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Utembe W, Andraos C, Gulumian M. Immunotoxicity of engineered nanomaterials and their role in asthma. Crit Rev Toxicol 2023; 53:491-505. [PMID: 37933836 DOI: 10.1080/10408444.2023.2270519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 10/03/2023] [Indexed: 11/08/2023]
Abstract
The toxicity of engineered nanomaterials (ENMs) in vivo and in vitro has formed the basis of most studies. However, the toxicity of ENMs, particularly on the immune system, i.e. immunotoxicity, and their role in manipulating it, are less known. This review addresses the initiation or exacerbation as well as the attenuation of allergic asthma by a variety of ENMs and how they may be used in drug delivery to enhance the treatment of asthma. This review also highlights a few research gaps in the study of the immunotoxicity of ENMs, for example, the potential drawbacks of assays used in immunotoxicity assays; the potential role of hormesis during dosing of ENMs; and the variables that result in discrepancies among different studies, such as the physicochemical properties of ENMs, differences in asthmatic animal models, and different routes of administration.
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Affiliation(s)
- Wells Utembe
- Toxicology and Biochemistry, National Institute for Occupational Health, National Health Laboratory Service, Johannesburg, South Africa
- Department of Environmental Health, University of Johannesburg, Johannesburg, South Africa
- Environmental Health Division, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Charlene Andraos
- Toxicology and Biochemistry, National Institute for Occupational Health, National Health Laboratory Service, Johannesburg, South Africa
- Water Research Group, Unit for Environmental Sciences and Management, North-West University, Potchefstroom, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mary Gulumian
- Water Research Group, Unit for Environmental Sciences and Management, North-West University, Potchefstroom, South Africa
- Haematology and Molecular Medicine Department, University of the Witwatersrand, Johannesburg, South Africa
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2
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Cárdaba B, Pelaia G. Editorial: Impact of system biology and molecular medicine on the management of complex immune mediated respiratory diseases, volume II. Front Med (Lausanne) 2023; 10:1187941. [PMID: 37351067 PMCID: PMC10282990 DOI: 10.3389/fmed.2023.1187941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 05/22/2023] [Indexed: 06/24/2023] Open
Affiliation(s)
- Blanca Cárdaba
- Immunology Department, IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain
- Center for Biomedical Network of Respiratory Diseases (CIBERES), ISCIII, Madrid, Spain
| | - Girolamo Pelaia
- Department of Health Sciences, University “Magna Græcia” of Catanzaro, Catanzaro, Italy
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3
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Chow MY, Pan HW, Lam JK. Delivery technology of inhaled therapy for asthma and COPD. ADVANCES IN PHARMACOLOGY 2023. [PMID: 37524490 DOI: 10.1016/bs.apha.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
Inhaled therapy is the cornerstone of the management of asthma and chronic obstructive pulmonary disease (COPD). Drugs such as bronchodilators and corticosteroids are administered directly to the airways for local effect and rapid onset of action while systemic exposure and side effects are minimized. There are four major types of inhaler devices used clinically to generate aerosols for inhalation, namely, pressurized metered-dose inhalers (pMDIs), nebulizers, Soft Mist™ inhalers (SMIs) and dry powder inhalers (DPIs). Each of them has its own unique characteristics that can target different patient groups. For instance, patients' inhaler technique is critical for pMDIs and SMIs to achieve proper drug deposition in the lung, which could be challenging for some patients. Nebulizers are designed to deliver aerosols to patients during tidal breathing, but they require electricity to operate and are less portable than other devices. DPIs are the only device that delivers aerosols in dry powder form with better stability, but they rely on patients' inspiration effort for powder dispersion, rendering them unsuitable for patients with compromised lung function. Choosing a device that can cater for the need of individual patient is paramount for effective inhaled therapy. This chapter provides an overview of inhaled therapy for the management of asthma and COPD. The operation principles, merits and limitations of different delivery technologies are examined. Looking ahead, the challenges of delivering novel therapeutics such as biologics through the pulmonary route are also discussed.
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4
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Talwar D, Singh S, Marwah V, Asawale K, Bhushan B. Stratified approaches for using biomarkers in phenotyping for the management of severe asthma in India. Lung India 2022; 39:65-69. [PMID: 34975055 PMCID: PMC8926217 DOI: 10.4103/lungindia.lungindia_129_21] [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] [Indexed: 11/04/2022] Open
Abstract
Various respiratory societies including the Global Initiative for Asthma (GINA), European Respiratory Society (ERS) and American Thoracic Society (ATS) define severe asthma as asthma that requires or remains uncontrolled despite treatment with systemic corticosteroids or high-dose inhaled corticosteroids plus another controller such as long acting beta agonist. The management of asthma as an entity is not straightforward due to inter-individual variability in assessment parameters. With the advent of science, targeted therapies are on the emergence for management of severe asthma. A biomarker can be used as a surrogate to phenotype a patient as well as to measure the response to therapy with any drug. Biomarkers have been critical for studies of disease pathogenesis and the development of new therapies in severe asthma. From a resource constraint perspective like countries in India, it is imperative to use biomarkers that are easily available are affordable cost. Choosing an ideal biomarkers is also important from a perspective of choosing a particular therapy. The cost associated with the biologicals is high and it is imperative to gauge the treatment effectiveness with the therapy at the earliest considering the out of pocket spends of the patients.
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Affiliation(s)
- Deepak Talwar
- Chairman, Metro Centre of Respiratory diseases, Metro Superspeciality hospital, Noida, U P, India
| | - Sarvinder Singh
- Head of Department, Department of Pulmonology, R&R Army Hospital, Delhi, India
| | - Vikas Marwah
- Head of Department, Dept of Pulmonary, Critical Care & Sleep Medicine, Army Institute of Cardiothoracic Sciences (AICTS), Pune, India
| | - Ketan Asawale
- Medical Advisor, Novartis Healthcare Pvt. Ltd, Mumbai, India
| | - Bharat Bhushan
- Medical Scientific Liaison, Novartis Healthcare Pvt. Ltd., Mumbai, India
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5
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Baos S, Calzada D, Cremades-Jimeno L, Sastre J, Picado C, Quiralte J, Florido F, Lahoz C, Cárdaba B. Nonallergic Asthma and Its Severity: Biomarkers for Its Discrimination in Peripheral Samples. Front Immunol 2018; 9:1416. [PMID: 29977241 PMCID: PMC6021512 DOI: 10.3389/fimmu.2018.01416] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 06/06/2018] [Indexed: 12/12/2022] Open
Abstract
Asthma is a complex and heterogeneous respiratory disorder characterized by chronic airway inflammation. It has generally been associated with allergic mechanisms related to type 2 airway inflammation. Nevertheless, between 10 and 33% of asthmatic individuals have nonallergic asthma (NA). Several targeted treatments are in clinical development for patients with Th2 immune response, but few biomarkers are been defined for low or non-Th2-mediated inflammation asthma. We have recently defined by gene expression a set of genes as potential biomarkers of NA, mainly associated with disease severity: IL10, MSR1, PHLDA1, SERPINB2, CHI3L1, IL8, and PI3. Here, we analyzed their protein expression and specificity using sera and isolated peripheral blood mononuclear cells (PBMCs). First, protein quantification was carried out using ELISA (in sera) or Western blot (proteins extracted from PBMCs by Trizol procedure), depending on the biomarker in 30 healthy controls (C) subjects and 30 NA patients. A receiver operating characteristic curve analysis was performed by using the R program to study the specificity and sensitivity of the candidate biomarkers at a gene- and protein expression level. Four kinds of comparisons were performed: total NA group vs C group, severe NA patients vs C, moderate-mild NA patients vs C, and severe NA patients vs moderate-mild NA patients. We found that all the single genes showed good sensitivity vs specificity for some phenotypic discrimination, with CHI3L1 and PI3 exhibiting the best results for C vs NA: CHI3L1 area under the curve (AUC) (CI 95%): 0.95 (0.84-1.00) and PI3 AUC: 0.99 (0.98-1.00); C vs severe NA: PI3 AUC: 1 (0.99-1.00); and C vs moderate-mild NA: CHI3L1 AUC: 1 (0.99-1.00) and PI3 AUC: 0.99 (0.96-1.00). However, the results for discriminating asthma disease and severity with protein expression were better when two or three biomarkers were combined. In conclusion, individual genes and combinations of proteins have been evaluated as reliable biomarkers for classifying NA subjects and their severity. These new panels could be good diagnostic tests.
