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Tang M, Charbit AR, Johansson MW, Jarjour NN, Denlinger LC, Raymond WW, Peters MC, Dunican EM, Castro M, Sumino K, Erzurum SC, Comhair SA, Moore WC, Levy BD, Israel E, Phipatanakul W, Phillips BR, Mauger DT, Bleecker ER, Wenzel SE, Fajt ML, Woodruff PG, Hastie AT, Fahy JV. Utility of eosinophil peroxidase as a biomarker of eosinophilic inflammation in asthma. J Allergy Clin Immunol 2024; 154:580-591.e6. [PMID: 38663815 DOI: 10.1016/j.jaci.2024.03.023] [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: 07/12/2023] [Revised: 02/26/2024] [Accepted: 03/06/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND The relative utility of eosinophil peroxidase (EPX) and blood and sputum eosinophil counts as disease biomarkers in asthma is uncertain. OBJECTIVE We sought to determine the utility of EPX as a biomarker of systemic and airway eosinophilic inflammation in asthma. METHODS EPX protein was measured by immunoassay in serum and sputum in 110 healthy controls to establish a normal reference range and in repeated samples of serum and sputum collected during 3 years of observation in 480 participants in the Severe Asthma Research Program 3. RESULTS Over 3 years, EPX levels in patients with asthma were higher than normal in 27% to 31% of serum samples and 36% to 53% of sputum samples. Eosinophils and EPX correlated better in blood than in sputum (rs values of 0.74 and 0.43, respectively), and high sputum EPX levels occurred in 27% of participants with blood eosinophil counts less than 150 cells/μL and 42% of participants with blood eosinophil counts between 150 and 299 cells/μL. Patients with persistently high sputum EPX values for 3 years were characterized by severe airflow obstruction, frequent exacerbations, and high mucus plug scores. In 59 patients with asthma who started mepolizumab during observation, serum EPX levels normalized in 96% but sputum EPX normalized in only 49%. Lung function remained abnormal even when sputum EPX normalized. CONCLUSIONS Serum EPX is a valid protein biomarker of systemic eosinophilic inflammation in asthma, and sputum EPX levels are a more sensitive biomarker of airway eosinophilic inflammation than sputum eosinophil counts. Eosinophil measures in blood frequently miss airway eosinophilic inflammation, and mepolizumab frequently fails to normalize airway eosinophilic inflammation even though it invariably normalizes systemic eosinophilic inflammation.
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Affiliation(s)
- Monica Tang
- University of California San Francisco, San Francisco, Calif
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - David T Mauger
- Pennsylvania State University College of Medicine, Hershey, Pa
| | | | | | | | | | | | - John V Fahy
- University of California San Francisco, San Francisco, Calif.
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2
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Kwok WC, Lau KK, Teo KC, Ho JCM. Correlation of sputum inflammatory markers with severity and blood inflammatory markers in bronchiectasis. J Thorac Dis 2024; 16:5190-5200. [PMID: 39268102 PMCID: PMC11388234 DOI: 10.21037/jtd-24-573] [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: 04/08/2024] [Accepted: 07/05/2024] [Indexed: 09/15/2024]
Abstract
Background As a disease characterized by chronic neutrophilic inflammation, various sputum biomarkers have been investigated in the association with the severity and prognosis of bronchiectasis. However, there is lack of data on the association between sputum interleukin-1beta (IL-1β), interleukin-8 (IL-8) and tumor necrosis factor-alpha (TNF-α) levels at clinical stable state and the clinical, spirometric and blood inflammatory parameters, as well as prognostic scores. The purpose of the study is to assess the association between sputum IL-1β, IL-8 and TNF-α levels at clinical stable state and various clinical and laboratory parameters in bronchiectasis. Methods A prospective study was conducted in a major regional hospital and tertiary respiratory referral centre in Hong Kong, including 44 Chinese patients with bronchiectasis. The correlation between stable state sputum IL-1β, IL-8 and TNF-α levels with various clinical, laboratory and spirometric parameters in bronchiectasis, as well as FACED [forced expiratory volume in one second (FEV1), age, chronic colonisation by Pseudomonas aeruginosa, radiological extension and dyspnoea]/E-FACED (FACED plus exacerbations) scores were assessed. Results Baseline sputum IL-1β level was found to have significant moderate positive correlation with baseline blood high sensitivity C-reactive protein (hs-CRP) level with Pearson correlation coefficient (r) of 0.529 (P=0.001). Baseline sputum IL-8 level was found to have significant moderate positive correlation with baseline FACED and E-FACED score with r of 0.574 (P<0.001) and 0.539 (P<0.001) respectively. Baseline sputum TNF-α level was found to have significant moderate positive correlation with baseline FACED score with r of 0.520 (P<0.001). Conclusions Sputum IL-1β and, IL-8 and TNF-α levels were shown to have significant correlation with various clinical, laboratory and spirometry parameters in bronchiectasis, as well as more severe disease as measured by FACED and E-FACED scores.
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Affiliation(s)
- Wang Chun Kwok
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Kui Kai Lau
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Kay Cheong Teo
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - James Chung Man Ho
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
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3
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Ali M, Nair P, Capretta A, Brennan JD. In-vitro Clinical Diagnostics using RNA-Cleaving DNAzymes. Chembiochem 2024; 25:e202400085. [PMID: 38574237 DOI: 10.1002/cbic.202400085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 04/02/2024] [Accepted: 04/04/2024] [Indexed: 04/06/2024]
Abstract
Over the last three decades, significant advancements have been made in the development of biosensors and bioassays that use RNA-cleaving DNAzymes (RCDs) as molecular recognition elements. While early examples of RCDs were primarily responsive to metal ions, the past decade has seen numerous RCDs reported for more clinically relevant targets such as bacteria, cancer cells, small metabolites, and protein biomarkers. Over the past 5 years several RCD-based biosensors have also been evaluated using either spiked biological matrixes or patient samples, including blood, serum, saliva, nasal mucus, sputum, urine, and faeces, which is a critical step toward regulatory approval and commercialization of such sensors. In this review, an overview of the methods used to generate RCDs and the properties of key RCDs that have been utilized for in vitro testing is first provided. Examples of RCD-based assays and sensors that have been used to test either spiked biological samples or patient samples are then presented, highlighting assay performance in different biological matrixes. A summary of current prospects and challenges for development of in vitro diagnostic tests incorporating RCDs and an overview of future directions of the field is also provided.
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Affiliation(s)
- Monsur Ali
- Biointerfaces Institute, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Parameswaran Nair
- Division of Respirology, McMaster University, and, Firestone Institute of Respiratory Health at St. Joseph's Health Care, Hamilton, ON, L8N 4A6, Canada
| | - Alfredo Capretta
- Biointerfaces Institute, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - John D Brennan
- Biointerfaces Institute, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
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4
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Xu L, Huang X, Chen Z, Yang M, Deng J. Eosinophil peroxidase promotes bronchial epithelial cells to secrete asthma-related factors and induces the early stage of airway remodeling. Clin Immunol 2024; 263:110228. [PMID: 38663494 DOI: 10.1016/j.clim.2024.110228] [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: 01/18/2024] [Revised: 04/17/2024] [Accepted: 04/22/2024] [Indexed: 04/30/2024]
Abstract
Asthma is a heterogeneous disease characterized by chronic airway inflammation, reversible airflow limitation, and airway remodeling. Eosinophil peroxidase (EPX) is the most abundant secondary granule protein unique to activated eosinophils. In this study, we aimed to illustrate the effect of EPX on the epithelial-mesenchymal transition (EMT) in BEAS-2B cells. Our research found that both EPX and ADAM33 were negatively correlated with FEV1/FVC and FEV1%pred, and positively correlated with IL-5 levels. Asthma patients had relatively higher levels of ADAM33 and EPX compared to the healthy control group. The expression of TSLP, TGF-β1 and ADAM33 in the EPX intervention group was significantly higher. Moreover, EPX could promote the proliferation, migration and EMT of BEAS-2B cells, and the effect of EPX on various factors was significantly improved by the PI3K inhibitor LY294002. The findings from this study could potentially offer a novel therapeutic target for addressing airway remodeling in bronchial asthma, particularly focusing on EMT.
