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Shamji MH, Boyle RJ. Management of childhood asthma and tools to evaluate asthma pathophysiology. Clin Exp Allergy 2023; 53:1138-1140. [PMID: 37963729 DOI: 10.1111/cea.14417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Affiliation(s)
- Mohamed H Shamji
- National Heart and Lung Institute, Imperial College London, London, UK
- NIHR Imperial Biomedical Research Centre, London, UK
| | - Robert J Boyle
- National Heart and Lung Institute, Imperial College London, London, UK
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2
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Bauer RN, Xie Y, Beaudin S, Wiltshire L, Wattie J, Muñoz C, Alsaji N, Oliveria JP, Ju X, MacLean J, Sommer DD, Keith PK, Satia I, Cusack RP, O'Byrne PM, Sperinde G, Hokom M, Li O, Banerjee P, Chen C, Staton T, Sehmi R, Gauvreau GM. Evaluation of the reproducibility of responses to nasal allergen challenge and effects of inhaled nasal corticosteroids. Clin Exp Allergy 2023; 53:1187-1197. [PMID: 37794659 DOI: 10.1111/cea.14406] [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: 02/09/2023] [Revised: 08/14/2023] [Accepted: 09/11/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND Similar immune responses in the nasal and bronchial mucosa implies that nasal allergen challenge (NAC) is a suitable early phase experimental model for drug development targeting allergic rhinitis (AR) and asthma. We assessed NAC reproducibility and the effects of intranasal corticosteroids (INCS) on symptoms, physiology, and inflammatory mediators. METHODS 20 participants with mild atopic asthma and AR underwent three single blinded nasal challenges each separated by three weeks (NCT03431961). Cohort A (n = 10) underwent a control saline challenge, followed by two allergen challenges. Cohort B (n = 10) underwent a NAC with no treatment intervention, followed by NAC with 14 days pre-treatment with saline nasal spray (placebo), then NAC with 14 days pre-treatment with INCS (220 μg triamcinolone acetonide twice daily). Nasosorption, nasal lavage, blood samples, forced expiratory volume 1 (FEV1), total nasal symptom score (TNSS), peak nasal inspiratory flow (PNIF) were collected up to 24 h after NAC. Total and active tryptase were measured as early-phase allergy biomarkers (≤30 min) and IL-13 and eosinophil cell counts as late-phase allergy biomarkers (3-7 h) in serum and nasal samples. Period-period reproducibility was assessed by intraclass correlation coefficients (ICC), and sample size estimates were performed using effect sizes measured after INCS. RESULTS NAC significantly induced acute increases in nasosorption tryptase and TNSS and reduced PNIF, and induced late increases in nasosorption IL-13 with sustained reductions in PNIF. Reproducibility across NACs varied for symptoms and biomarkers, with total tryptase 5 min post NAC having the highest reproducibility (ICC = 0.91). Treatment with INCS inhibited NAC-induced IL-13 while blunting changes in TNSS and PNIF. For a similar crossover study, 7 participants per treatment arm are needed to detect treatment effects comparable to INCS for TNSS. CONCLUSION NAC-induced biomarkers and symptoms are reproducible and responsive to INCS. NAC is suitable for assessing pharmacodynamic activity and proof of mechanism for drugs targeting allergic inflammation.
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Affiliation(s)
- Rebecca N Bauer
- Translational Medicine, Genentech Inc, South San Francisco, California, USA
| | - Yanqing Xie
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Suzanne Beaudin
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Lesley Wiltshire
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jennifer Wattie
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Caroline Muñoz
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Nadia Alsaji
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - John Paul Oliveria
- Translational Medicine, Genentech Inc, South San Francisco, California, USA
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Xiaotian Ju
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jonathan MacLean
- Department of Surgery, Otolaryngology-Head & Neck Surgery Division, McMaster University, Hamilton, Ontario, Canada
| | - Doron D Sommer
- Department of Surgery, Otolaryngology-Head & Neck Surgery Division, McMaster University, Hamilton, Ontario, Canada
| | - Paul K Keith
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Imran Satia
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Ruth P Cusack
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Paul M O'Byrne
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Gizette Sperinde
- Translational Medicine, Genentech Inc, South San Francisco, California, USA
| | - Martha Hokom
- Translational Medicine, Genentech Inc, South San Francisco, California, USA
| | - Olga Li
- Translational Medicine, Genentech Inc, South San Francisco, California, USA
| | - Prajna Banerjee
- Translational Medicine, Genentech Inc, South San Francisco, California, USA
| | - Chen Chen
- Translational Medicine, Genentech Inc, South San Francisco, California, USA
| | - Tracy Staton
- Translational Medicine, Genentech Inc, South San Francisco, California, USA
| | - Roma Sehmi
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Gail M Gauvreau
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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Ramu S, Akbarshahi H, Mogren S, Berlin F, Cerps S, Menzel M, Hvidtfeldt M, Porsbjerg C, Uller L, Andersson CK. Direct effects of mast cell proteases, tryptase and chymase, on bronchial epithelial integrity proteins and anti-viral responses. BMC Immunol 2021; 22:35. [PMID: 34078278 PMCID: PMC8170739 DOI: 10.1186/s12865-021-00424-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 05/04/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Mast cells (MCs) are known to contribute to both acute and chronic inflammation. Bronchial epithelial cells are the first line of defence against pathogens and a deficient anti-viral response has been suggested to play a role in the pathogenesis of asthma exacerbations. However, effects of MC mediators on bronchial epithelial immune response have been less studied. The aim of this study is to investigate the direct effects of stimulation with MC proteases, tryptase and chymase, on inflammatory and anti-viral responses in human bronchial epithelial cells (HBECs). METHOD Cultured BEAS-2b cells and primary HBECs from 3 asthmatic patients were stimulated with tryptase or chymase (0.1 to 0.5 μg/ml) for 1, 3, 6 and 24 h. To study the effects of MC mediators on the anti-viral response, cells were stimulated with 10 μg/ml of viral mimic Poly (I:C) for 3 and 24 h following pre-treatment with 0.5 μg/ml tryptase or chymase for 3 h. Samples were analysed for changes in pro-inflammatory and anti-viral mediators and receptors using RT-qPCR, western blot and Luminex. RESULTS Tryptase and chymase induced release of the alarmin ATP and pro-inflammatory mediators IL-8, IL-6, IL-22 and MCP-1 from HBECs. Moreover, tryptase and chymase decreased the expression of E-cadherin and zonula occludens-1 expression from HBECs. Pre-treatment of HBECs with tryptase and chymase further increased Poly (I:C) induced IL-8 release at 3 h. Furthermore, tryptase significantly reduced type-I and III interferons (IFNs) and pattern recognition receptor (PRR) expression in HBECs. Tryptase impaired Poly (I:C) induced IFN and PRR expression which was restored by treatment of a serine protease inhibitor. Similar effects of tryptase on inflammation and anti-viral responses were also confirmed in primary HBECs from asthmatic patients. CONCLUSION MC localization within the epithelium and the release of their proteases may play a critical role in asthma pathology by provoking pro-inflammatory and alarmin responses and downregulating IFNs. Furthermore, MC proteases induce downregulation of epithelial junction proteins which may lead to barrier dysfunction. In summary, our data suggests that mast cells may contribute towards impaired anti-viral epithelial responses during asthma exacerbations mediated by the protease activity of tryptase.
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Affiliation(s)
- Sangeetha Ramu
- Department of Experimental Medical Science, Lund University, Lund, Sweden
| | - Hamid Akbarshahi
- Department of Experimental Medical Science, Lund University, Lund, Sweden.,Department of Respiratory Medicine and Allergology, Lund University, Lund, Sweden
| | - Sofia Mogren
- Department of Experimental Medical Science, Lund University, Lund, Sweden
| | - Frida Berlin
- Department of Experimental Medical Science, Lund University, Lund, Sweden
| | - Samuel Cerps
- Department of Experimental Medical Science, Lund University, Lund, Sweden
| | - Mandy Menzel
- Department of Experimental Medical Science, Lund University, Lund, Sweden
| | - Morten Hvidtfeldt
- Department of Respiratory Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Celeste Porsbjerg
- Department of Respiratory Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Lena Uller
- Department of Experimental Medical Science, Lund University, Lund, Sweden
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Yusin J, Wang V, Henning SM, Yang J, Tseng CH, Thames G, Arnold I, Heber D, Lee RP, Sanavio L, Pan Y, Qin T, Li Z. The Effect of Broccoli Sprout Extract on Seasonal Grass Pollen-Induced Allergic Rhinitis. Nutrients 2021; 13:nu13041337. [PMID: 33920642 PMCID: PMC8074067 DOI: 10.3390/nu13041337] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 03/26/2021] [Accepted: 04/15/2021] [Indexed: 12/15/2022] Open
Abstract
Patients exposed to pollutants are more likely to suffer from allergic rhinitis and may benefit from antioxidant treatment. Our study determined if patients diagnosed with grass-induced allergic rhinitis could benefit from broccoli sprout extract (BSE) supplementation. In total, 47 patients were confirmed with grass-induced allergic rhinitis and randomized to one of four groups: group 1 (nasal steroid spray + BSE), group 2 (nasal steroid spray + placebo tablet), group 3 (saline nasal spray + BSE) and group 4 (saline nasal spray + placebo tablet). Peak Nasal Inspiratory Flow (PNIF), Total Nasal Symptoms Scores (TNSS) and nasal mucus cytokine levels were analyzed in samples collected before and after the 3-week intervention. Comparing before and after the intervention, PNIF improved significantly when comparing Groups 1 and 2, vs. placebo, at various time points (p ≤ 0.05 at 5, 15, 60 and 240 min) following nasal challenge, while TNSS was only statistically significant at 5 (p = 0.03), 15 (p = 0.057) and 30 (p = 0.05) minutes. There were no statistically significant differences in various cytokine markers before and after the intervention. Combining nasal corticosteroid with BSE led to the most significant improvement in objective measures.
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Affiliation(s)
- Joseph Yusin
- Department of Allergy and Immunology, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA; (V.W.); (G.T.); (I.A.); (Z.L.)
- Correspondence: ; Tel.: +1-310-478-3711 (ext. 40230); Fax: +1-310-268-4712
| | - Vivian Wang
- Department of Allergy and Immunology, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA; (V.W.); (G.T.); (I.A.); (Z.L.)
| | - Susanne M. Henning
- Department of Internal Medicine, University of California Los Angeles Medical Center, Los Angeles, CA 90095, USA; (S.M.H.); (J.Y.); (C.-H.T.); (D.H.); (R.-P.L.); (L.S.); (Y.P.); (T.Q.)
| | - Jieping Yang
- Department of Internal Medicine, University of California Los Angeles Medical Center, Los Angeles, CA 90095, USA; (S.M.H.); (J.Y.); (C.-H.T.); (D.H.); (R.-P.L.); (L.S.); (Y.P.); (T.Q.)
| | - Chi-Hong Tseng
- Department of Internal Medicine, University of California Los Angeles Medical Center, Los Angeles, CA 90095, USA; (S.M.H.); (J.Y.); (C.-H.T.); (D.H.); (R.-P.L.); (L.S.); (Y.P.); (T.Q.)
| | - Gail Thames
- Department of Allergy and Immunology, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA; (V.W.); (G.T.); (I.A.); (Z.L.)
- Department of Internal Medicine, University of California Los Angeles Medical Center, Los Angeles, CA 90095, USA; (S.M.H.); (J.Y.); (C.-H.T.); (D.H.); (R.-P.L.); (L.S.); (Y.P.); (T.Q.)
| | - Irina Arnold
- Department of Allergy and Immunology, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA; (V.W.); (G.T.); (I.A.); (Z.L.)