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Affiliation(s)
- Selene Baos
- Immunology Department, Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain
- Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - David Calzada
- Immunology Department, Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain
| | - Lucía Cremades-Jimeno
- Immunology Department, Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain
| | - Joaquín Sastre
- Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Allergy Department, Fundación Jiménez Díaz, Madrid, Spain
| | - César Picado
- Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Service of Pneumology, Hospital Clinic, Universitat de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Joaquín Quiralte
- Allergy Department, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Fernando Florido
- Allergy Department, Hospital Universitario San Cecilio, Granada, Spain
| | - Carlos Lahoz
- Immunology Department, Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain
- Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Blanca Cárdaba
- Immunology Department, Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain
- Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Madrid, Spain
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6
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Kılıç A, Santolini M, Nakano T, Schiller M, Teranishi M, Gellert P, Ponomareva Y, Braun T, Uchida S, Weiss ST, Sharma A, Renz H. A systems immunology approach identifies the collective impact of 5 miRs in Th2 inflammation. JCI Insight 2018; 3:97503. [PMID: 29875322 DOI: 10.1172/jci.insight.97503] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 03/29/2018] [Indexed: 12/20/2022] Open
Abstract
Allergic asthma is a chronic inflammatory disease dominated by a CD4+ T helper 2 (Th2) cell signature. The immune response amplifies in self-enforcing loops, promoting Th2-driven cellular immunity and leaving the host unable to terminate inflammation. Posttranscriptional mechanisms, including microRNAs (miRs), are pivotal in maintaining immune homeostasis. Since an altered expression of various miRs has been associated with T cell-driven diseases, including asthma, we hypothesized that miRs control mechanisms ensuring Th2 stability and maintenance in the lung. We isolated murine CD4+ Th2 cells from allergic inflamed lungs and profiled gene and miR expression. Instead of focusing on the magnitude of miR differential expression, here we addressed the secondary consequences for the set of molecular interactions in the cell, the interactome. We developed the Impact of Differential Expression Across Layers, a network-based algorithm to prioritize disease-relevant miRs based on the central role of their targets in the molecular interactome. This method identified 5 Th2-related miRs (mir27b, mir206, mir106b, mir203, and mir23b) whose antagonization led to a sharp reduction of the Th2 phenotype. Overall, a systems biology tool was developed and validated, highlighting the role of miRs in Th2-driven immune response. This result offers potentially novel approaches for therapeutic interventions.
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Affiliation(s)
- Ayşe Kılıç
- Institute of Laboratory Medicine and Pathobiochemistry, Molecular Diagnostics, Philipps University Marburg, Marburg, Germany
| | - Marc Santolini
- Center for Complex Network Research, Department of Physics, Northeastern University, Boston, Massachusetts, USA.,Brigham and Women's Hospital, Channing Division of Network Medicine, Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.,Center for Cancer Systems Biology (CCSB) and Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Taiji Nakano
- Institute of Laboratory Medicine and Pathobiochemistry, Molecular Diagnostics, Philipps University Marburg, Marburg, Germany
| | - Matthias Schiller
- Clinic for Dermatology and Venereology, University Medical Center Rostock, Rostock, Germany
| | - Mizue Teranishi
- Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany
| | - Pascal Gellert
- Breast Cancer Now Research Centre at The Institute of Cancer Research, London, United Kingdom
| | - Yuliya Ponomareva
- Institute of Cardiovascular Regeneration, Centre for Molecular Medicine, Goethe- University Frankfurt, Frankfurt Germany
| | - Thomas Braun
- Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany
| | - Shizuka Uchida
- Cardiovascular Innovation Institute, University of Louisville, Louisville, Kentucky, USA
| | - Scott T Weiss
- Brigham and Women's Hospital, Channing Division of Network Medicine, Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Amitabh Sharma
- Brigham and Women's Hospital, Channing Division of Network Medicine, Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Harald Renz
- Institute of Laboratory Medicine and Pathobiochemistry, Molecular Diagnostics, Philipps University Marburg, Marburg, Germany
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Ryan NM, Vertigan AE, Birring SS. An update and systematic review on drug therapies for the treatment of refractory chronic cough. Expert Opin Pharmacother 2018; 19:687-711. [PMID: 29658795 PMCID: PMC5935050 DOI: 10.1080/14656566.2018.1462795] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 04/05/2018] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Chronic Cough (CC) is common and often associated with significant comorbidity and decreased quality of life. In up to 50% of cases, the cough is refractory despite extensive investigation and treatment trials. It is likely that the key abnormality in refractory CC is dysfunctional, hypersensitive sensory nerves, similar to conditions such as laryngeal hypersensitivity and neuropathic pain. AREAS COVERED The aim of this systematic review is to assess drug therapies for refractory CC. The authors review the current management of CC and provide discussion of the similarities between neuropathic pain and refractory CC. They review repurposed and new pharmacological treatments. Several meta-analyses were performed to compare the efficacy of treatments where possible. EXPERT OPINION Repurposed pain medications such as gabapentin and pregabalin reduce the frequency of cough and improve quality of life. Along with speech pathology, they are important and alternate treatments for refractory CC. However, more treatments are needed and the P2X3 ion channel receptor antagonists show the most promise. With a better understanding of neuronal activation and sensitisation and their signal processing in the brain, improved animal models of cough, and the use of validated cough measurement tools, more effective treatments will develop.
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Affiliation(s)
- Nicole M. Ryan
- Clinical Toxicology Research Group, School of Medicine and Public Health, The University of Newcastle, Calvary Mater Hospital, Newcastle, Australia
| | - Anne E. Vertigan
- Centre for Asthma and Respiratory Diseases, School of Medicine and Public Health, Hunter Medical Research Institute, The University of Newcastle, Newcastle, Australia
- Department of Speech Pathology, John Hunter Hospital, Hunter New England Health, Newcastle, Australia
| | - Surinder S. Birring
- Division of Asthma, Allergy & Lung Biology, School of Transplantation, Immunology, Infection & Inflammation Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, UK
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8
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Thomas WR. Broad perspectives of allergen specific immunotherapy. Hum Vaccin Immunother 2017; 13:2385-2389. [PMID: 28933669 PMCID: PMC5647984 DOI: 10.1080/21645515.2017.1374522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Wayne Robert Thomas
- Telethon Kids Institute, University of Western Australia , Subiaco, Western Australia, Australia
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9
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Bigler J, Boedigheimer M, Schofield JPR, Skipp PJ, Corfield J, Rowe A, Sousa AR, Timour M, Twehues L, Hu X, Roberts G, Welcher AA, Yu W, Lefaudeux D, Meulder BD, Auffray C, Chung KF, Adcock IM, Sterk PJ, Djukanović R. A Severe Asthma Disease Signature from Gene Expression Profiling of Peripheral Blood from U-BIOPRED Cohorts. Am J Respir Crit Care Med 2017; 195:1311-1320. [PMID: 27925796 DOI: 10.1164/rccm.201604-0866oc] [Citation(s) in RCA: 127] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
RATIONALE Stratification of asthma at the molecular level, especially using accessible biospecimens, could greatly enable patient selection for targeted therapy. OBJECTIVES To determine the value of blood analysis to identify transcriptional differences between clinically defined asthma and nonasthma groups, identify potential patient subgroups based on gene expression, and explore biological pathways associated with identified differences. METHODS Transcriptomic profiles were generated by microarray analysis of blood from 610 patients with asthma and control participants in the U-BIOPRED (Unbiased Biomarkers in Prediction of Respiratory Disease Outcomes) study. Differentially expressed genes (DEGs) were identified by analysis of variance, including covariates for RNA quality, sex, and clinical site, and Ingenuity Pathway Analysis was applied. Patient subgroups based on DEGs were created by hierarchical clustering and topological data analysis. MEASUREMENTS AND MAIN RESULTS A total of 1,693 genes were differentially expressed between patients with severe asthma and participants without asthma. The differences from participants without asthma in the nonsmoking severe asthma and mild/moderate asthma subgroups were significantly related (r = 0.76), with a larger effect size in the severe asthma group. The majority of, but not all, differences were explained by differences in circulating immune cell populations. Pathway analysis showed an increase in chemotaxis, migration, and myeloid cell trafficking in patients with severe asthma, decreased B-lymphocyte development and hematopoietic progenitor cells, and lymphoid organ hypoplasia. Cluster analysis of DEGs led to the creation of subgroups among the patients with severe asthma who differed in molecular responses to oral corticosteroids. CONCLUSIONS Blood gene expression differences between clinically defined subgroups of patients with asthma and individuals without asthma, as well as subgroups of patients with severe asthma defined by transcript profiles, show the value of blood analysis in stratifying patients with asthma and identifying molecular pathways for further study. Clinical trial registered with www.clinicaltrials.gov (NCT01982162).
