, should be evaluated within the framework of a patient's clinical history, because allergen sensitization does not necessarily imply clinical relevant allergies.
Collapse
|
29
|
Heffler E, Carpagnano GE, Favero E, Guida G, Maniscalco M, Motta A, Paoletti G, Rolla G, Baraldi E, Pezzella V, Piacentini G, Nardini S. Fractional Exhaled Nitric Oxide (FENO) in the management of asthma: a position paper of the Italian Respiratory Society (SIP/IRS) and Italian Society of Allergy, Asthma and Clinical Immunology (SIAAIC). Multidiscip Respir Med 2020; 15:36. [PMID: 32269772 PMCID: PMC7137762 DOI: 10.4081/mrm.2020.36] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 02/05/2020] [Indexed: 02/08/2023] Open
Abstract
Asthma prevalence in Italy is on the rise and is estimated to be over 6% of the general population. The diagnosis of asthma can be challenging and elusive, especially in children and the last two decades has brought evidences that asthma is not a single disease but consists of various phenotypes. Symptoms can be underestimated by the patient or underreported to the clinician and physical signs can be scanty. Usual objective measures, like spirometry, are necessary but sometimes not significant. Despite proper treatment, asthma can be a very severe condition (even leading to death), however new drugs have recently become available which can be very effective in its control. Since asthma is currently thought to be caused by inflammation, a direct measure of the latter can be of paramount importance. For this purpose, the measurement of Fractional Exhaled Nitric Oxide (FENO) has been used since the early years of the current century as a non-invasive, easy-to-assess tool useful for diagnosing and managing asthma. This SIP-IRS/SIAAIC Position Paper is a narrative review which summarizes the evidence behind the usefulness of FENO in the diagnosis, management and phenotypization of asthma.
Collapse
Affiliation(s)
- Enrico Heffler
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Rozzano (MI).,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI)
| | - Giovanna Elisiana Carpagnano
- Department of Medical and Surgical Sciences, University of Foggia; Section of Respiratory Diseases, Hospital d'Avanzo, Foggia
| | - Elisabetta Favero
- Department of Medicine-DIMED, Immunological and Respiratory Rare Disease, Allergologic Clinic Ca' Foncello Hospital, Treviso
| | - Giuseppe Guida
- Allergy and Pneumology Unit, A.O. S. Croce e Carle, Cuneo
| | - Mauro Maniscalco
- Respiratory Rehabilitation Unit, ICS Maugeri, Institute of Telese Terme IRCCS
| | - Andrea Motta
- Institute of Biomolecular Chemistry, National Research Council, Pozzuoli (NA)
| | - Giovanni Paoletti
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Rozzano (MI).,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI)
| | - Giovanni Rolla
- Allergy and Clinical Immunology, University of Turin and A.O. Mauriziano, Turin
| | - Eugenio Baraldi
- Department of Woman's and Child's Health, University Hospital of Padua
| | - Vincenza Pezzella
- Department of Woman, Child and of General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples
| | - Giorgio Piacentini
- Paediatric Section, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona
| | - Stefano Nardini
- Italian Respiratory Society-Società Italiana di Pneumologia, Milan, Italy
| |
Collapse
|
30
|
Ansotegui IJ, Melioli G, Canonica GW, Caraballo L, Villa E, Ebisawa M, Passalacqua G, Savi E, Ebo D, Gómez RM, Luengo Sánchez O, Oppenheimer JJ, Jensen-Jarolim E, Fischer DA, Haahtela T, Antila M, Bousquet JJ, Cardona V, Chiang WC, Demoly PM, DuBuske LM, Ferrer Puga M, Gerth van Wijk R, González Díaz SN, Gonzalez-Estrada A, Jares E, Kalpaklioğlu AF, Kase Tanno L, Kowalski ML, Ledford DK, Monge Ortega OP, Morais Almeida M, Pfaar O, Poulsen LK, Pawankar R, Renz HE, Romano AG, Rosário Filho NA, Rosenwasser L, Sánchez Borges MA, Scala E, Senna GE, Sisul JC, Tang ML, Thong BYH, Valenta R, Wood RA, Zuberbier T. IgE allergy diagnostics and other relevant tests in allergy, a World Allergy Organization position paper. World Allergy Organ J 2020; 13:100080. [PMID: 32128023 PMCID: PMC7044795 DOI: 10.1016/j.waojou.2019.100080] [Citation(s) in RCA: 233] [Impact Index Per Article: 58.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 10/08/2019] [Indexed: 02/06/2023] Open
Abstract
Currently, testing for immunoglobulin E (IgE) sensitization is the cornerstone of diagnostic evaluation in suspected allergic conditions. This review provides a thorough and updated critical appraisal of the most frequently used diagnostic tests, both in vivo and in vitro. It discusses skin tests, challenges, and serological and cellular in vitro tests, and provides an overview of indications, advantages and disadvantages of each in conditions such as respiratory, food, venom, drug, and occupational allergy. Skin prick testing remains the first line approach in most instances; the added value of serum specific IgE to whole allergen extracts or components, as well as the role of basophil activation tests, is evaluated. Unproven, non-validated, diagnostic tests are also discussed. Throughout the review, the reader must bear in mind the relevance of differentiating between sensitization and allergy; the latter entails not only allergic sensitization, but also clinically relevant symptoms triggered by the culprit allergen.