- Department of Internal Medicine, University of California Los Angeles Medical Center, Los Angeles, CA 90095, USA; (S.M.H.); (J.Y.); (C.-H.T.); (D.H.); (R.-P.L.); (L.S.); (Y.P.); (T.Q.)
| | - David Heber
- Department of Internal Medicine, University of California Los Angeles Medical Center, Los Angeles, CA 90095, USA; (S.M.H.); (J.Y.); (C.-H.T.); (D.H.); (R.-P.L.); (L.S.); (Y.P.); (T.Q.)
| | - Ru-Po Lee
- Department of Internal Medicine, University of California Los Angeles Medical Center, Los Angeles, CA 90095, USA; (S.M.H.); (J.Y.); (C.-H.T.); (D.H.); (R.-P.L.); (L.S.); (Y.P.); (T.Q.)
| | - Laura Sanavio
- Department of Internal Medicine, University of California Los Angeles Medical Center, Los Angeles, CA 90095, USA; (S.M.H.); (J.Y.); (C.-H.T.); (D.H.); (R.-P.L.); (L.S.); (Y.P.); (T.Q.)
| | - Yajing Pan
- Department of Internal Medicine, University of California Los Angeles Medical Center, Los Angeles, CA 90095, USA; (S.M.H.); (J.Y.); (C.-H.T.); (D.H.); (R.-P.L.); (L.S.); (Y.P.); (T.Q.)
| | - Tianyu Qin
- Department of Internal Medicine, University of California Los Angeles Medical Center, Los Angeles, CA 90095, USA; (S.M.H.); (J.Y.); (C.-H.T.); (D.H.); (R.-P.L.); (L.S.); (Y.P.); (T.Q.)
| | - Zhaoping Li
- Department of Allergy and Immunology, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA; (V.W.); (G.T.); (I.A.); (Z.L.)
- Department of Internal Medicine, University of California Los Angeles Medical Center, Los Angeles, CA 90095, USA; (S.M.H.); (J.Y.); (C.-H.T.); (D.H.); (R.-P.L.); (L.S.); (Y.P.); (T.Q.)
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Evaluation of the upper airway microbiome and immune response with nasal epithelial lining fluid absorption and nasal washes. Sci Rep 2020; 10:20618. [PMID: 33244064 PMCID: PMC7692476 DOI: 10.1038/s41598-020-77289-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 11/03/2020] [Indexed: 01/04/2023] Open
Abstract
Despite being commonly used to collect upper airway epithelial lining fluid, nasal washes are poorly reproducible, not suitable for serial sampling, and limited by a dilution effect. In contrast, nasal filters lack these limitations and are an attractive alternative. To examine whether nasal filters are superior to nasal washes as a sampling method for the characterization of the upper airway microbiome and immune response, we collected paired nasal filters and washes from a group of 40 healthy children and adults. To characterize the upper airway microbiome, we used 16S ribosomal RNA and shotgun metagenomic sequencing. To characterize the immune response, we measured total protein using a BCA assay and 53 immune mediators using multiplex magnetic bead-based assays. We conducted statistical analyses to compare common microbial ecology indices and immune-mediator median fluorescence intensities (MFIs) between sample types. In general, nasal filters were more likely to pass quality control in both children and adults. There were no significant differences in microbiome community richness, α-diversity, or structure between pediatric samples types; however, these were all highly dissimilar between adult sample types. In addition, there were significant differences in the abundance of amplicon sequence variants between sample types in children and adults. In adults, total proteins were significantly higher in nasal filters than nasal washes; consequently, the immune-mediator MFIs were not well detected in nasal washes. Based on better quality control sequencing metrics and higher immunoassay sensitivity, our results suggest that nasal filters are a superior sampling method to characterize the upper airway microbiome and immune response in both children and adults.
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Kuga K, Ito K, Chen W, Wang P, Kumagai K. A numerical investigation of the potential effects of e-cigarette smoking on local tissue dosimetry and the deterioration of indoor air quality. INDOOR AIR 2020; 30:1018-1038. [PMID: 32159877 DOI: 10.1111/ina.12666] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 02/19/2020] [Accepted: 03/09/2020] [Indexed: 05/28/2023]
Abstract
Electronic (e)-cigarette smoking is considered to be less harmful than traditional tobacco smoking because of the lack of a combustion process. However, e-cigarettes have the potential to release harmful chemicals depending on the constituents of the vapor. To date, there has been significant evidence on the adverse health effects of e-cigarette usage. However, what is less known are the impacts of the chemicals contained in exhaled air from an e-cigarette smoker on indoor air quality, the second-hand passive smoking of residents, and the toxicity of the exhaled air. In this study, we develop a comprehensive numerical model and computer-simulated person to investigate the potential effects of e-cigarette smoking on local tissue dosimetry and the deterioration of indoor air quality. We also conducted demonstrative numerical analyses for first-hand and second-hand e-cigarette smoking in an indoor environment. To investigate local tissue dosimetry, we used newly developed physiologically based pharmacokinetic/toxicokinetic models that reproduce inhalation exposure by way of the respiratory tract and dermal exposure through the human skin surface. These models were integrated into the computer-simulated person. Our numerical simulation results quantitatively demonstrated the potential impacts of e-cigarette smoking in enclosed spaces on indoor air quality.
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Affiliation(s)
- Kazuki Kuga
- Interdisciplinary Graduate School of Engineering Sciences, Kyushu University, Kasuga, Japan
| | - Kazuhide Ito
- Faculty of Engineering Sciences, Kyushu University, Kasuga, Japan
| | - Wenhao Chen
- Indoor Air Quality Program, Environmental Health Laboratory, California Department of Public Health, Richmond, CA, USA
| | - Ping Wang
- Indoor Air Quality Program, Environmental Health Laboratory, California Department of Public Health, Richmond, CA, USA
| | - Kazukiyo Kumagai
- Indoor Air Quality Program, Environmental Health Laboratory, California Department of Public Health, Richmond, CA, USA
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Berghi O, Dumitru M, Caragheorgheopol R, Tucureanu C, Simioniuc-Petrescu A, Sfrent-Cornateanu R, Giurcaneanu C. The Relationship between Chemokine Ligand 3 and Allergic Rhinitis. Cureus 2020; 12:e7783. [PMID: 32461855 PMCID: PMC7243633 DOI: 10.7759/cureus.7783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 04/22/2020] [Indexed: 11/05/2022] Open
Abstract
Background Allergic rhinitis (AR) is a chronic and frequent condition characterized by an excessive response of the immune system to innocent substances encountered in the nasal mucosa. These reactions are mediated by many factors, including chemokines. Chemokine ligand 3 (CCL3, a macrophage inflammatory protein 1α) is a chemokine implicated in the activation of mast cells - white cells shown to be highly involved in orchestrating allergic reactions. The present study evaluated the role of CCL3 in AR. Material and methods Thirty-nine participants, including 24 patients with AR and 15 healthy controls, were evaluated for allergies to dust mites, cat and dog danders, cockroaches (Blatella germanica), molds, grasses, weeds, and tree pollen using skin prick tests. Participants were also evaluated for inflammatory conditions by measuring total blood count with differential; concentrations of rheumatoid factor, fibrinogen, and C-reactive protein; and erythrocyte sedimentation rate. CCL3 in blood samples was measured at the Immunology Laboratory, Cantacuzino National Institute for Military Medical Research and Development, Bucharest, Romania, using Human Multianalyte Profiling Base Kits (R&D Systems Inc., Minneapolis, MN). Results Mean serum CCL3 concentration was significantly higher in patients with AR than in controls (15.03 ± 7.11 pg/ml vs. 8.34 ± 4.46 pg/ml, p = 0.001 [t-test] and p = 0.026 [Mann-Whitney test]). CCL3 concentrations correlated with polysensitization, defined as two or more positive prick tests per patient (r = 0.325, p = 0.046) and seasonal AR (r = 0.482, p = 0.002). Conclusions Elevated levels of CCL3 were seen in our patients with AR. We have observed correlations with polysensitization and seasonal allergies. These results suggest that chemokines might play an important role in the pathogenesis of AR. In the future, chemokines might be used in endotype classification of patients with AR and as a possible target in the treatment of AR.
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Affiliation(s)
- Ovidiu Berghi
- Dermatology, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
| | - Mihai Dumitru
- Anatomy, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
| | - Ramona Caragheorgheopol
- Immunology, Immunology Laboratory, "Cantacuzino" National Institute for Military Medical Research and Development, Bucharest, ROU
- Immunology, University of Bucharest, Bucharest, ROU
| | - Catalin Tucureanu
- Immunology, Immunology Laboratory, "Cantacuzino" National Institute for Military Medical Research and Development, Bucharest, ROU
| | | | - Roxana Sfrent-Cornateanu
- Immunology and Pathophysiology, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
| | - Calin Giurcaneanu
- Oncologic Dermatology, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
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Tomazic PV, Darnhofer B, Birner-Gruenberger R. Nasal mucus proteome and its involvement in allergic rhinitis. Expert Rev Proteomics 2020; 17:191-199. [PMID: 32266843 PMCID: PMC7261402 DOI: 10.1080/14789450.2020.1748502] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Introduction: Nasal mucus is the first line defense barrier against various pathogens including allergens. Proteins in nasal mucus maybe used as biomarkers for diagnosis or future therapeutic strategies. Proteomics opens the possibility to investigate whole human proteomes. Areas Covered: We aimed to analyze the existing literature on nasal mucus and nasal secretions proteomic approaches especially in allergic rhinitis. A PubMed/Medline search was conducted entering the following keywords and combinations: “nasal mucus”, “nasal lavage fluid,” nasal secretions,” “nasal swabs,” “allergic rhinitis,” ”proteins,” and “proteomics.” Expert opinion: The majority of studies focus on single proteins or protein groups mainly using ELISA techniques. Four studies met the criteria using mass spectrometry in the analysis of nasal mucus proteomes in rhinologic diseases. In these studies, 7, 35, 267, and 430 proteins were identified, respectively. These four studies are discussed in this review and put in relation to seven other proteomic studies that focus on nasal lavage fluid and nasal secretions obtained by swabs or filter paper. To put it in a nutshell, proteomics facilitates the investigation of the nasal secretome and its role in healthy and diseased state and as potential biomarkers for new diagnostic or therapeutic approaches.
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Affiliation(s)
| | - Barbara Darnhofer
- Diagnostic and Research Institute of Pathology, Diagnostic and Research Center of Molecular Medicine, Medical University of Graz, Graz, Austria.,BioTechMed-Graz, The Omics Center Graz, Graz, Austria
| | - Ruth Birner-Gruenberger
- Diagnostic and Research Institute of Pathology, Diagnostic and Research Center of Molecular Medicine, Medical University of Graz, Graz, Austria.,BioTechMed-Graz, The Omics Center Graz, Graz, Austria.,Institute of Chemical Technologies and Analytics, Vienna University of Technology, Vienna, Austria
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Strehl C, Ehlers L, Gaber T, Buttgereit F. Glucocorticoids-All-Rounders Tackling the Versatile Players of the Immune System. Front Immunol 2019; 10:1744. [PMID: 31396235 PMCID: PMC6667663 DOI: 10.3389/fimmu.2019.01744] [Citation(s) in RCA: 158] [Impact Index Per Article: 31.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 07/10/2019] [Indexed: 12/13/2022] Open
Abstract
Glucocorticoids regulate fundamental processes of the human body and control cellular functions such as cell metabolism, growth, differentiation, and apoptosis. Moreover, endogenous glucocorticoids link the endocrine and immune system and ensure the correct function of inflammatory events during tissue repair, regeneration, and pathogen elimination via genomic and rapid non-genomic pathways. Due to their strong immunosuppressive, anti-inflammatory and anti-allergic effects on immune cells, tissues and organs, glucocorticoids significantly improve the quality of life of many patients suffering from diseases caused by a dysregulated immune system. Despite the multitude and seriousness of glucocorticoid-related adverse events including diabetes mellitus, osteoporosis and infections, these agents remain indispensable, representing the most powerful, and cost-effective drugs in the treatment of a wide range of rheumatic diseases. These include rheumatoid arthritis, vasculitis, and connective tissue diseases, as well as many other pathological conditions of the immune system. Depending on the therapeutically affected cell type, glucocorticoid actions strongly vary among different diseases. While immune responses always represent complex reactions involving different cells and cellular processes, specific immune cell populations with key responsibilities driving the pathological mechanisms can be identified for certain autoimmune diseases. In this review, we will focus on the mechanisms of action of glucocorticoids on various leukocyte populations, exemplarily portraying different autoimmune diseases as heterogeneous targets of glucocorticoid actions: (i) Abnormalities in the innate immune response play a crucial role in the initiation and perpetuation of giant cell arteritis (GCA). (ii) Specific types of CD4+ T helper (Th) lymphocytes, namely Th1 and Th17 cells, represent important players in the establishment and course of rheumatoid arthritis (RA), whereas (iii) B cells have emerged as central players in systemic lupus erythematosus (SLE). (iv) Allergic reactions are mainly triggered by several different cytokines released by activated Th2 lymphocytes. Using these examples, we aim to illustrate the versatile modulating effects of glucocorticoids on the immune system. In contrast, in the treatment of lymphoproliferative disorders the pro-apoptotic action of glucocorticoids prevails, but their mechanisms differ depending on the type of cancer. Therefore, we will also give a brief insight into the current knowledge of the mode of glucocorticoid action in oncological treatment focusing on leukemia.
