1
|
Toumpanakis D, Usmani OS. Small airways in asthma: Pathophysiology, identification and management. CHINESE MEDICAL JOURNAL PULMONARY AND CRITICAL CARE MEDICINE 2023; 1:171-180. [PMID: 39171124 PMCID: PMC11332871 DOI: 10.1016/j.pccm.2023.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Indexed: 08/23/2024]
Abstract
Background The aim of this review is to summarize the current evidence regarding small airway disease in asthma, focusing on recent advances in small airway pathophysiology, assessment and therapeutic implications. Methods A search in Medline was performed, using the keywords "small airways", "asthma", "oscillometry", "nitrogen washout" and "imaging". Our review was based on studies from adult asthmatic patients, although evidence from pediatric populations is also discussed. Results In asthma, inflammation in small airways, increased mucus production and airway wall remodelling are the main pathogenetic mechanisms of small airway disease. Small airway dysfunction is a key component of asthma pathophysiology, leading to increased small airway resistance and airway closure, with subsequent ventilation inhomogeneities, hyperresponsiveness and airflow limitation. Classic tests of lung function, such as spirometry and body plethysmography are insensitive to detect small airway disease, providing only indirect measurements. As discussed in our review, both functional and imaging techniques that are more specific for small airways, such as oscillometry and the multiple breath nitrogen washout have delineated the role of small airways in asthma. Small airways disease is prevalent across all asthma disease stages and especially in severe disease, correlating with important clinical outcomes, such as asthma control and exacerbation frequency. Moreover, markers of small airways dysfunction have been used to guide asthma treatment and monitor response to therapy. Conclusions Assessment of small airway disease provides unique information for asthma diagnosis and monitoring, with potential therapeutic implications.
Collapse
Affiliation(s)
- Dimitrios Toumpanakis
- National Heart and Lung Institute, Imperial College London, London, SW3 6LY, United Kingdom
- General State Hospital for Thoracic Diseases of Athens “Sotiria”, Athens, 11527, Greece
| | - Omar S. Usmani
- National Heart and Lung Institute, Imperial College London, London, SW3 6LY, United Kingdom
| |
Collapse
|
2
|
Xiong Y, Luo Y, Yuwen T, Li J, Chen R, Shi F. The Regulatory Role of miR-107-Cdk6-Rb Pathway in Airway Smooth Muscle Cells in Asthma. J Asthma Allergy 2023; 16:433-445. [PMID: 37102069 PMCID: PMC10124628 DOI: 10.2147/jaa.s405457] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 04/03/2023] [Indexed: 04/28/2023] Open
Abstract
Purpose Airway remodeling is a significant pathological change of asthma. This study aimed to detect differentially expressed microRNAs in the serum of asthma patients and airway smooth muscle cells (ASMCs) of asthmatic mice, exploring their role in the airway remodeling of asthma. Methods The differentially expressed microRNAs in the serum of mild and moderate-severe asthma patients compared to healthy subjects were revealed using the "limma" package. Gene Ontology (GO) analysis was used to annotate the functions of microRNA target genes. The relative expressions of miR-107 (miR-107-3p in mice sharing the same sequence) in the primary airway smooth muscle cells (ASMCs) of the asthma mice model were tested by RT-qPCR. Cyclin-dependent kinases 6 (Cdk6), a target gene of miR-107, was predicted by algorithms and validated by dual-luciferase reporter assay and Western blot. The roles of miR-107, Cdk6, and protein Retinoblastoma (Rb) in ASMCs were examined by transwell assay and EDU KIT in vitro. Results The expression of miR-107 was down-regulated in both mild and moderate-severe asthma patients. Intriguingly, the level of miR-107 was also decreased in ASMCs of the asthma mice model. Up-regulating miR-107 suppressed ASMCs' proliferation by targeting Cdk6 and the phosphorylation level of Rb. Increasing the expression of Cdk6 or suppressing Rb activity abrogated the proliferation inhibition effect of ASMCs induced by miR-107. In addition, miR-107 also inhibits ASMC migration by targeting Cdk6. Conclusion The expression of miR-107 is down-regulated in serums of asthma patients and ASMCs of asthmatic mice. It plays a critical role in regulating the proliferation and migration of ASMCs via targeting Cdk6.
Collapse
Affiliation(s)
- Yi Xiong
- Emergency Department, Shenzhen People’s Hospital, Shenzhen, Guangdong Province, People’s Republic of China
- Biomedical Research Institute, Shenzhen Peking University-The Hong Kong University of Science and Technology Medical Center, Shenzhen, Guangdong Province, People’s Republic of China
| | - Yani Luo
- Biomedical Research Institute, Shenzhen Peking University-The Hong Kong University of Science and Technology Medical Center, Shenzhen, Guangdong Province, People’s Republic of China
| | - Ting Yuwen
- Biomedical Research Institute, Shenzhen Peking University-The Hong Kong University of Science and Technology Medical Center, Shenzhen, Guangdong Province, People’s Republic of China
| | - Jiana Li
- Biomedical Research Institute, Shenzhen Peking University-The Hong Kong University of Science and Technology Medical Center, Shenzhen, Guangdong Province, People’s Republic of China
| | - Rongchang Chen
- Key Laboratory of Shenzhen Respiratory Diseases, Institute of Shenzhen Respiratory Diseases, Shenzhen People’s Hospital, Shenzhen, Guangdong Province, People’s Republic of China
- Correspondence: Rongchang Chen, Email
| | - Fei Shi
- Emergency Department, Shenzhen People’s Hospital, Shenzhen, Guangdong Province, People’s Republic of China
- Fei Shi, Email
| |
Collapse
|
3
|
Pini L, Ziletti GC, Ciarfaglia M, Giordani J, Tantucci C. Acute Effect of Bronchodilator on Intrathoracic Airway Wall Compliance in COPD Patients. Lung 2022; 200:473-480. [PMID: 35851429 PMCID: PMC9360132 DOI: 10.1007/s00408-022-00556-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 07/03/2022] [Indexed: 12/01/2022]
Abstract
Purpose In patients with chronic obstructive pulmonary disease (COPD), bronchial responsiveness after acute administration of short acting bronchodilators is conventionally assessed by measuring the improvement of forced expiratory volume in the first second (FEV1) during a maximal forced expiratory maneuver. This study aimed to measure the variation of intrathoracic airway wall compliance (AWC) after acute administration of short acting beta-2 agonist in COPD patients since this might influence the final modification of airway caliber during maximal expiratory effort and the resulting bronchodilation as inferred by FEV1 changes. Methods In a group of 10 patients suffering from COPD, intrathoracic AWC was measured at middle (50% of Forced Vital Capacity (FVC) and low (75% of FVC) lung volumes using the interrupter method during forced expiratory maneuver in basal conditions and after acute inhalation of albuterol (salbutamol) (400 mcg by MDI). Ten healthy subjects were examined similarly as a control group. Results Lower values of baseline intrathoracic AWC at both lung volumes were found in COPD patients (1.72 ± 0.20 ml/cmH2O and 1.08 ± 0.20 ml/cmH2O, respectively) as compared to controls (2.28 ± 0.27 ml/cmH2O and 1.44 ± 0.22 ml/cmH2O, respectively) (p < 0.001). In COPD patients, AWC increased significantly at both lung volumes after salbutamol, amounting to 1.81 ± 0.38 ml/cmH2O and 1.31 ± 0.39 ml/cmH2O, respectively (p < 0.01), but the relative change was not different from that observed in controls. Conclusion In COPD patients, AWC is reduced compared to controls, but after bronchodilator, the intrathoracic airways become more compliant. The consequent increased collapsibility under high positive pleural pressure could limit the airway caliber improvement seen after bronchodilator, as assessed by the FEV1 changes during the forced expiratory maneuver, underestimating the effective bronchodilation achieved in these patients.
Collapse
Affiliation(s)
- Laura Pini
- Respiratory Medicine Unit, ASST - Spedali Civili di Brescia, Piazzale Spedali Civili 1, Brescia, Italy.
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
| | - Giulia Claudia Ziletti
- Respiratory Medicine Unit, ASST - Spedali Civili di Brescia, Piazzale Spedali Civili 1, Brescia, Italy
| | - Manuela Ciarfaglia
- Respiratory Medicine Unit, ASST - Spedali Civili di Brescia, Piazzale Spedali Civili 1, Brescia, Italy
| | - Jordan Giordani
- Respiratory Medicine Unit, ASST - Spedali Civili di Brescia, Piazzale Spedali Civili 1, Brescia, Italy
| | - Claudio Tantucci
- Respiratory Medicine Unit, ASST - Spedali Civili di Brescia, Piazzale Spedali Civili 1, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| |
Collapse
|
4
|
The airway smooth muscle sodium/calcium exchanger NCLX is critical for airway remodeling and hyperresponsiveness in asthma. J Biol Chem 2022; 298:102259. [PMID: 35841929 PMCID: PMC9372629 DOI: 10.1016/j.jbc.2022.102259] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 06/27/2022] [Accepted: 06/30/2022] [Indexed: 12/13/2022] Open
Abstract
The structural changes of airway smooth muscle (ASM) that characterize airway remodeling (AR) are crucial to the pathogenesis of asthma. During AR, ASM cells dedifferentiate from a quiescent to a proliferative, migratory, and secretory phenotype. Calcium (Ca2+) is a ubiquitous second messenger that regulates many cellular processes, including proliferation, migration, contraction, and metabolism. Furthermore, mitochondria have emerged as major Ca2+ signaling organelles that buffer Ca2+ through uptake by the mitochondrial Ca2+ uniporter and extrude it through the Na+/Ca2+ exchanger (NCLX/Slc8b1). Here, we show using mitochondrial Ca2+-sensitive dyes that NCLX only partially contributes to mitochondrial Ca2+ extrusion in ASM cells. Yet, NCLX is necessary for ASM cell proliferation and migration. Through cellular imaging, RNA-Seq, and biochemical assays, we demonstrate that NCLX regulates these processes by preventing mitochondrial Ca2+ overload and supporting store-operated Ca2+ entry, activation of Ca2+/calmodulin-dependent kinase II, and transcriptional and metabolic reprogramming. Using small animal respiratory mechanic measurements and immunohistochemistry, we show that smooth muscle-specific NCLX KO mice are protected against AR, fibrosis, and hyperresponsiveness in an experimental model of asthma. Our findings support NCLX as a potential therapeutic target in the treatment of asthma.
Collapse
|
5
|
STIM1 is a core trigger of airway smooth muscle remodeling and hyperresponsiveness in asthma. Proc Natl Acad Sci U S A 2022; 119:2114557118. [PMID: 34949717 PMCID: PMC8740694 DOI: 10.1073/pnas.2114557118] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2021] [Indexed: 12/20/2022] Open
Abstract
Stromal-interacting molecule 1 (STIM1) proteins are essential for the function of store-operated Ca2+ entry (SOCE). Using transcriptomics, metabolomics, imaging, and inducible smooth muscle–specific STIM1 knockout mice expressing genetically encoded Ca2+ sensors, we reveal a crucial function of STIM1 in airway remodeling and airway hyperresponsiveness in asthma. STIM1-mediated Ca2+ oscillations in airway smooth muscle (ASM) cells are critical for ASM remodeling through metabolic and transcriptional reprogramming and cytokine secretion, including IL-6. These effects are driven by Ca2+-dependent activation of the transcription factor isoform NFAT4 specifically in ASM. Our data provide evidence that ASM STIM1 and SOCE are central triggers of asthma manifestations and advocate for the future use of STIM1 as a molecular target in asthma therapy. Airway remodeling and airway hyperresponsiveness are central drivers of asthma severity. Airway remodeling is a structural change involving the dedifferentiation of airway smooth muscle (ASM) cells from a quiescent to a proliferative and secretory phenotype. Here, we show up-regulation of the endoplasmic reticulum Ca2+ sensor stromal-interacting molecule 1 (STIM1) in ASM of asthmatic mice. STIM1 is required for metabolic and transcriptional reprogramming that supports airway remodeling, including ASM proliferation, migration, secretion of cytokines and extracellular matrix, enhanced mitochondrial mass, and increased oxidative phosphorylation and glycolytic flux. Mechanistically, STIM1-mediated Ca2+ influx is critical for the activation of nuclear factor of activated T cells 4 and subsequent interleukin-6 secretion and transcription of pro-remodeling transcription factors, growth factors, surface receptors, and asthma-associated proteins. STIM1 drives airway hyperresponsiveness in asthmatic mice through enhanced frequency and amplitude of ASM cytosolic Ca2+ oscillations. Our data advocates for ASM STIM1 as a target for asthma therapy.