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Affiliation(s)
- Liping Xu
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Xuemei Huang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Zhangrong Chen
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Meiling Yang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Jingmin Deng
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
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5
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Idler BM, Iijima K, Ochkur SI, Jacobsen EA, Rank MA, Kita H, Lal D. Eosinophil Peroxidase: A Biomarker for Eosinophilic Chronic Rhinosinusitis Agnostic of Polyp Status. Laryngoscope 2024; 134:69-78. [PMID: 37255054 PMCID: PMC10687314 DOI: 10.1002/lary.30787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 05/03/2023] [Accepted: 05/15/2023] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To evaluate eosinophil peroxidase (EPX) as a biomarker for tissue levels of eosinophilia, cytokines, and chemokines within chronic rhinosinusitis (CRS). METHODS Twenty-eight subjects undergoing sinonasal surgery were prospectively enrolled. Ethmoid tissue was analyzed with an in-house EPX immunoassay and a 48-plex cytokine-chemokine array. Clinical severity was assessed using SNOT-22 and Lund-Mackay scores. Subjects were grouped as follows: controls, polyp status (CRS with [CRSwNP] and without nasal polyps [CRSsNP]), tissue eosinophilia (eosinophilic CRS [eCRS], non-eosinophilic CRS [neCRS]), or combinations thereof (eCRSwNP, eCRSsNP, neCRSsNP). eCRS was defined as >10 eosinophils per high power field (HPF). Subjects without CRS or asthma were enrolled as controls. RESULTS EPX was elevated in CRSwNP compared to control (p = 0.007), in eCRS compared to neCRS (p = 0.002), and in eCRSwNP along with eCRSsNP compared to neCRSsNP (p = 0.023, p = 0.015, respectively). eCRS displayed elevated IL-5 compared to neCRS (p = 0.005). No significant differences in EPX or IL-5 were observed between eCRSwNP and eCRSsNP. IL-5 was elevated in eCRSwNP (p = 0.019) compared neCRSsNP. Area under the receiver operator characteristic curve was 0.938 (95% CI, 0.835-1.00) for EPX and tissue eosinophilia, with an optimal cut-point of 470 ng/mL being 100% specific and 81.25% sensitive for tissue eosinophilia. Linear regression revealed a strong correlation between EPX and IL-5 (R2 = 0.64, p < 0.001). Comparing EPX and IL-5, only EPX displayed significant correlation with SNOT-22 (p = 0.04) and Lund-Mackay score (p = 0.004). CONCLUSION EPX is associated with tissue eosinophilia in CRS patients regardless of polyp status. EPX correlates with IL-5 and could be potentially considered a biomarker for anti-IL-5 therapies. LEVEL OF EVIDENCE 3 Laryngoscope, 134:69-78, 2024.
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Affiliation(s)
- Beau M. Idler
- Mayo Clinic Alix School of Medicine, Mayo Clinic Arizona, Scottsdale, 85259
| | - Koji Iijima
- Division of Allergy, Asthma, and Clinical Immunology, Mayo Clinic Arizona, Scottsdale, 85259
| | - Sergei I. Ochkur
- Division of Allergy, Asthma, and Clinical Immunology, Mayo Clinic Arizona, Scottsdale, 85259
| | - Elizabeth A. Jacobsen
- Division of Allergy, Asthma, and Clinical Immunology, Mayo Clinic Arizona, Scottsdale, 85259
| | - Matthew A. Rank
- Division of Allergy, Asthma, and Clinical Immunology, Mayo Clinic Arizona, Scottsdale, 85259
- Department of Otorhinolaryngology-Head and Neck Surgery, Mayo Clinic Arizona, Phoenix, 85054
| | - Hirohito Kita
- Division of Allergy, Asthma, and Clinical Immunology, Mayo Clinic Arizona, Scottsdale, 85259
- Department of Otorhinolaryngology-Head and Neck Surgery, Mayo Clinic Arizona, Phoenix, 85054
| | - Devyani Lal
- Department of Otorhinolaryngology-Head and Neck Surgery, Mayo Clinic Arizona, Phoenix, 85054
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6
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Jesenak M, Diamant Z, Simon D, Tufvesson E, Seys SF, Mukherjee M, Lacy P, Vijverberg S, Slisz T, Sediva A, Simon HU, Striz I, Plevkova J, Schwarze J, Kosturiak R, Alexis NE, Untersmayr E, Vasakova MK, Knol E, Koenderman L. Eosinophils-from cradle to grave: An EAACI task force paper on new molecular insights and clinical functions of eosinophils and the clinical effects of targeted eosinophil depletion. Allergy 2023; 78:3077-3102. [PMID: 37702095 DOI: 10.1111/all.15884] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/21/2023] [Accepted: 08/27/2023] [Indexed: 09/14/2023]
Abstract
Over the past years, eosinophils have become a focus of scientific interest, especially in the context of their recently uncovered functions (e.g. antiviral, anti-inflammatory, regulatory). These versatile cells display both beneficial and detrimental activities under various physiological and pathological conditions. Eosinophils are involved in the pathogenesis of many diseases which can be classified into primary (clonal) and secondary (reactive) disorders and idiopathic (hyper)eosinophilic syndromes. Depending on the biological specimen, the eosinophil count in different body compartments may serve as a biomarker reflecting the underlying pathophysiology and/or activity of distinct diseases and as a therapy-driving (predictive) and monitoring tool. Personalized selection of an appropriate therapeutic strategy directly or indirectly targeting the increased number and/or activity of eosinophils should be based on the understanding of eosinophil homeostasis including their interactions with other immune and non-immune cells within different body compartments. Hence, restoring as well as maintaining homeostasis within an individual's eosinophil pool is a goal of both specific and non-specific eosinophil-targeting therapies. Despite the overall favourable safety profile of the currently available anti-eosinophil biologics, the effect of eosinophil depletion should be monitored from the perspective of possible unwanted consequences.
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Affiliation(s)
- Milos Jesenak
- Department of Clinical Immunology and Allergology, University Teaching Hospital in Martin, Martin, Slovak Republic
- Department of Paediatrics, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, University Teaching Hospital in Martin, Martin, Slovak Republic
- Department of Pulmonology and Phthisiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, University Teaching Hospital in Martin, Martin, Slovak Republic
| | - Zuzana Diamant
- Department of Clinical Sciences Lund, Respiratory Medicine, Allergology and Palliative Medicine, Lund University, Lund, Sweden
- Department Microbiology Immunology & Transplantation, KU Leuven, Catholic University of Leuven, Leuven, Belgium
- Department of Respiratory Medicine, First Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic
| | - Dagmar Simon
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Ellen Tufvesson
- Department of Clinical Sciences Lund, Respiratory Medicine, Allergology and Palliative Medicine, Lund University, Lund, Sweden
| | - Sven F Seys
- Laboratory of Clinical Immunology, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - Manali Mukherjee
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- The Firestone Institute for Respiratory Health, Research Institute of St. Joe's Hamilton, Hamilton, Ontario, Canada
| | - Paige Lacy
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Susanne Vijverberg
- Amsterdam UMC Location University of Amsterdam, Pulmonary Diseases, Amsterdam, The Netherlands
| | - Tomas Slisz
- Department of Respiratory Medicine, First Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic
| | - Anna Sediva
- Department of Immunology, 2nd Faculty of Medicine, Charles University, Motol University Hospital, Prague, Czech Republic
| | - Hans-Uwe Simon
- Institute of Pharmacology, University of Bern, Bern, Switzerland
- Institute of Biochemistry, Brandenburg Medical School, Neuruppin, Germany
| | - Ilja Striz
- Department of Clinical and Transplant Immunology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Jana Plevkova
- Department of Pathophysiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
| | - Jurgen Schwarze
- Child Life and Health and Centre for Inflammation Research, The Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Radovan Kosturiak
- Department of Paediatrics, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, University Teaching Hospital in Martin, Martin, Slovak Republic
- Outpatient Clinic for Clinical Immunology and Allergology, Nitra, Slovak Republic
| | - Neil E Alexis
- Center for Environmental Medicine, Asthma and Lung Biology, Department of Paediatrics, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Eva Untersmayr
- Institute of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Martina Koziar Vasakova
- Department of Respiratory Medicine, First Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic
| | - Edward Knol
- Department Center of Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
- Department Dermatology/Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Leo Koenderman
- Department Center of Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
- Department Pulmonary Diseases, University Medical Center Utrecht, Utrecht, The Netherlands
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7
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Siddiqui S, Wenzel SE, Bozik ME, Archibald DG, Dworetzky SI, Mather JL, Killingsworth R, Ghearing N, Schwartz JT, Ochkur SI, Jacobsen EA, Busse WW, Panettieri RA, Prussin C. Safety and Efficacy of Dexpramipexole in Eosinophilic Asthma (EXHALE): A randomized controlled trial. J Allergy Clin Immunol 2023; 152:1121-1130.e10. [PMID: 37277072 DOI: 10.1016/j.jaci.2023.05.014] [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: 02/03/2023] [Revised: 04/07/2023] [Accepted: 05/01/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND There is a need for new and effective oral asthma therapies. Dexpramipexole, an oral eosinophil-lowering drug, has not previously been studied in asthma. OBJECTIVE We sought to evaluate the safety and efficacy of dexpramipexole in lowering blood and airway eosinophilia in subjects with eosinophilic asthma. METHODS We performed a randomized, double-blind, placebo-controlled proof-of-concept trial in adults with inadequately controlled moderate to severe asthma and blood absolute eosinophil count (AEC) greater than or equal to 300/μL. Subjects were randomly assigned (1:1:1:1) to dexpramipexole 37.5, 75, or 150 mg BID (twice-daily) or placebo. The primary end point was the relative change in AEC from baseline to week 12. Prebronchodilator FEV1 week-12 change from baseline was a key secondary end point. Nasal eosinophil peroxidase was an exploratory end point. RESULTS A total of 103 subjects were randomly assigned to dexpramipexole 37.5 mg BID (N = 22), 75 mg BID (N = 26), 150 mg BID (N = 28), or placebo (N = 27). Dexpramipexole significantly reduced placebo-corrected AEC week-12 ratio to baseline, in both the 150-mg BID (ratio, 0.23; 95% CI, 0.12-0.43; P < .0001) and the 75-mg BID (ratio, 0.34; 95% CI, 0.18-0.65; P = .0014) dose groups, corresponding to 77% and 66% reductions, respectively. Dexpramipexole reduced the exploratory end point of nasal eosinophil peroxidase week-12 ratio to baseline in the 150-mg BID (median, 0.11; P = .020) and the 75-mg BID (median, 0.17; P = .021) groups. Placebo-corrected FEV1 increases were observed starting at week 4 (nonsignificant). Dexpramipexole displayed a favorable safety profile. CONCLUSIONS Dexpramipexole demonstrated effective eosinophil lowering and was well tolerated. Additional larger clinical trials are needed to understand the clinical efficacy of dexpramipexole in asthma.