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Affiliation(s)
- Cindy Strehl
- Department of Rheumatology and Clinical Immunology, Charité—Universitätsmedizin Berlin, Berlin, Germany
- German Rheumatism Research Centre (DRFZ) Berlin, Berlin, Germany
| | - Lisa Ehlers
- Department of Rheumatology and Clinical Immunology, Charité—Universitätsmedizin Berlin, Berlin, Germany
- German Rheumatism Research Centre (DRFZ) Berlin, Berlin, Germany
| | - Timo Gaber
- Department of Rheumatology and Clinical Immunology, Charité—Universitätsmedizin Berlin, Berlin, Germany
- German Rheumatism Research Centre (DRFZ) Berlin, Berlin, Germany
| | - Frank Buttgereit
- Department of Rheumatology and Clinical Immunology, Charité—Universitätsmedizin Berlin, Berlin, Germany
- German Rheumatism Research Centre (DRFZ) Berlin, Berlin, Germany
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10
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Pantin CT, Southworth T, Wetzel K, Singh D. Reproducibility of nasal allergen challenge responses in adults with allergic rhinitis. Clin Pharmacol 2019; 11:67-76. [PMID: 31191044 PMCID: PMC6521845 DOI: 10.2147/cpaa.s184404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background Allergic rhinitis is characterized by nasal inflammation in response to allergen exposure. Nasal allergen challenges are used in clinical trials evaluating drug effects. Reproducibility of nasal secretion cytokine responses and physiological measurements are needed to determine the optimum measurements and power calculations for future studies. We have investigated the reproducibility of nasal cytokine measurements, using ready-to-use polyvinyl acetate sponges to collect nasal secretions, and measurements of nasal physiological responses. Methods Twelve subjects with allergic rhinitis and no history of respiratory disease, and 12 subjects with asthma and allergic rhinitis underwent a nasal allergen challenge. This was repeated at 7-14 days later. Results There were increases in IL-5, CCL11, and CXCL8 responses post-challenge (all P<0.05). There was better reproducibility at later time points when higher cytokine levels were detected for IL-5 (ri =0.64 at 8 hours) and CXCL8 (ri =0.91 at 8 hours). Acoustic rhinometry provided good to excellent reproducibility (ri =0.66-0.89). Rhinomanometry had lower reproducibility with greater variation (ri =0.10-0.70), with some subjects unable to perform the measurement. Multiplex immunoassays provided greater sensitivity for CCL11 measurements. There were no differences between allergic rhinitis patients with and without asthma. Conclusion Polyvinyl acetate sponges are a practical and reproducible way to sample nasal secretions. Acoustic rhinometry is a practical and reproducible method for assessing physiological responses. There were no differences in nasal response due to the presence of concurrent asthma.
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Affiliation(s)
- Charles T Pantin
- Medicines Evaluation Unit, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, University of Manchester, Manchester, UK,
| | - Thomas Southworth
- Medicines Evaluation Unit, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, University of Manchester, Manchester, UK,
| | - Kristiane Wetzel
- Translational Medicine and Clinical Pharmacology, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach an der Riss, Germany
| | - Dave Singh
- Medicines Evaluation Unit, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, University of Manchester, Manchester, UK,
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Bjermer L, Westman M, Holmström M, Wickman MC. The complex pathophysiology of allergic rhinitis: scientific rationale for the development of an alternative treatment option. Allergy Asthma Clin Immunol 2019; 15:24. [PMID: 31015846 PMCID: PMC6469109 DOI: 10.1186/s13223-018-0314-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 12/20/2018] [Indexed: 01/27/2023] Open
Abstract
Allergic rhinitis (AR) poses a global health problem and can be challenging to treat. Many of the current symptomatic treatments for AR have been available for decades, yet there has been little improvement in patient quality of life or symptom burden over the years. In this review, we ask why this might be and explore the pathophysiological gaps that exist within the various AR treatment classes. We focus on the benefits and drawbacks of different treatment options and delivery routes for AR treatments and consider how, given what is known about AR pathophysiology and symptomatology, patients may be offered more effective treatment options for rapid, effective, and sustained AR control. In particular, we consider how a new AR preparation, MP-AzeFlu (Dymista®, Meda, Sweden), comprising a formulation of an intranasal antihistamine (azelastine hydrochloride), an intranasal corticosteroid (fluticasone propionate), and excipients delivered in a single spray, may offer benefits over and above single and multiple AR therapy options. We review the evidence in support of this treatment across the spectrum of AR disease. The concept of AR control is also reviewed within the context of new European Union and Contre les Maladies Chroniques pour un VIeillissement Actif-Allergic Rhinitis and its Impact on Asthma initiatives.
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Affiliation(s)
- Leif Bjermer
- 1Department of Respiratory Medicine & Allergology, Skane University Hospital, 22185, Lund, Sweden
| | - Marit Westman
- 2Dept. of ENT-diseases, Karolinska University Hospital, 171 76 Stockholm, Sweden.,3Immunology and Allergy Unit, Department of Medicine Solna, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Mats Holmström
- 4Dept. of Clinical Science, Intervention and Technology, Division of Ear, Nose and Throat Diseases, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Magnus C Wickman
- 5Department of Environmental Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden.,Sach's Children's Hospital, 118 83 Stockholm, Sweden
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12
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Watts AM, Cripps AW, West NP, Cox AJ. Modulation of Allergic Inflammation in the Nasal Mucosa of Allergic Rhinitis Sufferers With Topical Pharmaceutical Agents. Front Pharmacol 2019; 10:294. [PMID: 31001114 PMCID: PMC6455085 DOI: 10.3389/fphar.2019.00294] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 03/11/2019] [Indexed: 12/14/2022] Open
Abstract
Allergic rhinitis (AR) is a chronic upper respiratory disease estimated to affect between 10 and 40% of the worldwide population. The mechanisms underlying AR are highly complex and involve multiple immune cells, mediators, and cytokines. As such, the development of a single drug to treat allergic inflammation and/or symptoms is confounded by the complexity of the disease pathophysiology. Complete avoidance of allergens that trigger AR symptoms is not possible and without a cure, the available therapeutic options are typically focused on achieving symptomatic relief. Topical therapies offer many advantages over oral therapies, such as delivering greater concentrations of drugs to the receptor sites at the source of the allergic inflammation and the reduced risk of systemic side effects. This review describes the complex pathophysiology of AR and identifies the mechanism(s) of action of topical treatments including antihistamines, steroids, anticholinergics, decongestants and chromones in relation to AR pathophysiology. Following the literature review a discussion on the future therapeutic strategies for AR treatment is provided.
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Affiliation(s)
- Annabelle M. Watts
- Menzies Health Institute Queensland, School of Medical Science, Griffith University, Southport, QLD, Australia
| | - Allan W. Cripps
- Menzies Health Institute Queensland, School of Medicine, Griffith University, Southport, QLD, Australia
| | - Nicholas P. West
- Menzies Health Institute Queensland, School of Medical Science, Griffith University, Southport, QLD, Australia
| | - Amanda J. Cox
- Menzies Health Institute Queensland, School of Medical Science, Griffith University, Southport, QLD, Australia
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13
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Wise SK, Lin SY, Toskala E, Orlandi RR, Akdis CA, Alt JA, Azar A, Baroody FM, Bachert C, Canonica GW, Chacko T, Cingi C, Ciprandi G, Corey J, Cox LS, Creticos PS, Custovic A, Damask C, DeConde A, DelGaudio JM, Ebert CS, Eloy JA, Flanagan CE, Fokkens WJ, Franzese C, Gosepath J, Halderman A, Hamilton RG, Hoffman HJ, Hohlfeld JM, Houser SM, Hwang PH, Incorvaia C, Jarvis D, Khalid AN, Kilpeläinen M, Kingdom TT, Krouse H, Larenas-Linnemann D, Laury AM, Lee SE, Levy JM, Luong AU, Marple BF, McCoul ED, McMains KC, Melén E, Mims JW, Moscato G, Mullol J, Nelson HS, Patadia M, Pawankar R, Pfaar O, Platt MP, Reisacher W, Rondón C, Rudmik L, Ryan M, Sastre J, Schlosser RJ, Settipane RA, Sharma HP, Sheikh A, Smith TL, Tantilipikorn P, Tversky JR, Veling MC, Wang DY, Westman M, Wickman M, Zacharek M. International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis. Int Forum Allergy Rhinol 2018; 8:108-352. [PMID: 29438602 PMCID: PMC7286723 DOI: 10.1002/alr.22073] [Citation(s) in RCA: 218] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 12/01/2017] [Accepted: 12/01/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Critical examination of the quality and validity of available allergic rhinitis (AR) literature is necessary to improve understanding and to appropriately translate this knowledge to clinical care of the AR patient. To evaluate the existing AR literature, international multidisciplinary experts with an interest in AR have produced the International Consensus statement on Allergy and Rhinology: Allergic Rhinitis (ICAR:AR). METHODS Using previously described methodology, specific topics were developed relating to AR. Each topic was assigned a literature review, evidence-based review (EBR), or evidence-based review with recommendations (EBRR) format as dictated by available evidence and purpose within the ICAR:AR document. Following iterative reviews of each topic, the ICAR:AR document was synthesized and reviewed by all authors for consensus. RESULTS The ICAR:AR document addresses over 100 individual topics related to AR, including diagnosis, pathophysiology, epidemiology, disease burden, risk factors for the development of AR, allergy testing modalities, treatment, and other conditions/comorbidities associated with AR. CONCLUSION This critical review of the AR literature has identified several strengths; providers can be confident that treatment decisions are supported by rigorous studies. However, there are also substantial gaps in the AR literature. These knowledge gaps should be viewed as opportunities for improvement, as often the things that we teach and the medicine that we practice are not based on the best quality evidence. This document aims to highlight the strengths and weaknesses of the AR literature to identify areas for future AR research and improved understanding.
