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Kim S, Xu Z, Forno E, Qin Y, Park HJ, Yue M, Yan Q, Manni ML, Acosta-Pérez E, Canino G, Chen W, Celedón JC. Cis- and trans-eQTM analysis reveals novel epigenetic and transcriptomic immune markers of atopic asthma in airway epithelium. J Allergy Clin Immunol 2023; 152:887-898. [PMID: 37271320 PMCID: PMC10592527 DOI: 10.1016/j.jaci.2023.05.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 04/03/2023] [Accepted: 05/02/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND Expression quantitative trait methylation (eQTM) analyses uncover associations between DNA methylation markers and gene expression. Most eQTM analyses of complex diseases have focused on cis-eQTM pairs (within 1 megabase). OBJECTIVES This study sought to identify cis- and trans-methylation markers associated with gene expression in airway epithelium from youth with and without atopic asthma. METHODS In this study, the investigators conducted both cis- and trans-eQTM analyses in nasal (airway) epithelial samples from 158 Puerto Rican youth with atopic asthma and 100 control subjects without atopy or asthma. The investigators then attempted to replicate their findings in nasal epithelial samples from 2 studies of children, while also examining whether their results in nasal epithelium overlap with those from an eQTM analysis in white blood cells from the Puerto Rican subjects. RESULTS This study identified 9,108 cis-eQTM pairs and 2,131,500 trans-eQTM pairs. Trans-associations were significantly enriched for transcription factor and microRNA target genes. Furthermore, significant cytosine-phosphate-guanine sites (CpGs) were differentially methylated in atopic asthma and significant genes were enriched for genes differentially expressed in atopic asthma. In this study, 50.7% to 62.6% of cis- and trans-eQTM pairs identified in Puerto Rican youth were replicated in 2 smaller cohorts at false discovery rate-adjusted P < .1. Replicated genes in the trans-eQTM analysis included biologically plausible asthma-susceptibility genes (eg, HDC, NLRP3, ITGAE, CDH26, and CST1) and are enriched in immune pathways. CONCLUSIONS Studying both cis- and trans-epigenetic regulation of airway epithelial gene expression can identify potential causal and regulatory pathways or networks for childhood asthma. Trans-eQTM CpGs may regulate gene expression in airway epithelium through effects on transcription factor and microRNA target genes.
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Affiliation(s)
- Soyeon Kim
- Division of Pediatric Pulmonary Medicine, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pa; Department of Pediatrics, School of Medicine, University of Pittsburgh, Pittsburgh, Pa
| | - Zhongli Xu
- Division of Pediatric Pulmonary Medicine, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pa; School of Medicine, Tsinghua University, Beijing, China
| | - Erick Forno
- Division of Pediatric Pulmonary Medicine, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pa; Department of Pediatrics, School of Medicine, University of Pittsburgh, Pittsburgh, Pa
| | - Yidi Qin
- Department of Human Genetics, School of Public Health, University of Pittsburgh, Pittsburgh, Pa
| | - Hyun Jung Park
- Department of Human Genetics, School of Public Health, University of Pittsburgh, Pittsburgh, Pa
| | - Molin Yue
- Department of Biostatistics, School of Public Health, University of Pittsburgh, Pittsburgh, Pa
| | - Qi Yan
- Department of Obstetrics and Gynecology, Columbia University, New York, NY
| | - Michelle L Manni
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh
| | - Edna Acosta-Pérez
- Behavioral Sciences Research Institute, University of Puerto Rico, San Juan, Puerto Rico
| | - Glorisa Canino
- Behavioral Sciences Research Institute, University of Puerto Rico, San Juan, Puerto Rico
| | - Wei Chen
- Division of Pediatric Pulmonary Medicine, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pa; School of Medicine, Tsinghua University, Beijing, China
| | - Juan C Celedón
- Division of Pediatric Pulmonary Medicine, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pa; Department of Pediatrics, School of Medicine, University of Pittsburgh, Pittsburgh, Pa.
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Lee KH, Kim HJ, Kim YJ, Kim JH, Song EY. Extracting Structured Genotype Information from Free-Text HLA Reports Using a Rule-Based Approach. J Korean Med Sci 2020; 35:e78. [PMID: 32233158 PMCID: PMC7105511 DOI: 10.3346/jkms.2020.35.e78] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 01/29/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Human leukocyte antigen (HLA) typing is important for transplant patients to prevent a severe mismatch reaction, and the result can also support the diagnosis of various disease or prediction of drug side effects. However, such secondary applications of HLA typing results are limited because they are typically provided in free-text format or PDFs on electronic medical records. We here propose a method to convert HLA genotype information stored in an unstructured format into a reusable structured format by extracting serotype/allele information. METHODS We queried HLA typing reports from the clinical data warehouse of Seoul National University Hospital (SUPPREME) from 2000 to 2018 as a rule-development data set (64,024 reports) and from the most recent year (6,181 reports) as a test set. We used a rule-based natural language approach using a Python regex function to extract the 1) number of patients in the report, 2) clinical characteristics such as indication of the HLA testing, and 3) precise HLA genotypes. The performance of the rules and codes was evaluated by comparison between the extracted results from the test set and a validation set generated by manual curation. RESULTS Among 11,287 reports for development set and 1,107 for the test set describing HLA typing for a single patient, iterative rule generation developed 124 extracting rules and 8 cleaning rules for HLA genotypes. Application of these rules extracted HLA genotypes with 0.892-0.999 precision and 0.795-0.998 recall for the five HLA genes. The precision and recall of the extracting rules for the number of patients in a report were 0.997 and 0.994 and those for the clinical variable extraction were 0.997 and 0.992, respectively. All extracted HLA alleles and serotypes were transformed according to formal HLA nomenclature by the cleaning rules. CONCLUSION The rule-based HLA genotype extraction method shows reliable accuracy. We believe that there are significant number of patients who takes profit when this under-used genetic information will be return to them.
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Affiliation(s)
- Kye Hwa Lee
- Center for Precision Medicine, Seoul National University Hospital, Seoul, Korea.
| | - Hyo Jung Kim
- Division of Biomedical Informatics, Seoul National University Biomedical Informatics and Systems Biomedical Informatics Research Center, Seoul National University College of Medicine, Seoul, Korea
| | - Yi Jun Kim
- Center for Precision Medicine, Seoul National University Hospital, Seoul, Korea
| | - Ju Han Kim
- Division of Biomedical Informatics, Seoul National University Biomedical Informatics and Systems Biomedical Informatics Research Center, Seoul National University College of Medicine, Seoul, Korea
| | - Eun Young Song
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea.