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Affiliation(s)
- Salman Siddiqui
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Sally E Wenzel
- University of Pittsburgh School of Public Health, Environmental & Occupational Health, Pittsburgh, Pa
| | | | | | | | | | | | - Natasha Ghearing
- Division of Allergy and Immunology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Justin T Schwartz
- Division of Allergy and Immunology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Sergei I Ochkur
- Division of Allergy, Asthma and Clinical Immunology, Scottsdale, Ariz; Department of Medicine, Mayo Clinic Arizona, Scottsdale, Ariz
| | - Elizabeth A Jacobsen
- Division of Allergy, Asthma and Clinical Immunology, Scottsdale, Ariz; Department of Medicine, Mayo Clinic Arizona, Scottsdale, Ariz
| | - William W Busse
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Reynold A Panettieri
- Rutgers Institute for Translational Medicine and Science, The State University of New Jersey, New Brunswick, NJ
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8
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Ali MM, Mukherjee M, Radford K, Patel Z, Capretta A, Nair P, Brennan JD. A Rapid Sputum-based Lateral Flow Assay for Airway Eosinophilia using an RNA-cleaving DNAzyme Selected for Eosinophil Peroxidase. Angew Chem Int Ed Engl 2023; 62:e202307451. [PMID: 37477970 DOI: 10.1002/anie.202307451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 07/22/2023]
Abstract
The first protein-binding allosteric RNA-cleaving DNAzyme (RCD) obtained by direct in vitro selection against eosinophil peroxidase (EPX), a validated marker for airway eosinophilia, is described. The RCD has nanomolar affinity for EPX, shows high selectivity against related peroxidases and other eosinophil proteins, and is resistant to degradation by mammalian nucleases. An optimized RCD was used to develop both fluorescence and lateral flow assays, which were evaluated using 38 minimally processed patient sputum samples (23 non-eosinophilic, 15 eosinophilic), producing a clinical sensitivity of 100 % and specificity of 96 %. This RCD-based lateral flow assay should allow for rapid evaluation of airway eosinophilia as an aid for guiding asthma therapy.
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Affiliation(s)
- M Monsur Ali
- Biointerfaces Institute, McMaster University, 1280 Main Street West, L8S 4K1, Hamilton, ON, Canada
| | - Manali Mukherjee
- Division of Respirology, McMaster University, Firestone Institute of Respiratory Health at St. Joseph's Health Care, L8N 4A6, Hamilton, ON, Canada
| | - Katherine Radford
- Division of Respirology, McMaster University, Firestone Institute of Respiratory Health at St. Joseph's Health Care, L8N 4A6, Hamilton, ON, Canada
| | - Zil Patel
- Division of Respirology, McMaster University, Firestone Institute of Respiratory Health at St. Joseph's Health Care, L8N 4A6, Hamilton, ON, Canada
| | - Alfredo Capretta
- Biointerfaces Institute, McMaster University, 1280 Main Street West, L8S 4K1, Hamilton, ON, Canada
| | - Parameswaran Nair
- Division of Respirology, McMaster University, Firestone Institute of Respiratory Health at St. Joseph's Health Care, L8N 4A6, Hamilton, ON, Canada
| | - John D Brennan
- Biointerfaces Institute, McMaster University, 1280 Main Street West, L8S 4K1, Hamilton, ON, Canada
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9
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Walter S, Ho J, Alvarado R, Smith G, Croucher DR, Liang S, Grayson JW, Mangussi-Gomes J, Van Es SL, Earls P, Rimmer J, Campbell R, Kalish L, Sacks R, Harvey RJ. Mepolizumab decreases tissue eosinophils while increasing type-2 cytokines in eosinophilic chronic rhinosinusitis. Clin Exp Allergy 2022; 52:1403-1413. [PMID: 35475305 DOI: 10.1111/cea.14152] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 03/14/2022] [Accepted: 04/11/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND Eosinophilic chronic rhinosinusitis is an often treatment-resistant inflammatory disease mediated by type-2 cytokines, including interleukin (IL)-5. Mepolizumab, a monoclonal antibody drug targeting IL-5, has demonstrated efficacy and safety in inflammatory airway disease, but there is negligible evidence on direct tissue response. The study's aim was to determine the local effect of mepolizumab on inflammatory biomarkers in sinonasal tissue of eosinophilic chronic rhinosinusitis patients. METHODS Adult patients with eosinophilic chronic rhinosinusitis received 100mg mepolizumab subcutaneously at four-weekly intervals for 24 weeks in this prospective phase 2 clinical trial. Tissue eosinophil counts, eosinophil degranulation (assessed as submucosal eosinophil peroxidase deposition by immunohistochemistry) and cytokine levels (measured in homogenates by immunoassay) were evaluated in ethmoid sinus tissue biopsies collected at baseline and at weeks 4, 8, 16 and 24. RESULTS Twenty patients (47.7 ± 11.7 years, 50% female) were included. Sinonasal tissue eosinophil counts decreased after 24 weeks of treatment with mepolizumab (101.64 ± 93.80 vs 41.74 ± 53.76 cells per 0.1 mm2 ; p = .035), eosinophil degranulation remained unchanged (5.79 ± 2.08 vs 6.07 ± 1.20, p = .662), and type-2 cytokine levels increased in sinonasal tissue for IL-5 (10.84 ± 18.65 vs 63.98 ± 50.66, p = .001), IL-4 (4.48 ± 3.77 vs 9.38 ± 7.56, p = .004), IL-13 (4.02 ± 2.57 vs 6.46 ± 3.99, p = .024) and GM-CSF (1.51 ± 1.74 vs 4.50 ± 2.97, p = .001). CONCLUSION Mepolizumab reduced eosinophils in sinonasal tissue, demonstrating that antagonism of IL-5 suppresses eosinophil trafficking. With reduced tissue eosinophils, a local type-2 inflammatory feedback loop may occur. The study exposes mechanistic factors which may explain incomplete treatment response.
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Affiliation(s)
- Sophie Walter
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia
| | - Jacqueline Ho
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia.,St Vincent's Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Raquel Alvarado
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia
| | - Greg Smith
- School of Medical Sciences, University of New South Wales, Sydney, Australia
| | - David R Croucher
- St Vincent's Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia.,Garvan Institute of Medical Research, Sydney, New South Wales, Australia
| | - Sharron Liang
- Department of Anatomical Pathology, St Vincent's Hospital, Sydney, Australia
| | - Jessica W Grayson
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia.,Department of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, UK
| | - João Mangussi-Gomes
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia
| | - Simone L Van Es
- School of Medical Sciences, University of New South Wales, Sydney, Australia.,New South Wales Health Education and Training Institute, Sydney, Australia
| | - Peter Earls
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia.,Department of Anatomical Pathology, St Vincent's Hospital, Sydney, Australia
| | - Janet Rimmer
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia.,Woolcock Institute, University of Sydney, Sydney, Australia.,Faculty of Medicine, Notre Dame University, Sydney, Australia
| | - Raewyn Campbell
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia.,Department of Otolaryngology Head and Neck Surgery, Royal Prince Alfred Hospital, Sydney, Australia.,Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Larry Kalish
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia.,Department of Otolaryngology, Head and Neck Surgery, Concord General Hospital, University of Sydney, Sydney, Australia.,Faculty of Medicine, University of Sydney, Sydney, Australia
| | - Raymond Sacks
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia.,Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia.,Department of Otolaryngology, Head and Neck Surgery, Concord General Hospital, University of Sydney, Sydney, Australia.,Faculty of Medicine, University of Sydney, Sydney, Australia
| | - Richard J Harvey
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia.,Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
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10
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Porpodis K, Tsiouprou I, Apostolopoulos A, Ntontsi P, Fouka E, Papakosta D, Vliagoftis H, Domvri K. Eosinophilic Asthma, Phenotypes-Endotypes and Current Biomarkers of Choice. J Pers Med 2022; 12:jpm12071093. [PMID: 35887589 PMCID: PMC9316404 DOI: 10.3390/jpm12071093] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 06/25/2022] [Accepted: 06/28/2022] [Indexed: 12/16/2022] Open
Abstract
Asthma phenotyping and endotyping are constantly evolving. Currently, several biologic agents have been developed towards a personalized approach to asthma management. This review will focus on different eosinophilic phenotypes and Th2-associated endotypes with eosinophilic inflammation. Additionally, airway remodeling is analyzed as a key feature of asthmatic eosinophilic endotypes. In addition, evidence of biomarkers is examined with a predictive value to identify patients with severe, uncontrolled asthma who may benefit from new treatment options. Finally, there will be a discussion on the results from clinical trials regarding severe eosinophilic asthma and how the inhibition of the eosinophilic pathway by targeted treatments has led to the reduction of recurrent exacerbations.