Collapse
Key Words
- AAAAI, American Academy of Allergy Asthma and Immunology
- ABA, Allergen Bead Array
- ACAAI, American College of Allergy Asthma and Immunology
- AEC, Allergen Exposure Chambers
- AIT, allergen immunotherapy
- AP, Alkaline Phosphatase
- AU/mL, Allergenic Units milliLiter
- Allergy
- Anti-IgE, Antibody against IgE
- BAT, Basophil Activation Test
- BAU/mL, Biologic Allergenic Units milliLiter
- CBA, Cytometric Bead Array
- CCD, Cross-reactive Carbohydrate Determinants
- CDER, Center for Drug Evaluation and Research (USA)
- CL, Chemiluminescence
- CaFE, Calibrated Fluorescence Enhancement
- DBPCFC, Double-Blind Placebo-Controlled Food Challenge
- Diagnostic strategies
- EAACI, European Academy of Allergy and Immunology
- EIA, Enzyme Immune Assay
- ELISA, Enzyme Linked Immuno Sorbent Analysis
- EMEA, European MEdicine Agencies
- ENPP-3, EctoNucleotide Pyrophosphatase/Phosphodiesterase 3
- FACS, Fluorescence-Activated Cell Sorting
- FDA, Food and Drug Administration (U.S. Department of Health and Human Services)
- FEIA, Fluorescent Enzyme Immunoassays
- FcεRI, High affinity IgE receptor
- H1, Histamine 1 receptor
- H2, Histamine 2 receptor
- HPO, Horseradish Peroxidase
- IDT, Intradermal Test
- ISAC, Immuno-Solid phase Allergen Chip
- IUIS, International Union of Immunological Societies
- IVD, in vitro diagnostic tool
- IgE
- IgE, immunoglobulin E
- In vitro tests
- LAMP-3, Lysosomal-Associated Membrane Protein
- MBAD, Molecule Based Allergy Diagnostics
- MRGPRX2, Mas-related G protein receptor 2
- NIH, National Institutes of Health (USA)
- NMBAs, NeuroMuscular Blocking Agents
- NPA, Negative Percent Agreement
- NSAIDs, Non-Steroidal Anti-Inflammatory Drugs
- PPA, Positive Percent Agreement
- PPT, Prick-Prick Test
- RAST, Radio Allergo Sorbent Test
- SCAR, severe cutaneous adverse drug reactions
- SPT, Skin prick test
- Skin tests
- kUA/L, kilo Units of Allergen/Liter for allergen-specific IgE antibody assays
- mAb, Monoclonal Antibody
- pNPP, p-Nitrophenylphosphate
- sIgE, specific IgE
- w/v, weight /volume
Collapse
Affiliation(s)
| | - Giovanni Melioli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Giorgio Walter Canonica
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Personalized Medicine, Asthma and Allergy, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Luis Caraballo
- Institute for Immunological Research, University of Cartagena, Cartagena, Colombia
| | - Elisa Villa
- Azienda Sanitaria Locale di Vercelli, S.C. Pneumologia, Vercelli, Italia
| | - Motohiro Ebisawa
- Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, Sagamihara, Kanagawa, Japan
| | - Giovanni Passalacqua
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Genoa, Italy
| | | | - Didier Ebo
- Department of Immunology - Allergology - Rheumatology, Antwerp University Hospital, Antwerp University, Department Immunology and Allergology, AZ Jan Palfijn Gent, Ghent, Belgium
| | | | - Olga Luengo Sánchez
- Allergy Section, Department of Internal Medicine, Vall d’Hebron University Hospital, Barcelona, Spain
| | | | - Erika Jensen-Jarolim
- Institute for Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, The Interuniversity Messerli Research Institute, University of Veterinary Medicine Vienna, Medical University Vienna, Vienna, Austria
| | - David A. Fischer
- Fischer Medicine Professional Corporation, Barrie, Ontario, Canada
| | - Tari Haahtela
- Skin and Allergy Hospital, University of Helsinki, Helsinki, Finland
| | | | - Jean J. Bousquet
- MACVIA-France, Montpellier, France
- INSERM, Villejuif, France
- Université Versailles St-Quentin-en-Yvelines, Montigny le Bretonneux, France
- Euforea, Brussels, Belgium
- CHU Montpellier, France
| | - Victoria Cardona
- Universitat Autónoma de Barcelona, Hospital Universitario Vall d'Hebron, Servicio de Medicina Interna, Sección de Alergología, Barcelona, Spain
| | - Wen Chin Chiang
- Mount Elizabeth Medical Centre, Chiang Children's Allergy & Asthma Clinic, Singapore, Singapore
| | - Pascal M. Demoly
- University Hospital Montpellier, Montpellier, France
- Sorbonne Université, Paris, France
| | | | - Marta Ferrer Puga
- The Unidad de Educación Médica, Department of Medical Education, School of Medicine, Clinica Universitad de Navarra, Navarra, Spain
| | | | | | | | | | | | | | - Marek L. Kowalski
- Faculty of Medicine, Department of Clinical Immunology & Allergy, Medical University of Łódź, Łódź, Poland
| | | | | | | | - Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany
| | - Lars K. Poulsen
- Gentofte University Hospital, Lab for Allergology, Allergy Clinic, Hellerup, Denmark
| | - Ruby Pawankar
- Nippon Medical School, Dept. of Otolaryngology, Tokyo, Japan
| | - Harald E. Renz
- University Hospital GI & MR GmbH, Institute of Laboratory Medicine & Pathology, Standort Marburg, Marburg, Germany
| | | | | | - Lanny Rosenwasser
- University of Missouri at Kansas City, School of Medicine, Kansas City, MO, USA
| | | | - Enrico Scala
- Experimental Allergy Unit, Istituto Dermopatico dell'Immacolata, Rome, Italy
| | | | | | - Mimi L.K. Tang
- Royal Children's Hospital, Department of Allergy & Immunology, Parkville, Victoria, Australia
| | - Bernard Yu-Hor Thong
- Tan Tock Seng Hospital, Deptartment of Rheumatology, Allergy & Immunology, Singapore, Singapore
| | - Rudolf Valenta
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
- NRC Institute of Immunology FMBA of Russia, Moscow, Russia
- Laboratory of Immunopathology, Department of Clinical Immunology and Allergy, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Robert A. Wood
- Johns Hopkins University School of Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Torsten Zuberbier
- Campus Charite Mitte, Klinik fur Dermatologie & Allergologie, Berlin, Germany
| |
Collapse
|
31
|
Granell R, Rodriguez S. Confirmed causal effect of obesity on asthma and new insights on potential underlying shared genetic mechanisms. J Allergy Clin Immunol 2019; 145:484-486. [PMID: 31812573 DOI: 10.1016/j.jaci.2019.11.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 11/22/2019] [Accepted: 11/27/2019] [Indexed: 12/31/2022]
Affiliation(s)
- Raquel Granell
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom.