Collapse
|
6
|
|
7
|
Bourdin A, Charriot J, Boissin C, Ahmed E, Suehs C, De Sevin A, Volpato M, Pahus L, Gras D, Vachier I, Halimi L, Hamerlijnck D, Chanez P. Will the asthma revolution fostered by biologics also benefit adult ICU patients? Allergy 2021; 76:2395-2406. [PMID: 33283296 DOI: 10.1111/all.14688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 11/26/2020] [Accepted: 11/29/2020] [Indexed: 12/01/2022]
Abstract
PURPOSE Asthma exacerbations are inflammatory events that rarely result in full hospitalization following an ER visit. Unfortunately, certain patients require prolonged support, including occasional external lung support through ECMO or ECCOR (with subsequent further exposure to other life-threatening issues), and some die. In parallel, biologics are revolutionizing severe asthma management, mostly in T2 high patients. METHODS We extensively reviewed the current unmet needs surrounding ICU-admitted asthma exacerbations, with a focus on currently available drugs and the underlying biological processes involved. We explored whether currently available T2-targeting drugs can reasonably be seen as potential players not only for relapse prevention but also as candidate drugs for a faster resolution of such episodes. The patient's perspective was also sought. RESULTS About 30% of asthma exacerbations admitted to the ICU do not resolve within five days. Persistent severe airway obstruction despite massive doses of corticosteroids and maximal pharmacologically induced bronchodilation is the main cause of treatment failure. Previous ICU admission is the main risk factor for such episodes and may eventually be considered as a T2 surrogate marker. Fatal asthma cases are hallmarked by poorly steroid-sensitive T2-inflammation associated with severe mucus plugging. New, fast-acting T2-targeting biologics (already used for preventing asthma exacerbations) have the potential to circumvent steroid sensitivity pathways and decrease mucus plugging. This unmet need was confirmed by patients who reported highly negative, traumatizing experiences. CONCLUSIONS There is room for improvement in the management of ICU-admitted severe asthma episodes. Clinical trials assessing how biologics might improve ICU outcomes are direly needed.
Collapse
Affiliation(s)
- Arnaud Bourdin
- Department of Respiratory Diseases Univ Montpellier, CHU Montpellier Montpellier France
- PhyMedExp Univ MontpellierCNRSINSERM, CHU Montpellier Montpellier France
| | - Jérémy Charriot
- Department of Respiratory Diseases Univ Montpellier, CHU Montpellier Montpellier France
- PhyMedExp Univ MontpellierCNRSINSERM, CHU Montpellier Montpellier France
| | - Clément Boissin
- Department of Respiratory Diseases Univ Montpellier, CHU Montpellier Montpellier France
| | - Engi Ahmed
- Department of Respiratory Diseases Univ Montpellier, CHU Montpellier Montpellier France
| | - Carey Suehs
- Department of Respiratory Diseases Univ Montpellier, CHU Montpellier Montpellier France
- Department of Medical Information Univ Montpellier, CHU Montpellier Montpellier France
| | - Arthur De Sevin
- Department of Respiratory Diseases Univ Montpellier, CHU Montpellier Montpellier France
| | - Mathilde Volpato
- Department of Respiratory Diseases Univ Montpellier, CHU Montpellier Montpellier France
| | - Laurie Pahus
- Aix Marseille UnivAPHM, Hôpital NORDCIC 9502Clinique des bronches allergies et sommeil, Chemin des Bourrely, 13015 Marseille France
- Aix Marseille UnivCNRSEFS, ADES Marseille France
- Aix Marseille UnivINSERM U1263INRA 1260 (C2VN) Marseille France
| | - Delphine Gras
- Aix Marseille UnivINSERM U1263INRA 1260 (C2VN) Marseille France
| | - Isabelle Vachier
- Department of Respiratory Diseases Univ Montpellier, CHU Montpellier Montpellier France
| | - Laurence Halimi
- Department of Respiratory Diseases Univ Montpellier, CHU Montpellier Montpellier France
| | | | - Pascal Chanez
- Aix Marseille UnivAPHM, Hôpital NORDCIC 9502Clinique des bronches allergies et sommeil, Chemin des Bourrely, 13015 Marseille France
- Aix Marseille UnivINSERM U1263INRA 1260 (C2VN) Marseille France
| |
Collapse
|
8
|
Wang KCW, James AL, Noble PB. Fetal Growth Restriction and Asthma: Is the Damage Done? Physiology (Bethesda) 2021; 36:256-266. [PMID: 34159809 DOI: 10.1152/physiol.00042.2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Trajectories of airway remodeling and functional impairment in asthma are consistent with the notion that airway pathology precedes or coincides with the onset of asthma symptoms and may be present at birth. An association between intrauterine growth restriction (IUGR) and asthma development has also been established, and there is value in understanding the underlying mechanism. This review considers airway pathophysiology as a consequence of IUGR that increases susceptibility to asthma.
Collapse
Affiliation(s)
- Kimberley C W Wang
- School of Human Sciences, The University of Western Australia, Crawley, Western Australia, Australia.,Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Alan L James
- Department of Pulmonary Physiology and Sleep Medicine, West Australian Sleep Disorders Research Institute, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.,Medical School, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Peter B Noble
- School of Human Sciences, The University of Western Australia, Crawley, Western Australia, Australia
| |
Collapse
|
9
|
Chetty A, Nielsen HC. Targeting Airway Smooth Muscle Hypertrophy in Asthma: An Approach Whose Time Has Come. J Asthma Allergy 2021; 14:539-556. [PMID: 34079293 PMCID: PMC8164696 DOI: 10.2147/jaa.s280247] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 04/20/2021] [Indexed: 01/13/2023] Open
Abstract
Airway smooth muscle (ASM) cell dysfunction is an important component of several obstructive pulmonary diseases, particularly asthma. External stimuli such as allergens, dust, air pollutants, and change in environmental temperatures provoke ASM cell hypertrophy, proliferation, and migration without adequate mechanistic controls. ASM cells can switch between quiescent, migratory, and proliferative phenotypes in response to extracellular matrix proteins, growth factors, and other soluble mediators. While some aspects of airway hypertrophy and remodeling could have beneficial effects, in many cases these contribute to a clinical phenotype of difficult to control asthma. In this review, we discuss the factors responsible for ASM hypertrophy and proliferation in asthma, focusing on cytokines, growth factors, and ion transporters, and discuss existing and potential approaches that specifically target ASM hypertrophy to reduce the ASM mass and improve asthma symptoms. The goal of this review is to highlight strategies that appear ready for translational investigations to improve asthma therapy.
Collapse
Affiliation(s)
- Anne Chetty
- Tufts Medical Center, Tufts University, Boston, MA, USA
| | | |
Collapse
|
10
|
Bhatawadekar SA, Peters U, Walsh RR, Daphtary N, MacLean ES, Mori V, Hodgdon K, Kinsey CM, Kaminsky DA, Bates JHT, Dixon AE. Central airway collapse is related to obesity independent of asthma phenotype. Respirology 2021; 26:334-341. [PMID: 33403681 DOI: 10.1111/resp.14005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/22/2020] [Accepted: 12/16/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND OBJECTIVE Late-onset non-allergic asthma in obesity is characterized by an abnormally compliant, collapsible lung periphery; it is not known whether this abnormality exists in proximal airways. We sought to compare collapsibility of central airways between lean and obese individuals with and without asthma. METHODS A cross-sectional study comparing luminal area and shape (circularity) of the trachea, left mainstem bronchus, right bronchus intermedius and right inferior lobar bronchus at RV and TLC by CT was conducted. RESULTS In 11 lean controls (BMI: 22.4 (21.5, 23.8) kg/m2 ), 10 lean individuals with asthma (23.6 (22.0, 24.8) kg/m2 ), 10 obese controls (45.5 (40.3, 48.5) kg/m2 ) and 21 obese individuals with asthma (39.2 (35.8, 42.9) kg/m2 ), lumen area and circularity increased significantly with an increase in lung volume from RV to TLC for all four airways (P < 0.05 for all). Changes in area and circularity with lung volume were similar in obese individuals with and without asthma, and both obese groups had severe airway collapse at RV. In multivariate analysis, change in lumen area was related to BMI and change in circularity to waist circumference, but neither was related to asthma diagnosis. CONCLUSION Excessive collapse of the central airways is related to obesity, and occurs in both obese controls and obese asthma. Increased airway collapse could contribute to ventilation abnormalities in obese individuals particularly at lower lung volumes, and complicate asthma in obese individuals.
Collapse
Affiliation(s)
- Swati A Bhatawadekar
- Division of Pulmonary Disease and Critical Care Medicine, Department of Medicine, University of Vermont College of Medicine, Burlington, VT, USA
| | - Ubong Peters
- Division of Pulmonary Disease and Critical Care Medicine, Department of Medicine, University of Vermont College of Medicine, Burlington, VT, USA
| | - Ryan R Walsh
- Department of Radiology, University of Vermont College of Medicine, Burlington, VT, USA
| | - Nirav Daphtary
- Division of Pulmonary Disease and Critical Care Medicine, Department of Medicine, University of Vermont College of Medicine, Burlington, VT, USA
| | - Erick S MacLean
- Division of Pulmonary Disease and Critical Care Medicine, Department of Medicine, University of Vermont College of Medicine, Burlington, VT, USA
| | - Vitor Mori
- Division of Pulmonary Disease and Critical Care Medicine, Department of Medicine, University of Vermont College of Medicine, Burlington, VT, USA
| | - Kevin Hodgdon
- Division of Pulmonary Disease and Critical Care Medicine, Department of Medicine, University of Vermont College of Medicine, Burlington, VT, USA
| | - C Matthew Kinsey
- Division of Pulmonary Disease and Critical Care Medicine, Department of Medicine, University of Vermont College of Medicine, Burlington, VT, USA
| | - David A Kaminsky
- Division of Pulmonary Disease and Critical Care Medicine, Department of Medicine, University of Vermont College of Medicine, Burlington, VT, USA
| | - Jason H T Bates
- Division of Pulmonary Disease and Critical Care Medicine, Department of Medicine, University of Vermont College of Medicine, Burlington, VT, USA
| | - Anne E Dixon
- Division of Pulmonary Disease and Critical Care Medicine, Department of Medicine, University of Vermont College of Medicine, Burlington, VT, USA
| |
Collapse
|
11
|
Guerra S, Lombardi E, Stern DA, Sherrill DL, Gilbertson-Dahdal D, Wheatley-Guy CM, Snyder EM, Wright AL, Martinez FD, Morgan WJ. Fetal Origins of Asthma: A Longitudinal Study from Birth to Age 36 Years. Am J Respir Crit Care Med 2020; 202:1646-1655. [PMID: 32649838 PMCID: PMC7737573 DOI: 10.1164/rccm.202001-0194oc] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 07/10/2020] [Indexed: 11/16/2022] Open
Abstract
Rationale: Deficits in infant lung function-including the ratio of the time to reach peak tidal expiratory flow to the total expiratory time (tptef/te) and maximal expiratory flow at FRC (V̇maxFRC)-have been linked to increased risk for childhood asthma.Objectives: To examine the individual and combined effects of tptef/te and V̇maxFRC in infancy on risk for asthma and abnormalities of airway structure into mid-adult life.Methods: One hundred eighty participants in the Tucson Children's Respiratory Study birth cohort had lung function measured by the chest-compression technique in infancy (mean age ± SD: 2.0 ± 1.2 mo). Active asthma was assessed in up to 12 questionnaires between ages 6 and 36 years. Spirometry and chest high-resolution computed tomographic (HRCT) imaging were completed in a subset of participants at age 26. The relations of infant tptef/te and V̇maxFRC to active asthma and airway structural abnormalities into adult life were tested in multivariable mixed models.Measurements and Main Results: After adjustment for covariates, a 1-SD decrease in infant tptef/te and V̇maxFRC was associated with a 70% (P = 0.001) and 55% (P = 0.005) increased risk of active asthma, respectively. These effects were partly independent, and two out of three infants who were in the lowest tertile for both tptef/te and V̇maxFRC developed active asthma by mid-adult life. Infant V̇maxFRC predicted reduced airflow and infant tptef/te reduced HRCT airway caliber at age 26.Conclusions: These findings underscore the long-lasting effects of the fetal origins of asthma, support independent contributions by infant tptef/te and V̇maxFRC to development of asthma, and link deficits at birth in tptef/te with HRCT-assessed structural airway abnormalities in adult life.
Collapse
Affiliation(s)
- Stefano Guerra
- Asthma and Airway Disease Research Center
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, College of Medicine – Tucson
- Mel and Enid Zuckerman College of Public Health
| | - Enrico Lombardi
- Asthma and Airway Disease Research Center
- Department of Medical Imaging, College of Medicine – Tucson, and
| | | | - Duane L. Sherrill
- Asthma and Airway Disease Research Center
- Department of Pediatrics, University of Arizona, Tucson, Arizona
| | | | | | - Eric M. Snyder
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, Arizona; and
| | | | | | - Wayne J. Morgan
- Asthma and Airway Disease Research Center
- Geneticure, Rochester, Minnesota
| |
Collapse
|
12
|
Bidirectional interaction of airway epithelial remodeling and inflammation in asthma. Clin Sci (Lond) 2020; 134:1063-1079. [PMID: 32369100 DOI: 10.1042/cs20191309] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 03/28/2020] [Accepted: 04/20/2020] [Indexed: 12/18/2022]
Abstract
Asthma is a chronic disease of the airways that has long been viewed predominately as an inflammatory condition. Accordingly, current therapeutic interventions focus primarily on resolving inflammation. However, the mainstay of asthma therapy neither fully improves lung function nor prevents disease exacerbations, suggesting involvement of other factors. An emerging concept now holds that airway remodeling, another major pathological feature of asthma, is as important as inflammation in asthma pathogenesis. Structural changes associated with asthma include disrupted epithelial integrity, subepithelial fibrosis, goblet cell hyperplasia/metaplasia, smooth muscle hypertrophy/hyperplasia, and enhanced vascularity. These alterations are hypothesized to contribute to airway hyperresponsiveness, airway obstruction, airflow limitation, and progressive decline of lung function in asthmatic individuals. Consequently, targeting inflammation alone does not suffice to provide optimal clinical benefits. Here we review asthmatic airway remodeling, focusing on airway epithelium, which is critical to maintaining a healthy respiratory system, and is the primary defense against inhaled irritants. In asthma, airway epithelium is both a mediator and target of inflammation, manifesting remodeling and resulting obstruction among its downstream effects. We also highlight the potential benefits of therapeutically targeting airway structural alterations. Since pathological tissue remodeling is likewise observed in other injury- and inflammation-prone tissues and organs, our discussion may have implications beyond asthma and lung disease.