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Affiliation(s)
- Konstantinos Porpodis
- Pulmonary Department, Aristotle University of Thessaloniki, George Papanikolaou Hospital, 57010 Thessaloniki, Greece; (K.P.); (I.T.); (A.A.); (E.F.); (D.P.)
| | - Ioanna Tsiouprou
- Pulmonary Department, Aristotle University of Thessaloniki, George Papanikolaou Hospital, 57010 Thessaloniki, Greece; (K.P.); (I.T.); (A.A.); (E.F.); (D.P.)
| | - Apostolos Apostolopoulos
- Pulmonary Department, Aristotle University of Thessaloniki, George Papanikolaou Hospital, 57010 Thessaloniki, Greece; (K.P.); (I.T.); (A.A.); (E.F.); (D.P.)
| | - Polyxeni Ntontsi
- 2nd University Department of Respiratory Medicine, Attikon Hospital, 12462 Athens, Greece;
| | - Evangelia Fouka
- Pulmonary Department, Aristotle University of Thessaloniki, George Papanikolaou Hospital, 57010 Thessaloniki, Greece; (K.P.); (I.T.); (A.A.); (E.F.); (D.P.)
| | - Despoina Papakosta
- Pulmonary Department, Aristotle University of Thessaloniki, George Papanikolaou Hospital, 57010 Thessaloniki, Greece; (K.P.); (I.T.); (A.A.); (E.F.); (D.P.)
| | - Harissios Vliagoftis
- Department of Medicine, University of Alberta, 567 HMRC, Edmonton, AB T6G 2S2, Canada;
| | - Kalliopi Domvri
- Pulmonary Department, Aristotle University of Thessaloniki, George Papanikolaou Hospital, 57010 Thessaloniki, Greece; (K.P.); (I.T.); (A.A.); (E.F.); (D.P.)
- Laboratory of Histology-Embryology, Medical School, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
- Correspondence: ; Tel.: +30-2313307258
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11
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da Paz ER, de Lima CMF, Felix SN, Schaeffer B, Galvão CES, Correia AT, Righetti RF, de Arruda Martins M, de Fátima Lopes Calvo Tibério I, Saraiva-Romanholo BM. Airway inflammatory profile among cleaning workers from different workplaces. BMC Pulm Med 2022; 22:170. [PMID: 35488256 PMCID: PMC9052628 DOI: 10.1186/s12890-022-01949-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 04/11/2022] [Indexed: 01/01/2023] Open
Abstract
Background Cleaning workers represent a significant proportion of the active population worldwide, with poor remuneration, particularly in developing countries. Despite this, they remain a relatively poorly studied occupational group. They are constantly exposed to agents that can cause symptoms and respiratory problems. This study aimed to evaluate upper airway inflammation in professional cleaning workers in three different occupational settings by comparing nasal cytology inflammation and clinical profiles. Methods We performed a cross-sectional study on the prevalence of upper airway inflammation and symptoms of asthma/rhinitis related to cleaning work, according to workplace. A total of 167 participants were divided into four groups: hospital, university, housekeeper and control. A nasal swab was collected for upper airway inflammation evaluation. Clinical profiles and respiratory symptom employee evaluations were performed using specific questionnaires (European Community Respiratory Health Survey—ECRS and the International Study of Asthma and Allergies in Childhood—ISAAC). Results Cleaning workers showed increased neutrophils and lymphocytes; the hospital and university groups showed increased macrophages compared to the housekeeper and control groups. The hospital and housekeeper groups showed increased eosinophils when they performed cleaning services for up to one year and reported having more asthma symptoms than the control group. Cleaning workers showed increased rhinitis symptoms. The university group showed increased rhinitis symptoms aggravated by the workplace compared with the hospital and housekeeper groups. Cleaning workers showed an increased affirmative response when directly asked about rhinitis symptoms compared to the control group. Conclusions Cleaning workers showed airway inflammation, asthma symptoms and rhinitis, regardless of the occupational environment to which they were exposed, as well as showed increased rhinitis and asthma symptoms. Hospital cleaning workers showed increased macrophages, lymphocytes and eosinophils compared to the others. The length of time spent performing cleaning work was not related to nasal inflammation or respiratory symptoms in this population. However, there were differences in workplaces. Registered on ClinicalTrials.gov. Trial registration number: NCT03311048. Registration date: 10.16.2017. Retrospectively registered. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-022-01949-5.
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Affiliation(s)
- Edinéia Rosa da Paz
- Instituto de Assistência Médica Ao Servidor Público Estadual (IAMSPE), Hospital Do Servidor Público Do Estado de São Paulo, Sao Paulo, SP, Brazil
| | | | - Soraia Nogueira Felix
- Instituto de Assistência Médica Ao Servidor Público Estadual (IAMSPE), Hospital Do Servidor Público Do Estado de São Paulo, Sao Paulo, SP, Brazil.
| | - Bruna Schaeffer
- Universidade Cidade de São Paulo (UNICID), São Paulo, SP, Brazil
| | | | - Aristides Tadeu Correia
- Departamento de Cardiopneumologia, Instituto do Coração, InCor-HCFMUSP, Universidade de São Paulo, Sao Paulo, SP, Brazil.,Laboratório de Investigação Médica- LIM 61, Serviço de Cirurgia Torácica, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Renato Fraga Righetti
- Hospital Sírio-Libanês, Serviço de Reabilitação, Sao Paulo, SP, Brazil.,Laboratório de Terapêutica Experimental (LIM-20), Faculdade de Medicina da USP (FMUSP), Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Milton de Arruda Martins
- Laboratório de Terapêutica Experimental (LIM-20), Faculdade de Medicina da USP (FMUSP), Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | - Beatriz Mangueira Saraiva-Romanholo
- Instituto de Assistência Médica Ao Servidor Público Estadual (IAMSPE), Hospital Do Servidor Público Do Estado de São Paulo, Sao Paulo, SP, Brazil.,Universidade Cidade de São Paulo (UNICID), São Paulo, SP, Brazil.,Laboratório de Terapêutica Experimental (LIM-20), Faculdade de Medicina da USP (FMUSP), Universidade de Sao Paulo, Sao Paulo, Brazil
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12
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Effective Management of Severe Asthma with Biologic Medications in Adult Patients: A Literature Review and International Expert Opinion. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 10:422-432. [PMID: 34763123 DOI: 10.1016/j.jaip.2021.10.059] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 10/26/2021] [Accepted: 10/28/2021] [Indexed: 12/11/2022]
Abstract
Severe asthma often remains uncontrolled despite effective treatments and evidence-based guidelines. A group of global experts in asthma and biologic medications from 9 countries considered the most relevant clinical variables to manage severe asthma in adult patients and guide treatment choice. The resulting recommendations address the investigation of biomarker levels (blood eosinophil count along with fractional concentration of exhaled nitric oxide [FeNO]), clinical features (oral corticosteroid [OCS] dependence, specific comorbid disease entities associated with severe type 2 asthma), and safety considerations. Current evidence suggests that biomarkers, including both blood or sputum eosinophil counts as well as FeNO, add prognostic and predictive value and should be measured in all patients with severe asthma. OCS use is an important factor in biologic selection, especially given the documented ability of some biologics to reduce OCS dependence. Comorbid diseases and relevant safety considerations to each biologic should also be considered. More data are needed to determine whether biomarker profiles identify patients suited to one biologic versus another as limited data support differential predictors of response. Further prospective head-to-head trials and post hoc analyses of clinical trial data are warranted. The authors believe that these recommendations have value as they offer expert opinion to assist health care providers in making difficult decisions regarding the quality of care in severe, type 2 asthma with biologic medications. They remain conditional and are based on limited data owing to a lack of head-to-head comparisons.
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13
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Bose S, Bime C, Henderson RJ, Blake KV, Castro M, DiMango E, Hanania NA, Holbrook JT, Irvin CG, Kraft M, Peters SP, Reibman J, Sugar EA, Sumino K, Wise RA, Rogers L. Biomarkers of Type 2 Airway Inflammation as Predictors of Loss of Asthma Control During Step-Down Therapy for Well-Controlled Disease: The Long-Acting Beta-Agonist Step-Down Study (LASST). THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:3474-3481. [PMID: 32693214 DOI: 10.1016/j.jaip.2020.06.067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 06/04/2020] [Accepted: 06/25/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Biomarkers that can predict loss of asthma control among patients being considered for step-down therapy in well-controlled disease are lacking. OBJECTIVE To evaluate whether baseline biomarkers of type 2 airway inflammation and/or serial measurement of fractional exhaled nitric oxide (Feno) predict loss of asthma control as therapy is stepped down. METHODS In subanalyses of a multicenter randomized, double-blind, parallel 3-arm trial comparing strategies for step-down therapy in well-controlled asthma (Long-Acting Beta-Agonist Step-Down Study), we assessed whether baseline atopy as determined by serum aeroallergen allergy screening test (Phadiatop), baseline serum eosinophil peroxidase, or baseline or serial Feno measurements during follow-up predicted the time to loss of asthma control among participants. Loss of asthma control was defined in the study protocol. We analyzed these associations in adjusted models including all participants, after testing for interactions with assignment to each of the 3 treatment groups (continuation of stable dose of combination inhaled corticosteroid-long-acting beta-agonist, step-down of inhaled corticosteroid, or discontinuation of long-acting bronchodilator). RESULTS Four hundred forty-seven of the 553 Long-Acting Beta-Agonist Step-Down Study participants who were randomized to 1 of 3 treatment arms and had at least 1 biomarker measurement were included in this analysis. At baseline, higher levels of Feno were significantly associated with greater levels of multiallergen IgE levels (P < .001), but not with serum eosinophil peroxidase (P = .742). Among all participants as a group, elevations in baseline biomarkers were not predictive of a higher risk of treatment failure. In addition, Feno levels measured serially at 6-week intervals demonstrated that compared with participants with low levels (<25 parts per billion), those with intermediate (25-50 parts per billion) and high (>50 parts per billion) levels did not have significantly increased likelihood of subsequent treatment failure (hazard ratios, 1.03 [95% CI, 0.59-1.78] and 1.29 [95% CI, 0.65-2.54], respectively). There were no significant interactions of treatment group and baseline biomarkers. CONCLUSIONS In patients with well-controlled asthma, neither baseline levels of type 2 airway inflammatory biomarkers nor serial measures of Feno are strong predictors of treatment failure.