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3
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Sheen YH, Kizilbash S, Ryoo E, Wi CI, Park M, Abraham RS, Ryu E, Divekar R, Juhn Y. Relationship between asthma status and antibody response pattern to 23-valent pneumococcal vaccination. J Asthma 2019; 57:381-390. [PMID: 30784333 DOI: 10.1080/02770903.2019.1575394] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Objective: Asthma poses an increased risk for serious pneumococcal disease, but little is known about the influence of asthma status on the 23-valent serotype-specific pneumococcal antibody response. We examined differences in antibody titers between pre- and post-vaccination with 23-valent pneumococcal polysaccharide vaccine (PPSV-23) in relation to asthma status. Methods: Asthma status was retrospectively ascertained by the Predetermined Asthma Criteria in an existing vaccine cohort through comprehensive medical record review. Twenty-three serotype-specific pneumococcal antibody titers measured at baseline and 4-6 weeks post-vaccination were analyzed. Vaccine responses to PPSV-23 were calculated from pre- to post-vaccine titers for each of the serotypes. Results: Of the 64 eligible and enrolled subjects, 18 (28%) had asthma. Controls (i.e., subjects without asthma) demonstrated a statistically significant fold change response compared to their baseline for all serotypes, while those with asthma did not mount a significant response to serotypes 7F, 22F, and 23F. The overall vaccine response as measured by fold change over baseline was lower in subjects with asthma than controls. Conclusions: Poorer humoral immune responses to PPSV-23 as measured by fold change were more likely to be observed in subjects with asthma compared to controls. We recommend the consideration of asthma status when interpreting vaccine response for immune competence workup through larger studies. Further studies are warranted to replicate these findings.
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Affiliation(s)
- Youn H Sheen
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA.,Department of Pediatrics, CHA University School of Medicine, Seoul, Korea
| | - Sarah Kizilbash
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA.,Department of Pediatrics, School of Medicine, University of Minnesota, Twin Cities, MN, USA
| | - Eell Ryoo
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA.,Department of Pediatrics, Gil Hospital, Gachon University, Incheon, Korea
| | - Chung-Il Wi
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Miguel Park
- Division of Allergic Diseases, Mayo Clinic, Rochester, MN, USA
| | - Roshini S Abraham
- Division of Clinical Biochemistry and Immunology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Euijung Ryu
- Department of Health Sciences and Research, Mayo Clinic, Rochester, MN, USA
| | - Rohit Divekar
- Division of Allergic Diseases, Mayo Clinic, Rochester, MN, USA
| | - Young Juhn
- Department of Pediatric and Adolescent Medicine/Internal Medicine, Mayo Clinic, Rochester, MN, USA
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Mahdi BM, Al-Hadithi ATR, Raouf H, Zalzala HH, Abid LA, Nehad Z. Effect of HLA on development of asthma. Ann Med Surg (Lond) 2018; 36:118-121. [PMID: 30455876 PMCID: PMC6230961 DOI: 10.1016/j.amsu.2018.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 09/26/2018] [Accepted: 10/01/2018] [Indexed: 11/25/2022] Open
Abstract
Background Asthma is a disease characterized by a chronic inflammation of the airways caused by the interaction of genetic susceptibility with environmental factors. Inflammation and remodeling are critical components of asthma. It is shown that many genes are involved in the pathogenesis of asthma. Aim of study To identify/compare the association between HLA-DRB1 alleles and development of asthma in a sample of Iraqi Arab Muslims. Patients and methods A case-control study (forty patients and forty healthy control) was carried out in Medical city Teaching Hospital, Baghdad-Iraq. The study participants were patients with asthma consulted the hospital from September - 2013 to January - 2015. HLA –DRB1genotyping was done using a panel of sequence-specific oligonucleotide probes (SSOP) using HLA-DRB1amplification and hybridization kits (SSO HLA type DRB1 plus and Mastermix for HLA type DRB1 Amp plus kits -Innogenetics-Belgium) using automated method by AutoLipa – 48Innogenetics-Belgum. Results There was an increased frequency of HLADRB1*03:01:01 in control group compared with patients group (P = 0.009, Odds ratio = 0.1228, 95% CI: 0.0254–0.5930). Other allele like HLA-DRB1* 070101was significantly increased in asthmatic patients in compares with control group (P = 0.005, Odds ratio = 6.641, 95% CI: 1.7319–25.4657). Conclusions HLA alleles have an effect on development asthma in patients with HLA-DRB1*070101 while HLADRB1* 030101 may have a protective effect in Iraqi Arab Muslims individuals against development of asthma. Asthma is a disease characterized by a chronic inflammation of the airways caused by the interaction of genetic susceptibility with environmental factors. To identify/compare the association between HLA-DRB1 alleles and development of asthma in a sample of Iraqi Arab Muslims. A case-control study ( forty patients and forty healthy control) was carried out in Medical city Teaching Hospital, Baghdad-Iraq. There was an increased frequency of HLADRB1*03:01:01 in control group compared with patients group (P = 0.009, Odds ratio = 0.1228, 95% CI: 0.0254–0.5930). Other allele like HLA-DRB1* 070101 was significantly increased in asthmatic patients in compares with control group (P = 0.005, Odds ratio = 6.641, 95% CI: 1.7319–25.4657). HLA alleles have an effect on development asthma in patients with HLA-DRB1*070101 while HLADRB1* 030101 may have a protective effect.
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Affiliation(s)
- Batool Mutar Mahdi
- HLA research unit, Al-Kindy College of Medicine, University of Baghdad, Baghdad, Iraq
| | | | - Hyam Raouf
- HLA research unit, Al-Kindy College of Medicine, University of Baghdad, Baghdad, Iraq
| | - Haider Hashim Zalzala
- HLA research unit, Al-Kindy College of Medicine, University of Baghdad, Baghdad, Iraq
| | - Laheeb Ali Abid
- HLA research unit, Al-Kindy College of Medicine, University of Baghdad, Baghdad, Iraq
| | - Zena Nehad
- HLA research unit, Al-Kindy College of Medicine, University of Baghdad, Baghdad, Iraq
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Sheen YH, Rajagopalan G, Snapper CM, Kita H, Wi CI, Umaretiya PJ, Juhn YJ. Influence of HLA-DR polymorphism and allergic sensitization on humoral immune responses to intact pneumococcus in a transgenic mouse model. HLA 2016; 88:25-34. [PMID: 27506953 DOI: 10.1111/tan.12851] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 06/06/2016] [Accepted: 07/21/2016] [Indexed: 01/22/2023]
Abstract
Asthma is independently associated with HLA-DR3 and increased risks of pneumococcal diseases. We aimed to determine whether HLA-DR polymorphism (HLA-DRB1*03), sensitization to house dust mite (HDM), or their interaction affects humoral immune responses to pneumococcal polysaccharide and protein antigens of intact pneumococci. Induction of serum titers of anti-pneumococcal polysaccharide and anti-surface protein IgM and IgG in response to immunization with intact pneumococci (Pn) serotype 14 was determined using humanized HLA-DR3 and DR2 transgenic mice. Transgenic mice were sensitized by injecting HDM and challenged with intranasal HDM. Mice were subsequently immunized with heat-killed Pn14 at day 24. Serum titers of anti-phosphorylcholine (PC) IgM and IgG, anti-pneumococcal polysaccharide, capsular type 14 (PPS14) IgM and IgG, and anti-pneumococcal surface protein A (PspA) IgG were measured. We included a total of 44 mice (22 DR3 and 22 DR2 mice) and half of mice in each group were sensitized with HDM (i.e. 22 HDM-sensitized and 22 control mice). HDM-sensitized mice, irrespective of HLA-DR polymorphism, had significantly lower humoral immune responses. HLA-DR3 mice, irrespective of HDM sensitization, elicited a significantly lower anti-PC IgG response. In contrast, the anti-PspA IgG response was higher in DR3 relative to DR2 mice. The effect of HDM sensitization on lowering humoral immune responses to Pn14 was observed in DR3 mice regardless of the nature of the antigen, whereas such decreases were observed only for the anti-PPS14 IgG and anti-PC IgM responses in DR2 mice. HDM sensitization lowered humoral immune responses to intact pneumococcus and this effect was significantly modified by the HLA-DR polymorphism.