| | - Santiago Rodriguez
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| |
Collapse
|
32
|
Puggioni F, Alves-Correia M, Mohamed MF, Stomeo N, Mager R, Marinoni M, Racca F, Paoletti G, Varricchi G, Giorgis V, Melioli G, Canonica GW, Heffler E. Immunostimulants in respiratory diseases: focus on Pidotimod. Multidiscip Respir Med 2019; 14:31. [PMID: 31700623 PMCID: PMC6827234 DOI: 10.1186/s40248-019-0195-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 07/23/2019] [Indexed: 12/18/2022] Open
Abstract
Usefulness of Pidotimod and its role as immunostimulant, has been discussed, we know, for several decades. Nevertheless, there is still much to know. Understanding its mechanisms and its potential usefulness in airway infections and its prevention, asthma both Th2 and non Th2 type, bronchiectasis, as adjuvant in vaccination and in allergen immunotherapy still remains to clearly unveil. The aim of this paper was to provide a useful updated review of the role of the main available immunostimulants, giving particular focus on Pidotimod use and its potentials utility in respiratory diseases. Pidotimod showed its usefulness in reducing need for antibiotics in airway infections, increasing the level of immunoglobulins (IgA, IgM, IgG) and T-lymphocyte subsets (CD3+, CD4+) endowed with immunomodulatory activity that affect both innate and adaptive immune responses. Higher expression of TLR2 and of HLA-DR molecules, induction of dendritic cell maturation and release of pro-inflammatory molecules, stimulation of T lymphocyte proliferation and differentiation toward a Th1 phenotype, as well as an increase of the phagocytosis have been demonstrated to be associated with Pidotimod in in vitro studies. All these activities are potentially useful for several respiratory conditions such as asthma, COPD, and recurrent respiratory tract infections.
Collapse
Affiliation(s)
- Francesca Puggioni
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI Italy
- Personalized Medicine, Allergy and Asthma - Humanitas Clinical and Research Center – IRCCS, Via Alessandro Manzoni 56, 20089 Rozzano, MI Italy
| | - Magna Alves-Correia
- Personalized Medicine, Allergy and Asthma - Humanitas Clinical and Research Center – IRCCS, Via Alessandro Manzoni 56, 20089 Rozzano, MI Italy
- Central Hospital of Funchal, SESARAM, EPE, Madeira, Portugal
| | - Manar-Farouk Mohamed
- Personalized Medicine, Allergy and Asthma - Humanitas Clinical and Research Center – IRCCS, Via Alessandro Manzoni 56, 20089 Rozzano, MI Italy
- Ain Shams University, Faculty of Medicine, Cairo, Egypt
| | - Niccolò Stomeo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI Italy
| | - Riccardo Mager
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI Italy
| | | | - Francesca Racca
- Personalized Medicine, Allergy and Asthma - Humanitas Clinical and Research Center – IRCCS, Via Alessandro Manzoni 56, 20089 Rozzano, MI Italy
| | - Giovanni Paoletti
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI Italy
- Personalized Medicine, Allergy and Asthma - Humanitas Clinical and Research Center – IRCCS, Via Alessandro Manzoni 56, 20089 Rozzano, MI Italy
| | - Gilda Varricchi
- Department of Translational Medical Sciences and Center for Basic and Clinical Immunology Research, University of Naples Federico II, Naples, Italy
| | - Veronica Giorgis
- Personalized Medicine, Allergy and Asthma - Humanitas Clinical and Research Center – IRCCS, Via Alessandro Manzoni 56, 20089 Rozzano, MI Italy
| | - Giovanni Melioli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI Italy
- Personalized Medicine, Allergy and Asthma - Humanitas Clinical and Research Center – IRCCS, Via Alessandro Manzoni 56, 20089 Rozzano, MI Italy
| | - Giorgio Walter Canonica
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI Italy
- Personalized Medicine, Allergy and Asthma - Humanitas Clinical and Research Center – IRCCS, Via Alessandro Manzoni 56, 20089 Rozzano, MI Italy
| | - Enrico Heffler
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI Italy
- Personalized Medicine, Allergy and Asthma - Humanitas Clinical and Research Center – IRCCS, Via Alessandro Manzoni 56, 20089 Rozzano, MI Italy
| |
Collapse
|
33
|
Strategies to reduce corticosteroid-related adverse events in asthma. Curr Opin Allergy Clin Immunol 2019; 19:61-67. [PMID: 30407207 DOI: 10.1097/aci.0000000000000493] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE OF REVIEW Severe asthmatics, despite the chronic use of high inhaled corticosteroids (ICS) doses and frequent intake of systemic corticosteroids, remains clinically and/or functionally uncontrolled. These patients are also often affected by rhinitis or chronic rhinosinusitis requiring frequent use of intranasal corticosteroids. Therefore, severe asthmatics are exposed to an overload of corticosteroids that is frequently associated with relevant and costly adverse events. This clinical problem and the strategies to overcome it are here summarized. RECENT FINDINGS Different therapeutic options may help in reducing the corticosteroid load in asthmatics, ranging from allergy immunotherapy (nonsuitable for severe uncontrolled patients), immunosuppressant agents like methotrexate or cyclosporine, novel biologic drugs (mainly anti-IgE, anti-IL5 and anti-IL4-receptor-alpha), and aspirin desensitization (for patients with anti-inflammatory drugs exacerbated respiratory disease). SUMMARY The evidence of even serious corticosteroid-related adverse events associated with consistent health-care costs, should prompt the entire scientific community and health regulatory authorities to promote actions to increase the use of well tolerated and effective strategies to reduce the corticosteroid need in asthmatics; the most promising option seems to be the add-on use of biologic agents.
Collapse
|
34
|
Heffler E, Paoletti G, Giorgis V, Puggioni F, Racca F, Del Giacco S, Bagnasco D, Caruso C, Brussino L, Rolla G, Canonica GW. Real-life studies of biologics used in asthma patients: key differences and similarities to trials. Expert Rev Clin Immunol 2019; 15:951-958. [PMID: 31389304 DOI: 10.1080/1744666x.2019.1653758] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Introduction: The precision medicine approach that is now mandatory for severe asthma management includes the use of novel biologic agents blocking specific immunological mechanisms that are responsible for disease phenotypes and endotypes: monoclonal antibodies blocking IgE, IL-5 and IL-4/IL-13 immunological pathways are so far available. Areas covered: Clinical trials involving a large number of patients proved their efficacy in reducing asthma exacerbations, improving lung function and quality of life, and reducing the need for systemic corticosteroid treatment. Since biologics have been available for routine use, a series of real-life experiences on severe asthmatics treated with them have been published: these studies confirmed the beneficial effects in a real-world setting (effectiveness) of these drugs and showed novel aspects that were not covered by clinical trials, such as their effect on particular subgroup of patients, unexpected adverse events, and potential novel indications. Expert opinion: Both clinical trials and real-life experiences are needed to establish robust data on biologic agents for severe asthma, with real-life studies giving more broader insights on different aspects related to the biologics themselves and to the disease.