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Affiliation(s)
- Sonali Bose
- Icahn School of Medicine at Mount Sinai, New York, NY; Johns Hopkins School of Medicine, Baltimore, Md
| | | | | | | | - Mario Castro
- Washington University School of Medicine, St Louis, Mo
| | - Emily DiMango
- Columbia University College of Physicians and Surgeons, New York, NY
| | | | | | | | - Monica Kraft
- University of Arizona College of Medicine, Tucson, Ariz
| | | | - Joan Reibman
- New York University School of Medicine, New York, NY
| | | | - Kaharu Sumino
- Washington University School of Medicine, St Louis, Mo
| | | | - Linda Rogers
- Icahn School of Medicine at Mount Sinai, New York, NY.
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14
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Akar-Ghibril N, Casale T, Custovic A, Phipatanakul W. Allergic Endotypes and Phenotypes of Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2020; 8:429-440. [PMID: 32037107 PMCID: PMC7569362 DOI: 10.1016/j.jaip.2019.11.008] [Citation(s) in RCA: 137] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 10/30/2019] [Accepted: 11/16/2019] [Indexed: 12/12/2022]
Abstract
Allergic asthma is defined as asthma associated with sensitization to aeroallergens, which leads to asthma symptoms and airway inflammation. Allergic asthma is the most common asthma phenotype. The onset of allergic asthma is most often in childhood and is usually accompanied by other comorbidities including atopic dermatitis and allergic rhinitis. It is often persistent although there is a wide variation in disease severity. It is a TH2-driven process. Biomarkers have been identified to distinguish patients with allergic asthma, particularly serum IgE levels, tests to indicate sensitization to aeroallergens such as specific IgE or skin prick test positivity, blood and sputum eosinophil levels, fraction of exhaled nitric oxide, and periostin. Treatments for allergic asthma include environmental control measures, allergen immunotherapy, and glucocorticoids. Biologics, targeting the TH2 pathway, have been shown to be effective in the treatment of allergic asthma.
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Affiliation(s)
- Nicole Akar-Ghibril
- Division of Pediatric Allergy/Immunology, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Thomas Casale
- Division of Allergy and Immunology, University of South Florida Health Morsani College of Medicine, Tampa, Fla
| | - Adnan Custovic
- Respiratory Division, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Wanda Phipatanakul
- Division of Pediatric Allergy/Immunology, Boston Children's Hospital, Harvard Medical School, Boston, Mass.
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15
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Narendra D, Blixt J, Hanania NA. Immunological biomarkers in severe asthma. Semin Immunol 2019; 46:101332. [PMID: 31735516 DOI: 10.1016/j.smim.2019.101332] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 10/21/2019] [Indexed: 12/13/2022]
Abstract
Severe asthma is heterogeneous in its clinical presentation, underlying pathophysiology, course and response to therapy. Clinical and physiological assessment of severe asthma is often inadequate in predicting underlying disease mechanisms and or response to medications. With the emergence of novel targeted therapies in severe asthma, the need for reproducible, easily measured biomarkers became obvious but only few are currently available for clinical use. These biomarkers along with the clinical presentation of the patient play an important role in identifying phenotypes and endotypes, predicting the clinical course and prognosis and improving the precision therapeutic approach to asthma.
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Affiliation(s)
- Dharani Narendra
- Section of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, Texas, United States
| | - John Blixt
- Section of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, Texas, United States
| | - Nicola A Hanania
- Section of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, Texas, United States.
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16
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Schroeder S, Ochkur SI, Shim KP, Galvin KM, Bauer CS, Lee JJ, Wright BL. Throat-derived eosinophil peroxidase is not a reliable biomarker of pediatric eosinophilic esophagitis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 5:1804-1805. [PMID: 29122165 DOI: 10.1016/j.jaip.2017.07.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 07/25/2017] [Indexed: 10/18/2022]
Affiliation(s)
| | | | - Kelly P Shim
- Phoenix Children's Hospital, Phoenix, Ariz; Mayo Clinic Arizona, Scottsdale, Ariz
| | - Katie M Galvin
- University of Arizona College of Medicine, Phoenix, Ariz
| | - Cindy S Bauer
- Phoenix Children's Hospital, Phoenix, Ariz; Mayo Clinic Arizona, Scottsdale, Ariz; University of Arizona College of Medicine, Phoenix, Ariz
| | | | - Benjamin L Wright
- Phoenix Children's Hospital, Phoenix, Ariz; Mayo Clinic Arizona, Scottsdale, Ariz; University of Arizona College of Medicine, Phoenix, Ariz.
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17
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Choi Y, Jeon H, Yang EA, Yoon JS, Kim HH. Nasal eosinophilia and eosinophil peroxidase in children and adolescents with rhinitis. KOREAN JOURNAL OF PEDIATRICS 2019; 62:353-359. [PMID: 31096743 PMCID: PMC6753315 DOI: 10.3345/kjp.2019.00318] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 04/24/2019] [Indexed: 01/21/2023]
Abstract
Background Researchers have shown that eosinophil peroxidase (EPO) is a relatively accurate marker of eosinophilia and eosinophil activity. However, its use as a marker of eosinophilic inflammation in nasal secretions is limited because the diagnostic cutoff values of EPO for use as a one-time test for allergic diseases such as allergic rhinitis have not been established. Purpose To identify the correlation between nasal eosinophil count and EPO in children and adolescents with rhinitis. Methods We recruited patients <18 years of age with rhinitis for more than 2 weeks or more than 2 episodes a year whose nasal eosinophil and EPO were measured at a single allergy clinic. The eosinophil percentage was calculated by dividing the eosinophil count by the number of total cells under light microscopy at ×1,000 magnification. EPO and protein were measured from nasal secretions. We retrospectively analyzed the correlation between nasal eosinophils and protein-corrected EPO (EPO/protein) value. Results Of the 67 patients enrolled, 41 were male (61.2%); the mean age was 8.2±4.0 years. The median nasal eosinophil count was 1 and percentage was 1%. The median protein-corrected EPO value was 12.5 ng/μg (range, 0–31 ng/μg). There was a statistically significant correlation between eosinophil count and percentage (P<0.001). However, the eosinophil percentage and EPO did not correlate. The eosinophil count and EPO had a statistically significant correlation (P =0.01). The EPO cutoff value examined for nasal eosinophil counts of 2, 5, 10, and 20 was 17.57 ng/μg regardless of the reference count. The largest area under the curve value was obtained when the receiver operating characteristic curve was drawn using the eosinophil count of 2. Conclusion Nasal eosinophil count was significantly associated with protein-corrected EPO.
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Affiliation(s)
- Yeonu Choi
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Haeun Jeon
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Eun Ae Yang
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jong-Seo Yoon
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun Hee Kim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
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18
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Carr TF, Zeki AA, Kraft M. Eosinophilic and Noneosinophilic Asthma. Am J Respir Crit Care Med 2019; 197:22-37. [PMID: 28910134 DOI: 10.1164/rccm.201611-2232pp] [Citation(s) in RCA: 216] [Impact Index Per Article: 43.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
- Tara F Carr
- 1 Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, University of Arizona, Tucson, Arizona; and
| | - Amir A Zeki
- 2 Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of California Davis School of Medicine, Davis, California
| | - Monica Kraft
- 1 Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, University of Arizona, Tucson, Arizona; and
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19
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Peng C, Van Meel ER, Cardenas A, Rifas-Shiman SL, Sonawane AR, Glass KR, Gold DR, Platts-Mills TA, Lin X, Oken E, Hivert MF, Baccarelli AA, De Jong NW, Felix JF, Jaddoe VW, Duijts L, Litonjua AA, DeMeo DL. Epigenome-wide association study reveals methylation pathways associated with childhood allergic sensitization. Epigenetics 2019; 14:445-466. [PMID: 30876376 DOI: 10.1080/15592294.2019.1590085] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Epigenetic mechanisms integrate both genetic variability and environmental exposures. However, comprehensive epigenome-wide analysis has not been performed across major childhood allergic phenotypes. We examined the association of epigenome-wide DNA methylation in mid-childhood peripheral blood (Illumina HumanMethyl450K) with mid-childhood atopic sensitization, environmental/inhalant and food allergen sensitization in 739 children in two birth cohorts (Project Viva-Boston, and the Generation R Study-Rotterdam). We performed covariate-adjusted epigenome-wide association meta-analysis and employed pathway and regional analyses of results. Seven-hundred and five methylation sites (505 genes) were significantly cross-sectionally associated with mid-childhood atopic sensitization, 1411 (905 genes) for environmental and 45 (36 genes) for food allergen sensitization (FDR<0.05). We observed differential methylation across multiple genes for all three phenotypes, including genes implicated previously in innate immunity (DICER1), eosinophilic esophagitis and sinusitis (SIGLEC8), the atopic march (AP5B1) and asthma (EPX, IL4, IL5RA, PRG2, SIGLEC8, CLU). In addition, most of the associated methylation marks for all three phenotypes occur in putative transcription factor binding motifs. Pathway analysis identified multiple methylation sites associated with atopic sensitization and environmental allergen sensitization located in/near genes involved in asthma, mTOR signaling, and inositol phosphate metabolism. We identified multiple differentially methylated regions associated with atopic sensitization (8 regions) and environmental allergen sensitization (26 regions). A number of nominally significant methylation sites in the cord blood analysis were epigenome-wide significant in the mid-childhood analysis, and we observed significant methylation - time interactions among a subset of sites examined. Our findings provide insights into epigenetic regulatory pathways as markers of childhood allergic sensitization.