Collapse
|
13
|
Abstract
This article will discuss in detail the pathophysiology of asthma from the point of view of lung mechanics. In particular, we will explain how asthma is more than just airflow limitation resulting from airway narrowing but in fact involves multiple consequences of airway narrowing, including ventilation heterogeneity, airway closure, and airway hyperresponsiveness. In addition, the relationship between the airway and surrounding lung parenchyma is thought to be critically important in asthma, especially as related to the response to deep inspiration. Furthermore, dynamic changes in lung mechanics over time may yield important information about asthma stability, as well as potentially provide a window into future disease control. All of these features of mechanical properties of the lung in asthma will be explained by providing evidence from multiple investigative methods, including not only traditional pulmonary function testing but also more sophisticated techniques such as forced oscillation, multiple breath nitrogen washout, and different imaging modalities. Throughout the article, we will link the lung mechanical features of asthma to clinical manifestations of asthma symptoms, severity, and control. © 2020 American Physiological Society. Compr Physiol 10:975-1007, 2020.
Collapse
Affiliation(s)
- David A Kaminsky
- University of Vermont Larner College of Medicine, Burlington, Vermont, USA
| | - David G Chapman
- University of Technology Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
14
|
Wang L, Chitano P, Seow CY. Mechanopharmacology of Rho-kinase antagonism in airway smooth muscle and potential new therapy for asthma. Pharmacol Res 2020; 159:104995. [PMID: 32534100 DOI: 10.1016/j.phrs.2020.104995] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 05/20/2020] [Accepted: 06/03/2020] [Indexed: 02/06/2023]
Abstract
The principle of mechanopharmacology of airway smooth muscle (ASM) is based on the premise that physical agitation, such as pressure oscillation applied to an airway, is able to induce bronchodilation by reducing contractility and softening the cytoskeleton of ASM. Although the underlying mechanism is not entirely clear, there is evidence to suggest that large-amplitude stretches are able to disrupt the actomyosin interaction in the crossbridge cycle and weaken the cytoskeleton in ASM cells. Rho-kinase is known to enhance force generation and strengthen structural integrity of the cytoskeleton during smooth muscle activation and plays a key role in the maintenance of force during prolonged muscle contractions. Synergy in relaxation has been observed when the muscle is subject to oscillatory length change while Rho-kinase is pharmacologically inhibited. In this review, inhibition of Rho-kinase coupled to therapeutic pressure oscillation applied to the airways is explored as a combination treatment for asthma.
Collapse
Affiliation(s)
- Lu Wang
- The Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Canada.
| | - Pasquale Chitano
- The Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Canada
| | - Chun Y Seow
- The Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Canada
| |
Collapse
|
15
|
Malmström K, Lohi J, Malmberg LP, Kotaniemi-Syrjänen A, Lindahl H, Sarna S, Pelkonen AS, Mäkelä MJ. Airway hyperresponsiveness, remodeling and inflammation in infants with wheeze. Clin Exp Allergy 2020; 50:558-566. [PMID: 32159879 DOI: 10.1111/cea.13598] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 01/23/2020] [Accepted: 03/08/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND The relationship of airway hyperresponsiveness to airway remodeling and inflammation in infants with wheeze is unclear. OBJECTIVE To investigate airway hyperresponsiveness, remodeling and inflammation in infants with wheeze and troublesome breathing. METHODS Inclusion criteria were as follows: full-term, 3-23 months of age; doctor -diagnosed wheeze and persistent recurrent troublesome breathing; without obvious structural defect, suspicion of ciliary dyskinesia, cystic fibrosis, immune deficiency or specified use of corticosteroids. Airway hyperresponsiveness (AHR) was evaluated by performing a methacholine bronchial challenge test combined with whole body plethysmography and rapid thoracoabdominal compression. Endobronchial biopsies were analysed for remodeling (thickness of reticular basement membrane and amount of airway smooth muscle) and for inflammation (numbers of inflammatory cells). Correlation analyses were performed. RESULTS Forty-nine infants fulfilled the inclusion criteria for the present study. Median age was 1.06 years (IQR 0.6; 1.5). Lung function was impaired in 39/49 (80%) children, at the median age of 1.1 years. Methacholine challenge was successfully performed in 38/49 children. Impaired baseline lung function was correlated with AHR (P = .047, Spearman). In children with the most sensitive quartile of AHR, the percentage of median bronchial airway smooth muscle % and the number of bronchial mast cells in airway smooth muscle were not significantly higher compared to others (P = .057 and 0.056, respectively). No association was found between AHR and thickness of reticular basement membrane or inflammatory cells. Only a small group of children with both atopy and AHR (the most reactive quartile) had thicker airway smooth muscle area than non-atopics with AHR (P = .031). CONCLUSIONS AND CLINICAL RELEVANCE These findings do not support the concept that AHR in very young children with wheeze is determined by eosinophilic inflammation or clear-cut remodeling although it is associated with impaired baseline lung function. The possible association of increased airway smooth muscle area among atopic children with AHR remains to be confirmed.
Collapse
Affiliation(s)
- Kristiina Malmström
- Skin and Allergy Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jouko Lohi
- Dept. of Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Leo Pekka Malmberg
- Skin and Allergy Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anne Kotaniemi-Syrjänen
- Skin and Allergy Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Harry Lindahl
- Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Seppo Sarna
- Dept. of Public Health, University of Helsinki, Helsinki, Finland
| | - Anna S Pelkonen
- Skin and Allergy Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mika J Mäkelä
- Skin and Allergy Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| |
Collapse
|
16
|
Comberiati P, Spahn JD, Paull K, Faino A, Cherniack R, Covar RA. Lung mechanical properties distinguish children with asthma with normal and diminished lung function. Clin Exp Allergy 2020; 50:453-462. [PMID: 31955479 DOI: 10.1111/cea.13573] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 12/24/2019] [Accepted: 01/08/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND Children with asthma, even those with severe persistent disease, can have forced expiratory volume in 1 second (FEV1 ) values ≥100% of predicted, while others have diminished FEV1 . OBJECTIVE We sought to characterize the lung mechanical properties underlying these two asthma phenotypes and the mechanisms explaining the paradox of severe asthmatic children, whom when clinically stable can have an FEV1 >100% of predicted, but during an acute bronchospastic episode can experience a life-threatening asthma event. METHODS Lung mechanics were evaluated in three groups of children: asthmatics with FEV1 ≥100% (HFEV1 ; n = 13), asthmatics with FEV1 ≤80% (LFEV1 ; n = 14) and non-asthmatic controls (n = 10). A linear mixed model was used to examine the relationship between volume and static transpulmonary pressures obtained at total lung capacity (TLC); actual TLC %of predicted and flow; and static transpulmonary pressure and flow. RESULTS HFEV1 asthmatics had larger airways (FEV1 z-scores 1.12 vs -2.37; P < .05), greater lung volumes (mean % of predicted TLC 134.8% vs 109.6%; P < .05) and lower airway resistance (mean %of predicted Raw 101.9% vs 199.9%; P < .05) compared to the LFEV1 group. Moreover, HFEV1 asthmatics had significantly reduced elastic recoil pressure (pressure-volume curve shifted upward and to the left) and higher lung compliance (0.21 vs 00.9 L/cm H2 O; P < .05) compared to the LFEV1 group. The pressure-flow curves revealed the LFEV1 group to have significantly increased resistance to flow in the upstream segment of the airways at all lung volumes studied compared to HFEV1 . CONCLUSION AND CLINICAL RELEVANCE HFEV1 asthmatic children display distinct lung mechanical proprieties compared to their LFEV1 asthmatic peers. With loss of elastic recoil pressure, the HFEV1 group could generate normal FEV1 due to proportionally enlarged airways and reduced airway resistance, while airflow limitation in the LFEV1 is due to increased airway resistance. Loss of elastic recoil and interdependence during acute bronchoconstriction episodes may predispose the HFEV1 group to catastrophic reductions in airflow.
Collapse
Affiliation(s)
- Pasquale Comberiati
- Section of Pediatrics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.,Department of Clinical Immunology and Allergology, IM Sechenov First Moscow State Medical University, Moscow, Russia
| | - Joseph D Spahn
- The Division of Allergy-Clinical Immunology, National Jewish Health Denver, CO, USA.,Division of Clinical Pharmacology, National Jewish Health Denver, CO, USA.,Division of Allergy-Clinical Immunology, Department of Pediatrics, Children's Hospital Colorado, Aurora, CO, USA
| | - Keith Paull
- The Division of Allergy-Clinical Immunology, National Jewish Health Denver, CO, USA
| | - Anna Faino
- Division of Biostatistics and Bioinformatics, National Jewish Health Denver, CO, USA
| | | | - Ronina A Covar
- The Division of Allergy-Clinical Immunology, National Jewish Health Denver, CO, USA.,Division of Clinical Pharmacology, National Jewish Health Denver, CO, USA
| |
Collapse
|
17
|
Keskin O, Ozkars MY, Gogebakan B, Kucukosmanoglu E, Keskin M, Bayram H. Exhaled TGF-β1 levels before and after an exercise challenge in asthmatic and healthy children, and during exacerbation. J Asthma 2019; 58:316-325. [PMID: 31709879 DOI: 10.1080/02770903.2019.1689261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND There is conflicting data regarding the role of transforming growth factor-β1 (TGF-β1) in the pathogenesis of airway hyper-reactivity and asthma exacerbation. OBJECTIVE To investigate the role of exhaled-TGF-β1 in exercise-induced bronchospasm (EIB) in asthmatic and nonasthmatic healthy children, and in asthma exacerbation and asthma control. METHODS The exhaled-TGF-β1 levels of 56 stable asthmatic children and 15 nonasthmatic healthy children were evaluated before and 30 min after an exercise challenge. The exhaled-TGF-β1 levels of 20 additional children with asthma exacerbation were evaluated. RESULTS While no significant difference in the exhaled-TGF-β1 levels was found at the baseline, exhaled-TGF-β1 levels after the exercise challenge were significantly higher in the non-EIB (n = 31) asthmatics when compared to the asthmatic children with EIB (n = 25) (p = 0.04). Although there was a statistically significant increase in the concentration of the exhaled-TGF-β1 after the exercise challenge in the non-EIB asthmatics (p = 0.008), the concentration of the TGF-β1 was not increased after the exercise challenge in EIB + asthmatics. The exhaled-TGF-β1 was significantly correlated with the ACT score (p = 0.01, r = 0.49) and the baseline FEV1 level (p = 0.02, r = 0.35). The exhaled-TGF-β1 levels were significantly higher in the stable asthmatic children when compared to the nonasthmatic children (p < 0.0001). There was no significant difference in exhaled-TGF-β1 levels after the exercise challenge in the nonasthmatics. The exhaled-TGF-β1 levels were significantly lower in those children with asthma exacerbation when compared to the stable asthmatic children (p = 0.0003). CONCLUSION Our results suggest that TGF-β1 may play a role in suppressing airway reactivity and its deficiency is associated with asthma exacerbation.