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Affiliation(s)
| | | | | | | | - Cezmi A. Akdis
- Allergy/Asthma, Swiss Institute of Allergy and Asthma Research, Switzerland
| | | | - Antoine Azar
- Allergy/Immunology, Johns Hopkins University, USA
| | | | | | | | | | - Cemal Cingi
- Otolaryngology, Eskisehir Osmangazi University, Turkey
| | | | | | | | | | | | | | - Adam DeConde
- Otolaryngology, University of California San Diego, USA
| | | | | | | | | | | | | | - Jan Gosepath
- Otorhinolaryngology, Helios Kliniken Wiesbaden, Germany
| | | | | | | | - Jens M. Hohlfeld
- Respiratory Medicine, Hannover Medical School, Airway Research Fraunhofer Institute for Toxicology and Experimental Medicine, German Center for Lung Research, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | | - Amber U. Luong
- Otolaryngology, McGovern Medical School at the University of Texas Health Science Center Houston, USA
| | | | | | | | - Erik Melén
- Pediatric Allergy, Karolinska Institutet, Sweden
| | | | | | - Joaquim Mullol
- Otolaryngology, Universitat de Barcelona, Hospital Clinic, IDIBAPS, Spain
| | | | | | | | - Oliver Pfaar
- Rhinology/Allergy, Medical Faculty Mannheim, Heidelberg University, Center for Rhinology and Allergology, Wiesbaden, Germany
| | | | | | - Carmen Rondón
- Allergy, Regional University Hospital of Málaga, Spain
| | - Luke Rudmik
- Otolaryngology, University of Calgary, Canada
| | - Matthew Ryan
- Otolaryngology, University of Texas Southwestern, USA
| | - Joaquin Sastre
- Allergology, Hospital Universitario Fundacion Jiminez Diaz, Spain
| | | | | | - Hemant P. Sharma
- Allergy/Immunology, Children's National Health System, George Washington University School of Medicine, USA
| | | | | | | | | | | | - De Yun Wang
- Otolaryngology, National University of Singapore, Singapore
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Badorrek P, Müller M, Koch W, Hohlfeld JM, Krug N. Specificity and reproducibility of nasal biomarkers in patients with allergic rhinitis after allergen challenge chamber exposure. Ann Allergy Asthma Immunol 2017; 118:290-297. [PMID: 28284536 DOI: 10.1016/j.anai.2017.01.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 01/05/2017] [Accepted: 01/18/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Allergic rhinitis is an inflammatory disease that causes cellular influx and mediator release in the nose. These inflammatory changes might be used as nasal biomarkers to assess the efficacy of novel anti-allergic treatments. OBJECTIVE To assess the specificity and reproducibility of nasal biomarkers in patients with allergic rhinitis after grass pollen exposure in an allergen challenge chamber. METHODS In a monocenter pilot study, 15 patients with allergic rhinitis and 19 healthy individuals underwent two 4-hour Dactylis glomerate pollen challenges in the challenge chamber with an interval of 21 days. Before challenge, on exit, and after 2 and 22 hours, a nasal lavage was performed and nasal secretions were collected on filter paper to determine a wide panel of cells and mediators. Furthermore, total nasal symptom score, nasal flow, and nasal nitric oxide were measured. RESULTS Pollen exposure significantly increased eosinophil, interleukin (IL) 5, IL-6, IL-13, and macrophage inflammatory protein 1β levels in allergic patients but not in healthy individuals. The effect could be reproduced for eosinophils, IL-5, IL-6, and macrophage inflammatory protein 1β after the second allergen challenge. By contrast, the IL-13 levels were higher and eotaxin levels first increased after repetitive allergen challenge. There was no correlation between total nasal symptom score and elevated cell or cytokine levels. Nasal nitric oxide levels were nonspecifically elevated in both patients with allergy and healthy controls. CONCLUSION A subset of cellular and soluble biomarkers in nasal lavage and secretion reveals specificity and reproducibility in patients with allergic rhinitis. These can be used to measure the immunologic efficacy of antiallergic treatments in an allergen challenge chamber. Carryover effects attributable to priming must be considered when designing cross-over studies. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00297843.
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Affiliation(s)
- Philipp Badorrek
- Fraunhofer Institute of Toxicology and Experimental Medicine, Hannover, Germany.
| | - Meike Müller
- Fraunhofer Institute of Toxicology and Experimental Medicine, Hannover, Germany
| | - Wolfgang Koch
- Fraunhofer Institute of Toxicology and Experimental Medicine, Hannover, Germany
| | - Jens M Hohlfeld
- Fraunhofer Institute of Toxicology and Experimental Medicine, Hannover, Germany; German Center for Lung Research, Biomedical Research in Endstage and Obstructive Lung Research, Hannover, Germany
| | - Norbert Krug
- Fraunhofer Institute of Toxicology and Experimental Medicine, Hannover, Germany; German Center for Lung Research, Biomedical Research in Endstage and Obstructive Lung Research, Hannover, Germany
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15
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Zissler UM, Esser-von Bieren J, Jakwerth CA, Chaker AM, Schmidt-Weber CB. Current and future biomarkers in allergic asthma. Allergy 2016; 71:475-94. [PMID: 26706728 DOI: 10.1111/all.12828] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2015] [Indexed: 12/12/2022]
Abstract
Diagnosis early in life, sensitization, asthma endotypes, monitoring of disease and treatment progression are key motivations for the exploration of biomarkers for allergic rhinitis and allergic asthma. The number of genes related to allergic rhinitis and allergic asthma increases steadily; however, prognostic genes have not yet entered clinical application. We hypothesize that the combination of multiple genes may generate biomarkers with prognostic potential. The current review attempts to group more than 161 different potential biomarkers involved in respiratory inflammation to pave the way for future classifiers. The potential biomarkers are categorized into either epithelial or infiltrate-derived or mixed origin, epithelial biomarkers. Furthermore, surface markers were grouped into cell-type-specific categories. The current literature provides multiple biomarkers for potential asthma endotypes that are related to T-cell phenotypes such as Th1, Th2, Th9, Th17, Th22 and Tregs and their lead cytokines. Eosinophilic and neutrophilic asthma endotypes are also classified by epithelium-derived CCL-26 and osteopontin, respectively. There are currently about 20 epithelium-derived biomarkers exclusively derived from epithelium, which are likely to innovate biomarker panels as they are easy to sample. This article systematically reviews and categorizes genes and collects current evidence that may promote these biomarkers to become part of allergic rhinitis or allergic asthma classifiers with high prognostic value.
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Affiliation(s)
- U. M. Zissler
- Center of Allergy & Environment (ZAUM); Technical University of Munich and Helmholtz Center Munich; German Research Center for Environmental Health member of the German Center for Lung Research (DZL); Munich Germany
| | - J. Esser-von Bieren
- Center of Allergy & Environment (ZAUM); Technical University of Munich and Helmholtz Center Munich; German Research Center for Environmental Health member of the German Center for Lung Research (DZL); Munich Germany
| | - C. A. Jakwerth
- Center of Allergy & Environment (ZAUM); Technical University of Munich and Helmholtz Center Munich; German Research Center for Environmental Health member of the German Center for Lung Research (DZL); Munich Germany
| | - A. M. Chaker
- Center of Allergy & Environment (ZAUM); Technical University of Munich and Helmholtz Center Munich; German Research Center for Environmental Health member of the German Center for Lung Research (DZL); Munich Germany
- Department of Otorhinolaryngology and Head and Neck Surgery; Medical School; Technical University of Munich; Munich Germany
| | - C. B. Schmidt-Weber
- Center of Allergy & Environment (ZAUM); Technical University of Munich and Helmholtz Center Munich; German Research Center for Environmental Health member of the German Center for Lung Research (DZL); Munich Germany
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16
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Špadijer-Mirković C, Perić A, Belić B, Vojvodić D. Clara cell protein 16 and eosinophil cationic protein production in chronically inflamed sinonasal mucosa. Int Forum Allergy Rhinol 2016; 6:529-36. [DOI: 10.1002/alr.21710] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 11/22/2015] [Accepted: 12/03/2015] [Indexed: 01/23/2023]
Affiliation(s)
- Cveta Špadijer-Mirković
- Department of Otorhinolaryngology, Rhinology Unit, Faculty of Medicine; Military Medical Academy; Belgrade Serbia
| | - Aleksandar Perić
- Department of Otorhinolaryngology, Rhinology Unit, Faculty of Medicine; Military Medical Academy; Belgrade Serbia
| | - Branislav Belić
- Department of Otorhinolaryngology, Faculty of Medical Sciences; Clinical Centre Kragujevac; Kragujevac Serbia
| | - Danilo Vojvodić
- Institute for Medical Research, Division of Clinical and Experimental Immunology, Faculty of Medicine; Military Medical Academy; Belgrade Serbia
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Leaker BR, Scadding G, Jones CR, Barnes PJ. Using magnetic resonance imaging to quantify the inflammatory response following allergen challenge in allergic rhinitis. IMMUNITY INFLAMMATION AND DISEASE 2015; 3:445-54. [PMID: 26733348 PMCID: PMC4693719 DOI: 10.1002/iid3.86] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 08/18/2015] [Accepted: 09/02/2015] [Indexed: 11/10/2022]
Abstract
Current rhinometric and flow assessments measure nasal patency and are often poorly correlated with rhinitis symptoms. To evaluate magnetic resonance imaging (MRI) as a new method to measure inflammatory changes in nasal and sinus mucosa following nasal allergen challenge. A pilot study (n = 6) determined the optimal technical settings for MRI to measure inflammatory change which were then adopted for the main study. This study was a single blind, placebo‐controlled, three‐way crossover trial in 14 subjects with seasonal allergic rhinitis. Effects of cetirizine, cetirizine and pseudoephedrine (Cet+PE), or placebo on total nasal symptom scores (TNSS), peak nasal inspiratory flow (PNIF), nasal nitric oxide (nNO), acoustic rhinometry, and MRI end points following nasal intranasal allergen challenge were measured. There were significant changes in all parameters after allergen challenge (P < 0.01), except for nNO. MRI end points were less variable and more consistent than PNIF and acoustic rhinometry in detecting changes after allergen challenge. Total nasal airspace volume was the most sensitive and reproducible MRI measurement, with a mean reduction from −5.37 cm3 (95%CI −7.35, −3.38; P < 0.001), which was maximal 60 min after allergen challenge. A change of one in TNSS corresponded to a change in MRI volume of −0.57 cm3. There was an improvement in all parameters (except nNO) in subjects taking Cet+PE compared with placebo, however this did not achieve significance probably because of the small study size (overall analysis P > 0.07; comparison of active versus placebo P > 0.09). MRI provides novel insights into the anatomical inflammatory changes post allergen challenge and provides a new method for assessment of nasal patency and objective measurement of inflammatory responses.