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Affiliation(s)
| | | | - James P R Schofield
- 3 Centre for Biological Sciences, Southampton University, Southampton, United Kingdom
| | - Paul J Skipp
- 3 Centre for Biological Sciences, Southampton University, Southampton, United Kingdom
| | - Julie Corfield
- 4 AstraZeneca R&D, Molndal, Sweden.,5 Areteva R&D, Nottingham, United Kingdom
| | - Anthony Rowe
- 6 Janssen Research and Development, High Wycombe, United Kingdom
| | - Ana R Sousa
- 7 Respiratory Therapeutic Unit, GSK, Stockley Park, United Kingdom
| | | | | | - Xuguang Hu
- 8 Amgen Inc., South San Francisco, California
| | - Graham Roberts
- 9 Respiratory Biomedical Research Unit, Faculty of Medicine, University Hospital Southampton, Southampton, United Kingdom
| | | | - Wen Yu
- 1 Amgen Inc., Seattle, Washington
| | - Diane Lefaudeux
- 10 European Institute for Systems Biology and Medicine, Centre National de la Recherche Scientifique, Lyon, France
| | - Bertrand De Meulder
- 10 European Institute for Systems Biology and Medicine, Centre National de la Recherche Scientifique, Lyon, France
| | - Charles Auffray
- 10 European Institute for Systems Biology and Medicine, Centre National de la Recherche Scientifique, Lyon, France
| | - Kian F Chung
- 11 National Heart & Lung Institute, Imperial College & Biomedical Research Unit, Royal Brompton & Harefield NHS Trust, London, United Kingdom; and
| | - Ian M Adcock
- 11 National Heart & Lung Institute, Imperial College & Biomedical Research Unit, Royal Brompton & Harefield NHS Trust, London, United Kingdom; and
| | - Peter J Sterk
- 12 Department of Respiratory Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Ratko Djukanović
- 9 Respiratory Biomedical Research Unit, Faculty of Medicine, University Hospital Southampton, Southampton, United Kingdom
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10
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Baos S, Calzada D, Cremades L, Sastre J, Quiralte J, Florido F, Lahoz C, Cárdaba B. Biomarkers associated with disease severity in allergic and nonallergic asthma. Mol Immunol 2016; 82:34-45. [PMID: 28011367 DOI: 10.1016/j.molimm.2016.12.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 12/02/2016] [Accepted: 12/08/2016] [Indexed: 12/29/2022]
Abstract
Asthma is a complex, chronic respiratory disease with a wide clinical spectrum. Use of high-throughput technologies has generated a great deal of data that require validation. In this work the objective was to validate molecular biomarkers related to asthmatic disease types in peripheral blood samples and define their relationship with disease severity. With this purpose, ninety-four previously described genes were analyzed by qRT-PCR in 30 healthy control (HC) subjects, 30 patients with nonallergic asthma (NA), 30 with allergic asthma (AA), and 14 patients with allergy (rhinitis) but without asthma (AR). RNA was extracted from peripheral blood mononuclear cells (PBMCs) using the TRIzol method. After data normalization, principal component analysis (PCA) was performed, and multiple approaches were used to test for differential gene expression. Relevance was defined by RQ (relative quantification) and corrected P value (<0.05). Protein levels of IL-8 and MSR1 were determined by ELISA and Western blot, respectively. PCA showed 4 gene expression clusters that correlated with the 4 clinical phenotypes. Analysis of differential gene expression between clinical groups and HCs revealed 26 statistically relevant genes in NA and 69 in AA. Protein interaction analysis revealed IL-8 to be a central protein. Average levels of IL-8 were higher in the asthma patients' sera (NA: 452.28±357.72, AA: 327.46±377pg/ml) than in HCs (286.09±179.10), but without reaching statistical significance. Nine genes, especially MSR1, were strongly associated with severe NA. In conclusion, several molecular biomarkers of asthma have been defined, some of which could be useful for the diagnosis or prognosis of disease severity.
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Affiliation(s)
- Selene Baos
- Immunology Department, IIS-Jiménez Díaz Foundation, UAM, Madrid, Spain; CIBERES, CIBER of Respiratory Diseases, Spain
| | - David Calzada
- Immunology Department, IIS-Jiménez Díaz Foundation, UAM, Madrid, Spain
| | - Lucía Cremades
- Immunology Department, IIS-Jiménez Díaz Foundation, UAM, Madrid, Spain
| | - Joaquín Sastre
- CIBERES, CIBER of Respiratory Diseases, Spain; Allergy Department, Jiménez Díaz Foundation, Madrid, Spain
| | - Joaquín Quiralte
- Allergy Department, Vírgen del Rocío University Hospital, Seville, Spain
| | - Fernando Florido
- Allergy Department, San Cecilio University Hospital, Granada, Spain
| | - Carlos Lahoz
- Immunology Department, IIS-Jiménez Díaz Foundation, UAM, Madrid, Spain; CIBERES, CIBER of Respiratory Diseases, Spain
| | - Blanca Cárdaba
- Immunology Department, IIS-Jiménez Díaz Foundation, UAM, Madrid, Spain; CIBERES, CIBER of Respiratory Diseases, Spain.
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11
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Koczulla AR, Vogelmeier CF, Garn H, Renz H. New concepts in asthma: clinical phenotypes and pathophysiological mechanisms. Drug Discov Today 2016; 22:388-396. [PMID: 27867084 DOI: 10.1016/j.drudis.2016.11.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 09/30/2016] [Accepted: 11/09/2016] [Indexed: 12/30/2022]
Abstract
Asthma is among the most common chronic inflammatory diseases worldwide. Recent evidence indicates that the pathogenesis shows a high degree of heterogeneity. Patient subsets have been identified that exhibit different cellular and molecular patterns of dysregulation. A prominent example is eosinophilic Th2-driven asthma. These unique and molecular patterns are termed endotypes. Characterization of endotypes has broad implications for therapeutic interventions. Although ∼80% of asthmatic patients respond well to standard anti-inflammatory therapies, the remaining subset particularly consisting of severe patients requires a more specialized endotype-specific approach. This interrelationship between clinical phenotypes, molecular endotypes and endotype-specific therapies is the focus of this review.
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Affiliation(s)
- Andreas R Koczulla
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University Marburg, Member of the German Center for Lung Research (DZL), Baldingerstrasse, 35043 Marburg, Germany
| | - Claus F Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University Marburg, Member of the German Center for Lung Research (DZL), Baldingerstrasse, 35043 Marburg, Germany
| | - Holger Garn
- Institute of Laboratory Medicine and Pathobiochemistry, Molecular Diagnostics, Philipps University Marburg, Medical Faculty, Baldingerstrasse, 35043 Marburg, Germany
| | - Harald Renz
- Institute of Laboratory Medicine and Pathobiochemistry, Molecular Diagnostics, Philipps University Marburg, Medical Faculty, Baldingerstrasse, 35043 Marburg, Germany.