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Affiliation(s)
- Y H Sheen
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA.,Department of Pediatrics, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea
| | - G Rajagopalan
- Department of Immunology, Mayo Clinic, Rochester, MN, USA
| | - C M Snapper
- Department of Pathology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - H Kita
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - C-I Wi
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - P J Umaretiya
- Children's Hospital Primary Care Center, Boston Children's Hospital, Boston, MA, USA
| | - Y J Juhn
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA.,Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
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6
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Yao Y, Zhu L, Li J, Jin Y, He L. Association of HLA-DRB1 Gene Polymorphism with Risk of Asthma: A Meta-Analysis. Med Sci Monit Basic Res 2016; 22:80-6. [PMID: 27503745 PMCID: PMC4989996 DOI: 10.12659/msmbr.900193] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 07/13/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The relationship between HLA-DRB1 alleles and asthma is controversial. The purpose of this study was to evaluate the relationship between HLA-DRB1 alleles and risk of asthma. MATERIAL AND METHODS We searched PubMed, Chinese National Knowledge Infrastructure (CNKI), Wan Fang (Chinese) database, and Chinese Biomedical Medical databases (CBM) to find studies on the relationship between HLA-DRB1 alleles and risk of asthma. We calculated the pooled odds ratio (OR) and 95% confidence interval (CI) using STATA 12.0. Finally, a total of 24 studies were included in this meta-analysis. RESULTS The results revealed that DRB1*03 was positively associated with risk of asthma (OR=1.51, 95%CI=1.27-1.80), and DRB1*15 was negatively associated with risk of asthma (OR=0.63, 95%CI=0.42-0.93), but no association was found in other HLA-DRB1 alleles. Subgroup analysis by age revealed that DRB1*03, DRB1*04, DRB1*09, and DRB1*15 were associated with asthma in children. Subgroup analysis by ethnicity showed that DRB1*03 and DRB1*15 were associated with asthma in whites, and DRB1*07 and DRB1*14 were associated with asthma in Asians. CONCLUSIONS This results of this meta-analysis suggest that HLA-DRB1 alleles are associated with asthma.
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Kontakioti E, Domvri K, Papakosta D, Daniilidis M. HLA and asthma phenotypes/endotypes: a review. Hum Immunol 2014; 75:930-9. [PMID: 24994462 DOI: 10.1016/j.humimm.2014.06.022] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 03/11/2014] [Accepted: 06/23/2014] [Indexed: 11/25/2022]
Abstract
Asthma is a complex chronic inflammatory disease of the airways caused by the interaction of genetic susceptibility with environmental influences. Genome-wide association studies (GWAS) represent the most powerful approach for asthma, that have identified several genes (e.g., IL18R1, IL33, SMAD3, ORMDL3, HLA-DQ and IL2RB loci). HLA super-locus is a genomic region in the chromosomal position 6p21. Since no gene can be considered as an asthma gene, able to reflect the complex etiology and the heterogeneity of the disease the terms 'phenotype' and more recently 'endotype' have been used. This review, according to literature availability, focuses on the relationship between human leukocyte antigens (HLA) region specifically the HLA class II genes and different asthma phenotypes/endotypes, such as allergic asthma/Th2 associated, occupational and aspirin-sensitive asthma. The most common HLA haplotypes in the different asthma phenotypes are HLA-DRB1in allergic asthma, HLA-DQB1in occupational asthma and HLA-DPB1 in aspirin-sensitive asthma. However, it is difficult to study the role of class II genes in vivo because of the heterogeneity of human population, the complexity of MHC, and the strong linkage disequilibrium among different class II genes. Despite the variation and the inconsistency of the HLA haplotypes and alleles in different types of asthma, the association between HLA class II genes and asthma has been demonstrated in the majority of studies.
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Affiliation(s)
- Eirini Kontakioti
- Asthma Clinic, Pulmonary Department, Aristotle University of Thessaloniki, George Papanikolaou Hospital, Exochi, Thessaloniki, Greece
| | - Kalliopi Domvri
- Asthma Clinic, Pulmonary Department, Aristotle University of Thessaloniki, George Papanikolaou Hospital, Exochi, Thessaloniki, Greece
| | - Despina Papakosta
- Asthma Clinic, Pulmonary Department, Aristotle University of Thessaloniki, George Papanikolaou Hospital, Exochi, Thessaloniki, Greece.
| | - Michail Daniilidis
- Immunology Research Laboratory, 1st Department of Internal Medicine, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
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Lama M, Chatterjee M, Chaudhuri TK. A study of the association of childhood asthma with HLA alleles in the population of Siliguri, West Bengal, India. ACTA ACUST UNITED AC 2014; 84:316-20. [PMID: 24962747 DOI: 10.1111/tan.12403] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 05/02/2014] [Accepted: 05/27/2014] [Indexed: 10/25/2022]
Abstract
Asthma is a heterogeneous disease for which a strong genetic basis is firmly established. It is a complex disorder influenced by gene-environment interaction. Human leukocyte antigen (HLA) genes have been shown to be consistently associated with asthma and its related phenotypes in various populations. The aim of this study was to determine the frequency of the selected HLA classes I and II allelic groups in asthmatic and control groups. HLA typing was performed using polymerase chain reaction-sequence-specific typing (PCR-SSP) method. The allele frequency was estimated by direct counting. Frequency of each HLA allelic group was compared between asthmatic group and control group using χ(2) test. P-value was corrected by multiplying with the number of the allelic groups studied. Odds ratio (OR) and its corresponding 95% confidence interval (CI) for each allelic group were calculated using graphpad instat 3.10. The results of this study showed a significantly higher frequency of HLA-DRB1*03 in asthmatics than in controls (11.43% vs 3.64%, OR = 3.78, 95% CI = 1.61-8.85, P = 0.0025, Pcorr < 0.05). Analysis of HLA alleles in low and high total serum immunoglobulin E (IgE) level in asthmatics revealed no significant association. HLA-DRB1*03 may be implicated in the susceptibility to asthma in the pediatric population.