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Affiliation(s)
| | - Glenis Scadding
- Royal National Throat Nose and Ear Hospital London WC1X 8DA UK
| | | | - Peter J Barnes
- National Heart and Lung Institute Imperial College London SW3 6LY UK
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18
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Nasal Lipopolysaccharide Challenge and Cytokine Measurement Reflects Innate Mucosal Immune Responsiveness. PLoS One 2015; 10:e0135363. [PMID: 26367003 PMCID: PMC4569396 DOI: 10.1371/journal.pone.0135363] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 07/18/2015] [Indexed: 01/27/2023] Open
Abstract
Background Practical methods of monitoring innate immune mucosal responsiveness are lacking. Lipopolysaccharide (LPS) is a component of the cell wall of Gram negative bacteria and a potent activator of Toll-like receptor (TLR)-4. To measure LPS responsiveness of the nasal mucosa, we administered LPS as a nasal spray and quantified chemokine and cytokine levels in mucosal lining fluid (MLF). Methods We performed a 5-way cross-over, single blind, placebo-controlled study in 15 healthy non-atopic subjects (n = 14 per protocol). Doses of ultrapure LPS (1, 10, 30 or 100μg/100μl) or placebo were administered by a single nasal spray to each nostril. Using the recently developed method of nasosorption with synthetic adsorptive matrices (SAM), a series of samples were taken. A panel of seven cytokines/chemokines were measured by multiplex immunoassay in MLF. mRNA for intercellular cell adhesion molecule-1 (ICAM-1) was quantified from nasal epithelial curettage samples taken before and after challenge. Results Topical nasal LPS was well tolerated, causing no symptoms and no visible changes to the nasal mucosa. LPS induced dose-related increases in MLF levels of IL-1β, IL-6, CXCL8 (IL-8) and CCL3 (MIP-1α) (AUC at 0.5 to 10h, compared to placebo, p<0.05 at 30 and 100μg LPS). At 100μg LPS, IL-10, IFN-α and TNF-α were also increased (p<0.05). Dose-related changes in mucosal ICAM-1 mRNA were also seen after challenge, and neutrophils appeared to peak in MLF at 8h. However, 2 subjects with high baseline cytokine levels showed prominent cytokine and chemokine responses to relatively low LPS doses (10μg and 30μg LPS). Conclusions Topical nasal LPS causes dose-dependent increases in cytokines, chemokines, mRNA and cells. However, responsiveness can show unpredictable variations, possibly because baseline innate tone is affected by environmental factors. We believe that this new technique will have wide application in the study of the innate immune responses of the respiratory mucosa. Key Messages Ultrapure LPS was used as innate immune stimulus in a human nasal challenge model, with serial sampling of nasal mucosal lining fluid (MLF) by nasosorption using a synthetic absorptive matrix (SAM), and nasal curettage of mucosal cells. A dose response could be demonstrated in terms of levels of IL-1β, IL-6, CXCL8 and CCL3 in MLF, as well as ICAM-1 mRNA in nasal curettage specimens, and levels of neutrophils in nasal lavage. Depending on higher baseline levels of inflammation, there were occasional magnified innate inflammatory responses to LPS. Trial Registration Clinical Trials.gov NCT02284074
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The paradigm of cytokine networks in allergic airway inflammation. Curr Opin Allergy Clin Immunol 2015; 15:41-8. [PMID: 25479317 DOI: 10.1097/aci.0000000000000129] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW Cytokines are immunomodulatory proteins important in cell signaling. Complex interactions of innate and adaptive immune cells, as well as structural cells and their cytokines, play crucial roles in regulating allergic airway inflammation. Here, we summarize current knowledge about the potential roles of known and newly identified helper T cells and epithelial cell-derived cytokines [interleukin (IL)-9, IL-17, IL-22, IL-25, and IL-33] in allergic rhinitis and asthma. RECENT FINDINGS Although T-helper (Th)2 cells were considered to be the main orchestrators of allergic airway inflammation, recent studies have revealed the potential interaction of other helper T cells and their cytokines in this process. Th17 cells may have a role in allergic rhinitis and asthma, and chronic rhinosinusitis with nasal polyps. An IL-9-producing subset called Th9 cells, Th22 cells which primarily secrete IL-22, IL-13, tumor necrosis factor-α, Th25 cells via producing IL-25 and epithelial cell-derived thymic stromal lymphopoietin, IL-33, IL-31, and IL-25 are believed to be important for the initiation of allergic reactions and inducing airway inflammation. SUMMARY A new paradigm of an interplay of cytokines is important in allergic rhinitis and asthma in orchestrating the allergic inflammatory response. Potential therapeutic applications emerging from the roles of these cytokines are promising, but need further research.
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TROPOS: designing a clinical trial to evaluate the oral corticosteroid-sparing effect of a biologic in severe asthma. ACTA ACUST UNITED AC 2015. [DOI: 10.4155/cli.15.37] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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21
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Scadding GW, Eifan AO, Lao‐Araya M, Penagos M, Poon SY, Steveling E, Yan R, Switzer A, Phippard D, Togias A, Shamji MH, Durham SR. Effect of grass pollen immunotherapy on clinical and local immune response to nasal allergen challenge. Allergy 2015; 70:689-96. [PMID: 25773990 PMCID: PMC4826905 DOI: 10.1111/all.12608] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2015] [Indexed: 02/03/2023]
Abstract
Rationale Nasal allergen provocations may be useful in investigating the pathophysiology of allergic rhinitis and effects of treatments. Objective To use grass pollen nasal allergen challenge (NAC) to investigate the effects of allergen immunotherapy in a cross‐sectional study. Methods We studied nasal and cutaneous responses in untreated subjects with seasonal grass‐pollen allergic rhinitis (n = 14) compared with immunotherapy‐treated allergics (n = 14), plus a nonatopic control group (n = 14). Volunteers underwent a standardized NAC with 2000 biological units of timothy grass allergen (equivalent to 1.3 μg major allergen, Phl p5). Nasal fluid was collected and analysed by ImmunoCAP and multiplex assays. Clinical response was assessed by symptom scores and peak nasal inspiratory flow (PNIF). Cutaneous response was measured by intradermal allergen injection. Retrospective seasonal symptom questionnaires were also completed. Results Immunotherapy‐treated patients had lower symptom scores (P = 0.04) and higher PNIF (P = 0.02) after challenge than untreated allergics. They had reduced early (P = 0.0007) and late (P < 0.0001) skin responses, and lower retrospective seasonal symptom scores (P < 0.0001). Compared to untreated allergics, immunotherapy‐treated patients had reduced nasal fluid concentrations of IL‐4, IL‐9 and eotaxin (all P < 0.05, 8 h level and/or area under the curve comparison), and trends for reduced IL‐13 (P = 0.07, area under the curve) and early‐phase tryptase levels (P = 0.06). Conclusions Nasal allergen challenge is sensitive in the detection of clinical and biological effects of allergen immunotherapy and may be a useful surrogate marker of treatment efficacy in future studies.
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Affiliation(s)
- G. W. Scadding
- Allergy and Clinical Immunology National Heart and Lung Institute Imperial College London London UK
| | - A. O. Eifan
- Allergy and Clinical Immunology National Heart and Lung Institute Imperial College London London UK
| | - M. Lao‐Araya
- Allergy and Clinical Immunology National Heart and Lung Institute Imperial College London London UK
| | - M. Penagos
- Allergy and Clinical Immunology National Heart and Lung Institute Imperial College London London UK
| | - S. Y. Poon
- Allergy and Clinical Immunology National Heart and Lung Institute Imperial College London London UK
| | - E. Steveling
- Allergy and Clinical Immunology National Heart and Lung Institute Imperial College London London UK
| | - R. Yan
- Allergy and Clinical Immunology National Heart and Lung Institute Imperial College London London UK
| | - A. Switzer
- Allergy and Clinical Immunology National Heart and Lung Institute Imperial College London London UK
| | | | - A. Togias
- The National Institute of Allergy and Infectious Diseases Bethesda MDUSA
| | - M. H. Shamji
- Allergy and Clinical Immunology National Heart and Lung Institute Imperial College London London UK
| | - S. R. Durham
- Allergy and Clinical Immunology National Heart and Lung Institute Imperial College London London UK
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Soliman M, North ML, Steacy LM, Thiele J, Adams DE, Ellis AK. Nasal allergen challenge studies of allergic rhinitis: a guide for the practicing clinician. Ann Allergy Asthma Immunol 2014; 113:250-6. [PMID: 25168223 DOI: 10.1016/j.anai.2014.06.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 06/18/2014] [Accepted: 06/24/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Mena Soliman
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario
| | - Michelle L North
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario
| | - Lisa M Steacy
- Allergy Research Unit, Kingston General Hospital, Kingston, Ontario
| | - Jenny Thiele
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario
| | - Daniel E Adams
- Allergy Research Unit, Kingston General Hospital, Kingston, Ontario
| | - Anne K Ellis
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario; Allergy Research Unit, Kingston General Hospital, Kingston, Ontario; Department of Medicine, Queen's University, Kingston, Ontario.
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Abstract
Allergic rhinitis, particularly seasonal allergic rhinitis, is considered a classic Th2-mediated disease, with important contributions to pathology by interleukins 4, 5 and 13. As such, allergic rhinitis is an excellent model for studying allergic inflammation, with findings potentially relevant to the mechanism of lower airways inflammation seen in allergic asthma. However, recent evidence has revealed roles for additional non-Th2 cytokines in asthma, including IL-17 family cytokines and epithelial-derived cytokines. Additionally, putative roles for epithelial-derived cytokines and innate lymphoid cells have been described in chronic rhinosinusitis with nasal polyps. Here, evidence for the involvement of different cytokines and cytokine groups in allergic rhinitis is considered.
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Affiliation(s)
- Guy Scadding
- Allergy and Clinical Immunology, Imperial College, London, South Kensington Campus, London, SW7 2AZ, UK,
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Peripheral erythrocytes decrease upon specific respiratory challenge with grass pollen allergen in sensitized mice and in human subjects. PLoS One 2014; 9:e86701. [PMID: 24466205 PMCID: PMC3899302 DOI: 10.1371/journal.pone.0086701] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 12/10/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND AIMS Specific hyper-responsiveness towards an allergen and non-specific airway hyperreactivity both impair quality of life in patients with respiratory allergic diseases. We aimed to investigate cellular responses following specific and non-specific airway challenges locally and systemically in i) sensitized BALB/c mice challenged with grass pollen allergen Phl p 5, and in ii) grass pollen sensitized allergic rhinitis subjects undergoing specific airway challenge in the Vienna Challenge Chamber (VCC). METHODS AND RESULTS BALB/c mice (n = 20) were intraperitoneally immunized with grass pollen allergen Phl p 5 and afterwards aerosol challenged with either the specific allergen Phl p 5 (n = 10) or the non-specific antigen ovalbumin (OVA) (n = 10). A protocol for inducing allergic asthma as well as allergic rhinitis, according to the united airway concept, was used. Both groups of exposed mice showed significantly reduced physical activity after airway challenge. Specific airway challenge further resulted in goblet cell hyperplasia, enhanced mucous secretion, intrapulmonary leukocyte infiltration and lymphoid follicle formation, associated with significant expression of IL-4, IL-5 and IL-13 in splenocytes and also partially in lung tissue. Concerning circulating blood cell dynamics, we observed a significant drop of erythrocyte counts, hemoglobin and hematocrit levels in both mouse groups, challenged with allergen or OVA. A significant decrease in circulating erythrocytes and hematocrit levels after airway challenges with grass pollen allergen was also found in grass pollen sensitized human rhinitis subjects (n = 42) at the VCC. The effects on peripheral leukocyte counts in mice and humans however were opposed, possibly due to the different primary inflammation sites. CONCLUSION Our data revealed that, besides significant leukocyte dynamics, particularly erythrocytes are involved in acute hypersensitivity reactions to respiratory allergens. A rapid recruitment of erythrocytes to the lungs to compensate for hypoxia is a possible explanation for these findings.
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Nayak AS. Mometasone furoate monohydrate nasal spray for the treatment of nasal congestion in allergic rhinitis. Expert Rev Clin Immunol 2014; 4:143-55. [DOI: 10.1586/1744666x.4.2.143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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26
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Perrin Y, Nutten S, Audran R, Berger B, Bibiloni R, Wassenberg J, Barbier N, Aubert V, Moulin J, Singh A, Magliola C, Mercenier A, Spertini F. Comparison of two oral probiotic preparations in a randomized crossover trial highlights a potentially beneficial effect of Lactobacillus paracasei NCC2461 in patients with allergic rhinitis. Clin Transl Allergy 2014; 4:1. [PMID: 24393277 PMCID: PMC3925289 DOI: 10.1186/2045-7022-4-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 12/17/2013] [Indexed: 12/14/2022] Open
Abstract
Background There is promising but conflicting evidence to recommend the addition of probiotics to foods for prevention and treatment of allergy. Based on previous studies with fermented milk containing Lactobacillus paracasei NCC2461, we aimed to compare the effect of a powder form of the latter probiotic with the effect of a blend of Lactobacillus acidophilus ATCC SD5221 and Bifidobacterium lactis ATCC SD5219 in patients with allergic rhinitis. Methods A double-blind, randomized, cross-over study, involving 31 adults with allergic rhinitis to grass pollen, was performed outside the grass pollen season (registration number: NCT01233154). Subjects received each product for 4-weeks in two phases separated by a wash-out period of 6 to 8 weeks. A nasal provocation test was performed before and after each 4-week product intake period, and outcome parameters (objective and subjective clinical symptoms; immune parameters) were measured during and/or 24 hours after the test. Results Out of the 31 subject enrolled, 28 completed the study. While no effect was observed on nasal congestion (primary outcome), treatment with NCC2461 significantly decreased nasal pruritus (determined by VAS), and leukocytes in nasal fluid samples, enhanced IL-5, IL-13 and IL-10 production by peripheral blood mononuclear cells in an allergen specific manner and tended to decrease IL-5 secretion in nasal fluid, in contrast to treatment with the blend of L. acidophilus and B. lactis. Conclusions Despite short-term consumption, NCC2461 was able to reduce subjective nasal pruritus while not affecting nasal congestion in adults suffering from grass pollen allergic rhinitis. The associated decrease in nasal fluid leukocytes and IL-5 secretion, and the enhanced IL-10 secretion in an allergen specific manner may partly explain the decrease in nasal pruritus. However, somewhat unexpected systemic immune changes were also noted. These data support the study of NCC2461 consumption in a seasonal clinical trial to further demonstrate its potentially beneficial effect.