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12
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A Novel Application of Ti-Substituted Polyoxometalates: Anti-Inflammatory Activity in OVA-Induced Asthma Murine Model. Bioinorg Chem Appl 2016; 2016:3239494. [PMID: 27436993 PMCID: PMC4942595 DOI: 10.1155/2016/3239494] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 05/17/2016] [Accepted: 05/29/2016] [Indexed: 12/02/2022] Open
Abstract
Objective. Asthma is a chronic inflammatory disorder. Despite extensive researches into the treatment and management of it, current treatments and management strategies are still limited. The search for a novel approach to its treatments is urgently needed. Researches on the potential medical use of polyoxometalates (POMs) have already shown it has antiviral and antitumor bioactivities. But the effects of POM in immune systems are still largely unknown. Methods. In order to investigate the role of POM in the asthmatic disease, we used OVA-induced asthma murine model and observed the pathological changes between mice that received three different Ti-substituted POMs (0.3 μg per mouse per dose) when challenged with OVA. We also measured the type 2 cytokine expressions to reveal the potential mechanism. Results and Conclusions. Our results showed that two Ti-substituted POMs, K5H2[FeW11TiO40]·17H2O and K5H[H2ZnW11TiO40]·35H2O, could reduce OVA-induced lung inflammation, serum IgE level (around 2000 ng/mL to less than 1000 ng/mL), leukocytes infiltration in the lung, and cytokines levels (including IL-4, IL-5, IL-13, and TNF-α) but Ti-centered POM K4[TiW12O40]·10H2O did not. Thus, Ti-substituted POMs may have pharmaceutical values especially in treatments for asthmatic diseases.
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13
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Effects of ASM-024, a modulator of acetylcholine receptor function, on airway responsiveness and allergen-induced responses in patients with mild asthma. Can Respir J 2016; 22:230-4. [PMID: 26252534 DOI: 10.1155/2015/832865] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES To evaluate the safety, tolerability and clinical activity of ASM-024, a new cholinergic compound with dual nicotinic and muscarinic activity, in mild allergic asthma. METHODS The present study involved 24 stable, mild allergic asthmatic subjects. In a cross-over design, ASM-024 (50 mg or 200 mg) or placebo were administered once daily by nebulization over three periods of nine consecutive days separated by a three-week washout. The effect of each treatment on the forced expiratory volume in 1 s (FEV1), provocative concentration of methacholine causing a 20% decline in FEV1 (PC20), early and late asthmatic responses, and allergen-induced inflammation were measured. RESULTS Seventeen subjects completed the study. During treatment with ASM-024 at 50 mg or 200 mg, the PC20 value increased respectively from a mean (± SD) 2.56±3.86 mg/mL to 4.11 mg/mL (P=0.007), and from 3.12±4.37 mg/mL to 5.23 mg/mL (P=0.005) (no change with placebo). On day 7 (day preceding allergen challenge), postdosing FEV1 increased by 2.0% with 50 mg (P=0.005) and 1.9% with 200 mg (P=0.008) (placebo -1.1%). ASM-24 had no inhibitory effect on early and late asthmatic responses, nor on sputum eosinophil or neutrophil levels. ASM-024 induced no serious adverse events, but caused cough in 22% and 48% of the subjects with 50 mg and 200 mg, respectively, compared with 10% who were on placebo. CONCLUSIONS ASM-024 did not inhibit allergen-induced asthmatic response and related airway inflammation, but reduced methacholine airway responsiveness and slightly improved lung function. The mechanism by which ASM-024 improves these outcomes requires further study.
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Kobayashi H, Naito M, Masuya M, Maruyama M, Urata K, Takahashi Y, Tomaru A, Fujiwara K, Ohnishi M, Takagi T, Kobayashi T, D'Alessandro-Gabazza C, Urawa M, Gabazza EC, Taguchi O, Takei Y. Circulating fibrocytes correlate with the asthma control test score. Allergol Immunopathol (Madr) 2016; 44:191-6. [PMID: 26774356 DOI: 10.1016/j.aller.2015.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 09/05/2015] [Accepted: 09/30/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Bronchial asthma is characterised by airway inflammation and remodelling with a decline of lung function. Fibrocytes are bone marrow-derived mesenchymal progenitor cells that play important roles in the pathogenesis of airway remodelling. Several clinical parameters are currently being used in routine clinical practice to assess outcome of therapy in asthma including frequency of rescue with short-acting β2-agonist and the asthma control test. In this study, we hypothesised that asthma control test is associated with circulating levels of fibrocytes in bronchial asthma. METHODS There were 20 patients with asthma and seven healthy controls. The number of CD45(+)Collagen I(+) circulating fibrocytes was assessed in the peripheral blood by flow cytometry. RESULTS The number of circulating fibrocytes was significantly increased in asthma patients with moderate and severe disease compared to controls, and it was inversely correlated with % forced expiratory volume in one second and % forced vital capacity (%FVC). The frequency of inhalation of short-acting β2 agonist and the asthma control test score was significantly and inversely correlated with the number of circulating fibrocytes. CONCLUSION The results of this study showed that the number of circulating fibrocytes is inversely correlated with clinical asthma control parameters, further supporting the relevance of measuring circulating fibrocytes as a marker of clinical control in bronchial asthma.
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Affiliation(s)
- H Kobayashi
- Department of Pulmonary and Critical Care Medicine, Mie University Graduate School of Medicine, Edobashi 2-174, Tsu City, Mie Prefecture 514-8507, Japan
| | - M Naito
- Department of Pulmonary and Critical Care Medicine, Mie University Graduate School of Medicine, Edobashi 2-174, Tsu City, Mie Prefecture 514-8507, Japan
| | - M Masuya
- Department of Hematopoietic Pathology, Mie University Graduate School of Medicine, Edobashi 2-174, Tsu City, Mie Prefecture 514-8507, Japan
| | - M Maruyama
- Department of Hematopoietic Pathology, Mie University Graduate School of Medicine, Edobashi 2-174, Tsu City, Mie Prefecture 514-8507, Japan
| | - K Urata
- Department of Pulmonary and Critical Care Medicine, Mie University Graduate School of Medicine, Edobashi 2-174, Tsu City, Mie Prefecture 514-8507, Japan
| | - Y Takahashi
- Department of Pulmonary and Critical Care Medicine, Mie University Graduate School of Medicine, Edobashi 2-174, Tsu City, Mie Prefecture 514-8507, Japan
| | - A Tomaru
- Department of Pulmonary and Critical Care Medicine, Mie University Graduate School of Medicine, Edobashi 2-174, Tsu City, Mie Prefecture 514-8507, Japan
| | - K Fujiwara
- Department of Pulmonary and Critical Care Medicine, Mie University Graduate School of Medicine, Edobashi 2-174, Tsu City, Mie Prefecture 514-8507, Japan
| | - M Ohnishi
- Department of Pulmonary and Critical Care Medicine, Mie University Graduate School of Medicine, Edobashi 2-174, Tsu City, Mie Prefecture 514-8507, Japan
| | - T Takagi
- Department of Pulmonary and Critical Care Medicine, Mie University Graduate School of Medicine, Edobashi 2-174, Tsu City, Mie Prefecture 514-8507, Japan
| | - T Kobayashi
- Department of Pulmonary and Critical Care Medicine, Mie University Graduate School of Medicine, Edobashi 2-174, Tsu City, Mie Prefecture 514-8507, Japan
| | - C D'Alessandro-Gabazza
- Department of Immunology, Mie University Graduate School of Medicine, Edobashi 2-174, Tsu City, Mie Prefecture 514-8507, Japan
| | - M Urawa
- Department of Pulmonary and Critical Care Medicine, Mie University Graduate School of Medicine, Edobashi 2-174, Tsu City, Mie Prefecture 514-8507, Japan; Department of Immunology, Mie University Graduate School of Medicine, Edobashi 2-174, Tsu City, Mie Prefecture 514-8507, Japan
| | - E C Gabazza
- Department of Immunology, Mie University Graduate School of Medicine, Edobashi 2-174, Tsu City, Mie Prefecture 514-8507, Japan.