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Affiliation(s)
- M Lama
- Cellular Immunology Laboratory, Department of Zoology, University of North Bengal, Siliguri, West Bengal, India; Department of Zoology, The University of Burdwan, Golapbag, West Bengal, India
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9
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Bottero P, Motta F, Bonini M, Vecchio F, Ierna F, Cuppari I, Sinico RA. Can HLA-DRB4 Help to Identify Asthmatic Patients at Risk of Churg-Strauss Syndrome? ISRN RHEUMATOLOGY 2014; 2014:843804. [PMID: 24734195 PMCID: PMC3963189 DOI: 10.1155/2014/843804] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 02/03/2014] [Indexed: 11/17/2022]
Abstract
HLA-DRB4 gene is associated with Churg-Strauss syndrome (CSS), a systemic eosinophilic vasculitis with a prodromal phase characterized by severe asthma, eosinophilia, nasal polyposis, and sinusitis. Aim of this study was to evaluate if the presence of HLA-DRB4 in asthmatic patients is associated with a clinical picture resembling that of the prodromal phase of CSS. HLA-DRB1 was determined in a cohort of 159 asthmatic patients and its frequency was compared with that of 1808 blood donors. HLA-DRB4 presence/absence was correlated with clinical features, including sinusitis, nasal polyposis, eosinophils, antiasthmatic drugs, asthma severity, and pulmonary function tests. HLA-DRB4 gene was associated with severe persistent asthma before treatment (P < 0.02), near fatal or severe hypoxemic asthma (P < 0.01), sinusitis (P < 0.01), nasal polyposis (P < 0.01), number of patients with eosinophils >1000/ μ l: (P < 0.05), need of beclomethasone >1000-2000 μ g/daily (P < 0.001), use of a third controller (P < 0.05), and oral prednisone (P < 0.02). HLA-DRB4 gene is associated in asthmatic patients with a clinical picture characterized by asthma severity, sinusitis, nasal polyposis, and eosinophilia closely resembling that of the prodromal phase of CSS and might be useful to suspect corticosteroids-masked cases of CSS.
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Affiliation(s)
- P Bottero
- Allergy and Clinical Immunology Outpatients Clinic, Azienda Ospedaliera Legnano, Ospedale di Magenta, Via Donatore di Sangue 50, Magenta, 20013 Milan, Italy
| | - F Motta
- Immunohematology Unit, Azienda Ospedaliera Legnano, Ospedale di Magenta, Via Donatore di sangue 50, Magenta, 20013 Milan, Italy
| | - M Bonini
- Hygienics and Public Health Unit, Azienda Sanitaria Locale Provincia Milano1, Via Spagliardi 19, Parabiago, 20014 Milan, Italy
| | - F Vecchio
- Allergy and Clinical Immunology Outpatients Clinic, Azienda Ospedaliera Legnano, Ospedale di Magenta, Via Donatore di Sangue 50, Magenta, 20013 Milan, Italy
| | - F Ierna
- Immunohematology Unit, Azienda Ospedaliera Legnano, Ospedale di Magenta, Via Donatore di sangue 50, Magenta, 20013 Milan, Italy
| | - I Cuppari
- Immunohematology Unit, Azienda Ospedaliera Legnano, Ospedale di Magenta, Via Donatore di sangue 50, Magenta, 20013 Milan, Italy
| | - R A Sinico
- Clinical Immunology Unit and Renal Unit, Department of Medicine, Azienda Ospedaliera Ospedale San Carlo Borromeo, Via Pio Secondo 3, 20153 Milan, Italy
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10
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Dhillon RK, Yawn BP, Yoo KH, Boyce TG, Jacobson RM, McGree ME, Weaver AL, Juhn YJ. Impact of Asthma on the Severity of Serious Pneumococcal Disease. ACTA ACUST UNITED AC 2014; Suppl 3. [PMID: 25243098 PMCID: PMC4166487 DOI: 10.4172/2161-1165.s3-001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We recently reported an increased risk of serious pneumococcal disease (SPD) in asthmatics. Little is known about the impact of asthma status on the severity of SPD. We compared the severity of serious pneumococcal disease (SPD) between patients with asthma and those without asthma. The study subjects were Rochester, Minnesota residents who developed SPD between 1964 and 1983. SPD and asthma status were ascertained by using explicit predetermined criteria Severity of SPD was assessed using intensive care unit (ICU) admission rate and total days of ICU stay and hospitalization associated with treatment for SPD. We found that there were no significant differences in severity outcomes between asthmatics (n=11) and non-asthmatics (n=163). Asthma status may increase the risk of SPD but not influence its severity. However, given a small sample size of our study, a larger study needs to be considered to clarify the relationship between asthma and severity of SPD.
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Affiliation(s)
- Ravneet K Dhillon
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
| | - Barbara P Yawn
- Department of Research, Olmsted Medical Center, Rochester, MN
| | - Kwang Ha Yoo
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN ; Department of Internal Medicine, Konkuk University College of Medicine, Seoul, Korea
| | - Thomas G Boyce
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
| | - Robert M Jacobson
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
| | | | - Amy L Weaver
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Young J Juhn
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
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12
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Juhn YJ. Influence of asthma epidemiology on the risk for other diseases. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2012; 4:122-31. [PMID: 22548204 PMCID: PMC3328728 DOI: 10.4168/aair.2012.4.3.122] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Accepted: 11/14/2011] [Indexed: 11/20/2022]
Abstract
Asthma is a multifactorial chronic disease affecting a significant proportion of people in the United States and worldwide. Numerous laboratory and epidemiological studies have attempted to understand the etiology and underlying mechanisms of asthma and to identify effective therapies. However, the impact of asthma on the risk for other diseases has drawn little attention. This paper discusses the potential effects of asthma as a risk factor for other diseases, explores the potential mechanisms, and reviews the implications of the findings to clinical practice, public health, and research.
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Affiliation(s)
- Young J. Juhn
- Division of Community Pediatric and Adolescent Medicine, Department of Pediatric and Adolescent Medicine and Division of Allergy, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
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Capili CR, Hettinger A, Rigelman-Hedberg N, Fink L, Boyce T, Lahr B, Juhn YJ. Increased risk of pertussis in patients with asthma. J Allergy Clin Immunol 2012; 129:957-63. [PMID: 22206778 PMCID: PMC3321509 DOI: 10.1016/j.jaci.2011.11.020] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Revised: 11/01/2011] [Accepted: 11/07/2011] [Indexed: 11/30/2022]
Abstract
BACKGROUND The recent pertussis outbreak in California highlights the effect of pertussis on public health. In 2004, a pertussis outbreak occurred in Olmsted County, Minnesota, despite a high vaccine uptake. This outbreak provided a natural experiment to assess the relationship between asthma and pertussis. OBJECTIVE We sought to determine whether asthmatic subjects have a higher risk of pertussis than nonasthmatic subjects. METHODS We conducted a population-based case-control study. There were 223 pertussis cases identified by means of PCR in 2004 and 2005. We identified age- and sex-matched control subjects from 5537 patients with negative test results for pertussis. We conducted a comprehensive medical record review and applied predetermined criteria to ascertain asthma status. Conditional logistic regression was fit to assess the effect of asthma status on the risk of pertussis. RESULTS Of the 223 subjects, 164 were eligible for the study, and 328 matched control subjects (1:2 matching) were enrolled. Of these 164 subjects, 50% were male, and 82% were white. The median age at the index date of pertussis was 14 years. Sixty-two (38%) of the 164 cases had asthma before the index date of pertussis compared with 85 (26%) of the 328 control subjects (odds ratio, 1.73; 95% CI, 1.12-2.67; P = 013). The population attributable risk percentage of asthma for risk of pertussis was 17%. CONCLUSIONS Given the high prevalence of asthma and the ongoing risk of pertussis throughout the United States, consideration of defining asthmatic subjects as a target group for pertussis vaccination (eg, replacing decennial tetanus-diphtheria booster with tetanus, diphtheria, and acellular pertussis vaccine for adolescents and adults) should be given.