Collapse
Affiliation(s)
- Enrico Heffler
- Department of Biomedical Sciences, Humanitas University , Pieve Emanuele , Italy.,Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center, IRCCS , Rozzano , Italy
| | - Giovanni Paoletti
- Department of Biomedical Sciences, Humanitas University , Pieve Emanuele , Italy.,Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center, IRCCS , Rozzano , Italy
| | - Veronica Giorgis
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center, IRCCS , Rozzano , Italy
| | - Francesca Puggioni
- Department of Biomedical Sciences, Humanitas University , Pieve Emanuele , Italy.,Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center, IRCCS , Rozzano , Italy
| | - Francesca Racca
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center, IRCCS , Rozzano , Italy
| | - Stefano Del Giacco
- Department of Medical Sciences "M. Aresu", University of Cagliari , Cagliari , Italy
| | - Diego Bagnasco
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa , Genoa , Italy
| | - Cristiano Caruso
- Allergy Unit - Fondazione Policlinico "A. Gemelli" - IRCSS , Rome , Italy
| | - Luisa Brussino
- Department of Medical Science, University of Torino & Allergy and Clinical Immunology Unit, AO Ordine Mauriziano "Umberto I" , Torino , Italy
| | - Giovanni Rolla
- Department of Medical Science, University of Torino & Allergy and Clinical Immunology Unit, AO Ordine Mauriziano "Umberto I" , Torino , Italy
| | - Giorgio Walter Canonica
- Department of Biomedical Sciences, Humanitas University , Pieve Emanuele , Italy.,Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center, IRCCS , Rozzano , Italy
| |
Collapse
|
35
|
Cosmi L, Maggi L, Mazzoni A, Liotta F, Annunziato F. Biologicals targeting type 2 immunity: Lessons learned from asthma, chronic urticaria and atopic dermatitis. Eur J Immunol 2019; 49:1334-1343. [PMID: 31355918 DOI: 10.1002/eji.201948156] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 05/22/2019] [Accepted: 07/26/2019] [Indexed: 12/17/2022]
Abstract
During the last decades, progression of research has led to great achievements for treatment and therapy of several disabling disorders, particularly in the field of chronic inflammatory diseases. The increased knowledge of the molecular mechanisms operating in such diseases has represented the first step in this process, and the discovery of molecules able to interfere with the natural history of the diseases, has been the second. This review is focused on the effects of biologics on type 2 diseases such as asthma, chronic urticaria and atopic dermatitis, both biologics just approved for clinical application and also those that are currently undergoing clinical trials. We will also discuss aspects and emphasize clinical trials and recently published studies, as well as research that is currently in the progress, which will be highly relevant for basic immunologists. Likewise, we will cover aspects that are pertinent for clinical immunologists and highlight translational studies that are evaluating novel biologicals in animal models.
Collapse
Affiliation(s)
- Lorenzo Cosmi
- Department of Experimental and Clinical Medicine and DENOTHE Center, University of Florence, Florence, Italy.,Immunology and Cell Therapy Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Laura Maggi
- Department of Experimental and Clinical Medicine and DENOTHE Center, University of Florence, Florence, Italy
| | - Alessio Mazzoni
- Department of Experimental and Clinical Medicine and DENOTHE Center, University of Florence, Florence, Italy
| | - Francesco Liotta
- Department of Experimental and Clinical Medicine and DENOTHE Center, University of Florence, Florence, Italy.,Immunology and Cell Therapy Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Francesco Annunziato
- Department of Experimental and Clinical Medicine and DENOTHE Center, University of Florence, Florence, Italy
| |
Collapse
|
36
|
Murray DD, Itenov TS, Sivapalan P, Eklöf JV, Holm FS, Schuetz P, Jensen JU. Biomarkers of Acute Lung Injury The Individualized Approach: for Phenotyping, Risk Stratification and Treatment Surveillance. J Clin Med 2019; 8:jcm8081163. [PMID: 31382587 PMCID: PMC6722821 DOI: 10.3390/jcm8081163] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 07/30/2019] [Accepted: 08/01/2019] [Indexed: 02/06/2023] Open
Abstract
Do we need biomarkers of lung damage and infection: For what purpose and how should they be used properly? Biomarkers of lung damage can be used for diagnosis, risk stratification/prediction, treatment surveillance and adjustment of targeted therapy. Additionally, novel "omics" methods may offer a completely different and effective way of improving the understanding of pathogenesis of lung damage and a way to develop new candidate lung damage biomarkers. In the current review, we give an overview within the field of acute lung damage of (i) disease mechanism biomarkers, (ii) of "ready to use" evidence-based biomarker-guided lung infection management, (iii) of novel strategies of inflammatory phenotyping and how this can be used to tailor corticosteroid treatment, (iv) a future perspective of where "omics" technologies and mindsets may become increasingly important in developing new strategies for treatment and for understanding the development of acute lung damage.
Collapse
Affiliation(s)
- Daniel D Murray
- PERSIMUNE, Department of Infectious Diseases, Rigshospitalet, DK-2100 Copenhagen, Denmark
| | | | - Pradeesh Sivapalan
- Respiratory Medicine Section, Department of Internal Medicine, Herlev-Gentofte Hospital, DK-2900 Hellerup, Denmark
| | - Josefin Viktoria Eklöf
- Respiratory Medicine Section, Department of Internal Medicine, Herlev-Gentofte Hospital, DK-2900 Hellerup, Denmark
| | - Freja Stæhr Holm
- Respiratory Medicine Section, Department of Internal Medicine, Herlev-Gentofte Hospital, DK-2900 Hellerup, Denmark
| | - Philipp Schuetz
- Medical University Department, Kantonsspital Aarau, 5001 Aarau, Switzerland
- Faculty of Medicine, University of Basel, 4001 Basel, Switzerland
| | - Jens Ulrik Jensen
- PERSIMUNE, Department of Infectious Diseases, Rigshospitalet, DK-2100 Copenhagen, Denmark.