| | - O Taguchi
- Department of Pulmonary and Critical Care Medicine, Mie University Graduate School of Medicine, Edobashi 2-174, Tsu City, Mie Prefecture 514-8507, Japan
| | - Y Takei
- Department of Pulmonary and Critical Care Medicine, Mie University Graduate School of Medicine, Edobashi 2-174, Tsu City, Mie Prefecture 514-8507, Japan
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15
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Fellner RC, Terryah ST, Tarran R. Inhaled protein/peptide-based therapies for respiratory disease. Mol Cell Pediatr 2016; 3:16. [PMID: 27098663 PMCID: PMC4839019 DOI: 10.1186/s40348-016-0044-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 04/13/2016] [Indexed: 11/10/2022] Open
Abstract
Asthma, chronic obstructive pulmonary disease (COPD), and cystic fibrosis (CF) are all chronic pulmonary diseases, albeit with different etiologies, that are characterized by airflow limitation, chronic inflammation, and abnormal mucus production/rheology. Small synthetic molecule-based therapies are commonly prescribed for all three diseases. However, there has been increased interest in “biologicals” to treat these diseases. Biologicals typically constitute protein- or peptide-based therapies and are often more potent than small molecule-based drugs. In this review, we shall describe the pros and cons of several different biological-based therapies for respiratory disease, including dornase alfa, a recombinant DNAase that reduces mucus viscosity and short palate lung and nasal epithelial clone 1 (SPLUNC1)-derived peptides that treat Na+ hyperabsorption and rebalance CF airway surface liquid homeostasis.
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Affiliation(s)
- Robert C Fellner
- Cystic Fibrosis and Pulmonary Diseases Research and Treatment Center, University of North Carolina, 7102 Marsico Hall, 125 Mason Farm Road, Chapel Hill, NC, 27599-7248, USA
| | - Shawn T Terryah
- Spyryx Biosciences, 801-9 Capitola Drive, Durham, NC, 27713, USA
| | - Robert Tarran
- Cystic Fibrosis and Pulmonary Diseases Research and Treatment Center, University of North Carolina, 7102 Marsico Hall, 125 Mason Farm Road, Chapel Hill, NC, 27599-7248, USA. .,Department of Cell Biology and Physiology, University of North Carolina, Chapel Hill, NC, 27599, USA.
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16
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Marth K, Spinola M, Kisiel J, Woergetter C, Petrovic M, Pohl W. Treatment response according to small airway phenotypes: a real-life observational study. Ther Adv Respir Dis 2016; 10:200-10. [PMID: 27060186 DOI: 10.1177/1753465816642635] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Scant clinical data are available on the effects of current treatments for asthma on different subgroups of patients with this disease. We conducted a prospective, noninterventional, multicenter real-life study in adult patients with persistent asthma, and we specifically analyzed the effects of treatment with extrafine beclometasone dipropionate/formoterol (BDP/F) in asthma patients categorized by phenotypes related to small airways (i.e. smoking habits, disease duration, and air trapping). METHODS Patients received BDP/F as a fixed combination (100/6 μg), administered in 1-2 inhalations twice daily over a period of 12 weeks. Peak expiratory flow (PEF), forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), number of asthma attacks, asthma control, and severity of asthma symptoms were evaluated in the overall population and in different subgroups at three different time points. RESULTS Overall, 213 patients were enrolled. In the overall population the treatment resulted in a significant increase in the proportion of well controlled patients (from 6.1% to 66.3%; p<0.001), and a reduction of uncontrolled subjects (70.3% versus 10.0%; p<0.001). BDP/F was also associated with a reduction in asthma attacks and an improvement of symptoms. These results were confirmed in specific subgroups of patients identified as small airway phenotypes: smokers, elderly patients, those with long duration of disease and air trapping. CONCLUSIONS This real-life observational study indicates that extrafine BDP/F in a fixed combination improves asthma control and symptoms in the overall population as well as specific subgroups of patients.
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Affiliation(s)
| | | | | | | | | | - Wolfgang Pohl
- 1130 Wien, KH Hietzing, Abt. f. Atmungs- u. Lungenkrankheiten, Austria
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17
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Levy BD, Noel PJ, Freemer MM, Cloutier MM, Georas SN, Jarjour NN, Ober C, Woodruff PG, Barnes KC, Bender BG, Camargo CA, Chupp GL, Denlinger LC, Fahy JV, Fitzpatrick AM, Fuhlbrigge A, Gaston BM, Hartert TV, Kolls JK, Lynch SV, Moore WC, Morgan WJ, Nadeau KC, Ownby DR, Solway J, Szefler SJ, Wenzel SE, Wright RJ, Smith RA, Erzurum SC. Future Research Directions in Asthma. An NHLBI Working Group Report. Am J Respir Crit Care Med 2016; 192:1366-72. [PMID: 26305520 DOI: 10.1164/rccm.201505-0963ws] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Asthma is a common chronic disease without cure. Our understanding of asthma onset, pathobiology, classification, and management has evolved substantially over the past decade; however, significant asthma-related morbidity and excess healthcare use and costs persist. To address this important clinical condition, the NHLBI convened a group of extramural investigators for an Asthma Research Strategic Planning workshop on September 18-19, 2014, to accelerate discoveries and their translation to patients. The workshop focused on (1) in utero and early-life origins of asthma, (2) the use of phenotypes and endotypes to classify disease, (3) defining disease modification, (4) disease management, and (5) implementation research. This report summarizes the workshop and produces recommendations to guide future research in asthma.
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Affiliation(s)
- Bruce D Levy
- 1 Brigham and Women's Hospital, Boston, Massachusetts
| | - Patricia J Noel
- 2 National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | | | | | | | - Nizar N Jarjour
- 5 University of Wisconsin Hospital and Clinics, Madison, Wisconsin
| | - Carole Ober
- 6 The University of Chicago, Chicago, Illinois
| | | | | | | | | | - Geoff L Chupp
- 11 Yale University School of Medicine, New Haven, Connecticut
| | | | - John V Fahy
- 7 University of California at San Francisco, San Francisco, California
| | | | | | - Ben M Gaston
- 13 Case Western Reserve University, Cleveland, Ohio
| | - Tina V Hartert
- 14 Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Jay K Kolls
- 15 University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Susan V Lynch
- 7 University of California at San Francisco, San Francisco, California
| | - Wendy C Moore
- 16 Wake Forest School of Medicine, Winston Salem, North Carolina
| | | | - Kari C Nadeau
- 18 Stanford School of Medicine, Stanford, California
| | | | | | - Stanley J Szefler
- 20 Children's Hospital Colorado and the University of Colorado School of Medicine, Denver, Colorado
| | - Sally E Wenzel
- 15 University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | - Robert A Smith
- 2 National Heart, Lung, and Blood Institute, Bethesda, Maryland
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18
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Ramaiah SK, Walker DB. Regulatory Forum Opinion Piece*: Veterinary Pathologists in Translational Pharmacology and Biomarker Integration in Drug Discovery and Development. Toxicol Pathol 2016; 44:137-46. [PMID: 26839329 DOI: 10.1177/0192623315620051] [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: 12/12/2022]
Abstract
This article highlights emerging roles for veterinary pathologists outside of traditional functions and in line with the translational research (TR) approach. Veterinary pathologists offer unique and valuable expertise toward addressing particular TR and associated translational pharmacology questions, identifying gaps and risks in biomarker and pathology strategies, and advancing TR team decision making. Veterinary pathologists' attributes that are integral to the TR approach include (i) well-developed understanding of comparative physiology, pathology, and disease; (ii) extensive experience in interpretation and integration of complex data sets on whole-body responses and utilizing this for deciphering pathogenesis and translating events between laboratory species and man; (iii) proficiency in recognizing differences in disease end points among individuals, animal species and strains, and assessing correlations between these differences and other investigative (including biomarker) findings; and (iv) strong background in a wide spectrum of research technologies that can address pathomechanistic questions and biomarker needs. Some of the more evident roles in which veterinary pathologists can offer their greatest contributions to address questions and strategies of TR and biomarker integration will be emphasized.