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Affiliation(s)
- Cheng Peng
- a Channing Division of Network Medicine, Department of Medicine , Brigham and Women's Hospital, Harvard Medical School , Boston , MA , USA
| | - Evelien R Van Meel
- b The Generation R Study Group, Erasmus MC , University Medical Center Rotterdam , Rotterdam , the Netherlands.,c Department of Pediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC , University Medical Center Rotterdam , Rotterdam , the Netherlands
| | - Andres Cardenas
- d Division of Environmental Health Science , University of California, Berkeley, School of Public Health , Berkeley , CA , USA
| | - Sheryl L Rifas-Shiman
- e Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine , Harvard Medical School and Harvard Pilgrim Health Care Institute , Boston , MA , USA
| | - Abhijeet R Sonawane
- a Channing Division of Network Medicine, Department of Medicine , Brigham and Women's Hospital, Harvard Medical School , Boston , MA , USA
| | - Kimberly R Glass
- a Channing Division of Network Medicine, Department of Medicine , Brigham and Women's Hospital, Harvard Medical School , Boston , MA , USA.,f Department of Biostatistics , Harvard T.H Chan School of Public Health , Boston , MA , USA
| | - Diane R Gold
- a Channing Division of Network Medicine, Department of Medicine , Brigham and Women's Hospital, Harvard Medical School , Boston , MA , USA.,g Department of Environmental Health , Harvard T. H. Chan School of Public Health , Boston , MA , USA
| | - Thomas A Platts-Mills
- h Division of Allergy and Clinical Immunology , University of Virginia School of Medicine , Charlottesville , VA , USA
| | - Xihong Lin
- f Department of Biostatistics , Harvard T.H Chan School of Public Health , Boston , MA , USA.,i Department of Statistics , Harvard University , Cambridge , MA , USA
| | - Emily Oken
- e Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine , Harvard Medical School and Harvard Pilgrim Health Care Institute , Boston , MA , USA
| | - Marie-France Hivert
- e Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine , Harvard Medical School and Harvard Pilgrim Health Care Institute , Boston , MA , USA.,j Diabetes Unit , Massachusetts General Hospital , Boston , MA , USA
| | - Andrea A Baccarelli
- k Department of Environmental Health Sciences , Columbia University Mailman School of Public Health , New York , NY , USA
| | - Nicolette W De Jong
- l Department of Internal Medicine, Allergology, Erasmus MC , University Medical Center Rotterdam , Rotterdam , the Netherlands
| | - Janine F Felix
- b The Generation R Study Group, Erasmus MC , University Medical Center Rotterdam , Rotterdam , the Netherlands.,m Department of Epidemiology, Erasmus MC , University Medical Center Rotterdam , Rotterdam , the Netherlands.,n Department of Pediatrics, Erasmus MC , University Medical Center Rotterdam , Rotterdam , the Netherlands
| | - Vincent W Jaddoe
- b The Generation R Study Group, Erasmus MC , University Medical Center Rotterdam , Rotterdam , the Netherlands.,m Department of Epidemiology, Erasmus MC , University Medical Center Rotterdam , Rotterdam , the Netherlands.,n Department of Pediatrics, Erasmus MC , University Medical Center Rotterdam , Rotterdam , the Netherlands
| | - Liesbeth Duijts
- b The Generation R Study Group, Erasmus MC , University Medical Center Rotterdam , Rotterdam , the Netherlands.,c Department of Pediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC , University Medical Center Rotterdam , Rotterdam , the Netherlands.,o Department of Pediatrics, Division of Neonatology , Erasmus MC, University Medical Center Rotterdam , Rotterdam , the Netherlands
| | - Augusto A Litonjua
- p Department of Pediatrics, Division of Pulmonary Medicine , University of Rochester Medical Center , Rochester , NY , USA
| | - Dawn L DeMeo
- a Channing Division of Network Medicine, Department of Medicine , Brigham and Women's Hospital, Harvard Medical School , Boston , MA , USA.,q Division of Pulmonary and Critical Care, Harvard Medical School , Department of Medicine, Brigham and Women's Hospital , Boston , MA , USA
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Eosinophil peroxidase, GATA3, and T-bet as tissue biomarkers in chronic rhinosinusitis. J Allergy Clin Immunol 2019; 143:2284-2287.e6. [PMID: 30738839 DOI: 10.1016/j.jaci.2019.01.038] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 01/24/2019] [Accepted: 01/29/2019] [Indexed: 11/20/2022]
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21
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Ye L, Wang H, Li H, Liu H, Lv T, Song Y, Zhang F. Eosinophil peroxidase over-expression predicts the clinical outcome of patients with primary lung adenocarcinoma. J Cancer 2019; 10:1032-1038. [PMID: 30854109 PMCID: PMC6400814 DOI: 10.7150/jca.24314] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 04/14/2018] [Indexed: 01/05/2023] Open
Abstract
Eosinophil peroxidase (EPO), a heme protein abundantly expressed in eosinophils, involves in the catalysis of cytotoxic oxidants associated with the pathogenesis of cancer, asthma, and allergic inflammatory disorders. To date, its roles in the pathogenesis of lung cancer are still not known. We determined the expression of EPO in the lung adenocarcinoma tissues and the normal adjacent lung tissues using Real-time PCR and Western blotting analysis, respectively. Also, EPO protein expression in 90 lung adenocarcinoma (AD) samples were confirmed with immunohistochemistry (IHC) using tissue microarrays. Meanwhile, we investigated the association between EPO and the clinicopathological characteristics and disease prognosis in the pulmonary adenocarcinoma patients, which demonstrated that EPO mRNA and protein were significantly higher in lung AD tissues that those of the adjacent normal lung tissues (P<0.05). EPO overexpression was significantly correlated with pathologic-tumour nodes metastasen stage (p-TNM stage, P=0.017) and lymph node metastasis (P=0.027). Patients with EPO overexpression showed shorter survival time than those with low EPO levels (P=0.017), according to the Kaplan-Meier survival curve. Furthermore, a multivariate Cox regression model was utilized to analyze the prognostic factors, which indicated that N stage (HR=0.965, 95% CI=0.328-1.359, P=0.008), p-TNM Stage (HR=3.127, 95% CI =2.463-5.015, P=0.021) and high EPO protein expression (HR=3.145, 95% CI=2.016-5.519, P=0.018) were independent factors for the prognosis of lung AD. In conclusion, increased EPO expression could be used as a biomarker for lung AD patients with poor prognosis.
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Affiliation(s)
- Liang Ye
- Department of Respiratory Medicine, Jinling Hospital, Nanjing Medical University, Nanjing, China.,Department of Respiratory Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Hongying Wang
- Department of Respiratory Medicine, Jinling Hospital, Southern Medical University, Nanjing 210002, China
| | - Huijuan Li
- Department of Respiratory Medicine, Jinling Hospital, Nanjing Medical University, Nanjing, China
| | - Hongbing Liu
- Department of Respiratory Medicine, Jinling Hospital, Nanjing Medical University, Nanjing, China
| | - Tangfeng Lv
- Department of Respiratory Medicine, Jinling Hospital, Nanjing Medical University, Nanjing, China
| | - Yong Song
- Department of Respiratory Medicine, Jinling Hospital, Nanjing Medical University, Nanjing, China
| | - Fang Zhang
- Department of Respiratory Medicine, Jinling Hospital, Nanjing Medical University, Nanjing, China
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Eguiluz-Gracia I, Tay TR, Hew M, Escribese MM, Barber D, O'Hehir RE, Torres MJ. Recent developments and highlights in biomarkers in allergic diseases and asthma. Allergy 2018; 73:2290-2305. [PMID: 30289997 DOI: 10.1111/all.13628] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 09/19/2018] [Accepted: 09/21/2018] [Indexed: 12/22/2022]
Abstract
The potential of precision medicine in allergy and asthma has only started to be explored. A significant clarification in the pathophysiology of rhinitis, chronic rhinosinusitis, asthma, food allergy and drug hypersensitivity was made in the last decade. This improved understanding led to a better classification of the distinct phenotypes and to the discovery of new drugs such as biologicals, targeting phenotype-specific mechanisms. Nevertheless, many conditions remain poorly understood such as non-eosinophilic airway diseases or non-IgE-mediated food allergy. Moreover, there is a need to predict the response to specific therapies and the outcome of drug and food provocations. The identification of patients at risk of progression towards severity is also an unmet need in order to establish adequate preventive or therapeutic measures. The implementation of precision medicine in the clinical practice requires the identification of phenotype-specific markers measurable in biological matrices. To become useful, these biomarkers need to be quantifiable by reliable systems, and in samples obtained in an easy, rapid and cost-efficient way. In the last years, significant research resources have been put in the identification of valid biomarkers for asthma and allergic diseases. This review summarizes these recent advances with focus on the biomarkers with higher clinical applicability.