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Affiliation(s)
| | | | | | - Lisa Fink
- Department of Pediatric and Adolescent Medicine, Mayo Clinic
| | - Thomas Boyce
- Department of Pediatric and Adolescent Medicine, Mayo Clinic
| | - Brian Lahr
- Department of Health Sciences Research, Mayo Clinic
| | - Young J. Juhn
- Department of Pediatric and Adolescent Medicine, Mayo Clinic
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14
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Bassig BA, Inskip PD, Burdette L, Shapiro WR, Selker RG, Fine HA, Loeffler JS, Black PM, Dubrow R, Brenner AV. Selected human leukocyte antigen class II polymorphisms and risk of adult glioma. J Neuroimmunol 2011; 233:185-91. [PMID: 21195488 PMCID: PMC3074044 DOI: 10.1016/j.jneuroim.2010.11.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2010] [Revised: 11/10/2010] [Accepted: 11/15/2010] [Indexed: 10/18/2022]
Abstract
Few studies have examined the relationship between human leukocyte antigen (HLA) polymorphisms and adult glioma, particularly at class II loci. We evaluated the association between selected HLA class II polymorphisms and adult glioma in a large, hospital-based case-control study, using unconditional logistic regression. DQB1 06 (OR=1.67, 95% CI=1.17-2.39) and DRB1 13 (OR=1.69, 95% CI=1.08-2.64) alleles were associated with an increased risk of glioma, while the DQB1 05 allele showed an inverse association (OR=0.63, 95% CI=0.43-0.93). These results, which were of borderline significance once controlled for the false discovery rate, suggest a potential role for the DQB1 06, DQB1 05, and DRB1 13 alleles in glioma susceptibility.
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Affiliation(s)
- Bryan A. Bassig
- Yale School of Public Health, Yale School of Medicine, 60 College Street, P.O. Box 208034, New Haven, CT 06510, USA
| | - Peter D. Inskip
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, 6120 Executive Blvd. MSC 7242, Bethesda, MD 20892, USA
| | - Laurie Burdette
- Core Genotyping Facility, Advanced Technology Program, SAIC-Frederick Inc., NCI-Frederick, Frederick, MD 21702, USA
| | - William R. Shapiro
- Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ 85013, USA
| | - Robert G. Selker
- Division of Neurosurgery, Western Pennsylvania Hospital, Pittsburgh, PA 15224, USA
| | - Howard A. Fine
- Neuro-Oncology Branch, National Cancer Institute, Bethesda, MD 20892, USA
| | - Jay S. Loeffler
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA 02114, USA
| | | | - Robert Dubrow
- Yale School of Public Health, Yale School of Medicine, 60 College Street, P.O. Box 208034, New Haven, CT 06510, USA
| | - Alina V. Brenner
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, 6120 Executive Blvd. MSC 7242, Bethesda, MD 20892, USA
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15
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Rajagopalan G, Tilahun AY, Iijima K, David CS, Kita H, Juhn YJ. HLA-DR polymorphism modulates response to house dust mites in a transgenic mouse model of airway inflammation. ACTA ACUST UNITED AC 2011; 77:589-92. [PMID: 21447115 DOI: 10.1111/j.1399-0039.2010.01617.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We and others have reported that HLA-DRB1*03 is associated with childhood asthma. To extend this observation and to prove this association, we sensitized and challenged either HLA-DR2 (HLA-DRB1*1502) or HLA-DR3 (HLA-DRB1*0301) transgenic mice with house-dust mite extract. Inflammatory cell counts and cytokine levels in the bronchoalveolar lavage (BAL) fluid between HLA-DR3 and DR2 mice were compared. HLA-DR3 transgenic mice had significantly elevated eosinophil counts, Interleukin-4 and Interleukin-13 levels in the BAL fluid but not interferron gamma-γ. Thus, our study suggests that HLA-DRB1*0301 plays an important role in mounting a Th2-predominant immune response to house dust mite and Th2-type inflammation in the lung.
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Affiliation(s)
- G Rajagopalan
- Department of Immunology, Mayo Clinic, Rochester, MN 55905, USA
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16
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Hanchard NA, Jacobson RM, Poland GA, Juhn YJ. An assessment of the association between childhood asthma and HLA DRB1*03 using extended haplotype analysis. ACTA ACUST UNITED AC 2011; 76:491-4. [PMID: 20735759 DOI: 10.1111/j.1399-0039.2010.01548.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Ancestral haplotypes between human leukocyte antigen (HLA) class I and class II alleles are well-recognized in the literature. We previously published a positive association between the class II HLA allele DRB1*03 and the subsequent development of asthma in a retrospective cohort of 383 children. To refine this association, we investigated whether DRB1*03-specific haplotypes extending across the HLA are associated with asthma incidence. We found evidence of strong HLA DRB1*03-dependent linkage disequilibrium across the region, but no association between DRB1*03 ancestral haplotypes and childhood asthma. We did, however, observe a trend toward a positive association between HLA DRB1*03 and asthma by adding non-ancestral DRB1*03 positive haplotypes. Our results suggest that the role of the HLA DRB1*03 in asthma susceptibility is independent of ancestral-haplotype-mediated linkage disequilibrium.
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Affiliation(s)
- N A Hanchard
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN 55905, USA
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17
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Knutsen AP, Vijay HM, Kumar V, Kariuki B, Santiago LA, Graff R, Wofford JD, Shah MR. Mold-sensitivity in children with moderate-severe asthma is associated with HLA-DR and HLA-DQ. Allergy 2010; 65:1367-75. [PMID: 20486920 DOI: 10.1111/j.1398-9995.2010.02382.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Several epidemiologic studies in the United States and Europe have linked Alternaria sensitivity to both persistence and severity of asthma. In this study, we examined T cell responses and HLA class II alleles in children with moderate-severe asthma. METHODS Ninety-six children with moderate-severe asthma were compared to 90 children with mild asthma. HLA class II genotyping was performed to determine HLA allelic frequencies. Th1/Th2 Alternaria-specific T cell cytokine responses were determined by the use of Alternaria-stimulated cultures. HLA class II restriction was examined by inhibition of Alternaria-stimulated lymphoproliferative responses with blocking anti-HLA class II monoclonal antibodies. RESULTS Children with moderate-severe asthma had significantly increased sensitivities to Aspergillus fumigatus; sensitivities to Alternaria were similar in both moderate-severe and mild asthmatics. The frequency of HLA-DRB1*13 alleles were increased in mold-sensitive moderate-severe asthmatic children. HLA-DRB1*03 tended to be increased in mold-sensitive moderate-severe asthmatics. The frequency of HLA-DQB1*03 alleles was significantly decreased in mold and Alternaria-sensitive moderate-severe asthma. HLA class II blocking monoclonal antibodies demonstrated HLA-DR restriction. Alternaria-stimulated IL-5 and IL-13 synthesis was significantly increased in moderate-severe asthmatics. IL-5 and IL-13 synthesis was significantly increased in Alternaria-stimulated lymphocyte cultures of HLA-DQB1*03- asthmatics compared to HLA-DQB1*03+ asthmatics. CONCLUSIONS In children with Alternaria-sensitive moderate-severe asthma, there was increased Th2 sensitivity to Alternaria stimulation. This was associated with HLA-DR restriction and with increased frequency of HLA-DRB1*13 and HLA-DRB1*03. There was decreased frequency of HLA-DQB1*03 in Alternaria-sensitive moderate-severe asthma, suggesting HLA-DQB1*03 may be protective of the development of Alternaria-sensitive severe asthma.