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Affiliation(s)
- Shashi K Ramaiah
- Translational Biomarkers and Clinical Pathology Labs, Drug Safety Research and Development, Pfizer Inc., Cambridge, Massachusetts, USA
| | - Dana B Walker
- Novartis Institute of Biomedical Research, Cambridge, Massachusetts, USA
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19
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De Ferrari L, Chiappori A, Bagnasco D, Riccio AM, Passalacqua G, Canonica GW. Molecular phenotyping and biomarker development: are we on our way towards targeted therapy for severe asthma? Expert Rev Respir Med 2015; 10:29-38. [PMID: 26566089 DOI: 10.1586/17476348.2016.1111763] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Although different phenotypes of severe asthma can be identified, all are characterized by common symptoms. Due to their heterogeneity, they exhibit differences in pathogenesis, etiology and clinical responses to therapeutic approaches. The identification of distinct molecular phenotypes to define severe asthmatic patients will allow us to better understand the pathophysiology of the disease and thus to more precisely target the treatment for each patient. To achieve this goal, a systematic search for new, reliable and stable biomarkers specific for each phenotype is essential. This review focuses on the current known molecular phenotypes of severe asthma and highlights the need for biomarkers that could (either alone or in combination) be predictive of the treatment outcome.
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Affiliation(s)
- Laura De Ferrari
- a Allergy and Respiratory Diseases, IRCCS San Martino-IST , University of Genoa , Genoa , Italy
| | - Alessandra Chiappori
- a Allergy and Respiratory Diseases, IRCCS San Martino-IST , University of Genoa , Genoa , Italy
| | - Diego Bagnasco
- a Allergy and Respiratory Diseases, IRCCS San Martino-IST , University of Genoa , Genoa , Italy
| | - Anna Maria Riccio
- a Allergy and Respiratory Diseases, IRCCS San Martino-IST , University of Genoa , Genoa , Italy
| | - Giovanni Passalacqua
- a Allergy and Respiratory Diseases, IRCCS San Martino-IST , University of Genoa , Genoa , Italy
| | - Giorgio Walter Canonica
- a Allergy and Respiratory Diseases, IRCCS San Martino-IST , University of Genoa , Genoa , Italy
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20
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Thomas M, Wilkinson T. Asthma diagnosis in the community--time for a change? Clin Exp Allergy 2015; 44:1206-9. [PMID: 25243811 DOI: 10.1111/cea.12392] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- M Thomas
- Primary Care and Population Sciences Division, University of Southampton, Southampton, UK; University Hospital Southampton NHS Foundation Trust, Southampton, UK; NIHR Southampton Respiratory Biomedical Research Unit, Southampton, UK
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21
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Diebold BA, Smith SM, Li Y, Lambeth JD. NOX2 As a Target for Drug Development: Indications, Possible Complications, and Progress. Antioxid Redox Signal 2015; 23:375-405. [PMID: 24512192 PMCID: PMC4545678 DOI: 10.1089/ars.2014.5862] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 02/08/2014] [Indexed: 12/27/2022]
Abstract
SIGNIFICANCE NOX2 is important for host defense, and yet is implicated in a large number of diseases in which inflammation plays a role in pathogenesis. These include acute and chronic lung inflammatory diseases, stroke, traumatic brain injury, and neurodegenerative diseases, including Alzheimer's and Parkinson's Diseases. RECENT ADVANCES Recent drug development programs have targeted several NOX isoforms that are implicated in a variety of diseases. The focus has been primarily on NOX4 and NOX1 rather than on NOX2, due, in part, to concerns about possible immunosuppressive side effects. Nevertheless, NOX2 clearly contributes to the pathogenesis of many inflammatory diseases, and its inhibition is predicted to provide a novel therapeutic approach. CRITICAL ISSUES Possible side effects that might arise from targeting NOX2 are discussed, including the possibility that such inhibition will contribute to increased infections and/or autoimmune disorders. The state of the field with regard to existing NOX2 inhibitors and targeted development of novel inhibitors is also summarized. FUTURE DIRECTIONS NOX2 inhibitors show particular promise for the treatment of inflammatory diseases, both acute and chronic. Theoretical side effects include pro-inflammatory and autoimmune complications and should be considered in any therapeutic program, but in our opinion, available data do not indicate that they are sufficiently likely to eliminate NOX2 as a drug target, particularly when weighed against the seriousness of many NOX2-related indications. Model studies demonstrating efficacy with minimal side effects are needed to encourage future development of NOX2 inhibitors as therapeutic agents.
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Affiliation(s)
- Becky A. Diebold
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Susan M.E. Smith
- Department of Biology and Physics, Kennesaw State University, Kennesaw, Georgia
| | - Yang Li
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - J. David Lambeth
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
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22
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Microbiome and Asthma: What Have Experimental Models Already Taught Us? J Immunol Res 2015; 2015:614758. [PMID: 26266269 PMCID: PMC4525458 DOI: 10.1155/2015/614758] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Accepted: 07/02/2015] [Indexed: 02/07/2023] Open
Abstract
Asthma is a chronic inflammatory disease that imposes a substantial burden on patients, their families, and the community. Although many aspects of the pathogenesis of classical allergic asthma are well known by the scientific community, other points are not yet understood. Experimental asthma models, particularly murine models, have been used for over 100 years in order to better understand the immunopathology of asthma. It has been shown that human microbiome is an important component in the development of the immune system. Furthermore, the occurrence of many inflammatory diseases is influenced by the presence of microbes. Again, experimental models of asthma have helped researchers to understand the relationship between the microbiome and respiratory inflammation. In this review, we discuss the evolution of murine models of asthma and approach the major studies involving the microbiome and asthma.
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23
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Canonica GW, Bartezaghi M, Marino R, Rigoni L. Prevalence of perennial severe allergic asthma in Italy and effectiveness of omalizumab in its management: PROXIMA - an observational, 2 phase, patient reported outcomes study. Clin Mol Allergy 2015; 13:10. [PMID: 26155196 PMCID: PMC4494726 DOI: 10.1186/s12948-015-0019-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 04/08/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We designed the PROXIMA study (Patient-Reported Outcomes and Xolair(®) In the Management of Asthma) to determine the proportion of patients with severe asthma sensitive to perennial allergens, and to evaluate asthma control and treatment adherence up to 12 months in patients treated with omalizumab in Italian population. In addition, an ancillary study was designed to explore protein biomarkers and characterize them in relation to severe allergic asthma and treatment effects by proteomic approach. METHODS PROXIMA is an observational, multicenter, cross-sectional and prospective cohort study conducted at 25 centers in Italy, in outpatient settings. The study consists of two phases: 1) a cross-sectional phase plans to enroll 600 patients with severe allergic asthma, in step 4 therapy as per GINA guidelines, aged ≥18 years, needing a step up in therapy, and 2) a longitudinal phase on patients who will start omalizumab add-on therapy per clinician's judgment at baseline visit (approximately 180-240 patients). The primary variable of the cross-sectional phase is the proportion of patients with severe asthma presenting with perennial form of allergy (skin prick test or in vitro test). The primary variable of longitudinal phase is proportion of patients who achieve disease control (assessed by Asthma Control Questionnaire [ACQ]) with omalizumab at 6 months, and maintain it at 12 months. Secondary variables are patient compliance to omalizumab, patient-reported perception of cognitive and emotional impact of the illness, assessed by Brief Illness Perception Questionnaire (Brief IPQ) and the health related quality of life evaluated by the EuroQoL 5D-3 L (EQ-5D-3 L). Safety endpoints will be recorded during the course of the study. Patients participating in the longitudinal phase will be enrolled for ancillary study if they provide additional informed consent. Protein species in complex mixtures will be identified using innovative MudPIT (Multidimensional Protein Identification Technology) method. CONCLUSIONS The results of this observational study will provide estimate of patient population allergic to perennial allergens in Italy and information on patient-reported outcomes with omalizumab therapy in a real-world setting. The exploratory proteomic analysis on asthma biomarkers could eventually provide new data to identify responder patients to anti IgE therapy.