- Respiratory Medicine Section, Department of Internal Medicine, Herlev-Gentofte Hospital, DK-2900 Hellerup, Denmark.
| |
Collapse
|
37
|
Asthma from immune pathogenesis to precision medicine. Semin Immunol 2019; 46:101294. [PMID: 31387788 DOI: 10.1016/j.smim.2019.101294] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 07/28/2019] [Accepted: 07/31/2019] [Indexed: 12/20/2022]
Abstract
Asthma is characterized by multiple immunological mechanisms (endotypes) determining variable clinical presentations (phenotypes). The identification of endotypic mechanisms is crucial to better characterize patients and to identify tailored therapeutic approaches with novel biological agents targeting specific immunological pathways. This review focused on summarizing the major immunological mechanisms involved in the pathogenesis of asthma, as well as on discussing the emergence of phenotypic features of the disease. Novel biological agents and other drugs targeting specific endotypes are discussed, as their use represent a precision medicine approach to the disease that is nowadays mandatory particularly for treating more severe patients.
Collapse
|
38
|
Expansion of different subpopulations of CD26 -/low T cells in allergic and non-allergic asthmatics. Sci Rep 2019; 9:7556. [PMID: 31101830 PMCID: PMC6525268 DOI: 10.1038/s41598-019-43622-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 04/17/2019] [Indexed: 02/07/2023] Open
Abstract
CD26 displays variable levels between effector (TH17 ≫ TH1 > TH2 > Treg) and naïve/memory (memory > naïve) CD4+ T lymphocytes. Besides, IL-6/IL−6R is associated with TH17-differentiation and asthma severity. Allergic/atopic asthma (AA) is dominated by TH2 responses, while TH17 immunity might either modulate the TH2-dependent inflammation in AA or be an important mechanism boosting non-allergic asthma (NAA). Therefore, in this work we have compared the expression of CD26 and CD126 (IL-6Rα) in lymphocytes from different groups of donors: allergic (AA) and non-allergic (NAA) asthma, rhinitis, and healthy subjects. For this purpose, flow cytometry, haematological/biochemical, and in vitro proliferation assays were performed. Our results show a strong CD26-CD126 correlation and an over-representation of CD26− subsets with a highly-differentiated effector phenotype in AA (CD4+CD26−/low T cells) and NAA (CD4−CD26− γδ-T cells). In addition, we found that circulating levels of CD26 (sCD26) were reduced in both AA and NAA, while loss of CD126 expression on different leukocytes correlated with higher disease severity. Finally, selective inhibition of CD26-mRNA translation led to enhanced T cell proliferation in vitro. These findings support that CD26 down-modulation could play a role in facilitating the expansion of highly-differentiated effector T cell subsets in asthma.
Collapse
|
39
|
Abstract
PURPOSE OF REVIEW Target therapy is the necessary step towards personalized medicine. The definition of asthma phenotypes and underlying mechanisms (endotypes) represent a key point in the development of new asthma treatments. Big data analysis, biomarker research and the availability of monoclonal antibodies, targeting specific cytokines is leading to the rapid evolution of knowledge. In this review, we sought to outline many of the recent advances in the field. RECENT FINDINGS Several attempts have been made to identify asthma phenotypes, sometimes with contrasting results. More success has been obtained concerning the pathogenetic mechanism of specific asthma patterns with the consequent identification of biomarkers and development of effective ad hoc treatment. SUMMARY We are in the middle of an extraordinary revolution of our mode of thinking about and approaching asthma. All the effort in the identification of clusters of patients with different disease clinical patterns, prognosis and response to treatment is closely linked to the identification of endotypes (Th2-low and Th2-high). This approach has allowed the development of the specific treatments (anti IgE, Anti IL5 and IL5R) that are now available and is leading to new ones.
Collapse
|
40
|
Heffler E, Puggioni F, Descalzi D, Racca F, Canonica GW, Melioli G. Microarray Immunodiagnostics for Aeroallergens. Curr Allergy Asthma Rep 2019; 19:10. [PMID: 30771109 DOI: 10.1007/s11882-019-0832-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE OF REVIEW The impact of new technologies, especially multiplexed molecular allergy diagnostics based on allergen arrays, on the management of complex patients with respiratory allergies has been important. RECENT FINDINGS Currently, the detailed characteristics of the IgE profile of the patient, such as sensitization to genuine or cross-reacting components or the sensitization to potentially harmful allergens, allow an allergist to tailor treatment in the context of precision medicine rules. A number of relevant articles have been published in recent years on this topic, and, in this review, the new added values of allergen array-based diagnostics are reported.
Collapse
Affiliation(s)
- Enrico Heffler
- Personalized Medicine, Asthma and Allergy, Humanitas Research Hospital, Rozzano, MI, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
| | - Francesca Puggioni
- Personalized Medicine, Asthma and Allergy, Humanitas Research Hospital, Rozzano, MI, Italy
| | - Desideria Descalzi
- Personalized Medicine, Asthma and Allergy, Humanitas Research Hospital, Rozzano, MI, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
| | - Francesca Racca
- Personalized Medicine, Asthma and Allergy, Humanitas Research Hospital, Rozzano, MI, Italy
| | - Giorgio Walter Canonica
- Personalized Medicine, Asthma and Allergy, Humanitas Research Hospital, Rozzano, MI, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
| | - Giovanni Melioli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy.