Collapse
Affiliation(s)
- Ozlem Keskin
- Paediatric Allergy and Immunology Department, Gaziantep University Hospital, Gaziantep, Turkey
| | - Mehmet Yasar Ozkars
- Paediatric Allergy and Immunology Department, Gaziantep University Hospital, Gaziantep, Turkey
| | - Bulent Gogebakan
- Pulmonology Department, Gaziantep University Hospital, Gaziantep, Turkey
| | - Ercan Kucukosmanoglu
- Paediatric Allergy and Immunology Department, Gaziantep University Hospital, Gaziantep, Turkey
| | - Mehmet Keskin
- Department of Paediatrics, Gaziantep University Hospital, Gaziantep, Turkey
| | - Hasan Bayram
- Pulmonology Department, Gaziantep University Hospital, Gaziantep, Turkey
| |
Collapse
|
18
|
Cho SH, Jo A, Casale T, Jeong SJ, Hong SJ, Cho JK, Holbrook JT, Kumar R, Smith LJ. Soy isoflavones reduce asthma exacerbation in asthmatic patients with high PAI-1-producing genotypes. J Allergy Clin Immunol 2019; 144:109-117.e4. [PMID: 30707970 PMCID: PMC6612283 DOI: 10.1016/j.jaci.2019.01.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 12/20/2018] [Accepted: 01/11/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND The 4G4G genotype of plasminogen activator inhibitor 1 (PAI-1) is associated with increased plasma PAI-1 levels and poor asthma control. Previous studies suggest that soy isoflavones can reduce PAI-1 levels. OBJECTIVE We sought to investigate PAI-1 genotype-specific differences of the soy isoflavone response in asthma outcomes. METHODS A PAI-1 functional polymorphism (rs1799768, 4G5G) was characterized in subjects with poorly controlled asthma enrolled in a randomized clinical trial of soy isoflavones (n = 265). Genotype-specific treatment responses on asthma outcomes were compared between soy isoflavones and placebo. Normal human bronchial epithelial cells were cultured with or without TGF-β1, genistein, or both, and PAI-1 levels were measured. RESULTS The 4G4G/4G5G genotype was associated with a greater risk for allergy-related worsened asthma symptoms and eczema at baseline compared with the 5G5G genotype. There was a significant interaction between the genotype and soy isoflavone intervention on oral corticosteroid use for asthma exacerbation (P = .005). In a subgroup analysis soy isoflavones significantly reduced the use of oral corticosteroids (number of events/person-year) by 4-fold compared with placebo in the 4G4G/4G5G genotype (0.2 vs 0.8; relative risk, 0.28; P < .001) but not in the 5G5G genotype. Soy isoflavones reduced plasma PAI-1 levels compared with placebo. Genistein treatment reduced TGF-β1-induced PAI-1 production in normal human bronchial epithelial cells. CONCLUSIONS This study demonstrates that soy isoflavone treatment provides a significant benefit in reducing the number of severe asthma exacerbations in asthmatic patients with the high PAI-1-producing genotype. PAI-1 polymorphisms can be used as a genetic biomarker for soy isoflavone-responsive patients with asthma.
Collapse
Affiliation(s)
- Seong H Cho
- Division of Allergy-Immunology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, Fla; Division of Rheumatology, Department of Internal Medicine, School of Medicine, Kyung Hee University, Seoul, Korea.
| | - Ara Jo
- Division of Allergy-Immunology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, Fla
| | - Thomas Casale
- Division of Allergy-Immunology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, Fla
| | - Su J Jeong
- Department of Statistics Support, Medical Science Research Institute, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Seung-Jae Hong
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Joong K Cho
- Division of Allergy-Immunology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, Fla
| | - Janet T Holbrook
- Center for Clinical Trials and Evidence Synthesis Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Md
| | - Rajesh Kumar
- Division of Allergy-Immunology, Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Ill
| | - Lewis J Smith
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Ill
| |
Collapse
|
19
|
Evasovic JM, Singer CA. Regulation of IL-17A and implications for TGF-β1 comodulation of airway smooth muscle remodeling in severe asthma. Am J Physiol Lung Cell Mol Physiol 2019; 316:L843-L868. [PMID: 30810068 PMCID: PMC6589583 DOI: 10.1152/ajplung.00416.2018] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 02/04/2019] [Accepted: 02/19/2019] [Indexed: 12/14/2022] Open
Abstract
Severe asthma develops as a result of heightened, persistent symptoms that generally coincide with pronounced neutrophilic airway inflammation. In individuals with severe asthma, symptoms are poorly controlled by high-dose inhaled glucocorticoids and often lead to elevated morbidity and mortality rates that underscore the necessity for novel drug target identification that overcomes limitations in disease management. Many incidences of severe asthma are mechanistically associated with T helper 17 (TH17) cell-derived cytokines and immune factors that mediate neutrophilic influx to the airways. TH17-secreted interleukin-17A (IL-17A) is an independent risk factor for severe asthma that impacts airway smooth muscle (ASM) remodeling. TH17-derived cytokines and diverse immune mediators further interact with structural cells of the airway to induce pathophysiological processes that impact ASM functionality. Transforming growth factor-β1 (TGF-β1) is a pivotal mediator involved in airway remodeling that correlates with enhanced TH17 activity in individuals with severe asthma and is essential to TH17 differentiation and IL-17A production. IL-17A can also reciprocally enhance activation of TGF-β1 signaling pathways, whereas combined TH1/TH17 or TH2/TH17 immune responses may additively impact asthma severity. This review seeks to provide a comprehensive summary of cytokine-driven T cell fate determination and TH17-mediated airway inflammation. It will further review the evidence demonstrating the extent to which IL-17A interacts with various immune factors, specifically TGF-β1, to contribute to ASM remodeling and altered function in TH17-driven endotypes of severe asthma.
Collapse
Affiliation(s)
- Jon M Evasovic
- Department of Pharmacology, School of Medicine, University of Nevada , Reno, Nevada
| | - Cherie A Singer
- Department of Pharmacology, School of Medicine, University of Nevada , Reno, Nevada
| |
Collapse
|
20
|
Airway remodeling in asthma: update on mechanisms and therapeutic approaches. Curr Opin Pulm Med 2018; 24:56-62. [PMID: 29076828 DOI: 10.1097/mcp.0000000000000441] [Citation(s) in RCA: 122] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW The term 'airway remodeling' reflects changes in the type, quantity, and nature of airway wall components and their organization. The purpose of this review is to look at recent publications on airway remodeling in asthma. RECENT FINDINGS Animal models and in-vitro studies have confirmed the involvement of airway epithelium, airway smooth muscle (ASM), and extracellular matrix components in asthma-related airway remodeling. They report influences on proliferation of ASM cells, and how their orientation or morphology, in addition to the heterogeneity of ASM mass at different levels of airways could influence their effects. Clinical benefits have been observed following reduction of ASM following bronchial thermoplasty. Asthmatic epithelial cell transcriptome alterations were found to involve metabolism and epigenetics, beyond epithelial mesenchymal trophic unit driven by injury and repair in chronic inflammation. New ways to explore airway remodeling such as imaging or endoscopic techniques have been evaluated. Finally, new data support the role of eosinophils and mast cells in remodeling and show the influence of new asthma drugs on this process. SUMMARY As recently stated by an American Thoracic Society task force, we need more research on airway remodeling, its determinants and clinical relevance, and on the effects of asthma drugs on its various components.
Collapse
|
21
|
Lutchen KR, Paré PD, Seow CY. Hyperresponsiveness: Relating the Intact Airway to the Whole Lung. Physiology (Bethesda) 2018; 32:322-331. [PMID: 28615315 DOI: 10.1152/physiol.00008.2017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 05/10/2017] [Accepted: 05/10/2017] [Indexed: 11/22/2022] Open
Abstract
We relate changes of the airway wall to the response of the intact airway and the whole lung. We address how mechanical conditions and specific structural changes for an airway contribute to hyperresponsiveness resistant to deep inspiration. This review conveys that the origins of hyperresponsiveness do not devolve into an abnormality at single structural level but require examination of the complex interplay of all the parts.
Collapse
Affiliation(s)
- Kenneth R Lutchen
- Department of Biomedical Engineering, Boston University, Boston, Massachusetts
| | - Peter D Paré
- Department of Medicine, Respiratory Division, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Heart Lung Innovation-St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada; and
| | - Chun Y Seow
- Centre for Heart Lung Innovation-St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada; and.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
22
|
Sørensen JK, Buchvald F, Berg AK, Robinson PD, Nielsen KG. Ventilation inhomogeneity and NO and CO diffusing capacity in ex-premature school children. Respir Med 2018; 140:94-100. [PMID: 29957288 DOI: 10.1016/j.rmed.2018.06.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 06/03/2018] [Accepted: 06/04/2018] [Indexed: 11/18/2022]
Abstract
AIM Ex-premature school children show mild-to-moderate airway obstruction and decreased CO diffusing capacity. Multiple breath nitrogen washout (N2MBW) and NO diffusing capacity (DLNO) measurements may provide new insight into long-term pulmonary and vascular impairment in bronchopulmonary dysplasia (BPD). METHODS We examined a randomly selected group of 70 ex-premature children (gestational age <28 weeks or birth weight <1500 g; 42 with and 28 without BPD) and 38 term-born healthy controls of 8-13 years of age. Subjects performed N2MBW (lung clearance index, LCI; Sacin, and Scond), DLNO (membrane related diffusing capacity, Dm and pulmonary capillary volume, Vc), Fractional exhaled NO, CO diffusing capacity, conventional spirometry (FEV1, FVC, FEF25-75) and plethysmography (RV, TLC). Respiratory symptoms were assessed by questionnaire. RESULTS Compared to healthy controls, the BPD group had higher z-scores for lung clearance index (P = 0.003), Sacin (P = 0.005), lower CO diffusing capacity (P = 0.025), DLNO (P = 0.022), DLNO/VA z-scores (P = 0.025) and a significant larger proportion had respiratory complaints. Amongst ex-premature children, the BPD group did not differ from the non-BPD group except for a decreased Dm (P = 0.023). Ex-premature with BPD showed predominantly airway obstruction (FEV1/FVC; P < 0.0001), signs of hyperinflation (RV/TLC-ratio; P = 0.028), and 25% had a positive bronchodilator response (>12% in FEV1). CONCLUSION Ex-premature school children exhibited relatively mild but significant long-term respiratory symptoms and pulmonary peripheral impairment judged by N2MBW and DLNO measurements along with well-known airway obstruction. Larger longitudinal studies are needed to assess the clinical use of these advanced methods of assessing ventilation inhomogeneity and DLNO.
Collapse
Affiliation(s)
- Jesper Kiehn Sørensen
- Danish Pediatric Pulmonary Service, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Frederik Buchvald
- Danish Pediatric Pulmonary Service, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Anna Korsgaard Berg
- Danish Pediatric Pulmonary Service, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Paul D Robinson
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, Australia; Discipline of Pediatrics and Child Health, Sydney Medical School, University of Sydney, Australia
| | - Kim Gjerum Nielsen
- Danish Pediatric Pulmonary Service, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
| |
Collapse
|
23
|
Aspergillus fumigatus Infection-Induced Neutrophil Recruitment and Location in the Conducting Airway of Immunocompetent, Neutropenic, and Immunosuppressed Mice. J Immunol Res 2018; 2018:5379085. [PMID: 29577051 PMCID: PMC5822902 DOI: 10.1155/2018/5379085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 11/05/2017] [Accepted: 11/22/2017] [Indexed: 12/27/2022] Open
Abstract
Susceptibility to fungal infection is commonly associated with impaired neutrophil responses. To study the mechanisms underlying this association, we investigated neutrophil recruitment to the conducting airway wall after Aspergillus fumigatus conidium inhalation in mouse models of drug-induced immunosuppression and antibody-mediated neutrophil depletion (neutropenia) by performing three-dimensional confocal laser-scanning microscopy of whole-mount primary bronchus specimens. Actin staining enabled visualization of the epithelial and smooth muscle layers that mark the airway wall. Gr-1+ or Ly6G+ neutrophils located between the epithelium and smooth muscles were considered airway wall neutrophils. The number of airway wall neutrophils for immunocompetent, immunosuppressed, and neutropenic mice before and 6 h after A. fumigatus infection were analyzed and compared. Our results show that the number of conducting airway wall neutrophils in immunocompetent mice significantly increased upon inflammation, while a dramatic reduction in this number was observed following immunosuppression and neutropenia. Interestingly, a slight increase in the infiltration of neutrophils into the airway wall was detected as a result of infection, even in immunosuppressed and neutropenic mice. Taken together, these data indicate that neutrophils are present in intact conducting airway walls and the number elevates upon A. fumigatus infection. Conducting airway wall neutrophils are affected by both neutropenia and immunosuppression.
Collapse
|
24
|
Walker JKL, Theriot BS, Ghio M, Trempus CS, Wong JE, McQuade VL, Liang J, Jiang D, Noble PW, Garantziotis S, Kraft M, Ingram JL. Targeted HAS2 Expression Lessens Airway Responsiveness in Chronic Murine Allergic Airway Disease. Am J Respir Cell Mol Biol 2017; 57:702-710. [PMID: 28787175 PMCID: PMC5765419 DOI: 10.1165/rcmb.2017-0095oc] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 07/24/2017] [Indexed: 01/02/2023] Open
Abstract
Hyaluronan (HA), a major component of the extracellular matrix, is secreted by airway structural cells. Airway fibroblasts in allergic asthma secrete elevated levels of HA in association with increased HA synthase 2 (HAS2) expression. Thus, we hypothesized that HA accumulation in the airway wall may contribute to airway remodeling and hyperresponsiveness in allergic airways disease. To examine this hypothesis, transgenic mice in which the α-smooth muscle actin (α-SMA) promoter drives HAS2 expression were generated. Mixed male and female α-SMA-HAS2 mice (HAS2+ mice, n = 16; HAS2- mice, n = 13) were sensitized via intraperitoneal injection and then chronically challenged with aerosolized ovalbumin (OVA) for 6 weeks. To test airway responsiveness, increasing doses of methacholine were delivered intravenously and airway resistance was measured using the forced oscillation technique. HA, cytokines, and cell types were analyzed in bronchoalveolar lavage fluid, serum, and whole lung homogenates. Lung sections were stained using antibodies specific for HA-binding protein (HABP) and α-SMA, as well as Masson's trichrome stain. Staining of lung tissue demonstrated significantly increased peribronchial HA, α-SMA, and collagen deposition in OVA-challenged α-SMA-HAS2+ mice compared with α-SMA-HAS2- mice. Unexpectedly, OVA-challenged α-SMA-HAS2+ mice displayed significantly reduced airway responsiveness to methacholine compared with similarly treated α-SMA-HAS2- mice. The total numbers of inflammatory cell types in the bronchoalveolar lavage fluid did not differ significantly between OVA-challenged α-SMA-HAS2+ mice and α-SMA-HAS2- mice. We conclude that allergen-challenged mice that overexpress HAS2 in myofibroblasts and smooth muscle cells develop increased airway fibrosis, which lessens airway hyperresponsiveness to bronchoconstrictors.