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Affiliation(s)
- A P Knutsen
- Department of Pediatrics, Saint Louis University, St. Louis, MO 63104, USA.
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18
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Foster SB, Lu M, Thompson B, Rich KC, Matukas LM, Mason R, Winchester R, MacDonald KS, Shearer WT. Association between HLA inheritance and asthma medication use in HIV positive children. AIDS 2010; 24:2133-5. [PMID: 20613458 PMCID: PMC3665405 DOI: 10.1097/qad.0b013e32833cba08] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This study's purpose was to determine whether asthma medication use in HIV positive children is associated with human leukocyte antigen (HLA) alleles. We reviewed HLA and medication data collected during the Women and Infants Transmission Study for 124 HIV positive children and their mothers. Analysis revealed that HLA-A68 (P = 0.006) was independent and predictive for time to first asthma medication use. There was a preventive association of Cw6 (P = 0.008) with asthma time. Highly active antiretroviral therapy (HAART) was also associated with time to first asthma medication use (P = 0.05). HLA alleles may modulate risk of developing a need for asthma medications and seem to function independently of the actions of HAART therapy.
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Affiliation(s)
- Samuel B. Foster
- Baylor College of Medicine and Texas Children's Hospital, Department of Pediatrics, Allergy and Immunology Section, Houston, TX
| | - Ming Lu
- Clinical Trials & Surveys Corp., Baltimore, MD
| | | | - Kenneth C. Rich
- University of Illinois at Chicago, Department of Pediatrics, Chicago, IL
| | | | - Rosemarie Mason
- University of Melbourne, Department of Microbiology and Immunology, Melbourne, Australia
| | | | | | - William T. Shearer
- Baylor College of Medicine and Texas Children's Hospital, Department of Pediatrics, Allergy and Immunology Section, Houston, TX
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19
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Valerio MA, Andreski PM, Schoeni RF, McGonagle KA. Examining the association between childhood asthma and parent and grandparent asthma status: implications for practice. Clin Pediatr (Phila) 2010; 49:535-41. [PMID: 20507869 PMCID: PMC3020897 DOI: 10.1177/0009922809356465] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Examination of intergenerational asthma beyond maternal asthma has been limited. The association between childhood asthma and intergenerational asthma status among a national cohort of children was examined. The genealogical sample (2552 children) participating in the Child Development Supplement of the Panel Study of Income Dynamics was studied. Multivariate regression was used to determine intergenerational asthma. Children with a parent with asthma were almost twice as likely (odds ratio [OR] = 1.96) to have asthma compared with those without a parent with asthma. Children with a parent and grandparent with asthma were more than 4 times more likely to have asthma compared with those without a parent and grandparent with asthma (OR = 4.27). Children with a grandparent with asthma were more likely to have asthma (OR = 1.52). A family history of asthma was a significant predictor of physician diagnosed asthma in children regardless of race/ethnicity and socioeconomic status. Findings support the collection of family history, including grandparent asthma status.
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Affiliation(s)
- Melissa A. Valerio
- University of Michigan, School of Public Health, Health Behavior and Health Education, Telephone: 734-763-0673, Fax: 734-763-7379,
| | - Patricia M. Andreski
- University of Michigan, Institute for Social Research, , Telephone: 734-615-5065, Fax Number: 734-936-3809
| | - Robert F. Schoeni
- University of Michigan, Institute for Social Research, , Telephone: 734-763-5131, Fax Number: 734-936-3809
| | - Katherine A. McGonagle
- University of Michigan, Institute for Social Research, , Telephone: 734-936-1773, Fax Number: 734-936-3809
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20
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Martyn MB, Molis W, Jacobson RM, Poland GA, Weaver AL, Juhn YJ. Human leukocyte antigen type and progression from onset of symptoms to development of asthma. Allergy Asthma Proc 2010; 31:120-5. [PMID: 20214848 PMCID: PMC7368177 DOI: 10.2500/aap.2010.31.3321] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This study investigated the influence of human leukocyte antigen (HLA) genes on the progression of asthma, from the initial onset of symptoms to when criteria for asthma are met. Study subjects were a subsample (n = 340) of 838 healthy children, aged 5-12 years, who participated in a previous study, and who had HLA data and asthma status. The duration in time from the initial onset of asthma symptoms documented in each subject's medical records to the index date when the subject first met criteria for asthma was determined. The time duration was compared between carriers and noncarriers of HLA genes of interest of the 340 original subjects with HLA data available, 114 children (33.5%) met criteria for asthma before 18 years of age. The median ages at onset of asthma symptoms and at the index date of asthma were 4.4 years and 7.2 years, respectively. The median time intervals between onset of symptoms and index date for HLA DRB1*11 carriers and noncarriers were 552 versus 61 days, respectively (p = 0.004). The same time intervals for HLA DQB1*0301 carriers and noncarriers were 420 versus 59 days, respectively (p = 0.012). However, HLA DQB1*0302 or DRB1*03 carriers had shorter median intervals, when compared with noncarriers (119 versus 266 days, respectively, p = 0.20; and 86 versus 258 days, respectively, p = 0.38) but they did not reach statistical significance. HLA type appears to influence the progression of asthma from initial symptoms to disease. Thus, genetic factors may affect the natural history of asthma.
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Affiliation(s)
| | - Whitney Molis
- Department of Pediatrics, Division of Community Pediatric and Adolescent Medicine, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
| | - Robert M. Jacobson
- Department of Pediatrics, Division of Community Pediatric and Adolescent Medicine, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
| | - Gregory A. Poland
- Department of Pediatrics, Division of Community Pediatric and Adolescent Medicine, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
| | - Amy L. Weaver
- Department of Pediatrics, Division of Community Pediatric and Adolescent Medicine, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
| | - Young J. Juhn
- Department of Pediatrics, Division of Community Pediatric and Adolescent Medicine, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
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21
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Kondo N, Matsui E, Nishimura A, Kaneko H. Pharmacogenetics of asthma in children. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2009; 2:14-9. [PMID: 20224673 PMCID: PMC2831608 DOI: 10.4168/aair.2010.2.1.14] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2009] [Accepted: 09/14/2009] [Indexed: 02/03/2023]
Abstract
Allergic diseases such as bronchial asthma and atopic dermatitis develop by a combination of genetic and environmental factors. Several candidate causative genes of asthma and atopy have been reported as the genetic factors. The clinical features of patients and causes of diseases vary. Therefore, personalized medicine (tailor-made medicine) is necessary for the improvement of quality of life (QOL) and for asthma cure. Pharmacogenetics is very important for personalized medicine. Here, we present the genetics and pharmacogenetics of asthma in children. Finally, we show the guideline for personalized medicine for asthma, particularly in childhood, including the pharmacogenetics of anti-asthmatic drugs, preliminarily produced by the authors.