| |
Collapse
|
41
|
Will precision medicine be available for all patients in the near future? Curr Opin Allergy Clin Immunol 2019; 19:75-80. [DOI: 10.1097/aci.0000000000000491] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
42
|
Canonica GW, Colombo GL, Bruno GM, Di Matteo S, Martinotti C, Blasi F, Bucca C, Crimi N, Paggiaro P, Pelaia G, Passalaqua G, Senna G, Heffler E. Shadow cost of oral corticosteroids-related adverse events: A pharmacoeconomic evaluation applied to real-life data from the Severe Asthma Network in Italy (SANI) registry. World Allergy Organ J 2019; 12:100007. [PMID: 30937132 PMCID: PMC6439414 DOI: 10.1016/j.waojou.2018.12.001] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 11/12/2018] [Accepted: 12/09/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Asthma is one of the most common non-communicable respiratory diseases, affecting about 6% of the general population. Severe asthma, even if afflicts a minority of asthmatics, drives the majority of costs of the disease. The aim of this study is to create a pharmacoeconomic model to predict the costs of corticosteroid-related adverse events in severe asthmatics and applying it to the first published epidemiologic data from the Severe Asthma Network in Italy (SANI) registry. METHODS The analysis was conducted from the perspective of the Italian National Healthcare System (INHS). Model inputs, derived from literature, included: asthma epidemiology data, frequency of adverse events, percentage of severe asthma treated with OCS and adverse event cost (Diagnosis-Related Group (DRG) national tariffs). We estimated costs per different patient groups: non-asthma controls, mild/moderate and severe asthmatics. Final results report estimated direct cost per patient and total direct cost for overall target population, showing economic impact related to corticosteroid complication. RESULTS Based on epidemiological data input, in Italy, asthmatic subjects resulted about 3,999,600, of which 199,980 with severe asthma. The number of patients with severe asthma OCS-treated was estimated at 123,988. Compared to the non-asthma control cohort and to that with moderate asthma annual cost per severe asthmatic patient resulted respectively about €892 and €606 higher, showing a corticosteroids shadow cost ranging from 45% to 30%.Applying the cost per patient to the target population identified for Italy, the budget impact model estimated a total annual cost related to OCS-related adverse events of €242.7 million for severe asthmatics. In respect with non-asthmatic and moderate population, an incremental expenditure of about € 110.6 million and €75.2, respectively, were shown. CONCLUSIONS Our study provides the first estimates of additional healthcare costs related to corticosteroid induced adverse events in severe asthma patient. Budget impact model results highlighted the relevant economic impact of OCS-related adverse events in severe asthma patients. The future extrapolation of additional data from SANI registry will support the development of a model to investigate the role of corticosteroids sparing drugs.
Collapse
Affiliation(s)
- Giorgio Walter Canonica
- Personalized Medicine, Asthma and Allergy, Humanitas Research Hospital, Rozzano, MI, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
| | - Giorgio Lorenzo Colombo
- Drug Science Department, Pavia University, Italy
- Studi Analisi Valutazioni Economiche (S.A.V.E.) S.r.l., Health Economics & Outcomes Research Center, Milan, Italy
| | - Giacomo Matteo Bruno
- Studi Analisi Valutazioni Economiche (S.A.V.E.) S.r.l., Health Economics & Outcomes Research Center, Milan, Italy
| | - Sergio Di Matteo
- Studi Analisi Valutazioni Economiche (S.A.V.E.) S.r.l., Health Economics & Outcomes Research Center, Milan, Italy
| | - Chiara Martinotti
- Studi Analisi Valutazioni Economiche (S.A.V.E.) S.r.l., Health Economics & Outcomes Research Center, Milan, Italy
| | - Francesco Blasi
- Department of Pathophysiology and Transplantation, University of Milan, Italy
- Internal Medicine Department, Respiratory Unit and Adult Cystic Fibrosis Center, Fondazione IRCCS “Cà Granda – Ospedale Maggiore Policlinico”, Milan, Italy
| | - Caterina Bucca
- Pneumology Unit, Cardiovascular and Thoracic Department, AOU Molinette “Città della Salute e della Scienza”, Department of Medical Sciences, University of Torino, Italy
| | - Nunzio Crimi
- Allergy and Respiratory Medicine, Department of Clinical and Experimental Medicine, University of Catania, Italy
| | - Pierluigi Paggiaro
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Italy
| | - Girolamo Pelaia
- Department of Medical and Surgical Sciences, Respiratory Unit – University Magna Graecia of Catanzaro, Italy
| | - Giovanni Passalaqua
- Allergy and Respiratory Diseases, Department of Internal Medicine (DIMI) – University of Genoa, Italy
| | - Gianenrico Senna
- Asthma Center and Allergy Unit, University of Verona and General Hospital, Verona, Italy
| | - Enrico Heffler
- Personalized Medicine, Asthma and Allergy, Humanitas Research Hospital, Rozzano, MI, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
| |
Collapse
|
43
|
Roth M, Stolz D. Biomarkers and personalised medicine for asthma. Eur Respir J 2019; 53:53/1/1802094. [PMID: 30606766 DOI: 10.1183/13993003.02094-2018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 11/02/2018] [Indexed: 12/27/2022]
Affiliation(s)
- Michael Roth
- Pulmonary Care Division, Internal Medicine, University Hospital Basel, Basel, Switzerland.,Pulmonary Cell Research, Dept Biomedicine, University Basel, Basel, Switzerland
| | - Daiana Stolz
- Pulmonary Care Division, Internal Medicine, University Hospital Basel, Basel, Switzerland.,Pulmonary Cell Research, Dept Biomedicine, University Basel, Basel, Switzerland
| |
Collapse
|
44
|
Brunner PM, Pavel AB, Khattri S, Leonard A, Malik K, Rose S, Jim On S, Vekaria AS, Traidl-Hoffmann C, Singer GK, Baum D, Gilleaudeau P, Sullivan-Whalen M, Fuentes-Duculan J, Li X, Zheng X, Estrada Y, Garcet S, Wen HC, Gonzalez J, Coats I, Cueto I, Neumann AU, Lebwohl MG, Krueger JG, Guttman-Yassky E. Baseline IL-22 expression in patients with atopic dermatitis stratifies tissue responses to fezakinumab. J Allergy Clin Immunol 2019; 143:142-154. [PMID: 30121291 DOI: 10.1016/j.jaci.2018.07.028] [Citation(s) in RCA: 122] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 07/06/2018] [Accepted: 07/27/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND IL-22 is potentially a pathogenic cytokine in patients with atopic dermatitis (AD), but the molecular effects of IL-22 antagonism have not been defined in human subjects. OBJECTIVE We sought to evaluate the cellular and molecular effects of IL-22 blockade in tissues from patients with moderate-to-severe AD. METHODS We assessed lesional and nonlesional skin from 59 patients with moderate-to-severe AD treated with anti-IL-22 (fezakinumab) versus placebo (2:1) using transcriptomic and immunohistochemistry analyses. RESULTS Greater reversal of the AD genomic profile was seen with fezakinumab versus placebo, namely 25.3% versus 10.5% at 4 weeks (P = 1.7 × 10-5) and 65.5% versus 13.9% at 12 weeks (P = 9.5 × 10-19), respectively. Because IL-22 blockade showed clinical efficacy only in patients with severe AD, we used baseline median IL-22 mRNA expression to stratify for high (n = 30) and low (n = 29) IL-22 expression groups. Much stronger mean transcriptomic improvements were seen with fezakinumab in the IL-22-high drug-treated group (82.8% and 139.4% at 4 and 12 weeks, respectively) than in the respective IL-22-high placebo-treated group (39.6% and 56.3% at 4 and 12 weeks) or the IL-22-low groups. Significant downregulations of multiple immune pathways, including TH1/CXCL9, TH2/CCL18/CCL22, TH17/CCL20/DEFB4A, and TH22/IL22/S100A's, were restricted to the IL-22-high drug group (P < .05). Consistently, tissue predictors of clinical response were mostly genes involved in T-cell and dendritic cell activation and differentiation. CONCLUSIONS This is the first report showing a profound effect of IL-22 blockade on multiple inflammatory pathways in AD. These data, supported by robust effects in patients with high IL-22 baseline expression, suggest a central role for IL-22 in AD, indicating the need for a precision medicine approach for improving therapeutic outcomes in patients with AD.