Collapse
Affiliation(s)
- Julia K. L. Walker
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
- School of Nursing, Duke University, Durham, North Carolina; and
| | - Barbara S. Theriot
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Michael Ghio
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Carol S. Trempus
- Laboratory of Immunity, Inflammation and Disease, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina
| | - Jordan E. Wong
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Victoria L. McQuade
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Jiurong Liang
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Dianhua Jiang
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Paul W. Noble
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Stavros Garantziotis
- Laboratory of Immunity, Inflammation and Disease, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina
| | - Monica Kraft
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Jennifer L. Ingram
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| |
Collapse
|
25
|
d'Hooghe JNS, Ten Hacken NHT, Weersink EJM, Sterk PJ, Annema JT, Bonta PI. Emerging understanding of the mechanism of action of Bronchial Thermoplasty in asthma. Pharmacol Ther 2017; 181:101-107. [PMID: 28757156 DOI: 10.1016/j.pharmthera.2017.07.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Bronchial Thermoplasty (BT) is an endoscopic treatment for moderate-to-severe asthma patients who are uncontrolled despite optimal medical therapy. Effectiveness of BT has been demonstrated in several randomized clinical trials. However, the asthma phenotype that benefits most of this treatment is unclear, partly because the mechanism of action is incompletely understood. BT was designed to reduce the amount of airway smooth muscle (ASM), but additional direct and indirect effects on airway pathophysiology are expected. This review will provide an overview of the different components of airway pathophysiology including remodeling, with the ASM as the key player. Current concepts in the understanding of BT clinical effectiveness with a focus on its impact on airway remodeling will be reviewed.
Collapse
Affiliation(s)
- J N S d'Hooghe
- Department of Respiratory Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - N H T Ten Hacken
- Department of Respiratory Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | - E J M Weersink
- Department of Respiratory Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - P J Sterk
- Department of Respiratory Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - J T Annema
- Department of Respiratory Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - P I Bonta
- Department of Respiratory Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
| |
Collapse
|
26
|
Prakash YS, Halayko AJ, Gosens R, Panettieri RA, Camoretti-Mercado B, Penn RB. An Official American Thoracic Society Research Statement: Current Challenges Facing Research and Therapeutic Advances in Airway Remodeling. Am J Respir Crit Care Med 2017; 195:e4-e19. [PMID: 28084822 DOI: 10.1164/rccm.201611-2248st] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Airway remodeling (AR) is a prominent feature of asthma and other obstructive lung diseases that is minimally affected by current treatments. The goals of this Official American Thoracic Society (ATS) Research Statement are to discuss the scientific, technological, economic, and regulatory issues that deter progress of AR research and development of therapeutics targeting AR and to propose approaches and solutions to these specific problems. This Statement is not intended to provide clinical practice recommendations on any disease in which AR is observed and/or plays a role. METHODS An international multidisciplinary group from within academia, industry, and the National Institutes of Health, with expertise in multimodal approaches to the study of airway structure and function, pulmonary research and clinical practice in obstructive lung disease, and drug discovery platforms was invited to participate in one internet-based and one face-to-face meeting to address the above-stated goals. Although the majority of the analysis related to AR was in asthma, AR in other diseases was also discussed and considered in the recommendations. A literature search of PubMed was performed to support conclusions. The search was not a systematic review of the evidence. RESULTS Multiple conceptual, logistical, economic, and regulatory deterrents were identified that limit the performance of AR research and impede accelerated, intensive development of AR-focused therapeutics. Complementary solutions that leverage expertise of academia and industry were proposed to address them. CONCLUSIONS To date, numerous factors related to the intrinsic difficulty in performing AR research, and economic forces that are disincentives for the pursuit of AR treatments, have thwarted the ability to understand AR pathology and mechanisms and to address it clinically. This ATS Research Statement identifies potential solutions for each of these factors and emphasizes the importance of educating the global research community as to the extent of the problem as a critical first step in developing effective strategies for: (1) increasing the extent and impact of AR research and (2) developing, testing, and ultimately improving drugs targeting AR.
Collapse
|
27
|
Bates JHT. Physiological Mechanisms of Airway Hyperresponsiveness in Obese Asthma. Am J Respir Cell Mol Biol 2017; 54:618-23. [PMID: 26909510 DOI: 10.1165/rcmb.2016-0019ps] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Obesity affects the incidence and severity of asthma in at least two major phenotypes: an early-onset allergic (EOA) form that is complicated by obesity and a late-onset nonallergic (LONA) form that occurs only in the setting of obesity. Both groups exhibit airway hyperresponsiveness to methacholine challenge but exhibit differential effects of weight loss. Measurements of lung function in patients with LONA obese asthma suggest that this group of individuals may simply be those unlucky enough to have airways that are more compliant than average, and that this leads to airway hyperresponsiveness at the reduced lung volumes caused by excess adipose tissue around the chest wall. In contrast, the frequent exacerbations in those with EOA obese asthma can potentially be explained by episodic inflammatory thickening of the airway wall synergizing with obesity-induced reductions in lung volume. These testable hypotheses are based on the strong likelihood that LONA and EOA obese asthma are distinct diseases. Both, however, may benefit from targeted therapeutics that impose elevations in lung volume.
Collapse
Affiliation(s)
- Jason H T Bates
- Department of Medicine, University of Vermont College of Medicine, Burlington, Vermont
| |
Collapse
|
28
|
Nieuwenhuis MAE, Vonk JM, Himes BE, Sarnowski C, Minelli C, Jarvis D, Bouzigon E, Nickle DC, Laviolette M, Sin D, Weiss ST, van den Berge M, Koppelman GH, Postma DS. PTTG1IP and MAML3, novel genomewide association study genes for severity of hyperresponsiveness in adult asthma. Allergy 2017; 72:792-801. [PMID: 27709636 DOI: 10.1111/all.13062] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2016] [Indexed: 01/15/2023]
Abstract
BACKGROUND The severity of bronchial hyperresponsiveness (BHR) is a fundamental feature of asthma. The severity of BHR varies between asthmatics and is associated with lack of asthma control. The mechanisms underlying this trait are still unclear. This study aimed to identify genes associated with BHR severity, using a genomewide association study (GWAS) on the slope of BHR in adult asthmatics. METHODS We performed a GWAS on BHR severity in adult asthmatics from the Dutch Asthma GWAS cohort (n = 650), adjusting for smoking and inhaled corticosteroid use, and verified results in three other cohorts. Furthermore, we performed eQTL and co-expression analyses in lung tissue. RESULTS In the discovery cohort, one genomewide significant hit located in phosphodiesterase 4D, cAMP-specif (PDE4D) and 26 SNPs with P-values < 1*10-5 were found. None of our findings replicated in adult and childhood replication cohorts jointly. In adult cohorts separately, rs1344110 in pituitary tumour-transforming 1 interacting protein (PTTG1IP) and rs345983 in Mastermind-like 3 (MAML3) replicated nominally; minor alleles of rs345983 and rs1344110 were associated with less severe BHR and higher lung tissue gene expression. PTTG1IP showed significant co-expression with pituitary tumour-transforming 1, the binding factor of PTTG1lP, and with vimentin and E-cadherin1. MAML3 co-expressed significantly with Mastermind-like 2 (MAML2), both involved in Notch signalling. CONCLUSIONS PTTG1IP and MAML3 are associated with BHR severity in adult asthma. The relevance of these genes is supported by the eQTL analyses and co-expression of PTTG1lP with vimentin and E-cadherin1, and MAML3 with MAML2.
Collapse
Affiliation(s)
- M. A. E. Nieuwenhuis
- Department of Pulmonary Diseases; University Medical Center Groningen; University of Groningen; Groningen The Netherlands
- Groningen Research Institute for Asthma and COPD (GRIAC); University Medical Center Groningen; University of Groningen; Groningen The Netherlands
| | - J. M. Vonk
- Groningen Research Institute for Asthma and COPD (GRIAC); University Medical Center Groningen; University of Groningen; Groningen The Netherlands
- Department of Epidemiology; University Medical Center Groningen; University of Groningen; Groningen The Netherlands
| | - B. E. Himes
- Department of Biostatistics and Epidemiology; University of Pennsylvania; Philadelphia PA USA
| | - C. Sarnowski
- Genetic Variation and Human Diseases Unit; U946; INSERM; Paris France
- Institut Universitaire d'Hématologie; Université Paris Diderot, Sorbonne Paris Cité; Paris France
| | - C. Minelli
- Respiratory Epidemiology, Occupational Medicine and Public Health; National Heart and Lung Institute; Imperial College; London UK
| | - D. Jarvis
- Respiratory Epidemiology, Occupational Medicine and Public Health; National Heart and Lung Institute; Imperial College; London UK
- MRC-PHE Centre for Environment & Health; London UK
| | - E. Bouzigon
- Genetic Variation and Human Diseases Unit; U946; INSERM; Paris France
- Institut Universitaire d'Hématologie; Université Paris Diderot, Sorbonne Paris Cité; Paris France
| | | | - M. Laviolette
- Institut Universitaire de Cardiologie et de Pneumologie de Québec; Laval University; Québec City QC Canada
| | - D. Sin
- The University of British Columbia James Hogg Research Laboratory; St Paul's Hospital; Vancouver BC Canada
- 7 Respiratory Division; Department of Medicine; University of British Columbia; Vancouver BC Canada
| | - S. T. Weiss
- Channing Division of Network Medicine; Department of Medicine; Brigham & Women's Hospital and Harvard Medical School; Boston MA USA
| | - M. van den Berge
- Department of Pulmonary Diseases; University Medical Center Groningen; University of Groningen; Groningen The Netherlands
- Groningen Research Institute for Asthma and COPD (GRIAC); University Medical Center Groningen; University of Groningen; Groningen The Netherlands
| | - G. H. Koppelman
- Groningen Research Institute for Asthma and COPD (GRIAC); University Medical Center Groningen; University of Groningen; Groningen The Netherlands
- Department of Pediatric Pulmonology and Pediatric Allergology; Beatrix Children's Hospital; University Medical Center Groningen; University of Groningen; Groningen The Netherlands
| | - D. S. Postma
- Department of Pulmonary Diseases; University Medical Center Groningen; University of Groningen; Groningen The Netherlands
- Groningen Research Institute for Asthma and COPD (GRIAC); University Medical Center Groningen; University of Groningen; Groningen The Netherlands
| |
Collapse
|
29
|
Boulet LP. Airway remodeling in asthma: Mechanisms, clinical relevance, treatment, and prevention. CANADIAN JOURNAL OF RESPIRATORY CRITICAL CARE AND SLEEP MEDICINE 2017. [DOI: 10.1080/24745332.2017.1295776] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
|
30
|
Chaudhury A, Gaude GS, Hattiholi J. Effects of oral montelukast on airway function in acute asthma: A randomized trial. Lung India 2017; 34:349-354. [PMID: 28671166 PMCID: PMC5504892 DOI: 10.4103/0970-2113.209234] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: The role of leukotriene receptor antagonist is well known in the management of chronic asthma, but their efficacy in acute exacerbation of asthma is unknown. The present study was done to evaluate the clinical efficacy of oral montelukast as an add on therapy to the usual standard therapy of acute attack of bronchial asthma. Materials and Methods: A randomized single-blinded controlled study was conducted in a tertiary care teaching hospital. A total of 162 patients with age >18 years of acute exacerbations due to bronchial asthma were included in the study. The patients were randomized into two study and control groups. The study group patients received oral montelukast (10 mg) once daily for 2 weeks, while the control group received a placebo. All the patients received standard therapy according to GINA guidelines. Improvements in lung function tests, clinical symptoms, and relapse rates were monitored at baseline, 1 week, 2 weeks, and 4 weeks. Side effects profile was also monitored. Results: A total of 160 patients were finally assessed. Seventy-eight patients belonged to study group and 82 in the control group. Baseline characteristics were similar and well matched in both groups. Mean age was 39.9 ± 15.8 years in the study group and 42.8 ± 12.8 in the control group and majority were female patients in both groups. At the end of 4 weeks, it was observed that the study group patients who received montelukast had better forced expiratory volume in 1 s (FEV1) improvement by 21% (0.21 L) as compared to the control group (P < 0.0033). It was also observed that there was a better improvement in peak expiratory flow rate (PEFR) at 2 weeks (0.4 L/s, 12%) and at 4 weeks (0.9 L/s, 23%) as compared to the control group (P < 0.0376 and P < 0.0003 respectively). There was no difference in forced vital capacity (FVC), FEV1/FVC ratio and relapse rates between the two groups. No serious adverse effects were observed during the study. Conclusions: In acute asthma exacerbations, the present study showed that additional administration of oral montelukast resulted in significantly higher FEV1 at 4 weeks and PEFR at 2 weeks and 4 weeks as compared to the standard treatment alone. These findings should be confirmed by conducting a larger population-based clinical study.