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Affiliation(s)
- Yannick Perrin
- Division of Immunology and Allergy, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | | | - Régine Audran
- Division of Immunology and Allergy, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | | | - Rodrigo Bibiloni
- Nestlé Research Centre, Lausanne, Switzerland.,Current address: AgResearch Ltd, Food and Bio-based Products, Hamilton, New Zealand
| | - Jacqueline Wassenberg
- Division of Immunology and Allergy, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Nathalie Barbier
- Division of Immunology and Allergy, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Vincent Aubert
- Division of Immunology and Allergy, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | | | | | | | | | - François Spertini
- Division of Immunology and Allergy, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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Hodsman P, Ashman C, Cahn A, De Boever E, Locantore N, Serone A, Pouliquen I. A phase 1, randomized, placebo-controlled, dose-escalation study of an anti-IL-13 monoclonal antibody in healthy subjects and mild asthmatics. Br J Clin Pharmacol 2013; 75:118-28. [PMID: 22616628 DOI: 10.1111/j.1365-2125.2012.04334.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
AIMS IL-13 is implicated as an important mediator of the pathology of asthma. This first clinical study with GSK679586, a novel humanized anti-IL-13 IgG1 monoclonal antibody, evaluated the safety, pharmacokinetics and pharmacodynamics of escalating single and repeat doses of GSK679586. METHODS In this randomized, double-blind study, healthy subjects received single intravenous infusions of GSK679586 (0.005, 0.05, 0.5, 2.5, 10 mg kg(-1)) or placebo and mild intermittent asthmatics received two once monthly intravenous infusions of GSK679586 (2.5, 10, 20 mg kg(-1)) or placebo. RESULTS GSK679586 displayed approximately linear pharmacokinetics (based on AUC and C(max)) with limited accumulation upon repeat administration. In mild intermittent asthmatics, treatment with GSK679586 produced an increase in serum total IL-13 concentrations, indicative of GSK679586-IL-13 complex formation. Additionally, mean levels of exhaled nitric oxide (FeNO), a marker of pulmonary inflammation, were reduced relative to baseline at 2.5, 10 and 20 mg kg(-1) doses of GSK679586 at both 2 weeks (19%, 44% and 52% decreases) and 8 weeks (29%, 55% and 42% decreases) after the second infusion. GSK679586 was well tolerated; the incidence of AEs was comparable across all presumed biologically active doses and there were no treatment-related SAEs. CONCLUSIONS GSK679586 demonstrated dose-dependent pharmacological activity in the lungs of mild intermittent asthmatics. These findings, together with the favourable safety profile and advantageous PK characteristics of a monoclonal antibody (e.g. a long half-life supporting less frequent dosing), warrant further investigation of GSK679586 in a broader asthma patient population.
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Comprehensive Profiling of Peripheral Immune Cells and Subsets in Patients with Intermittent Allergic Rhinitis Compared to Healthy Controls and After Treatment with Glucocorticoids. Inflammation 2013; 36:821-9. [DOI: 10.1007/s10753-013-9608-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Healey GD, Evans N, Hopkin JM, Davies G, Walker W. Evaluation of nasal epithelium sampling as a tool in the preclinical development of siRNA-based therapeutics for asthma. J Cell Mol Med 2013; 17:356-64. [PMID: 23402658 PMCID: PMC3823017 DOI: 10.1111/jcmm.12014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Accepted: 11/28/2012] [Indexed: 01/14/2023] Open
Abstract
The development of siRNA-based asthma therapeutics is currently hampered by a paucity of relevant biomarkers and the need to ascertain tissue-specific gene targeting in the context of active disease. Epithelial STAT6 expression is fundamental to asthma pathogenesis in which inflammatory changes are found throughout the respiratory tract. Therefore, to improve preclinical evaluation, we tested the efficacy of STAT6-targeting siRNA within nasal epithelial cells (NEC's) obtained from asthmatic and non-asthmatic donors. STAT6 expression was invariant in both donor groups and amenable to suppression by siRNA treatment. In addition, STAT6 mRNA was also suppressible by apically delivered siRNA treatment in comparative differentiated nasal epithelial cell-line monolayer cultures. Analysis of donor NEC's showed consistent elevation in CCL26 (eotaxin-3) mRNA within the asthmatic group suggesting potential as a relevant biomarker. Furthermore, targeting of STAT6 with siRNA attenuated IL-13-driven CCL26 expression in these cells, pointing to the utility of this approach in preclinical testing. Finally, siRNA-mediated suppression of STAT6 was independent of donor disease phenotype or epithelial cell differentiation status, signifying therapeutic potential.
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Affiliation(s)
- Gareth D Healey
- College of Medicine, Institute of Life Science, Swansea University, Swansea, UK.
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Seki E, Yoshizumi M, Tanaka R, Ryo A, Ishioka T, Tsukagoshi H, Kozawa K, Okayama Y, Okabe-Kado J, Goya T, Kimura H. Cytokine profiles, signalling pathways and effects of fluticasone propionate in respiratory syncytial virus-infected human foetal lung fibroblasts. Cell Biol Int 2013; 37:326-39. [PMID: 23377960 DOI: 10.1002/cbin.10044] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Accepted: 12/31/2012] [Indexed: 12/29/2022]
Abstract
To examine cytokine production in response to RSV infection, we assessed the levels of 29 cytokines released from RSV-infected human foetal lung fibroblasts. We also examined the relationships between the effects of fluticasone propionate and various signalling pathways in the cells. Twenty-four hours after infection (1MOI), RSV-infected cells released cytokines, for example proinflammatory cytokines (IL-1β, IL-6 and TNF-α), anti-inflammatory (IL-1ra), Th1 (IFN-γ, IFN-λ1a, IL-2 and IL-12), Th2 (IL-4, IL-5, IL-10 and IL-13), granulopoiesis-inducing (G-CSF and GM-CSF), eosinophil recruitment-inducing (eotaxin and RANTES) and neutrophil recruitment-inducing cytokines (IL-8, IP-10, MCP-1 and MIP-1α). Aberrant release of most was significantly suppressed by fluticasone propionate. Twelve hours after RSV infection, increased phosphorylation of Akt, p38 MAPK, ERK1/2 and IκB-α was noted. Fluticasone propionate suppressed the phosphorylation of Akt, p38 MAPK, and ERK1/2, but not IκB-α, in virus-infected cells. TLR-4 expression was unchanged in control and RSV-infected cells, and TLR-3 and RIG-I expression was not detected. The results indicate that RSV infection induces aberrant production and release of certain cytokines through these signalling pathways in human lung fibroblasts. Overproduction and imbalance of these cytokines may be associated with the pathophysiology of RSV-induced excessive and allergic inflammation.
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Affiliation(s)
- Erina Seki
- Department of Surgery, Institute of Medical Sciences, Kyorin University, 6-20-2 Shinkawa, Mitaka-shi, Tokyo 181-8611, Japan
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Optimisation of grass pollen nasal allergen challenge for assessment of clinical and immunological outcomes. J Immunol Methods 2012; 384:25-32. [DOI: 10.1016/j.jim.2012.06.013] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Revised: 06/22/2012] [Accepted: 06/22/2012] [Indexed: 02/02/2023]
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Zhao Y, Wang H, Gustafsson M, Muraro A, Bruhn S, Benson M. Combined multivariate and pathway analyses show that allergen-induced gene expression changes in CD4+ T cells are reversed by glucocorticoids. PLoS One 2012; 7:e39016. [PMID: 22701743 PMCID: PMC3373548 DOI: 10.1371/journal.pone.0039016] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2012] [Accepted: 05/15/2012] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Glucocorticoids (GCs) play a key role in the treatment of allergy. However, the genome-wide effects of GCs on gene expression in allergen-challenged CD4(+) T cells have not been described. The aim of this study was to perform a genome-wide analysis to investigate whether allergen-induced gene expression changes in CD4(+) T cells could be reversed by GCs. METHODOLOGY/PRINCIPAL FINDINGS Gene expression microarray analysis was performed to profile gene expression in diluent- (D), allergen- (A), and allergen + hydrocortisone- (T) challenged CD4(+) T cells from patients with seasonal allergic rhinitis. Principal component analysis (PCA) showed good separation of the three groups. To identify the correlation between changes in gene expression in allergen-challenged CD4(+) T cells before and after GC treatment, we performed orthogonal partial least squares discriminant analysis (OPLS-DA) followed by Pearson correlation analysis. This revealed that allergen-induced genes were widely reversed by GC treatment (r = -0.77, P<0.0001). We extracted 547 genes reversed by GC treatment from OPLS-DA models based on their high contribution to the discrimination and found that those genes belonged to several different inflammatory pathways including TNFR2 Signalling, Interferon Signalling, Glucocorticoid Receptor Signalling and T Helper Cell Differentiation. The results were supported by gene expression microarray analyses of two independent materials. CONCLUSIONS/SIGNIFICANCE Allergen-induced gene expression changes in CD4(+) T cells were reversed by treatment with glucocorticoids. The top allergen-induced genes that reversed by GC treatment belonged to several inflammatory pathways and genes of known or potential relevance for allergy.
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Affiliation(s)
- Yelin Zhao
- Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Hui Wang
- Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden
- Department of Pediatrics, University of Gothenburg, Gothenburg, Sweden
| | - Mika Gustafsson
- Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Antonella Muraro
- Department of Pediatrics, Center for Food Allergy Diagnosis and Treatment, Veneto Region, University of Padua, Padua, Italy
| | - Sören Bruhn
- Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Mikael Benson
- Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden
- * E-mail:
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Ekman AK, Virtala R, Fransson M, Adner M, Benson M, Jansson L, Cardell LO. Systemic up-regulation of TLR4 causes lipopolysaccharide-induced augmentation of nasal cytokine release in allergic rhinitis. Int Arch Allergy Immunol 2012; 159:6-14. [PMID: 22555057 DOI: 10.1159/000335196] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2011] [Accepted: 11/04/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Allergic rhinitis is a systemic disorder, and it is clinically well recognized that it can be aggravated by infection. Activation of the innate immune system constitutes a critical element in the process. Toll-like receptors (TLRs) comprise a part of the innate immune system, and lipopolysaccharide (LPS)-induced activation of TLR4 represents bacterial-induced interactions in various model systems. The present study examines how TLR2 and TLR4 expression is affected by symptomatic allergic rhinitis, and if LPS added upon allergen affects nasal cytokine release. METHODS In patients with pollen-induced allergic rhinitis and healthy non-allergic volunteers, nasal lavage (NAL), peripheral blood and bone marrow were sampled before and during the pollen season. TLR2 and TLR4 expression was determined flow cytometrically. Changes in the TLR receptor expression pattern were evaluated by a nasal challenge with allergen followed by LPS, or vice versa. Symptoms along with cells and cytokines in NAL were analyzed. RESULTS TLR4 expression increased in leukocytes in NAL, peripheral blood and bone marrow during symptomatic allergic rhinitis. A similar increase was seen for TLR2 in neutrophils in blood. Nasal challenge with allergen followed by LPS augmented the release of IL-4, IL-5, IL-10, IL-13, IFN-γ and TNF-α. CONCLUSION A systemic up-regulation of TLR4 in symptomatic allergic rhinitis may explain why LPS preceded by allergen increases nasal cytokine release.