Collapse
Affiliation(s)
- Patrick M Brunner
- Laboratory for Investigative Dermatology, Rockefeller University, New York, NY
| | - Ana B Pavel
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Saakshi Khattri
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Alexandra Leonard
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Kunal Malik
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Sharon Rose
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Shelbi Jim On
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Anjali S Vekaria
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Claudia Traidl-Hoffmann
- Institute of Environmental Medicine, University Center for Health Sciences at the Klinikum Augsburg, Technical University Munich and Helmholtz Zentrum München-German Research Center for Environmental Health, Augsburg, Germany; Christine Kühne-Center for Allergy Research and Education (CK-CARE), Davos, Switzerland
| | - Giselle K Singer
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Danielle Baum
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | | | | | - Xuan Li
- Laboratory for Investigative Dermatology, Rockefeller University, New York, NY
| | - Xiuzhong Zheng
- Laboratory for Investigative Dermatology, Rockefeller University, New York, NY
| | - Yeriel Estrada
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Sandra Garcet
- Laboratory for Investigative Dermatology, Rockefeller University, New York, NY
| | - Huei-Chi Wen
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Juana Gonzalez
- Laboratory for Investigative Dermatology, Rockefeller University, New York, NY
| | - Israel Coats
- Laboratory for Investigative Dermatology, Rockefeller University, New York, NY
| | - Inna Cueto
- Laboratory for Investigative Dermatology, Rockefeller University, New York, NY
| | - Avidan U Neumann
- Institute of Environmental Medicine, University Center for Health Sciences at the Klinikum Augsburg, Technical University Munich and Helmholtz Zentrum München-German Research Center for Environmental Health, Augsburg, Germany
| | - Mark G Lebwohl
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - James G Krueger
- Laboratory for Investigative Dermatology, Rockefeller University, New York, NY
| | - Emma Guttman-Yassky
- Laboratory for Investigative Dermatology, Rockefeller University, New York, NY; Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY.
| |
Collapse
|
45
|
Personalized Approach to Severe Asthma. BIOMED RESEARCH INTERNATIONAL 2018; 2018:2465172. [PMID: 30671448 PMCID: PMC6323523 DOI: 10.1155/2018/2465172] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 11/18/2018] [Indexed: 01/29/2023]
|
46
|
Abstract
Asthma is a heterogenous disease characterized by multiple phenotypes driven by different mechanisms. The implementation of precision medicine in the management of asthma requires the identification of phenotype-specific markers measurable in biological fluids. To become useful, these biomarkers need to be quantifiable by reliable systems, reproducible in the clinical setting, easy to obtain and cost-effective. Using biomarkers to predict asthma outcomes and therapeutic response to targeted therapies has a great clinical significance, particularly in severe asthma. In the last years, significant research has been realized in the identification of valid biomarkers for asthma. This review focuses on the existent and emerging biomarkers with clinical higher applicability in the management of asthma.
Collapse
Affiliation(s)
- Angelica Tiotiu
- Pulmonology Department, University Hospital, 9, Rue du Morvan, 54511 Nancy, Vandœuvre-lès-Nancy France
- EA 3450 DevAH, Development, Adaptation, Cardio-Respiratory Regulations and Motor Control, University of Lorraine, Nancy, France
- National Heart and Lung Institute, Airway Disease Section, Imperial College London, London, UK
| |
Collapse
|
47
|
Abstract
BACKGROUND Personalized medicine offers new perspectives for diagnostic measurements and medical treatment, but also puts greater demands on the physician. OBJECTIVES Developments, potentials and potential pitfalls of personalized medicine in allergology. METHODS Overview, evaluation and discussion of the current state of science on the basis of selected examples. RESULTS Allergic diseases like allergic rhinitis, atopic eczema or anaphylaxis can be classified into various clinical phenotypes, which are based on different immunological endotypes. These can be captured and categorized by a wide variety of omics technologies. The identification of endotype specific biomarkers holds promising opportunities of more precise diagnostics, the implementation of novel targeted therapies or the development of optimized preventive strategies. However, individualized analysis and assessment of the significance of the measurements represent special challenges. CONCLUSIONS Findings of the complex omics technologies need to be evaluated by comprehensive prospective studies in order to validate their clinical relevance and suitability for personalized medicine in allergology.