Collapse
Affiliation(s)
- Alisha Chaudhury
- Department of Pulmonary Medicine, Jawaharlal Nehru Medical College, K L E University, Belgaum, Karnataka, India
| | - Gajanan S Gaude
- Department of Pulmonary Medicine, Jawaharlal Nehru Medical College, K L E University, Belgaum, Karnataka, India
| | - Jyothi Hattiholi
- Department of Pulmonary Medicine, Jawaharlal Nehru Medical College, K L E University, Belgaum, Karnataka, India
| |
Collapse
|
31
|
Bates JHT. Systems physiology of the airways in health and obstructive pulmonary disease. WILEY INTERDISCIPLINARY REVIEWS-SYSTEMS BIOLOGY AND MEDICINE 2016; 8:423-37. [PMID: 27340818 DOI: 10.1002/wsbm.1347] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 05/11/2016] [Accepted: 05/12/2016] [Indexed: 01/10/2023]
Abstract
Fresh air entering the mouth and nose is brought to the blood-gas barrier in the lungs by a repetitively branching network of airways. Provided the individual airway branches remain patent, this airway tree achieves an enormous amplification in cross-sectional area from the trachea to the terminal bronchioles. Obstructive lung diseases such as asthma occur when airway patency becomes compromised. Understanding the pathophysiology of these obstructive diseases thus begins with a consideration of the factors that determine the caliber of an individual airway, which include the force balance between the inward elastic recoil of the airway wall, the outward tethering forces of its parenchymal attachments, and any additional forces due to contraction of airway smooth muscle. Other factors may also contribute significantly to airway narrowing, such as thickening of the airway wall and accumulation of secretions in the lumen. Airway obstruction becomes particularly severe when these various factors occur in concert. However, the effect of airway abnormalities on lung function cannot be fully understood only in terms of what happens to a single airway because narrowing throughout the airway tree is invariably heterogeneous and interdependent. Obstructive lung pathologies thus manifest as emergent phenomena arising from the way in which the airway tree behaves a system. These emergent phenomena are studied with clinical measurements of lung function made by spirometry and by mechanical impedance measured with the forced oscillation technique. Anatomically based computational models are linking these measurements to underlying anatomic structure in systems physiology terms. WIREs Syst Biol Med 2016, 8:423-437. doi: 10.1002/wsbm.1347 For further resources related to this article, please visit the WIREs website.
Collapse
Affiliation(s)
- Jason H T Bates
- Department of Medicine, University of Vermont College of Medicine, Burlington, VT, USA
| |
Collapse
|
32
|
Hiorns JE, Jensen OE, Brook BS. Nonlinear compliance modulates dynamic bronchoconstriction in a multiscale airway model. Biophys J 2016; 107:3030-3042. [PMID: 25517167 PMCID: PMC4269780 DOI: 10.1016/j.bpj.2014.10.067] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 10/28/2014] [Accepted: 10/29/2014] [Indexed: 02/02/2023] Open
Abstract
The role of breathing and deep inspirations (DI) in modulating airway hyperresponsiveness remains poorly understood. In particular, DIs are potent bronchodilators of constricted airways in nonasthmatic subjects but not in asthmatic subjects. Additionally, length fluctuations (mimicking DIs) have been shown to reduce mean contractile force when applied to airway smooth muscle (ASM) cells and tissue strips. However, these observations are not recapitulated on application of transmural pressure (PTM) oscillations (that mimic tidal breathing and DIs) in isolated intact airways. To shed light on this paradox, we have developed a biomechanical model of the intact airway, accounting for strain-stiffening due to collagen recruitment (a large component of the extracellular matrix (ECM)), and dynamic actomyosin-driven force generation by ASM cells. In agreement with intact airway studies, our model shows that PTM fluctuations at particular mean transmural pressures can lead to only limited bronchodilation. However, our model predicts that moving the airway to a more compliant point on the static pressure-radius relationship (which may involve reducing mean PTM), before applying pressure fluctuations, can generate greater bronchodilation. This difference arises from competition between passive strain-stiffening of ECM and force generation by ASM yielding a highly nonlinear relationship between effective airway stiffness and PTM, which is modified by the presence of contractile agonist. Effectively, the airway at its most compliant may allow for greater strain to be transmitted to subcellular contractile machinery. The model predictions lead us to hypothesize that the maximum possible bronchodilation of an airway depends on its static compliance at the PTM about which the fluctuations are applied. We suggest the design of additional experimental protocols to test this hypothesis.
Collapse
Affiliation(s)
- Jonathan E Hiorns
- School of Mathematical Sciences, University of Nottingham, University Park, Nottingham, United Kingdom
| | - Oliver E Jensen
- School of Mathematics, University of Manchester, Manchester, United Kingdom
| | - Bindi S Brook
- School of Mathematical Sciences, University of Nottingham, University Park, Nottingham, United Kingdom.
| |
Collapse
|
33
|
Adam RJ, Hisert KB, Dodd JD, Grogan B, Launspach JL, Barnes JK, Gallagher CG, Sieren JP, Gross TJ, Fischer AJ, Cavanaugh JE, Hoffman EA, Singh PK, Welsh MJ, McKone EF, Stoltz DA. Acute administration of ivacaftor to people with cystic fibrosis and a G551D-CFTR mutation reveals smooth muscle abnormalities. JCI Insight 2016; 1:e86183. [PMID: 27158673 DOI: 10.1172/jci.insight.86183] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Airflow obstruction is common in cystic fibrosis (CF), yet the underlying pathogenesis remains incompletely understood. People with CF often exhibit airway hyperresponsiveness, CF transmembrane conductance regulator (CFTR) is present in airway smooth muscle (ASM), and ASM from newborn CF pigs has increased contractile tone, suggesting that loss of CFTR causes a primary defect in ASM function. We hypothesized that restoring CFTR activity would decrease smooth muscle tone in people with CF. METHODS To increase or potentiate CFTR function, we administered ivacaftor to 12 adults with CF with the G551D-CFTR mutation; ivacaftor stimulates G551D-CFTR function. We studied people before and immediately after initiation of ivacaftor (48 hours) to minimize secondary consequences of CFTR restoration. We tested smooth muscle function by investigating spirometry, airway distensibility, and vascular tone. RESULTS Ivacaftor rapidly restored CFTR function, indicated by reduced sweat chloride concentration. Airflow obstruction and air trapping also improved. Airway distensibility increased in airways less than 4.5 mm but not in larger-sized airways. To assess smooth muscle function in a tissue outside the lung, we measured vascular pulse wave velocity (PWV) and augmentation index, which both decreased following CFTR potentiation. Finally, change in distensibility of <4.5-mm airways correlated with changes in PWV. CONCLUSIONS Acute CFTR potentiation provided a unique opportunity to investigate CFTR-dependent mechanisms of CF pathogenesis. The rapid effects of ivacaftor on airway distensibility and vascular tone suggest that CFTR dysfunction may directly cause increased smooth muscle tone in people with CF and that ivacaftor may relax smooth muscle. FUNDING This work was funded in part from an unrestricted grant from the Vertex Investigator-Initiated Studies Program.
Collapse
Affiliation(s)
- Ryan J Adam
- Department of Biomedical Engineering.,Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Katherine B Hisert
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | | | - Brenda Grogan
- National Referral Centre for Adult Cystic Fibrosis, St. Vincent's University Hospital and University College Dublin School of Medicine, Dublin, Ireland
| | - Janice L Launspach
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA
| | | | - Charles G Gallagher
- National Referral Centre for Adult Cystic Fibrosis, St. Vincent's University Hospital and University College Dublin School of Medicine, Dublin, Ireland
| | | | - Thomas J Gross
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA
| | | | | | - Eric A Hoffman
- Department of Biomedical Engineering.,Department of Radiology, and
| | - Pradeep K Singh
- Department of Medicine, University of Washington, Seattle, Washington, USA.,Department of Microbiology, University of Washington, Seattle, Washington, USA
| | - Michael J Welsh
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA.,Department of Molecular Physiology and Biophysics.,Howard Hughes Medical Institute, and.,Pappajohn Biomedical Institute, University of Iowa, Iowa City, Iowa, USA
| | - Edward F McKone
- National Referral Centre for Adult Cystic Fibrosis, St. Vincent's University Hospital and University College Dublin School of Medicine, Dublin, Ireland
| | - David A Stoltz
- Department of Biomedical Engineering.,Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA.,Department of Molecular Physiology and Biophysics.,Pappajohn Biomedical Institute, University of Iowa, Iowa City, Iowa, USA
| |
Collapse
|
34
|
Ma Y, Huang W, Liu C, Li Y, Xia Y, Yang X, Sun W, Bai H, Li Q, Peng Z. Immunization against TGF-β1 reduces collagen deposition but increases sustained inflammation in a murine asthma model. Hum Vaccin Immunother 2016; 12:1876-85. [PMID: 26901684 DOI: 10.1080/21645515.2016.1145849] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Transforming growth factor (TGF)-β1 is involved in the processes of airway inflammation and remodeling; however, its reported roles in asthma pathogenesis are controversial. We sought both to investigate the effects of active immunization targeting TGF-β1 on allergen-induced airway inflammatory responses and to evaluate its possible application for asthma treatment. BALB/c mice were immunized with a virus-like-particle (VLP) vaccine presenting a TGF-β1 peptide. For the preventive intervention of acute allergic airway inflammation, immunization was conducted before sensitization and challenges with ovalbumin (OVA), and for the therapeutic treatment of chronic inflammatory responses, immunization was initiated after inflammatory responses were established. Preventive immunization with VLPs led to increased proinflammatory IL-4, IL-13, and IL-33 levels in the bronchoalveolar lavage fluids (BALF) with no significant effects on lung tissue inflammation and airway goblet cell hyperplasia. Therapeutic treatment showed that at 24 h after the fourth 2-day challenge with OVA following 2 intraperitoneal sensitizations, airway subepithelial collagen deposition was significantly ameliorated in vaccinated mice, whereas the lung histology and cytokine profile in the BALF were not changed. In contrast, after a 4-week recovery from the last OVA challenge, the vaccinated mice's collagen deposition remained reduced, but they sustained lung-tissue inflammation and goblet-cell hyperplasia; elevated IL-13, TNF, and IFN-γ levels in the BALF; and increased airway resistance, tissue resistance, and tissue elastance. In a conclusion, the role of TGF-β1 is complicated in allergic airway inflammatory responses. It is important to make a careful assessment in accordance with specific disease conditions when targeting TGF-β1 for a therapeutic purpose.
Collapse
Affiliation(s)
- Yanbing Ma
- a Laboratory of Molecular Immunology, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College , Kunming , China
| | - Weiwei Huang
- a Laboratory of Molecular Immunology, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College , Kunming , China
| | - Cunbao Liu
- a Laboratory of Molecular Immunology, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College , Kunming , China
| | - Yang Li
- a Laboratory of Molecular Immunology, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College , Kunming , China
| | - Ye Xia
- a Laboratory of Molecular Immunology, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College , Kunming , China
| | - Xu Yang
- a Laboratory of Molecular Immunology, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College , Kunming , China
| | - Wenjia Sun
- a Laboratory of Molecular Immunology, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College , Kunming , China
| | - Hongmei Bai
- a Laboratory of Molecular Immunology, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College , Kunming , China
| | - Qihan Li
- b Department of Viral Immunology , Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing , China
| | - Zhikang Peng
- c Department of Pediatrics and Child Health , University of Manitoba , Winnipeg , Canada
| |
Collapse
|
35
|
Chapman DG, Irvin CG. Mechanisms of airway hyper-responsiveness in asthma: the past, present and yet to come. Clin Exp Allergy 2015; 45:706-19. [PMID: 25651937 DOI: 10.1111/cea.12506] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Airway hyper-responsiveness (AHR) has long been considered a cardinal feature of asthma. The development of the measurement of AHR 40 years ago initiated many important contributions to our understanding of asthma and other airway diseases. However, our understanding of AHR in asthma remains complicated by the multitude of potential underlying mechanisms which in reality are likely to have different contributions amongst individual patients. Therefore, the present review will discuss the current state of understanding of the major mechanisms proposed to contribute to AHR and highlight the way in which AHR testing is beginning to highlight distinct abnormalities associated with clinically relevant patient populations. In doing so we aim to provide a foundation by which future research can begin to ascribe certain mechanisms to specific patterns of bronchoconstriction and subsequently match phenotypes of bronchoconstriction with clinical phenotypes. We believe that this approach is not only within our grasp but will lead to improved mechanistic understanding of asthma phenotypes and we hoped to better inform the development of phenotype-targeted therapy.