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Affiliation(s)
- A-K Ekman
- Division of ENT Diseases, CLINTEC, Karolinska University Hospital, Stockholm, Sweden
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Kvarnhammar AM, Rydberg C, Järnkrants M, Eriksson M, Uddman R, Benson M, Cardell LO. Diminished levels of nasal S100A7 (psoriasin) in seasonal allergic rhinitis: an effect mediated by Th2 cytokines. Respir Res 2012; 13:2. [PMID: 22230654 PMCID: PMC3287248 DOI: 10.1186/1465-9921-13-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Accepted: 01/09/2012] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND S100A7 is an antimicrobial peptide involved in several inflammatory diseases. The aim of the present study was to explore the expression and regulation of S100A7 in seasonal allergic rhinitis (SAR). METHODS Nasal lavage (NAL) fluid was obtained from healthy controls before and after lipopolysaccharide (LPS) provocation, from SAR patients before and after allergen challenge, and from SAR patients having completed allergen-specific immunotherapy (ASIT). Nasal biopsies, nasal epithelial cells and blood were acquired from healthy donors. The airway epithelial cell line FaDu was used for in vitro experiments. Real-time RT-PCR and immunohistochemistry were used to determine S100A7 expression in nasal tissue and cells. Release of S100A7 in NAL and culture supernatants was measured by ELISA. The function of recombinant S100A7 was explored in epithelial cells, neutrophils and peripheral blood mononuclear cells (PBMC). RESULTS Nasal administration of LPS induced S100A7 release in healthy non-allergic subjects. The level of S100A7 was lower in NAL from SAR patients than from healthy controls, and it was further reduced in the SAR group 6 h post allergen provocation. In contrast, ASIT patients displayed higher levels after completed treatment. S100A7 was expressed in the nasal epithelium and in glands, and it was secreted by cultured epithelial cells. Stimulation with IL-4 and histamine repressed the epithelial S100A7 release. Further, recombinant S100A7 induced activation of neutrophils and PBMC. CONCLUSIONS The present study shows an epithelial expression and excretion of S100A7 in the nose after microbial stimulation. The levels are diminished in rhinitis patients and in the presence of an allergic cytokine milieu, suggesting that the antimicrobial defense is compromised in patients with SAR.
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Affiliation(s)
- Anne Månsson Kvarnhammar
- Division of ENT Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Huddinge, Sweden.
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Wassenberg J, Nutten S, Audran R, Barbier N, Aubert V, Moulin J, Mercenier A, Spertini F. Effect of Lactobacillus paracasei ST11 on a nasal provocation test with grass pollen in allergic rhinitis. Clin Exp Allergy 2011; 41:565-73. [PMID: 21395878 DOI: 10.1111/j.1365-2222.2011.03695.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Probiotics have been associated with prevention and improvement of symptoms in atopic diseases such as atopic dermatitis. However, few studies exist that document their efficacy for upper airways allergies such as allergic rhinitis. OBJECTIVE To investigate the effect of short-term oral administration of Lactobacillus paracasei ST11 on a nasal provocation test (NPT) with grass pollen. METHODS Thirty-one adult volunteers with allergic rhinitis were enrolled in a randomized, double-blind, placebo-controlled study, based on two 4-week cross-over periods of product consumption (ST11-fermented milk vs. placebo), separated by a wash-out period of 6-8 weeks. Objective and subjective clinical parameters of NPT as well as systemic and nasal immunological parameters were compared between the two treatment periods (registration number: NCT 011 50 253). RESULTS Subjects that received ST11-fermented milk had lower nasal congestion than subjects under placebo (visual analogical scale; P<0.05). Nasal pruritus followed the same trend. However, no significant change in combined nasal reaction threshold was observed between the two periods. IL-5 secretion by peripheral blood mononuclear cells and serum allergen-specific IgG4 were significantly lower in ST11-fermented milk group compared to placebo group. IL-8 and IL-10 secretion followed the same trend. CONCLUSION AND CLINICAL RELEVANCE Short-term treatment with ST11-fermented milk before NPT significantly improved a clinical marker of NPT (subjective nasal congestion) and down-regulated systemic immune markers (IL-5 from peripheral blood mononuclear cells and serum IgG4). These data strongly suggest that probiotics may down modulate key parameters of allergic rhinitis and warrant future evaluation in seasonal trials.
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Affiliation(s)
- J Wassenberg
- Division of Immunology and Allergy, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland Nestle Research Centre, Lausanne, Switzerland
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Retractions in the American Journal of Respiratory and Critical Care Medicine (AJRCCM). Clin Exp Allergy 2011. [DOI: 10.1111/j.1365-2222.2011.03741.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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O'Neil SE, Malmhäll C, Samitas K, Pullerits T, Bossios A, Lötvall J. Quantitative expression of osteopontin in nasal mucosa of patients with allergic rhinitis: effects of pollen exposure and nasal glucocorticoid treatment. Allergy Asthma Clin Immunol 2010; 6:28. [PMID: 21044308 PMCID: PMC2988772 DOI: 10.1186/1710-1492-6-28] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2010] [Accepted: 11/02/2010] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Osteopontin (OPN) is a multifunctional cytokine that has been primarily investigated in Th1 diseases. Recently, it has also been implicated in Th2-mediated allergic diseases, such as asthma. The expression of OPN in allergic rhinitis (AR) is currently unknown, as is the effect of intranasal glucocorticosteroids (GCs) on that expression. METHODS Subjects with AR were randomised to receive treatment with fluticasone propionate (FP) (n = 12) or a placebo (n = 16) over the grass pollen season and nasal biopsies were taken prior to, and during the season. OPN expression in the nasal mucosa was examined with immunohistochemistry. Healthy non-AR controls (n = 5) were used as a comparator. RESULTS OPN expression was detected in epithelial cells, subepithelial infiltrating/inflammatory cells and cells lining the vessels and glands of all subjects. Comparison of the pre- and peak-pollen season biopsy sections in placebo treated patients revealed no increase in OPN expression during the grass pollen season (5.7% vs 6.4%). Treatment with a local glucocorticosteroid did not alter the expression of OPN during pollen exposure (6.2% vs 6.7%). CONCLUSION OPN has been increasingly associated with the pathogenesis of various Th2-mediated diseases. However, our finding that the OPN expression in the nasal mucosa of AR patients is not significantly affected by allergen exposure and is comparable to that of the healthy controls, suggests that intracellular OPN is not directly involved in the pathogenesis of allergic rhinitis.
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Affiliation(s)
- Serena E O'Neil
- Krefting Research Centre, Sahlgrenska Academy, University of Gothenburg, Sweden.
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Biomarkers in asthma and allergic rhinitis. Pulm Pharmacol Ther 2010; 23:468-81. [PMID: 20601050 DOI: 10.1016/j.pupt.2010.06.006] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2010] [Accepted: 06/23/2010] [Indexed: 11/20/2022]
Abstract
A biological marker (biomarker) is a physical sign or laboratory measurement that can serve as an indicator of biological or pathophysiological processes or as a response to a therapeutic intervention. An applicable biomarker possesses the characteristics of clinical relevance (sensitivity and specificity for the disease) and is responsive to treatment effects, in combination with simplicity, reliability and repeatability of the sampling technique. Presently, there are several biomarkers for asthma and allergic rhinitis that can be obtained by non-invasive or semi-invasive airway sampling methods meeting at least some of these criteria. In clinical practice, such biomarkers can provide complementary information to conventional disease markers, including clinical signs, spirometry and PC(20)methacholine or histamine. Consequently, biomarkers can aid to establish the diagnosis, in staging and monitoring of the disease activity/progression or in predicting or monitoring of a treatment response. Especially in (young) children, reliable, non-invasive biomarkers would be valuable. Apart from diagnostic purposes, biomarkers can also be used as (surrogate) markers to predict a (novel) drug's efficacy in target populations. Therefore, biomarkers are increasingly applied in early drug development. When implementing biomarkers in clinical practice or trials of asthma and allergic rhinitis, it is important to consider the heterogeneous nature of the inflammatory response which should direct the selection of adequate biomarkers. Some biomarker sampling techniques await further development and/or validation, and should therefore be applied as a "back up" of established biomarkers or methods. In addition, some biomarkers or sampling techniques are less suitable for (very young) children. Hence, on a case by case basis, a decision needs to be made what biomarker is adequate for the target population or purpose pursued. Future development of more sophisticated sampling methods and quantification techniques, such as--omics and biomedical imaging, will enable detection of adequate biomarkers for both clinical and research applications.
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Kaya TI, Tursen U, Ikizoglu G. Therapeutic use of topical corticosteroids in the vesiculobullous lesions of incontinentia pigmenti. Clin Exp Dermatol 2009; 34:e611-3. [DOI: 10.1111/j.1365-2230.2009.03301.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Canonica GW, Compalati E. Minimal persistent inflammation in allergic rhinitis: implications for current treatment strategies. Clin Exp Immunol 2009; 158:260-71. [PMID: 19765020 PMCID: PMC2792821 DOI: 10.1111/j.1365-2249.2009.04017.x] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2009] [Indexed: 12/21/2022] Open
Abstract
Patients with allergic rhinitis have traditionally been placed into 'seasonal' and 'perennial' categories, which do not account for the subclinical inflammatory state that exists in many patients. In subjects with seasonal and perennial allergic rhinitis, even subthreshold doses of allergen have been found to cause inflammatory cell infiltration in the nasal mucosa, including increases in expression of cellular adhesion molecules, nasal and conjunctival eosinophilia, and other markers of inflammation, which do not result in overt allergy symptoms. This state - which has been termed 'minimal persistent inflammation'- may contribute to hyperreactivity and increased susceptibility to development of clinical symptoms as well as common co-morbidities of allergic rhinitis, such as asthma. Treating overt allergy symptoms as well as this underlying inflammatory state requires agents that have well-established clinical efficacy, convenient administration, potent anti-inflammatory effects and proven long-term safety, so that long-term continuous administration is feasible. Of the three major classes of commonly used allergic rhinitis medications - intranasal corticosteroids, anti-histamines, and anti-leukotrienes - intranasal corticosteroids appear to represent the most reasonable therapeutic option in patients who would benefit from continuous inhibition of persistent inflammation.
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MESH Headings
- Administration, Intranasal
- Allergens/immunology
- Asthma/etiology
- Chronic Disease
- Glucocorticoids/therapeutic use
- Histamine H1 Antagonists/therapeutic use
- Humans
- Intercellular Adhesion Molecule-1/immunology
- Leukotriene Antagonists/therapeutic use
- Rhinitis, Allergic, Perennial/complications
- Rhinitis, Allergic, Perennial/drug therapy
- Rhinitis, Allergic, Perennial/immunology
- Rhinitis, Allergic, Seasonal/complications
- Rhinitis, Allergic, Seasonal/drug therapy
- Rhinitis, Allergic, Seasonal/immunology
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Affiliation(s)
- G W Canonica
- Allergy and Respiratory Diseases, Clinic Dipartmento di Medicina Interna e Specialita Mediche (DIMI), University of Genova, Genova, Italy.