Collapse
Affiliation(s)
- W Pfützner
- Klinik für Dermatologie und Allergologie, Allergie Zentrum Hessen, Universitätsklinikum Gießen und Marburg, Standort Marburg, Philipps-Universität Marburg, Baldinger Str., 35043, Marburg, Deutschland.
| | - J Pickert
- Klinik für Dermatologie und Allergologie, Allergie Zentrum Hessen, Universitätsklinikum Gießen und Marburg, Standort Marburg, Philipps-Universität Marburg, Baldinger Str., 35043, Marburg, Deutschland
| | - C Möbs
- Klinik für Dermatologie und Allergologie, Allergie Zentrum Hessen, Universitätsklinikum Gießen und Marburg, Standort Marburg, Philipps-Universität Marburg, Baldinger Str., 35043, Marburg, Deutschland
| |
Collapse
|
48
|
Menzies-Gow A, Canonica GW, Winders TA, Correia de Sousa J, Upham JW, Fink-Wagner AH. A Charter to Improve Patient Care in Severe Asthma. Adv Ther 2018; 35:1485-1496. [PMID: 30182174 PMCID: PMC6182619 DOI: 10.1007/s12325-018-0777-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Indexed: 12/16/2022]
Abstract
Severe asthma is a subtype of asthma that is difficult to treat and control. By conservative estimates, severe asthma affects approximately 5-10% of patients with asthma worldwide. Severe asthma impairs patients' health-related quality of life, and patients are at risk of life-threatening asthma attacks. Severe asthma also accounts for the majority of health care expenditures associated with asthma. Guidelines recommend that patients with severe asthma be referred to a specialist respiratory team for correct diagnosis and expert management. This is particularly important to ensure that they have access to newly available biologic treatments. However, many patients with severe asthma can suffer multiple asthma attacks and wait several years before they are referred for specialist care. As global patient advocates, we believe it is essential to raise awareness and understanding for patients, caregivers, health care professionals, and the public about the substantial impact of severe asthma and to create opportunities for improving patient care. Patients should be empowered to live a life free of symptoms and the adverse effects of traditional medications (e.g., oral corticosteroids), reducing hospital visits and emergency care, the loss of school and work days, and the constraints placed on their daily lives. Here we provide a Patient Charter for severe asthma, consisting of six core principles, to mobilize national governments, health care providers, payer policymakers, lung health industry partners, and patients/caregivers to address the unmet need and burden in severe asthma and ultimately work together to deliver meaningful improvements in care. FUNDING AstraZeneca.
Collapse
Affiliation(s)
| | - G-Walter Canonica
- Personalized Medicine Asthma and Allergy Center, Humanitas University and Research Hospital, Milan, Italy
| | - Tonya A Winders
- Allergy & Asthma Network / Global Allergy & Asthma Patient Platform (GAAPP), Vienna, VA, USA
| | - Jaime Correia de Sousa
- School of Medicine, ICVS/3B's-PT Government Associate Laboratory, Life and Health Sciences Research Institute, University of Minho, Braga, Portugal
| | - John W Upham
- Diamantina Institute, The University of Queensland, Brisbane, Australia
| | | |
Collapse
|
49
|
Ferrando M, Bagnasco D, Heffler E, Paoletti G, Passalacqua G, Puggioni F, Canonica GW. Personalizing the approach to asthma treatment. EXPERT REVIEW OF PRECISION MEDICINE AND DRUG DEVELOPMENT 2018. [DOI: 10.1080/23808993.2018.1517024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Matteo Ferrando
- Allergy & Respiratory Diseases, IRCCS Policlinico San Martino Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Diego Bagnasco
- Allergy & Respiratory Diseases, IRCCS Policlinico San Martino Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Enrico Heffler
- Personalized Medicine, Asthma and Allergy Clinic, Humanitas Research Hospital, Milano, Italy
- Department of Biomedical Sciences, Humanitas University, Milano, Italy
| | - Giovanni Paoletti
- Department of Biomedical Sciences, Humanitas University, Milano, Italy
- Department of Medical Sciences “M. Aresu”, Allergy and Clinical Immunology Unit, University of Cagliari, Cagliari, Italy
| | - Giovanni Passalacqua
- Allergy & Respiratory Diseases, IRCCS Policlinico San Martino Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Francesca Puggioni
- Personalized Medicine, Asthma and Allergy Clinic, Humanitas Research Hospital, Milano, Italy
- Department of Biomedical Sciences, Humanitas University, Milano, Italy
| | - Giorgio Walter Canonica
- Personalized Medicine, Asthma and Allergy Clinic, Humanitas Research Hospital, Milano, Italy
- Department of Biomedical Sciences, Humanitas University, Milano, Italy
| |
Collapse
|
50
|
Padilla Galo A, Labor M, Tiotiu A, Baiardini I, Scichilone N, Braido F. Impact of reslizumab on outcomes of severe asthmatic patients: current perspectives. PATIENT-RELATED OUTCOME MEASURES 2018; 9:267-273. [PMID: 30147386 PMCID: PMC6103306 DOI: 10.2147/prom.s146966] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Approximately 5%–10% of asthmatics suffer from severe asthma. New biological treatments represent a great opportunity to reduce asthma burden and to improve asthma patients’ lives. Reslizumab will soon be available in several European countries. This anti-IL-5 IgG4/κ monoclonal antibody, administered intravenously at a dose of 3 mg/kg over 20–50 minutes every 4 weeks, has been shown to be safe and effective in patients with 400 eosinophils/μL or more in their peripheral blood. The clinical effects in reducing asthma exacerbations and in improving the quality of life and lung function are clear, but further research is needed to determine the best biological compound for a specific cluster of patients. Research data have shown that in patients who were expressing other clinical features of eosinophilic inflammation over asthma (rhinosinusitis and nasal polyposis), the clinical benefit of reslizumab was greater. Furthermore, it has also been observed that in patients with unsatisfactory response to mepolizumab, reslizumab is able to significantly improve the clinical and biological parameters. The aim of personalized medicine is to provide the right drug to the right patient at the right dose at the right moment. The biological treatments that were developed to modify specific pathological pathways not only provide us with the tools for the management of asthma patients but also clarify the biological mechanisms involved in its pathogenesis.
Collapse
Affiliation(s)
- Alicia Padilla Galo
- Unit of Pneumology, Agencia Sanitaria Costa del Sol, Marbella, Málaga, Spain
| | - Marina Labor
- Department of Pulmonology, University Hospital Center Osijek, Osijek, Croatia.,Faculty of Medicine, J.J. Strossmayer University of Osijek, Osijek, Croatia
| | - Angelica Tiotiu
- Department of Pulmonology, CHRU Nancy, DevAH-Development, Adaptation and Disadvantage, Cardiorespiratory Regulations and Motor Control, University of Lorraine, Nancy, France,
| | - Ilaria Baiardini
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Nicola Scichilone
- Department of Biomedicine and Internal and Specialistic Medicine (DIBIMIS), University of Palermo, Palermo, Italy
| | - Fulvio Braido
- Department of Internal Medicine, Respiratory Diseases and Allergy Clinic, University of Genova - Azienda Policlinico IRCCs San Martino, Genova, Italy
| |
Collapse
|