Collapse
Affiliation(s)
- D G Chapman
- Woolcock Institute of Medical Research, Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Department of Medicine, University of Vermont College of Medicine, Burlington, VT, USA
| | | |
Collapse
|
36
|
Chen H, Xia Q, Feng X, Cao F, Yu H, Song Y, Ni X. Effect of P2X4R on airway inflammation and airway remodeling in allergic airway challenge in mice. Mol Med Rep 2015; 13:697-704. [PMID: 26648454 PMCID: PMC4686060 DOI: 10.3892/mmr.2015.4622] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 10/29/2015] [Indexed: 11/29/2022] Open
Abstract
P2X4 receptor (P2X4R) is the most widely expressed subtype of the P2XRs in the purinergic receptor family. Adenosine triphosphate (ATP), a ligand for this receptor, has been implicated in the pathogenesis of asthma. ATP-P2X4R signaling is involved in pulmonary vascular remodeling, and in the proliferation and differentiation of airway and alveolar epithelial cell lines. However, the role of P2X4R in asthma remains to be elucidated. This aim of the present study was to investigate the effects of P2X4R in a murine experimental asthma model. The asthmatic model was established by the inhalation of ovalbumin (OVA) in BALB/c mice. The mice were treated with P2X4R-specific agonists and antagonists to investigate the role of this receptor in vivo. Pathological changes in the bronchi and lung tissues were examined using hematoxylin and eosin staining, Masson's trichrome staining and Alcian blue staining. The inflammatory cells in the bronchoalveolar lavage fluid were counted, and the expression levels of P2X4R, α-smooth muscle actin (α-SMA) and proliferating cell nuclear antigen (PCNA) were detected using western blotting. In the OVA-challenged mice, inflammation, infiltration, collagen deposition, mucus production, and the expression levels of P2X4R and PCNA were all increased; however, the expression of α-SMA was decreased, compared with the mice in the control group. Whereas treatment with the P2X4R agonist, ATP, enhanced the allergic reaction, treatment with the P2X4R antagonist, 5-BDBD, attenuated the allergic reaction. The results suggested that ATP-P2X4R signaling may not only contribute to airway inflammation, but it may also contribute to airway remodeling in allergic asthma in mice.
Collapse
Affiliation(s)
- Hongxia Chen
- Department of Pathology, Harbin Medical University-Daqing, Daqing, Heilongjiang 163319, P.R. China
| | - Qingqing Xia
- Department of Anatomy, Harbin Medical University-Daqing, Daqing, Heilongjiang 163319, P.R. China
| | - Xiaoqian Feng
- Department of Pathology, Harbin Medical University-Daqing, Daqing, Heilongjiang 163319, P.R. China
| | - Fangyuan Cao
- Department of Pathology, Harbin Medical University-Daqing, Daqing, Heilongjiang 163319, P.R. China
| | - Hang Yu
- Department of Physiology, Harbin Medical University-Daqing, Daqing, Heilongjiang 163319, P.R. China
| | - Yinli Song
- Department of Pathology, Harbin Medical University-Daqing, Daqing, Heilongjiang 163319, P.R. China
| | - Xiuqin Ni
- Department of Anatomy, Harbin Medical University-Daqing, Daqing, Heilongjiang 163319, P.R. China
| |
Collapse
|
37
|
Chen M, Hegde A, Choi YH, Theriot BS, Premont RT, Chen W, Walker JKL. Genetic Deletion of β-Arrestin-2 and the Mitigation of Established Airway Hyperresponsiveness in a Murine Asthma Model. Am J Respir Cell Mol Biol 2015; 53:346-54. [PMID: 25569510 DOI: 10.1165/rcmb.2014-0231oc] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
β-Arrestin-2 (βarr2) is a ubiquitously expressed cytosolic protein that terminates G protein-coupled receptor signaling and transduces G protein-independent signaling. We previously showed that mice lacking βarr2 do not develop an asthma phenotype when sensitized to, and challenged with, allergens. The current study evaluates if an established asthma phenotype can be mitigated by deletion of βarr2 using an inducible Cre recombinase. We sensitized and challenged mice to ovalbumin (OVA) and demonstrated that on Day (d) 24 the allergic asthma phenotype was apparent in uninduced βarr2 and wild-type (WT) mice. In a second group of OVA-treated mice, tamoxifen was injected on d24 to d28 to activate Cre recombinase, and OVA aerosol challenge was continued through d44. The asthma phenotype was assessed using lung mechanics measurements, bronchoalveolar lavage cell analysis, and histological assessment of mucin and airway inflammation. Compared with their respective saline-treated controls, OVA-treated WT mice and mice expressing the inducible Cre recombinase displayed a significant asthma phenotype at d45. Whereas tamoxifen treatment had no significant effect on the asthma phenotype in WT mice, it inhibited βarr2 expression and caused a significant reduction in airway hyper-responsiveness (AHR) in Cre-inducible mice. These findings suggest that βarr2 is actively required for perpetuation of the AHR component of the allergic asthma phenotype. Our finding that βarr2 participates in the perpetuation of AHR in an asthma model means that targeting βarr2 may provide immediate and potentially long-term relief from daily asthma symptoms due to AHR irrespective of inflammation.
Collapse
Affiliation(s)
- Minyong Chen
- Departments of 1 Medicine (Gastroenterology) and
| | | | | | | | | | - Wei Chen
- Departments of 1 Medicine (Gastroenterology) and
| | - Julia K L Walker
- 2 Medicine (Pulmonary), and.,3 Duke University School of Nursing, Duke University Medical Center, Durham, North Carolina
| |
Collapse
|
38
|
Abstract
Asthma remains a major health problem with significant morbidity, mortality and economic costs. In asthma, airway remodelling, which refers to all the microscopic structural changes seen in the airway tissue, has been recognised for many decades and remains one of the defining characteristics of the disease; however, it is still poorly understood. The detrimental pathophysiological consequences of some features of remodelling, like increased airway smooth muscle mass and subepithelial fibrosis, are well documented. However, whether targeting these by therapy would be beneficial is unknown. Although the prevailing thinking is that remodelling is an abnormal response to persistent airway inflammation, recent evidence, especially from studies of remodelling in asthmatic children, suggests that the two processes occur in parallel. The effects of asthma therapy on airway remodelling have not been studied extensively due to the challenges of obtaining airway tissue in the context of clinical trials. Corticosteroids remain the cornerstone of asthma therapy, and their effects on remodelling have been better studied than other drugs. Bronchial thermoplasty is the only asthma therapy to primarily target remodelling, although how it results in the apparent clinical benefits seen is not exactly clear. In this article we discuss the mechanisms of airway remodelling in asthma and review the effects of conventional and novel asthma therapies on the process.
Collapse
Affiliation(s)
- Rachid Berair
- Department of Infection, Immunity and Inflammation, Institute for Lung Health, Glenfield Hospital, University of Leicester, Leicester, LE3 9QP, UK
| | | |
Collapse
|
39
|
Syyong HT, Pascoe CD, Zhang J, Arsenault BA, Solomon D, Elliott WM, Hackett TL, Walker DC, Paré PD, Seow CY. Ultrastructure of human tracheal smooth muscle from subjects with asthma and nonasthmatic subjects. Standardized methods for comparison. Am J Respir Cell Mol Biol 2015; 52:304-14. [PMID: 25055045 DOI: 10.1165/rcmb.2014-0176oc] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
A characteristic feature of asthma is exaggerated airway narrowing, termed airway hyper-responsiveness (AHR) due to contraction of airway smooth muscle (ASM). Although smooth muscle (SM)-specific asthma susceptibility genes have been identified, it is not known whether asthmatic ASM is phenotypically different from nonasthmatic ASM in terms of subcellular structure or mechanical function. The present study is the first to systematically quantify, using electron microscopy, the ultrastructure of tracheal SM from subjects with asthma and nonasthmatic subjects. Methodological details concerning tissue sample preparation, ultrastructural quantification, and normalization of isometric force by appropriate morphometric parameters are described. We reasoned that genetic and/or acquired differences in the ultrastructure of asthmatic ASM could be associated with functional changes. We recently reported that asthmatic ASM is better able to maintain and recover active force generation after length oscillations simulating deep inspirations. The present study was designed to seek structural evidence to account for this observation. Contrary to our hypotheses, no significant qualitative or quantitative differences were found in the subcellular structure of asthmatic versus nonasthmatic tracheal SM. Specifically, there were no differences in average SM cell cross-sectional area; fraction of the cell area occupied by nonfilamentous area; amounts of mitochondria, dense bodies, and dense plaques; myosin and actin filament densities; basal lamina thickness; and the number of microtubules. These results indicate that functional differences in ASM do not necessarily translate into observable structural changes.
Collapse
|
40
|
Leigh R, Proud D. Virus-induced modulation of lower airway diseases: pathogenesis and pharmacologic approaches to treatment. Pharmacol Ther 2014; 148:185-98. [PMID: 25550230 PMCID: PMC7173263 DOI: 10.1016/j.pharmthera.2014.12.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 12/24/2014] [Indexed: 02/08/2023]
Abstract
Uncomplicated upper respiratory viral infections are the most common cause of days lost from work and school and exert a major economic burden. In susceptible individuals, however, common respiratory viruses, particularly human rhinoviruses, also can have a major impact on diseases that involve the lower airways, including asthma, chronic obstructive pulmonary diseases (COPD) and cystic fibrosis (CF). Respiratory virus-induced wheezing illnesses in early life are a significant risk factor for the subsequent development of asthma, and virus infections may also play a role in the development and progression of airway remodeling in asthma. It is clear that upper respiratory tract virus infections can spread to the lower airway and trigger acute attacks of asthma, COPD or CF. These exacerbations can be life-threatening, and exert an enormous burden on health care systems. In recent years we have gained new insights into the mechanisms by which respiratory viruses may induce acute exacerbations of lower airway diseases, as well as into host defense pathways that may regulate the outcomes to viral infections. In the current article we review the role of viruses in lower airway diseases, including our current understanding on pathways by which they may cause remodeling and trigger acute exacerbations. We also review the efficacy of current and emerging therapies used to treat these lower airway diseases on the outcomes due to viral infection, and discuss alternative therapeutic approaches for the management of virus-induced airway inflammation.
Collapse
Affiliation(s)
- Richard Leigh
- Airway Inflammation Research Group, Snyder Institute for Chronic Diseases and Department of Medicine, University of Calgary Faculty of Medicine, Calgary, Canada; Airway Inflammation Research Group, Snyder Institute for Chronic Diseases and Department of Physiology & Pharmacology, University of Calgary Faculty of Medicine, Calgary, Canada
| | - David Proud
- Airway Inflammation Research Group, Snyder Institute for Chronic Diseases and Department of Physiology & Pharmacology, University of Calgary Faculty of Medicine, Calgary, Canada.
| |
Collapse
|
41
|
Hernandez JM, Janssen LJ. Revisiting the usefulness of thromboxane-A2 modulation in the treatment of bronchoconstriction in asthma. Can J Physiol Pharmacol 2014; 93:111-7. [PMID: 25581104 DOI: 10.1139/cjpp-2014-0364] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Airway smooth muscle (ASM) is the effector cell in the bronchoconstrictory pathway. It is believed that the bronchoconstriction present in asthma is associated with changes in the airway milieu that affect ASM excitation-contraction coupling and Ca(2+)-handling. Asthmatics also react differently to ventilatory mechanical strain. Deep inspiration (DI), which produces bronchodilation in healthy individuals, is less effective in asthmatics, and even enhances bronchoconstriction in moderate to severely affected patients. Our laboratory has previously studied the mechanotransductory pathway of airway stretch-activated contractions (Rstretch) leading to DI-induced bronchoconstriction. We demonstrated the ability of agonists acting through thromboxane A2 (TxA2) receptors to amplify airway Rstretch responses. Despite the involvement of excitatory prostanoids in bronchoconstriction, clinical trials on treatments targeting TxA2-synthase inhibition and TP-receptor antagonism have produced mixed results. Studies in Western populations produced mostly negative results, whereas studies performed in Asian populations showed mostly positive outcomes. In this review, we discuss the role of TxA2-synthase inhibition and TP-receptor antagonism in the treatment of asthmatics. We present information regarding variations in study designs and the possible role of TP-receptor gene polymorphisms in previous study outcome discrepancies. Perhaps future studies should focus on asthmatic patients with DI-induced bronchoconstriction in particular, planting the seed for the individualized treatments for asthmatics.
Collapse
Affiliation(s)
- Jeremy Mark Hernandez
- Firestone Institute for Respiratory Health, Father Sean O'Sullivan Research Centre, and Department of Medicine, McMaster University, St. Joseph's Hospital, 50 Charlton Avenue East, Hamilton, ON L8N 4A6, Canada
| | | |
Collapse
|
42
|
Chauhan PS, Subhashini, Dash D, Singh R. Intranasal curcumin attenuates airway remodeling in murine model of chronic asthma. Int Immunopharmacol 2014; 21:63-75. [DOI: 10.1016/j.intimp.2014.03.021] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 03/22/2014] [Accepted: 03/31/2014] [Indexed: 11/17/2022]
|
43
|
Tai A, Tran H, Roberts M, Clarke N, Wilson J, Robertson CF. The association between childhood asthma and adult chronic obstructive pulmonary disease. Thorax 2014; 69:805-10. [DOI: 10.1136/thoraxjnl-2013-204815] [Citation(s) in RCA: 215] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
44
|
Nastase MV, Iozzo RV, Schaefer L. Key roles for the small leucine-rich proteoglycans in renal and pulmonary pathophysiology. Biochim Biophys Acta Gen Subj 2014; 1840:2460-70. [PMID: 24508120 DOI: 10.1016/j.bbagen.2014.01.035] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Accepted: 01/28/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND Small leucine-rich proteoglycans (SLRPs) are molecules that have signaling roles in a multitude of biological processes. In this respect, SLRPs play key roles in the evolution of a variety of diseases throughout the human body. SCOPE OF REVIEW We will critically review current developments in the roles of SLRPs in several types of disease of the kidney and lungs. Particular emphasis will be given to the roles of decorin and biglycan, the best characterized members of the SLRP gene family. MAJOR CONCLUSIONS In both renal and pulmonary disorders, SLRPs are essential elements that regulate several pathophysiological processes including fibrosis, inflammation and tumor progression. Decorin has remarkable antifibrotic and antitumorigenic properties and is considered a valuable potential treatment of these diseases. Biglycan can modulate inflammatory processes in lung and renal inflammation and is a potential target in the treatment of inflammatory conditions. GENERAL SIGNIFICANCE SLRPs can serve as either treatment targets or as potential treatment in renal or lung disease. This article is part of a Special Issue entitled Matrix-mediated cell behaviour and properties.