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Affiliation(s)
- Naomi Kondo
- Department of Pediatrics, Graduate School of Medicine, Gifu University, Gifu, Japan
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22
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Kang CI, Rouse MS, Patel R, Kita H, Juhn YJ. Allergic airway inflammation and susceptibility to pneumococcal pneumonia in a murine model with real-time in vivo evaluation. Clin Exp Immunol 2009; 156:552-61. [PMID: 19438610 DOI: 10.1111/j.1365-2249.2009.03925.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The relationship between allergic airway inflammation and pneumococcal pneumonia is not well understood. We assessed susceptibility to experimental pneumococcal pneumonia in mice with and without allergic airway inflammation. Susceptibility to pneumococcal pneumonia was evaluated by challenging mice with a bioluminescent Streptococcus pneumoniae strain after sensitization with ovalbumin (OVA), with subsequent monitoring of pneumococcal infection using real-time photonic imaging. Of 46 OVA-sensitized mice challenged with pneumococci, 13 (28%) developed imaging findings consistent with pneumococcal pneumonia. In comparison, 28 (57%) of 49 non-sensitized control mice developed pneumococcal pneumonia (P = 0.005). While none of the control group developed meningitis (0%, none of 28), two mice in the OVA-sensitized group developed meningitis (15.4%, two of 13) (P = 0.09). The mean bacterial count in the lung was significantly lower in the OVA-sensitized than the non-sensitized group (8.26 +/- 0.69 versus 9.21 +/- 0.67 log(10) colony-forming units (CFU)/g, P = 0.002). There was a trend towards the mean bacterial count in the spleen being higher in the OVA-sensitized versus the non-sensitized group (8.14 +/- 0.89 versus 7.45 +/- 1.07 log(10) CFU/g, P = 0.071). A high level of interleukin (IL)-4 in lung homogenates was associated with risk of pneumococcal infection independent of sensitization with OVA (odds ratio: 49.7, 95% confidence interval 2.92-846.5, per increment of 1.0 pg/ml). In the murine model studied, acute allergic airway inflammation reduced susceptibility to pneumococcal pneumonia. IL-4 may increase the risk of pneumococcal pneumonia independently of allergic airway inflammation.
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Affiliation(s)
- C-I Kang
- Division of Infectious Diseases, College of Medicine, Mayo Clinic, Rochester, MN 55905, USA
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23
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Molis WE, Bagniewski S, Weaver AL, Jacobson RM, Juhn YJ. Timeliness of diagnosis of asthma in children and its predictors. Allergy 2008; 63:1529-35. [PMID: 18925889 DOI: 10.1111/j.1398-9995.2008.01749.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND There is a paucity of literature using medical records to evaluate the timeliness of asthma diagnosis in children and the predictors associated with timeliness of asthma diagnosis. METHODS Subjects were obtained from a convenience sample of 839 children, aged 5-13 years. We conducted comprehensive medical record reviews for these children to determine their asthma status by applying predetermined criteria for asthma. Predictors were evaluated for an association with timeliness of asthma diagnosis. RESULTS Of 839 children, 276 children met the criteria for asthma before 18 years of age. Of these subjects, 97 had timely diagnosis of asthma while 179 did not have timely diagnosis of asthma with the median delay of 3.3 years. Children with definite asthma at the time of index date was three times more timely to be diagnosed with asthma [hazard ratios (HR) 3.3, 95% CI: 2.43-4.47, P < 0.001], compared to those with probable asthma. Children with a family history of asthma were more timely to be diagnosed with asthma (HR 1.36, 95% CI: 1.03-1.8, P = 0.031). Children with exercise-induced wheezing or bronchospasm were more timely to be diagnosed with asthma (HR 1.79, 95% CI: 0.95-3.36, P = 0.07), compared to those with spasmodic (or bronchospastic) cough. CONCLUSIONS Many asthmatic children are not diagnosed with asthma in a timely manner, especially in those without the commonly recognized factors associated with asthma. Health care providers need to be reminded that asthma can still occur in those without commonly recognized risk factors. Asthma guidelines need to emphasize this aspect.
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Affiliation(s)
- W E Molis
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN 55905, USA
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24
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Bartůnková J, Kayserová J, Shoenfeld Y. Allergy and autoimmunity: parallels and dissimilarity: the yin and yang of immunopathology. Autoimmun Rev 2008; 8:302-8. [PMID: 18848649 DOI: 10.1016/j.autrev.2008.09.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2008] [Accepted: 09/19/2008] [Indexed: 12/20/2022]
Abstract
The etiopathogenesis of allergy and autoimmune diseases is caused by genetic and acquired (environmental) factors, which might be common to both immunopathologies. Genetic factors play an important role in the development and process of immunopathological diseases. Several studies suggest a close relation between gene polymorphism of HLA and cytokines and development of autoimmunity and allergy. Certain gene polymorphisms act as risk or as protective factors. The infection also plays an important role in the induction of allergy and autoimmunity--as a trigger or as a protective factor. Moreover, similar clinical manifestations of both immunopathologies could result in diagnostic problems. This review summarizes the linkage of mechanisms of etiopathogenesis, clinical manifestations and therapeutic strategy between allergic and autoimmune diseases.
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Affiliation(s)
- Jirina Bartůnková
- Department of Immunology, 2nd Medical Faculty, Charles University of Prague, University Hospital Motol, V Uvalu 84, 150 06 Prague 5, Czech Republic.
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25
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Abstract
Asthma is a chronic inflammatory lung disease that leads to significant morbidity, mortality, and economic burden. The clinical symptoms, which are a result of airway inflammation and reversible airway obstruction, have led to the mainstay of therapies for asthma: anti-inflammatory medications and bronchodilators. However, the efficacies of the various classes of medications are not equal among all patients and may be affected by asthma phenotypes, environmental exposures, and genetic differences. Similarly, the risk for developing asthma and the natural history of the disease show great inter-individual variability due to these same factors. Over the past few decades, much effort has been focused on the genetics of asthma, and investigators have identified more than one hundred potential asthma susceptibility genes, of which at least ten have been replicated in numerous independent studies. In parallel, researchers have also identified genetic factors that impact the pharmacotherapeutic responses to the major classes of asthma medications. While the results of previous studies have been promising, future investigations need to combine genetics, pharmacogenetics, accurate disease phenotyping, and environmental exposures to build the foundation for personalized and predictive medicine for the 21st century. The ultimate goal is to enable physicians to identify those at risk for asthma, intervene to prevent or attenuate the disease, and select the optimal medical regimen for each individual patient. If successful, the resulting paradigm shift in medical practice will lead to improved clinical outcomes and decreased health care expenditures.
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Affiliation(s)
- Manoj R Warrier
- Institute for Personalized and Predictive Medicine and Division of Allergy and Immunology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH 45229, USA.