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Affiliation(s)
| | - Marta Bartezaghi
- />Novartis Farma SpA, Largo U. Boccioni 1, Origgio (VA), 21040 Italy
| | - Raffaele Marino
- />Novartis Farma SpA, Largo U. Boccioni 1, Origgio (VA), 21040 Italy
| | - Laura Rigoni
- />Novartis Farma SpA, Largo U. Boccioni 1, Origgio (VA), 21040 Italy
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24
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Thomas M. Why aren't we doing better in asthma: time for personalised medicine? NPJ Prim Care Respir Med 2015; 25:15004. [PMID: 25741858 PMCID: PMC4373498 DOI: 10.1038/npjpcrm.2015.4] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 12/16/2014] [Accepted: 12/19/2014] [Indexed: 12/25/2022] Open
Abstract
After decades of improvement, asthma outcomes have stalled. Mortality, hospitalisations, exacerbations and symptom control remain sub-optimal. In controlled trials, most patients gain high levels of control, but in ‘real-life’ routine clinical practice most patients do not. Avoidable factors are found in most asthma deaths and hospital admissions. This perspective paper considers and contextualises the factors underlying poor asthma outcomes, and it suggests approaches that could improve the situation. Factors discussed include severe, therapy-resistant disease and the role of new and upcoming pharmacological therapies in improving outcomes. These are likely to be beneficial when targeted on patients with severe disease and discrete phenotypic characteristics, identified through biomarkers. However, for the majority of patients treated in the community, they are unlikely to be used widely, and better use of current therapy classes will be more important. Non-adherence with regular inhaled corticosteroid treatment and over-use of rescue bronchodilators are common, and many patients have poor inhaler technique. Self-management is frequently poor, particularly in those with psychosocial disadvantages and co-morbidities. Communication between clinicians and patients is sometimes poor, with failure to detect avoidable poor control and non-adherence, and failure to provide the necessary information and education to support efficient self-management. Strategies for improving monitoring and clinician–patient interactions to allow personalised treatment are considered. These strategies have the potential to allow individual patient needs to be recognised and efficient targeting of the variety of effective pharmacological and non-pharmacological interventions that we possess, which has the potential to improve both individual and population outcomes.
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Affiliation(s)
- Mike Thomas
- 1] Faculty of Medicine, Primary Care and Population Sciences, University of Southampton, Southampton, UK [2] Univer sity Hospital Southampton NHS Foundation Trust, Southampton, UK [3] NIHR Southampton Respiratory Biomedical Research Unit, Southampton, UK [4] NIHR Collaboration for Leadershi p in Applied Health Research and Care, Southampton, UK
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25
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Abstract
Asthma is the most common inflammatory disease of the lungs. The prevalence of asthma is increasing in many parts of the world that have adopted aspects of the Western lifestyle, and the disease poses a substantial global health and economic burden. Asthma involves both the large-conducting and the small-conducting airways, and is characterized by a combination of inflammation and structural remodelling that might begin in utero. Disease progression occurs in the context of a developmental background in which the postnatal acquisition of asthma is strongly linked with allergic sensitization. Most asthma cases follow a variable course, involving viral-induced wheezing and allergen sensitization, that is associated with various underlying mechanisms (or endotypes) that can differ between individuals. Each set of endotypes, in turn, produces specific asthma characteristics that evolve across the lifecourse of the patient. Strong genetic and environmental drivers of asthma interconnect through novel epigenetic mechanisms that operate prenatally and throughout childhood. Asthma can spontaneously remit or begin de novo in adulthood, and the factors that lead to the emergence and regression of asthma, irrespective of age, are poorly understood. Nonetheless, there is mounting evidence that supports a primary role for structural changes in the airways with asthma acquisition, on which altered innate immune mechanisms and microbiota interactions are superimposed. On the basis of the identification of new causative pathways, the subphenotyping of asthma across the lifecourse of patients is paving the way for more-personalized and precise pathway-specific approaches for the prevention and treatment of asthma, creating the real possibility of total prevention and cure for this chronic inflammatory disease.
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Affiliation(s)
- Stephen T. Holgate
- Clinical and Experimental Sciences, Mail Point 810, Level F, Sir Henry Wellcome Building, ,grid.123047.30000000103590315Southampton General Hospital, Southampton, SO16 6YD UK
| | - Sally Wenzel
- grid.21925.3d0000 0004 1936 9000Subsection Chief of Allergy, Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh, Asthma Institute at UPMC/UPSOM, Pittsburgh, Pennsylvania USA
| | - Dirkje S. Postma
- grid.4494.d0000 0000 9558 4598Department of Pulmonology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Scott T. Weiss
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts USA
| | - Harald Renz
- grid.10253.350000 0004 1936 9756Institute of Laboratory Medicine and Pathobiochemistry, Molecular Diagnostics, Philipps University Marburg, University Hospital Giessen and Marburg GmbH, Campus Marburg, Marburg, Germany
| | - Peter D. Sly
- grid.1003.20000 0000 9320 7537Queensland Children's Medical Research Institute and Centre for Child Health Research, University of Queensland, Brisbane, Australia
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26
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Martin RA, Hodgkins SR, Dixon AE, Poynter ME. Aligning mouse models of asthma to human endotypes of disease. Respirology 2014; 19:823-33. [PMID: 24811131 PMCID: PMC4107015 DOI: 10.1111/resp.12315] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Revised: 03/01/2014] [Accepted: 03/28/2014] [Indexed: 12/20/2022]
Abstract
Substantial gains in understanding the pathophysiologic mechanisms underlying asthma have been made using preclinical mouse models. However, because asthma is a complex, heterogeneous syndrome that is rarely due to a single allergen and that often presents in the absence of atopy, few of the promising therapeutics that demonstrated effectiveness in mouse models have translated into new treatments for patients. This has resulted in an urgent need to characterize T helper (Th) 2-low, non-eosinophilic subsets of asthma, to study models that are resistant to conventional treatments such as corticosteroids and to develop therapies targeting patients with severe disease. Classifying asthma based on underlying pathophysiologic mechanisms, known as endotyping, offers a stratified approach for the development of new therapies for asthma. In preclinical research, new models of asthma are being utilized that more closely resemble the clinical features of different asthma endotypes, including the presence of interleukin-17 and a Th17 response, a biomarker of severe disease. These models utilize more physiologically relevant sensitizing agents, exacerbating factors and allergens, as well as incorporate time points that better reflect the natural history and chronicity of clinical asthma. Importantly, some models better represent non-classical asthma endotypes that facilitate the study of non-Th2-driven pathology and resemble the complex nature of clinical asthma, including corticosteroid resistance. Placing mouse asthma models into the context of human asthma endotypes will afford a more relevant approach to the understanding of pathophysiological mechanisms of disease that will afford the development of new therapies for those asthmatics that remain difficult to treat.
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Affiliation(s)
- Rebecca A Martin
- Vermont Lung Center, Department of Medicine, Division of Pulmonary Disease and Critical Care, University of Vermont, Burlington, Vermont, USA
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Omalizumab in asthma: an update on recent developments. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2014; 2:525-36.e1. [PMID: 25213045 DOI: 10.1016/j.jaip.2014.03.010] [Citation(s) in RCA: 146] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Revised: 03/25/2014] [Accepted: 03/27/2014] [Indexed: 01/07/2023]
Abstract
IgE is central to the pathophysiology of allergic asthma. Omalizumab, a humanized anti-IgE mAb, specifically binds free IgE and interrupts the allergic cascade by preventing binding of IgE with its high-affinity FcεRI receptors on mast cells, antigen-presenting cells, and other inflammatory cells. The clinical efficacy of omalizumab has been well documented in a number of clinical trials that involve adults, adolescents, and children with moderate-to-severe and severe allergic asthma. In these studies, omalizumab reduced exacerbations, asthma symptoms, inhaled corticosteroid and rescue medication use, and improved quality of life relative to placebo or best standard of care. Similar benefits have been reported in observational studies in "real-world" populations of patients. Results from recent pooled data from randomized clinical trials and from a large prospective cohort study provide reassurance about the long-term safety of omalizumab. Omalizumab dosing is individualized according to body weight and serum-IgE level, and recent adjustments to the dosing algorithm in Europe have enabled more patients to be eligible for treatment. Ongoing and future research is investigating the optimal duration of therapy, accurate predictors of response to treatment, and efficacy in nonatopic asthma as well as other IgE-mediated conditions.