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Affiliation(s)
- Ibon Eguiluz-Gracia
- Unidad de Alergia; IBIMA-Hospital Regional Universitario de Malaga-UMA; ARADyAL; Malaga Spain
| | - Tunn Ren Tay
- Department of Respiratory and Critical Care Medicine; Changi General Hospital; Singapore Singapore
| | - Mark Hew
- Allergy, Asthma and Clinical Immunology Service; The Alfred Hospital; Melbourne Victoria Australia
- School of Public Health & Preventive Medicine; Monash University; Melbourne Victoria Australia
| | - Maria M. Escribese
- Facultad de Medicina; Instituto de Medicina Molecular Aplicada (IMMA); Universidad San Pablo CEU; Madrid Spain
- Departamento de Ciencias Médicas Básicas; Facultad de Medicina; Universidad San Pablo CEU; Madrid Spain
| | - Domingo Barber
- Facultad de Medicina; Instituto de Medicina Molecular Aplicada (IMMA); Universidad San Pablo CEU; Madrid Spain
| | - Robyn E. O'Hehir
- Allergy, Asthma and Clinical Immunology Service; The Alfred Hospital; Melbourne Victoria Australia
- Department of Allergy, Clinical Immunology & Respiratory Medicine; Central Clinical School; Monash University; Melbourne Victoria Australia
| | - Maria J. Torres
- Unidad de Alergia; IBIMA-Hospital Regional Universitario de Malaga-UMA; ARADyAL; Malaga Spain
- Andalusian Center for Nanomedicine and Biotechnology - BIONAND; Malaga Spain
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23
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Carr TF, Kraft M. Use of biomarkers to identify phenotypes and endotypes of severeasthma. Ann Allergy Asthma Immunol 2018; 121:414-420. [PMID: 30059792 DOI: 10.1016/j.anai.2018.07.029] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 07/19/2018] [Accepted: 07/22/2018] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Severe asthma can be classified into phenotypes and endotypes, which may inform clinicians about inflammatory pathways leading to disease and ultimately guide optimal therapeutic strategy. Biomarkers, objectively measurable characteristics of the disease, are of increasing interest to clinicians and researchers as powerful tools to distinguish among the severe asthma phenotypes and endotypes. The objective of this review is to highlight current knowledge of biomarker applications to identify phenotypes and endotypes of severe asthma. DATA SOURCES Sources used include observational cohorts, clinical trials, translational studies, comprehensive reviews, and expert/taskforce statements. STUDY SELECTIONS Included studies were selected for their relevance to the topic and for strength of data or study design. RESULTS In severe asthma, biomarkers can be used for diagnosis of phenotype or endotype, can also be predictive of clinical outcomes or response to therapy, and may be dynamic with time or therapy. Fully determining phenotype or endotype of severe asthma will require interpretation of combinations of commercially available biomarkers. CONCLUSION Biomarkers have multiple potential clinical applications in severe asthma. Novel biomarkers may add accuracy to this field.
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Affiliation(s)
- Tara F Carr
- Asthma and Airway Disease Research Center, University of Arizona, Tucson, Arizona.
| | - Monica Kraft
- Asthma and Airway Disease Research Center, University of Arizona, Tucson, Arizona
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24
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Khoury P, Akuthota P, Ackerman SJ, Arron JR, Bochner BS, Collins MH, Kahn JE, Fulkerson PC, Gleich GJ, Gopal-Srivastava R, Jacobsen EA, Leiferman KM, Francesca LS, Mathur SK, Minnicozzi M, Prussin C, Rothenberg ME, Roufosse F, Sable K, Simon D, Simon HU, Spencer LA, Steinfeld J, Wardlaw AJ, Wechsler ME, Weller PF, Klion AD. Revisiting the NIH Taskforce on the Research needs of Eosinophil-Associated Diseases (RE-TREAD). J Leukoc Biol 2018; 104:69-83. [PMID: 29672914 PMCID: PMC6171343 DOI: 10.1002/jlb.5mr0118-028r] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 02/21/2018] [Accepted: 02/21/2018] [Indexed: 02/05/2023] Open
Abstract
Eosinophil-associated diseases (EADs) are rare, heterogeneous disorders characterized by the presence of eosinophils in tissues and/or peripheral blood resulting in immunopathology. The heterogeneity of tissue involvement, lack of sufficient animal models, technical challenges in working with eosinophils, and lack of standardized histopathologic approaches have hampered progress in basic research. Additionally, clinical trials and drug development for rare EADs are limited by the lack of primary and surrogate endpoints, biomarkers, and validated patient-reported outcomes. Researchers with expertise in eosinophil biology and eosinophil-related diseases reviewed the state of current eosinophil research, resources, progress, and unmet needs in the field since the 2012 meeting of the NIH Taskforce on the Research of Eosinophil-Associated Diseases (TREAD). RE-TREAD focused on gaps in basic science, translational, and clinical research on eosinophils and eosinophil-related pathogenesis. Improved recapitulation of human eosinophil biology and pathogenesis in murine models was felt to be of importance. Characterization of eosinophil phenotypes, the role of eosinophil subsets in tissues, identification of biomarkers of eosinophil activation and tissue load, and a better understanding of the role of eosinophils in human disease were prioritized. Finally, an unmet need for tools for use in clinical trials was emphasized. Histopathologic scoring, patient- and clinician-reported outcomes, and appropriate coding were deemed of paramount importance for research collaborations, drug development, and approval by regulatory agencies. Further exploration of the eosinophil genome, epigenome, and proteome was also encouraged. Although progress has been made since 2012, unmet needs in eosinophil research remain a priority.
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Affiliation(s)
- Paneez Khoury
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Praveen Akuthota
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California, La Jolla, California, USA
| | - Steven J Ackerman
- Department of Biochemistry and Molecular Genetics, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Joseph R Arron
- Immunology Discovery, Genentech, Inc., South San Francisco, California, USA
| | - Bruce S Bochner
- Department of Medicine, Division of Allergy and Immunology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Margaret H Collins
- Division of Pathology and Laboratory Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA
| | | | - Patricia C Fulkerson
- Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Gerald J Gleich
- Departments of Dermatology and Medicine, University of Utah Health, Salt Lake City, Utah, USA
| | - Rashmi Gopal-Srivastava
- National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, Maryland, USA
| | | | - Kristen M Leiferman
- Department of Dermatology, University of Utah Health, Salt Lake City, Utah, USA
| | - Levi-Schaffer Francesca
- Pharmacology and Experimental Therapeutics Unit, Institute for Drug Research, School of Pharmacy, Faculty of Medicine, The Hebrew University, Jerusalem, Israel
| | - Sameer K Mathur
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Michael Minnicozzi
- Division of Allergy, Immunology and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | | | - Marc E Rothenberg
- Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | | | - Kathleen Sable
- American Partnership For Eosinophilic Disorders, Atlanta, Georgia, USA
| | - Dagmar Simon
- Department of Dermatology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Hans-Uwe Simon
- Institute of Pharmacology, University of Bern, Bern, Switzerland
| | - Lisa A Spencer
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Andrew J Wardlaw
- Institute for Lung Health, University of Leicester, Leicester, England
| | | | - Peter F Weller
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Amy D Klion
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
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Tabatabaian F, Ledford DK. Omalizumab for severe asthma: toward personalized treatment based on biomarker profile and clinical history. J Asthma Allergy 2018; 11:53-61. [PMID: 29662320 PMCID: PMC5892947 DOI: 10.2147/jaa.s107982] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Asthma is a heterogeneous syndrome with numerous underlining molecular and inflammatory mechanisms contributing to the wide spectrum of clinical phenotypes. Multiple therapies targeting severe asthma with type 2 (T2) high inflammation are or soon will be available. T2 high inflammation is defined as inflammation associated with atopy or eosinophilia or an increase in cytokines associated with T-helper 2 lymphocytes. Omalizumab is a humanized anti-IgE monoclonal antibody and the first biologic therapy approved for moderate-severe allergic asthma. Despite the specificity of biologic therapies like omalizumab, clinical response is variable, with approximately 50% of treated patients achieving the primary outcome. A prior identification of the ideal candidate for therapy would improve patient outcomes and optimize the use of health care resources. As the number of biologic therapies for asthma increases, the goal is identification of biomarkers or clinical phenotypes likely to respond to a specific therapy. This review focuses on potential biomarkers and clinical history that may identify responders to omalizumab therapy for asthma.
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Affiliation(s)
- Farnaz Tabatabaian
- Division of Allergy and Immunology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Dennis K Ledford
- Division of Allergy and Immunology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
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26
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Tabatabaian F, Ledford DK, Casale TB. Biologic and New Therapies in Asthma. Immunol Allergy Clin North Am 2017; 37:329-343. [PMID: 28366480 DOI: 10.1016/j.iac.2017.01.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Several biologics are currently FDA approved for asthma that target Th2 high patients. Unfortunately, 50% of patients with severe asthma do not fit this phenotype of disease and have fewer effective therapeutic options. In the clinical setting, total IgE, FeNO and peripheral blood eosinophils are important tools in defining Th2 high patients with asthma. However, precise biomarkers to predict better response to one specific Th2 high asthma therapy versus another is lacking. It is important to recognize that none of the current medications targeting the Th2 pathway induces persistent immunomodulation or remission.