Collapse
Affiliation(s)
- Madalina V Nastase
- Pharmazentrum Frankfurt/ZAFES, Institut für Allgemeine Pharmakologie und Toxikologie, Klinikum der Goethe-Universität Frankfurt am Main, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany.
| | - Renato V Iozzo
- Department of Pathology, Anatomy and Cell Biology, and the Cancer Cell Biology and Signaling Program, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA.
| | - Liliana Schaefer
- Pharmazentrum Frankfurt/ZAFES, Institut für Allgemeine Pharmakologie und Toxikologie, Klinikum der Goethe-Universität Frankfurt am Main, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany.
| |
Collapse
|
45
|
Burrowes KS, De Backer J, Smallwood R, Sterk PJ, Gut I, Wirix-Speetjens R, Siddiqui S, Owers-Bradley J, Wild J, Maier D, Brightling C. Multi-scale computational models of the airways to unravel the pathophysiological mechanisms in asthma and chronic obstructive pulmonary disease (AirPROM). Interface Focus 2014; 3:20120057. [PMID: 24427517 DOI: 10.1098/rsfs.2012.0057] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
THE RESPIRATORY SYSTEM COMPRISES SEVERAL SCALES OF BIOLOGICAL COMPLEXITY: the genes, cells and tissues that work in concert to generate resultant function. Malfunctions of the structure or function of components at any spatial scale can result in diseases, to the detriment of gas exchange, right heart function and patient quality of life. Vast amounts of data emerge from studies across each of the biological scales; however, the question remains: how can we integrate and interpret these data in a meaningful way? Respiratory disease presents a huge health and economic burden, with the diseases asthma and chronic obstructive pulmonary disease (COPD) affecting over 500 million people worldwide. Current therapies are inadequate owing to our incomplete understanding of the disease pathophysiology and our lack of recognition of the enormous disease heterogeneity: we need to characterize this heterogeneity on a patient-specific basis to advance healthcare. In an effort to achieve this goal, the AirPROM consortium (Airway disease Predicting Outcomes through patient-specific computational Modelling) brings together a multi-disciplinary team and a wealth of clinical data. Together we are developing an integrated multi-scale model of the airways in order to unravel the complex pathophysiological mechanisms occurring in the diseases asthma and COPD.
Collapse
Affiliation(s)
- K S Burrowes
- Department of Computer Science , University of Oxford , Parks Road, Oxford OX1 3QD , UK
| | | | - R Smallwood
- Kroto Research Institute , University of Sheffield , Sheffield , UK
| | - P J Sterk
- Academic Medical Centre , University of Amsterdam , Amsterdam , The Netherlands
| | - I Gut
- Centro Nacional de Analysis Genómica, Fundacio Privada Parc Cientific de Barcelona , Barcelona , Spain
| | | | - S Siddiqui
- Institute for Lung Health , University of Leicester , Leicester , UK
| | - J Owers-Bradley
- School of Physics and Astronomy, University of Nottingham , Nottingham , UK
| | - J Wild
- Unit of Academic Radiology , University of Sheffield , Sheffield , UK
| | - D Maier
- Biomax Informatics AG , Munich , Germany
| | - C Brightling
- Institute for Lung Health , University of Leicester , Leicester , UK
| |
Collapse
|
46
|
Morton R, Eid N. From Childhood Asthma to Chronic Obstructive Pulmonary Disease: Evidence Supporting a Disease Continuum. PEDIATRIC ALLERGY, IMMUNOLOGY, AND PULMONOLOGY 2013; 26:168-174. [PMID: 35923041 DOI: 10.1089/ped.2013.0305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
In this review, we analyze the available evidence showing a link between asthma and chronic obstructive pulmonary disease (COPD). Many features (epidemiologic, physiologic, and histologic) overlap between these two conditions. Both environmental cigarette smoke exposure and early lung development are risk factors for the development of asthma and COPD. However, recent studies suggest that up to 25% of COPD cases were nonsmokers. Asthma during early childhood, independent of smoking history, may be an independent risk factor for the later development of COPD. One explanation for this phenomenon suggests that early small airway dysfunction (including chronic airway inflammation and airway remodeling) can lead to permanent impairment in lung physiology. Several reasons why control of airway inflammation is difficult in some patients are explored. Finally, we examine the available evidence suggesting overlapping histologic features in both asthma and COPD.
Collapse
Affiliation(s)
- Ronald Morton
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky
| | - Nemr Eid
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky
| |
Collapse
|
47
|
Bianchi A, Ozier A, Ousova O, Raffard G, Crémillieux Y. Ultrashort-TE MRI longitudinal study and characterization of a chronic model of asthma in mice: inflammation and bronchial remodeling assessment. NMR IN BIOMEDICINE 2013; 26:1451-1459. [PMID: 23761222 DOI: 10.1002/nbm.2975] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Revised: 04/15/2013] [Accepted: 04/16/2013] [Indexed: 06/02/2023]
Abstract
Asthma is a chronic disease characterized by bronchial hyperresponsiveness (BHR), bronchial inflammation and remodeling. The great improvements in (1)H MRI ultrashort-TE (UTE) sequences in the last decade have allowed lung images with high-resolution and good signal-to-noise ratio to be obtained in parenchymal tissues. In this article, we present a UTE (1)H MRI high-resolution study of a chronic model of asthma in mice with the aim to longitudinally assess the main features of asthma using a fully noninvasive approach. Balb/c mice (n = 6) were sensitized with ovalbumin over a period of 75 days. The control group (n = 3) received normal saline on the same days. MRI acquisitions were performed on days 0, 38 and 78 to study the inflammatory volumes and bronchial remodeling (peribronchial signal intensity index, PBSI). Plethysmographic studies were performed on days 0, 39 and 79 to assess BHR to methacholine using the enhanced pause (Penh) ratio. The average inflammatory volume measured by MRI in the ovalbumin group (15.6 ± 2.4 μL) was increased significantly relative to control mice (-0.3 ± 0.7 μL) on day 38. The inflammatory volume was larger (34.2 ± 3.1 μL) on day 78 in the ovalbumin group. PBSI was significantly higher in the ovalbumin group on day 78 (1.53 ± 0.08) relative to the control group (1.16 ± 0.10), but not on day 38. After sensitization, asthmatic mice presented BHR to methacholine on days 39 and 79. Penh ratios correlated significantly with the inflammatory volume on day 39 and with the PBSI on day 79. This study shows, for the first time, that high-resolution UTE (1)H MRI of the lungs may allow the noninvasive quantification of peribronchial eosinophilic inflammation with airways occlusion by mucus and of bronchial remodeling in a murine asthma model that correlates with functional parameters.
Collapse
Affiliation(s)
- Andrea Bianchi
- Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Université Bordeaux Segalen, Bordeaux, France; Centre de Résonance Magnétique des Systèmes Biologiques, UMR 5536, Université Bordeaux Segalen, Bordeaux, France
| | | | | | | | | |
Collapse
|
48
|
Paré PD, Mitzner W. Counterpoint: alterations in airway smooth muscle phenotype do not cause airway hyperresponsiveness in asthma. J Appl Physiol (1985) 2013; 113:839-42. [PMID: 22942220 DOI: 10.1152/japplphysiol.00483.2012a] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Peter D Paré
- Department of Laboratory Medicine and Pathology University of British Columbia
| | | |
Collapse
|
49
|
Mühlfeld C, Ochs M. Quantitative microscopy of the lung: a problem-based approach. Part 2: stereological parameters and study designs in various diseases of the respiratory tract. Am J Physiol Lung Cell Mol Physiol 2013; 305:L205-21. [PMID: 23709622 DOI: 10.1152/ajplung.00427.2012] [Citation(s) in RCA: 106] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Design-based stereology provides efficient methods to obtain valuable quantitative information of the respiratory tract in various diseases. However, the choice of the most relevant parameters in a specific disease setting has to be deduced from the present pathobiological knowledge. Often it is difficult to express the pathological alterations by interpretable parameters in terms of volume, surface area, length, or number. In the second part of this companion review article, we analyze the present pathophysiological knowledge about acute lung injury, diffuse parenchymal lung diseases, emphysema, pulmonary hypertension, and asthma to come up with recommendations for the disease-specific application of stereological principles for obtaining relevant parameters. Worked examples with illustrative images are used to demonstrate the work flow, estimation procedure, and calculation and to facilitate the practical performance of equivalent analyses.
Collapse
Affiliation(s)
- Christian Mühlfeld
- Institute of Functional and Applied Anatomy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
| | | |
Collapse
|
50
|
Noble PB, Jones RL, Cairncross A, Elliot JG, Mitchell HW, James AL, McFawn PK. Airway narrowing and bronchodilation to deep inspiration in bronchial segments from subjects with and without reported asthma. J Appl Physiol (1985) 2013; 114:1460-71. [PMID: 23493364 DOI: 10.1152/japplphysiol.01489.2012] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The present study presents preliminary findings on how structural/functional abnormalities of the airway wall relate to excessive airway narrowing and reduced bronchodilatory response to deep inspiration (DI) in subjects with a history of asthma. Bronchial segments were acquired from subjects undergoing surgery, mostly to remove pulmonary neoplasms. Subjects reported prior doctor-diagnosed asthma ( n = 5) or had no history of asthma ( n = 8). In vitro airway narrowing in response to acetylcholine was assessed to determine maximal bronchoconstriction and sensitivity, under static conditions and during simulated tidal and DI maneuvers. Fixed airway segments were sectioned for measurement of airway wall dimensions, particularly the airway smooth muscle (ASM) layer. Airways from subjects with a history of asthma had increased ASM ( P = 0.014), greater maximal airway narrowing under static conditions ( P = 0.003), but no change in sensitivity. Maximal airway narrowing was positively correlated with the area of the ASM layer ( r = 0.58, P = 0.039). In tidally oscillating airways, DI produced bronchodilation in airways from the control group ( P = 0.0001) and the group with a history of asthma ( P = 0.001). While bronchodilation to DI was reduced with increased airway narrowing ( P = 0.02; r = −0.64)), when the level of airway narrowing was matched, there was no difference in magnitude of bronchodilation to DI between groups. Results suggest that greater ASM mass in asthma contributes to exaggerated airway narrowing in vivo. In comparison, the airway wall in asthma may have a normal response to mechanical stretch during DI. We propose that increased maximal airway narrowing and the reduced bronchodilatory response to DI in asthma are independent.
Collapse
Affiliation(s)
- Peter B. Noble
- School of Anatomy, Physiology and Human Biology, University of Western Australia, Crawley, Perth, Western Australia, Australia
- Centre for Neonatal Research and Education, School of Paediatrics and Child Health, University of Western Australia, Crawley, Perth, Western Australia, Australia
| | - Robyn L. Jones
- Department of Pulmonary Physiology and Sleep Medicine, West Australian Sleep Disorders Research Institute, Sir Charles Gairdner Hospital, Nedlands, Perth, Western Australia, Australia; and
- School of Medicine and Pharmacology, University of Western Australia, Crawley, Perth, Western Australia, Australia
| | - Alvenia Cairncross
- School of Anatomy, Physiology and Human Biology, University of Western Australia, Crawley, Perth, Western Australia, Australia
| | - John G. Elliot
- Department of Pulmonary Physiology and Sleep Medicine, West Australian Sleep Disorders Research Institute, Sir Charles Gairdner Hospital, Nedlands, Perth, Western Australia, Australia; and
- School of Medicine and Pharmacology, University of Western Australia, Crawley, Perth, Western Australia, Australia
| | - Howard W. Mitchell
- School of Anatomy, Physiology and Human Biology, University of Western Australia, Crawley, Perth, Western Australia, Australia
| | - Alan L. James
- Department of Pulmonary Physiology and Sleep Medicine, West Australian Sleep Disorders Research Institute, Sir Charles Gairdner Hospital, Nedlands, Perth, Western Australia, Australia; and
- School of Medicine and Pharmacology, University of Western Australia, Crawley, Perth, Western Australia, Australia
| | - Peter K. McFawn
- School of Anatomy, Physiology and Human Biology, University of Western Australia, Crawley, Perth, Western Australia, Australia
| |
Collapse
|