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26
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Jacobson JS, Goldstein IF, Canfield SM, Ashby-Thompson M, Husain SA, Chew GL, Perzanowski MS, Hoepner L, Garfinkel R, Mellins RB. Early respiratory infections and asthma among New York City Head Start children. J Asthma 2008; 45:301-8. [PMID: 18446594 DOI: 10.1080/02770900801911186] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Respiratory infections in neonates have been found to predict wheeze among young children. We hypothesized that among preschool children from low-income minority communities in New York City, current asthma would be associated with a history of respiratory infection in the first few months after their birth. METHODS We asked parents of children in New York City Head Start centers (preschool programs for children of low-income families) to respond to a questionnaire covering demographic factors, lifestyle, home environment, and health history, including a detailed history of respiratory conditions. We used logistic regression to model the association of asthma and asthma severity with history of respiratory infections, controlling for gender, ethnicity, family history of asthma, and other factors. RESULTS Among 1,022 children (mean age 4+/- 0.6 years) whose parents provided information about their health history, 359 (35%) met our criteria for asthma. Overall, 22% had had a cold by 6 months and 17% an ear infection by 8 months of age. In multivariable models, children with asthma had had more colds (OR = 2.8, 95% confidence interval [CI] 1.4-6.0) and ear infections (OR = 3.4, 95% CI 1.7-6.9) in the past year than other children. Associations of respiratory infections with emergency department use for asthma (as a measure of severity) were similar. In models that did not control for infections in the past year, ages at first cold and first ear infection were associated with asthma and emergency department visits in the past year. CONCLUSIONS In this sample of preschool children, respiratory infections were common and were associated with asthma and health care utilization for asthma exacerbations. If these findings are confirmed, preventive measures among children who develop such infections at a very early age should be explored to help reduce the burden of asthma in this age group.
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Affiliation(s)
- Judith S Jacobson
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York 10032, USA.
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27
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Juhn YJ, Johnson SK, Hashikawa AH, Voigt RG, Campeau LJ, Yawn BP, Williams AR. The potential biases in studying the relationship between asthma and microbial infection. J Asthma 2008; 44:827-32. [PMID: 18097858 DOI: 10.1080/02770900701743804] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To assess bias in parent reports of asthma status of children and detection bias of medical records-based asthma ascertainment and to examine effects of such bias on the association between asthma status and infections. METHODS A prospective cohort study was conducted to compare the correlations between the frequency of acute illnesses and that of medical evaluations between children with or without asthma according to parental report and medical record review by following a group of children who were enrolled in the Mayo Clinic Sick Child Care Program in Rochester, Minnesota. Parents completed a self-administered questionnaire to determine asthma status of their child. Also, comprehensive medical record reviews were conducted to determine asthma status of each subject by applying predetermined criteria for asthma. RESULTS A convenience sample of 115 parents and their children participated in this study. The mean age of the parents who participated in the study was 32.8 years (standard deviation: 5.4 years); 93% were female (mothers); and 90% were white. Of the 115 children who participated in this study, 84% were reported to be white and 49% were female. The mean age of the children was 2 years (standard deviation: 1.0 year). Parents whose children had asthma by report appeared to be less likely to seek medical evaluations (Spearman's rho: 0.42,p = 0.11) when their children had acute illnesses, compared to those of non-asthmatic children (rho: 0.64,p < 0.001). Concerns that asthmatic patients (rho: 0.62,p < 0.001) are more likely to see health care providers and undergo medical evaluations and laboratory tests when they have acute illnesses than non-asthmatic patients (rho: 0.64,p < 0.001) are not supported by our study. CONCLUSION Parental report bias needs to be considered carefully when studying the relationship between asthma and microbial infection.
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Affiliation(s)
- Young J Juhn
- Mayo Clinic Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
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Yoo KH. Clinical Year in Review of Asthma for Pulmonary Physicians : The Epidemiologic Hypothesis for the Relationship between Asthma and Infectious Disease. Tuberc Respir Dis (Seoul) 2008. [DOI: 10.4046/trd.2008.65.1.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Kwang-Ha Yoo
- Department of Internal Medicine, Konkuk University College of Medicine, Seoul, Korea
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Yoo KH, Molis WE, Weaver AL, Jacobson RM, Juhn YJ. The impact of electronic medical records on timeliness of diagnosis of asthma. J Asthma 2007; 44:753-8. [PMID: 17994406 DOI: 10.1080/02770900701645447] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
We assessed timeliness of diagnosis of asthma before and after the inception of electronic medical record (EMR). The proportions of children with a delay in diagnosis of asthma before and after the inception of EMR were 67.8% and 56.8%, respectively (p = 0.088). A significant proportion of children have delayed diagnosis of asthma, and availability of EMR plays a minimal role in reducing delays in diagnosis of asthma. However, considering the limited statistical power and a potential trend of EMR toward the positive impact on timely diagnosis of asthma, the study results need to be revisited in a larger study.
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Affiliation(s)
- Kwang Ha Yoo
- Department of Internal Medicine, Konkuk University College of Medicine, Seoul, Korea
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Munthe-Kaas MC, Carlsen KL, Carlsen KH, Egeland T, Håland G, Devulapalli CS, Akselsen H, Undlien D. HLA Dr-Dq haplotypes and the TNFA-308 polymorphism: associations with asthma and allergy. Allergy 2007; 62:991-8. [PMID: 17686102 DOI: 10.1111/j.1398-9995.2007.01377.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The HLA (human leukocyte antigen) class II genes DQB1 and DRB1 and the Tumor Necrosis Factor alpha gene (TNFA) within the HLA complex (chromosome 6p21) have been associated with asthma and allergy. Due to the strong linkage disequilibrium characterizing this complex and the multiple asthma/allergy expressions, we aimed to determine which of these genes were primarily involved in specific asthma/allergy traits. METHODS The DRB1-DQB1 alleles and TNFA-308 polymorphism were genotyped in 959 children from the Environment and Childhood Asthma study and analyzed for possible associations with allergic and non-allergic asthma (with/without at least one positive skin prick test for allergens) and specific allergic sensitization, as well as bronchial hyperresponsiveness and total IgE, using both allele and extended haplotype analyses. RESULTS Different genes within the HLA complex were associated with separate asthma and allergy traits. Nonallergic asthma was associated with both the TNFA-308A allele [Odds ratio (OR) 1.7 (1.3-2.3)] and DRB1 03 allele [OR 1.6(1-2.6)], but extended DRB1 03-TNFA-308 haplotype analysis suggested that the DRB1-DQB1 association was secondary to linkage disequilibrium with the TNFA-308 polymorphism. Allergies were associated with HLA class II alleles only; birch sensitization with DQB1 0603-DRB1 13 [OR 2.3 (1.4-4.0)] and mugwort sensitization with DQB1 0609-DRB1 13 [OR 7.1 (1.9-27.0)] and DQB1 0501-DRB1 01 [OR 2.0 (1.0-4.0)]. CONCLUSIONS Our data suggests that asthma is not associated with DRB1 or DQB1 but rather TNFA or a gene(s) in linkage disequilibrium, while sensitization to specific allergens is associated with particular alleles at the DQ and/or DR loci. A novel association between DQB1 0603-DRB1 13 and birch allergy is identified.
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Affiliation(s)
- M C Munthe-Kaas
- Department of Pediatrics, Ullevål University Hospital, Oslo, Norway
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