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Meyers DA, Bleecker ER, Holloway JW, Holgate ST. Asthma genetics and personalised medicine. THE LANCET. RESPIRATORY MEDICINE 2014; 2:405-15. [PMID: 24794577 PMCID: PMC4768462 DOI: 10.1016/s2213-2600(14)70012-8] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Unbiased genetic approaches, especially genome-wide association studies, have identified novel genetic targets in the pathogenesis of asthma, but so far these targets account for only a small proportion of the heritability of asthma. Recognition of the importance of disease heterogeneity, the need for improved disease phenotyping, and the fact that genes involved in the inception of asthma are likely to be different from those involved in severity widens the scope of asthma genetics. The identification of genes implicated in several causal pathways suggests that genetic scores could be used to capture the effect of genetic variations on individuals. Gene-environment interaction adds another layer of complexity, which is being successfully explored by epigenetic approaches. Pharmacogenetics is one example of how gene-environment interactions are already being taken into account in the identification of drug responders and non-responders, and patients most susceptible to adverse effects. Such applications represent one component of personalised medicine, an approach that places the individual at the centre of health care.
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Affiliation(s)
- Deborah A Meyers
- Center for Genomics and Personalized Medicine Research, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Eugene R Bleecker
- Center for Genomics and Personalized Medicine Research, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - John W Holloway
- Center for Genomics and Personalized Medicine Research, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Stephen T Holgate
- Human Development and Health, and Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK.
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Calzetta L, Rogliani P, Cazzola M, Matera MG. Advances in asthma drug discovery: evaluating the potential of nasal cell sampling and beyond. Expert Opin Drug Discov 2014; 9:595-607. [PMID: 24749518 DOI: 10.1517/17460441.2014.909403] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Inhaled corticosteroid anti-inflammatory therapy is effective at controlling disease symptoms of asthma, but a subset of patients remains symptomatic despite optimal treatment, creating a clear unmet medical need. Moreover, none of the currently available drugs for asthma are really disease-modifying or curative. Although murine models of asthma, based on transgenic and knockout animals, may offer an integrated pathophysiological system for studying the characteristics of airway inflammation and hyperresponsiveness, these alterations are noteworthily different compared with those observed in asthmatic patients. Since a clear functional and inflammatory relationship between the nasal mucosa and bronchial tissue in patients suffering from asthma and allergic rhinitis has been recognized, using preclinical models based on human nasal cells sampling might support a prompt and effective anti-inflammatory drug discovery in asthma. AREAS COVERED The authors provide a review, which discusses the potential role of nasal cell sampling and its application in advanced drug discovery for asthma. The contents range from the similarities and differences between asthma and allergic rhinitis up to artificial airway models based on sophisticated human lung-on-a-chip devices. EXPERT OPINION Nasal cell sampling and processing have reached a great potential in asthma drug discovery. The authors believe that models of asthma, which are based on human nasal cells, can provide valuable indications of proof of pharmacological and potential therapeutic efficacy in both preclinical and early clinical settings.
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Affiliation(s)
- Luigino Calzetta
- IRCCS, San Raffaele Pisana Hospital, Department of Pulmonary Rehabilitation , Rome , Italy
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Bice JB, Leechawengwongs E, Montanaro A. Biologic targeted therapy in allergic asthma. Ann Allergy Asthma Immunol 2014; 112:108-15. [PMID: 24468249 DOI: 10.1016/j.anai.2013.12.013] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 12/04/2013] [Accepted: 12/06/2013] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To review the structure, function, clinical utility, and safety of current biologic targeted therapies being used for the treatment of asthma. DATA SOURCES Medical literature obtained from PubMed and OVID searches from June to November 2013. STUDY SELECTIONS Studies were selected based on article impact, relevance, and clinical significance. Particular emphasis was placed on articles discussing therapies targeted at IgE, interleukin (IL)-4, IL-4 receptor, IL-5, IL-13, tumor necrosis factor-α, CRTh2, and toll-like receptors 7 and 9. RESULTS Since the approval of omalizumab in 2003, the development of biologic asthma therapies has grown at a remarkable pace. With approximately 30 drugs currently in clinical trials and dozens more in development, the future of asthma biologic therapies is promising. Despite several well-publicized setbacks, researchers remain focused on elucidating the complex pathophysiology of asthma. The hope is that asthma biologic therapies will eventually be tailored to an individual's asthma phenotype. With more than 300 million people worldwide affected by asthma and with roughly 5% to 10% of this population living with severe, uncontrolled asthma, the need for new biologic therapies is great. CONCLUSION The introduction of each new biologic therapy into clinical trials has been associated with great anticipation, but the outcome of these trials, in many cases, has led to disappointment. Given the lack of overwhelming positive responses, these results have emphasized that asthma is a complex clinical syndrome with multiple underlying genotypes and clinical phenotypes. It has become abundantly clear that it is very unlikely that there is one "magic bullet" to cure all patients with asthma.
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Affiliation(s)
- Jeffrey B Bice
- School of Medicine, Tulane University, New Orleans, Louisiana
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Molinari G, Colombo G, Celenza C. Respiratory allergies: a general overview of remedies, delivery systems, and the need to progress. ISRN ALLERGY 2014; 2014:326980. [PMID: 25006500 PMCID: PMC3972928 DOI: 10.1155/2014/326980] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 12/24/2013] [Indexed: 01/10/2023]
Abstract
The spread of respiratory allergies is increasing in parallel with the alarm of the scientific community. Evidently, our knowledge of the onset mechanisms of these diseases and, as a consequence, of the available remedies is inadequate. This review provides a brief, general description of current therapeutic resources and the state of research with regard to both drugs and medical devices in order to highlight their limits and the urgent need for progress. Increasing the amount of basic biochemical research will improve our knowledge of such onset mechanisms and the potential efficacy of therapeutic preparations.
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Affiliation(s)
- Giuliano Molinari
- Biochemistry Consulting Service, Giuliano Molinari, 20017 Rho, Milan, Italy
| | - Giselda Colombo
- Allergy and Immunology Unit, San Raffaele Hospital, 20132 Milan, Italy
| | - Cinzia Celenza
- Quality Assurance Service, Sandoz S.P.A., 21040 Origgio, Varese, Italy
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Neylan TC, Schadt EE, Yehuda R. Biomarkers for combat-related PTSD: focus on molecular networks from high-dimensional data. Eur J Psychotraumatol 2014; 5:23938. [PMID: 25206954 PMCID: PMC4138711 DOI: 10.3402/ejpt.v5.23938] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 06/17/2014] [Accepted: 06/23/2014] [Indexed: 12/23/2022] Open
Abstract
Posttraumatic stress disorder (PTSD) and other deployment-related outcomes originate from a complex interplay between constellations of changes in DNA, environmental traumatic exposures, and other biological risk factors. These factors affect not only individual genes or bio-molecules but also the entire biological networks that in turn increase or decrease the risk of illness or affect illness severity. This review focuses on recent developments in the field of systems biology which use multidimensional data to discover biological networks affected by combat exposure and post-deployment disease states. By integrating large-scale, high-dimensional molecular, physiological, clinical, and behavioral data, the molecular networks that directly respond to perturbations that can lead to PTSD can be identified and causally associated with PTSD, providing a path to identify key drivers. Reprogrammed neural progenitor cells from fibroblasts from PTSD patients could be established as an in vitro assay for high throughput screening of approved drugs to determine which drugs reverse the abnormal expression of the pathogenic biomarkers or neuronal properties.
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Affiliation(s)
- Thomas C Neylan
- Department of Psychiatry, University of California, San Francisco, CA, USA ; Mental Health Service, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Eric E Schadt
- Department of Genetics and Genomic Sciences, Mount Sinai School of Medicine, New York, NY, USA
| | - Rachel Yehuda
- Department of Psychiatry, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA ; Department of Psychiatry and Neurobiology, Mount Sinai School of Medicine, New York, NY, USA
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