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Segundo GR, Gomes FA, Fernandes KP, Alves R, Silva DA, Taketomi EA. Local cytokines and clinical symptoms in children with allergic rhinitis after different treatments. Biologics 2009; 3:469-74. [PMID: 19851472 PMCID: PMC2763317 DOI: 10.2147/btt.2009.3595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Therapy for allergic rhinitis aims to control symptoms and improve the quality of life. The treatment of allergic rhinitis includes allergen avoidance, environmental controls, pharmacologic treatment, and specific immunotherapy. Objectives The aim of this study is to evaluate the clinical changes and the levels of interferon-γ (IFN-γ) and interleukin-5 (IL-5) in nasal lavage fluid from children with allergic rhinitis after different types of pharmacologic treatment (mometasone, montelukast, or desloratadine). Methods Twenty-four children aged from six to 12 years with moderate persistent allergic rhinitis were randomized into three groups receiving monotherapy treatment over four weeks: nasal corticosteroid (mometasone), leukotriene modifier (montelukast), or antihistamine (desloratadine). The perception of symptom improvement during the medication use was evaluated at the end of the treatment. Samples of nasal lavage fluid were collected before and after treatment for measuring IFN-γ and IL-5 cytokines by ELISA. Results All parents perceived an improvement in symptoms. Significant enhancement was seen in the mometasone group compared to those with montelukast (P = 0.01) and desloratadine (P = 0.02). No significant differences were found among the three groups in the levels of IL-5 and IFN-γ in nasal fluid at baseline or after treatment. Only the group treated with mometasone showed a slight but significant reduction in IL-5 levels after the treatment period as compared with levels before the treatment (P = 0.0469). Conclusion The group treated with mometasone showed better improvement of clinical symptoms and a slight reduction in IL-5 levels in the nasal fluid. This may indirectly reflect the relative immunomodulatory effects of the drugs tested.
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Jyonouchi S, Brown-Whitehorn TA, Spergel JM. Association of eosinophilic gastrointestinal disorders with other atopic disorders. Immunol Allergy Clin North Am 2009; 29:85-97, x. [PMID: 19141344 DOI: 10.1016/j.iac.2008.09.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Eosinophilic esophagitis is a chronic disease that leads to either persistent symptoms or, at times, intermittent "flares." It shares many features with other atopic diseases (asthma, allergic rhinitis, and atopic dermatitis), including the following: T helper 2 cells and eosinophils play a critical role in the pathogenesis of the disease; avoidance of allergens promotes remission of disease and symptom control; and locally applied corticosteroids provide control. Finally, most patients who have eosinophilic gastrointestinal disorders have an associated atopic disease.
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Affiliation(s)
- Soma Jyonouchi
- Division of Allergy and Immunology, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, USA
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Okano M. Mechanisms and clinical implications of glucocorticosteroids in the treatment of allergic rhinitis. Clin Exp Immunol 2009; 158:164-73. [PMID: 19737138 DOI: 10.1111/j.1365-2249.2009.04010.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Allergic rhinitis is a common airway disease characterized by hypersensitivity, exudation, hypersecretion, inflammatory cell infiltration and remodelling. Intranasal glucocorticosteroids are the most effective drugs for controlling the inflammation caused by allergic rhinitis. Glucocorticosteroids exert anti-inflammatory effects through at least two pathways: the transactivation pathway and the transrepression pathway. Glucocorticosteroids also exert regulatory functions by inducing regulatory cytokines and forkhead box P3 (FoxP3(+)) regulatory T cells. Evidence suggests that intranasal glucocorticosteroids control not only nasal symptoms but also ocular symptoms. In contrast to sedating H1 receptor antagonists, intranasal glucocorticosteroids can improve impaired performance symptoms, such as daytime sleepiness, associated with allergic rhinitis. Recent studies suggest that intranasal glucocorticosteroids might also be useful for the prophylactic treatment of pollinosis; this possibility is supported by the molecular mechanism of the anti-inflammatory action of glucocorticosteroids. These findings suggest that intranasal glucocorticosteroids might be positioned as first-line drugs for the treatment of both perennial and seasonal allergic rhinitis.
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Affiliation(s)
- M Okano
- Department of Otolaryngology - Head and Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
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Baumann D, Bachert C, Högger P. Dissolution in nasal fluid, retention and anti-inflammatory activity of fluticasone furoate in human nasal tissue ex vivo. Clin Exp Allergy 2009; 39:1540-50. [PMID: 19538495 DOI: 10.1111/j.1365-2222.2009.03306.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Intranasal glucocorticoids represent the most effective pharmacologic treatment of allergic rhinitis. So far, no clinical data are available that compare fluticasone furoate (FF) with other intranasally applied glucocorticoids. OBJECTIVE Because the pharmacokinetic behaviour of drugs governs their presence at the therapeutic target site we analysed selected in vitro properties of FF in comparison with triamcinolone acetonide (TCA), budesonide (Bud), fluticasone propionate (FP) and mometasone furoate (MF). Additionally, we determined the anti-inflammatory activity of the glucocorticoid fraction residing in human nasal tissue samples after washing. METHODS We analysed the solubility of the compounds in artificial human nasal fluid and the retention in human nasal tissue as well as typical spray volumes of commercially available drug preparations. As an anti-inflammatory measure, we evaluated the inhibition of IL-8 release from epithelial cells. RESULTS FF is delivered in the smallest application volume per spray. Despite the low aqueous solubility of glucocorticoids, a fraction of the compounds is already dissolved in the aqueous supernatants of drug preparations (Bud>TCA>FP>MF>FF). The dissolution of FP, MF and FF was significantly enhanced in artificial nasal fluid and FF displayed the most pronounced enhancement of solubility in the presence of proteins. Consistent with this result, the highest retention in nasal tissue was observed for FF, followed by FP>MF>Bud>TCA. After washing of the nasal tissue samples, all compounds inhibited IL-8 release, with FF displaying the highest activity. CONCLUSION FF displayed beneficial properties for nasal application. Its low application volume per spray is a prerequisite for effective drug utilization by avoiding immediate loss by nose runoff or drip down the throat. Sustained dissolution and high tissue binding of FF should contribute towards an extended presence of compounds in nasal tissue as a basis for a prolonged pharmacologic activity.
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Affiliation(s)
- D Baumann
- Institut für Pharmazie und Lebensmittelchemie, Universität Würzburg, Würzburg, Germany
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Shirasaki H, Kikuchi M, Kanaizumi E, Himi T. Accumulation of CRTH2-positive leukocytes in human allergic nasal mucosa. Ann Allergy Asthma Immunol 2009; 102:110-5. [PMID: 19230460 DOI: 10.1016/s1081-1206(10)60239-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Prostaglandin D2 (PGD2) has been thought to be a potent mediator involved in allergic rhinitis because PGD2 has been recovered from the nasal lavage fluid of patients with allergic rhinitis after allergen provocation and because PGD2 receptor antagonists relieved nasal allergic symptoms in an animal model of allergic rhinitis. The inflammatory effects of PGD2 are exerted through high-affinity interactions with 2 G protein-coupled receptors: D-prostanoid receptor 1 and chemoattractant-homologous receptor expressed on TH2 cells (CRTH2). CRTH2 may mediate the recruitment of leukocytes during a nasal allergic response. OBJECTIVE To evaluate the number of CRTH2-expressing cells in allergic and nonallergic human nasal mucosa by means of immunohistochemical analysis. METHODS Human turbinates were obtained after turbinectomy from 14 patients with nasal obstruction refractory to medical therapy. To identify cells expressing the CRTH2 protein, double immunostaining was performed using anti-CRTH2 antibody and monoclonal anti-leukocyte antibodies. RESULTS The immunohistochemical study revealed that anti-CRTH2 antibody labeled eosinophils, macrophages, mast cells, T lymphocytes, epithelial cells, and submucosal glands in the nasal mucosa. CRTH2 expressions of these leukocytes in allergic nasal mucosa are significantly up-regulated compared with those in nonallergic nasal mucosa. CONCLUSION These results suggest that CRTH2 may play an important role in the recruitment of leukocytes into allergic nasal mucosa.
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Affiliation(s)
- Hideaki Shirasaki
- Department of Otolaryngology, Sapporo Medical University, School of Medicine, Sapporo, Japan.
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Abstract
BACKGROUND It has been proposed that some patients with nonallergic rhinitis may have "localized allergy" of the nasal mucosa. Nasal challenges with aeroallergens can help determine whether a patient is clinically allergic via an IgE-mediated pathway. OBJECTIVE To determine the prevalence of localized allergy in patients with negative skin prick test results via nasal challenges with an array of allergens. METHODS Twenty individuals with perennial rhinitis and negative epicutaneous test results to common perennial aeroallergens underwent nasal challenges to glycerin, Alternaria, cockroach, timothy grass, cat hair, and Dermatophagoides pteronyssinus. Total symptom scores, peak nasal inspiratory flow rates, and nasal eosinophil counts were determined. RESULTS Of 20 patients with nonallergic rhinitis, 4 were hyperresponsive to glycerin and were not subsequently challenged. Eleven patients had negative nasal challenges. Five patients developed positive challenges (total symptom score > or = 5) to 7 allergens. These 5 patients returned for nasal provocation testing to their offending allergens, and these repeated challenges were negative. Three control subjects with allergic rhinitis developed positive challenges after nasal allergen challenge. CONCLUSIONS Although some individuals with nonallergic rhinitis can have positive nasal allergen challenges, these results were not reproducible in the present patient population.
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Chaung HC, Ho CT, Huang TC. Anti-hypersensitive and anti-inflammatory activities of water extract ofZingiber zerumbet(L.) Smith. FOOD AGR IMMUNOL 2008. [DOI: 10.1080/09540100802047783] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Bernstein IL, Li JT, Bernstein DI, Hamilton R, Spector SL, Tan R, Sicherer S, Golden DBK, Khan DA, Nicklas RA, Portnoy JM, Blessing-Moore J, Cox L, Lang DM, Oppenheimer J, Randolph CC, Schuller DE, Tilles SA, Wallace DV, Levetin E, Weber R. Allergy diagnostic testing: an updated practice parameter. Ann Allergy Asthma Immunol 2008; 100:S1-148. [PMID: 18431959 DOI: 10.1016/s1081-1206(10)60305-5] [Citation(s) in RCA: 291] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Bernardini R, Pucci N, Rossi ME, Lombardi E, De Martino M, Mori F, Ciprandi G, Novembre E, Marcucci F, Massai C, Azzari C, Vierucci A. Allergen specific nasal challenge to latex in children with latex allergy: clinical and immunological evaluation. Int J Immunopathol Pharmacol 2008; 21:333-341. [PMID: 18547477 DOI: 10.1177/039463200802100210] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2023] Open
Abstract
There are no data concerning the significance of allergen specific nasal challenge to latex (ASNCL) in the pediatric population and the effect of mometasone furoate nasal spray (MFNS), topic corticosteroid exerting a potent anti-inflammatory activity in children with latex allergic rhinitis. The aims of this study are: to investigate the clinical and immune pathological effects of ASNCL in children with latex allergy; to study the effects of MFNS pre-medication on the clinical and immune pathological effects of ASNCL in children with latex allergy. Thirteen children: 6 male and 7 female, mean (SD) age 9.6 (2.9) years, with latex allergy and seven children: 3 male and 4 female, mean (SD) age 9.9 (3.8) years, without latex allergy underwent ASNCL. Nasal symptoms were recorded, nasal lavage fluid was collected to measure tryptase, eosinophil cationic protein (ECP), interleukin-5, interferon-gamma levels, and spirometric test was performed for each patient without or with premedication with MFNS. ASNCL induced a clinical allergic response and increased tryptase levels only in children with latex allergy. No serious adverse events occurred after ASNCL. MFNS premedication reduced both tryptase and ECP levels only in children with latex allergy. ASNCL is a simple, reliable and useful tool to make or confirm the diagnosis of nasal symptoms due to latex; it allows us to study both clinical symptoms and local immunological changes. MFNS premedication before an ASNCL may prevent some immunological responses induced by ASNCL without clinical allergic modifications.
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Affiliation(s)
- R Bernardini
- Pediatric Allergy and Pulmonology Center, Department of Pediatrics, University of Florence, Anna Meyer Children's Hospital, Via Luca Giordano 13, Florence, Italy.
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