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Affiliation(s)
- Farnaz Tabatabaian
- Division of Allergy and Immunology, Department of Internal medicine, Morsani College of Medicine, University of South Florida, 13330 USF Laurel Dr. 5th Floor, MDC 80, Tampa, FL 33612-4799, USA
| | - Dennis K Ledford
- Division of Allergy and Immunology, Department of Internal medicine, Morsani College of Medicine, University of South Florida, 13330 USF Laurel Dr. 5th Floor, MDC 80, Tampa, FL 33612-4799, USA; Division of Allergy and Immunology, Department of Internal Medicine, Morsani College of Medicine, James A. Haley VA Hospital, University of South Florida, 13000 Bruce B, Downs Boulevard, Tampa, FL 33612, USA
| | - Thomas B Casale
- Division of Allergy and Immunology, Department of Internal medicine, Morsani College of Medicine, University of South Florida, 13330 USF Laurel Dr. 5th Floor, MDC 80, Tampa, FL 33612-4799, USA; Division of Allergy and Immunology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, 12901 Bruce B Downs Boulevard, MDC 19, Tampa, FL 33612 USA.
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27
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Wright BL, Ochkur SI, Olson NS, Shim KP, Jacobsen EA, Rank MA, Dellon ES, Lee JJ. Normalized serum eosinophil peroxidase levels are inversely correlated with esophageal eosinophilia in eosinophilic esophagitis. Dis Esophagus 2017; 31:4714780. [PMID: 29228243 PMCID: PMC7373170 DOI: 10.1093/dote/dox139] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 11/03/2017] [Indexed: 12/11/2022]
Abstract
Eosinophil peroxidase is an eosinophil-specific, cytoplasmic protein stored in the secondary granules of eosinophils. While eosinophil peroxidase deposition is increased in the esophagus in eosinophilic esophagitis (EOE), its potential role as a peripheral marker is unknown. This study aims to examine the relationship between serum eosinophil peroxidase and esophageal eosinophilia in eosinophilic esophagitis. Prospectively collected serum from 19 subjects with incident EoE prior to treatment and 20 non-EoE controls were tested for serum eosinophil peroxidase, eosinophilic cationic protein, and eosinophil derived neurotoxin using ELISA. Matching esophageal tissue sections were stained and assessed for eosinophil peroxidase deposition using a histopathologic scoring algorithm. Mean peripheral blood absolute eosinophil counts in eosinophilic esophagitis subjects were significantly elevated compared to controls (363 vs. 195 cells/μL, P = 0.008). Absolute median serum eosinophil peroxidase, eosinophil cationic protein, and eosinophil derived neurotoxin did not differ between groups; however, when normalized for absolute eosinophil counts, eosinophilic esophagitis subjects had significantly lower median eosinophil peroxidase levels (2.56 vs. 6.96 ng/mL per eos/μL, P = 0.002, AUC 0.79 (0.64, 0.94 95% CI)). Multivariate analysis demonstrated this relationship persisted after controlling for atopy. Esophageal biopsies from eosinophilic esophagitis subjects demonstrated marked eosinophil peroxidase deposition (median score 46 vs. 0, P < 0.0001). Normalized eosinophil peroxidase levels inversely correlated with esophageal eosinophil density (r = -0.41, P = 0.009). In contrast to marked tissue eosinophil degranulation, circulating eosinophils appear to retain their granule proteins in EoE. Investigations of normalized serum eosinophil peroxidase levels as a biomarker of EoE are ongoing.
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Affiliation(s)
- B L Wright
- Division of Allergy, Asthma and Clinical Immunology, Department of Medicine,Division of Pulmonology, Department of Pediatrics, Phoenix Children's Hospital, Phoenix, Arizona,Address correspondence to: Benjamin L. Wright, MD, Assistant Professor, Mayo Clinic Arizona, 13400 E Shea Blvd, Scottsdale, AZ 85259, USA.
| | - S I Ochkur
- Department of Biochemistry and Molecular Biology, Mayo Clinic Arizona, Scottsdale
| | - N S Olson
- Department of Biochemistry and Molecular Biology, Mayo Clinic Arizona, Scottsdale
| | - K P Shim
- Division of Pulmonology, Department of Pediatrics, Phoenix Children's Hospital, Phoenix, Arizona,Department of Biochemistry and Molecular Biology, Mayo Clinic Arizona, Scottsdale
| | - E A Jacobsen
- Department of Biochemistry and Molecular Biology, Mayo Clinic Arizona, Scottsdale
| | - M A Rank
- Division of Allergy, Asthma and Clinical Immunology, Department of Medicine
| | - E S Dellon
- Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - J J Lee
- Department of Biochemistry and Molecular Biology, Mayo Clinic Arizona, Scottsdale
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28
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Eosinophils and eosinophil-associated diseases: An update. J Allergy Clin Immunol 2017; 141:505-517. [PMID: 29045815 DOI: 10.1016/j.jaci.2017.09.022] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 08/25/2017] [Accepted: 09/04/2017] [Indexed: 01/01/2023]
Abstract
The goal of this series is to offer a survey of the latest literature for clinicians and scientists alike, providing a list of important recent advances relevant to the broad field of allergy and immunology. This particular assignment was to cover the topic of eosinophils. In an attempt to highlight major ideas, themes, trends, and advances relevant to basic and clinical aspects of eosinophil biology, a search of articles published since 2015 in the Journal of Allergy and Clinical Immunology and other high-impact journals was performed. Articles were then reviewed and organized, and then key findings were summarized. Given space limitations, many outstanding articles could not be included, but the hope is that what follows provides a succinct overview of recently published work that has significantly added to our knowledge of eosinophils and eosinophil-associated diseases.
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29
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Bertozo LDC, Zeraik ML, Ximenes VF. Dansylglycine, a fluorescent probe for specific determination of halogenating activity of myeloperoxidase and eosinophil peroxidase. Anal Biochem 2017; 532:29-37. [DOI: 10.1016/j.ab.2017.05.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 05/26/2017] [Accepted: 05/31/2017] [Indexed: 12/25/2022]
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30
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Al Efraij K, FitzGerald JM. Emerging interleukin receptor antagonists for the treatment of asthma. Expert Opin Emerg Drugs 2017; 22:275-283. [PMID: 28832218 DOI: 10.1080/14728214.2017.1369954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Asthma is a heterogeneous disease, usually characterized by chronic airway inflammation. Most patients with asthma can be well-controlled with inhaled corticosteroids and, if necessary, the addition of a long-acting beta agonist. Despite these therapies, 5% to 10% of patients with asthma have severe, uncontrolled asthma. Selecting patients based on peripheral eosinophil counts and a history of exacerbations has led to significant decreases in exacerbations and an improvement in asthma control with medications that target IL-4, IL-5 and IL-13/. Areas covered: This review will cover the definition of severe asthma, existing treatment options, biomarkers, and the emerging role of interleukin antagonists in the treatment of severe asthma. Expert opinion: IL antagonists are novel drugs targeting important inflammatory cytokines in asthma. Anti-IL-5 drugs provide the most promise as they have obtained regulatory approval and are available for use. Anti-IL-4 drug results are also promising. There is, however, uncertainty regarding the success of anti-IL-13 drugs development at this point. An ongoing focus of research is to significantly increase our understanding of the biology of asthma, and in particular severe asthma, making more and better targeted therapies. There may also be potential in the future to use these new drugs earlier in the development of asthma, as disease-modifying interventions that might be associated with remission or even cure.
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Affiliation(s)
- Khalid Al Efraij
- a Faculty of Medicine, Division of Respirology , University of British Columbia , Vancouver , BC , Canada
| | - J Mark FitzGerald
- a Faculty of Medicine, Division of Respirology , University of British Columbia , Vancouver , BC , Canada
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31
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Ho T, Dasgupta A, Hargreave FE, Nair P. The use of cellular and molecular biomarkers to manage COPD exacerbations. Expert Rev Respir Med 2017; 11:403-411. [PMID: 28347199 DOI: 10.1080/17476348.2017.1307738] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Chronic obstructive pulmonary disease (COPD) exacerbations are a common cause of respiratory morbidity and mortality, and have various etiologies. Multiple cellular and molecular biomarkers have been associated with exacerbations. Quantitative sputum cell counts are able to identify the presence and type of bronchitis, which is an important contributor to exacerbations. Their utility to monitor bronchitis and to help treat exacerbations has been evaluated, yet they are not used in routine clinical practice. Areas covered: This review will provide a brief summary of biomarkers utilized in COPD, with a focus on the application of cellular markers for the management of exacerbations. A case study will demonstrate the application of these methods. With quantitative sputum cell counts, the presence of eosinophilic bronchitis predicts corticosteroid-responsiveness, while neutrophilic bronchitis identifies infection and suggests the need for antibiotics. Gastroesophageal reflux-related aspiration and heart failure can also be identified by examining sputum. Expert commentary: Quantitative sputum cytometry is an essential tool in the management of exacerbations of COPD, particularly those prone to frequent exacerbations. Treatment based on sputum cell counts is superior to current guideline-based recommendations to prevent future exacerbations and hospitalizations in observational and single-centre controlled trials. Large multicentre clinical trials are necessary to confirm this.
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Affiliation(s)
- Terence Ho
- a Firestone Institute for Respiratory Health, St Joseph's Healthcare Hamilton, and Department of Medicine , McMaster University , Hamilton , ON , Canada
| | - Angira Dasgupta
- a Firestone Institute for Respiratory Health, St Joseph's Healthcare Hamilton, and Department of Medicine , McMaster University , Hamilton , ON , Canada
| | - Frederick E Hargreave
- a Firestone Institute for Respiratory Health, St Joseph's Healthcare Hamilton, and Department of Medicine , McMaster University , Hamilton , ON , Canada
| | - Parameswaran Nair
- a Firestone Institute for Respiratory Health, St Joseph's Healthcare Hamilton, and Department of Medicine , McMaster University , Hamilton , ON , Canada
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