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Keeratichananont W, Kaenmuang P, Geater SL, Denyuk R, Kanchanakanok C. Correlation of fractional exhaled nitric oxide (FeNO) and clinical outcomes in patients with chronic obstructive pulmonary disease: A prospective cohort study. Respir Med 2024; 229:107682. [PMID: 38815659 DOI: 10.1016/j.rmed.2024.107682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 05/24/2024] [Accepted: 05/26/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND Fractional exhaled nitric oxide (FeNO) is an acceptable and noninvasive marker for defining eosinophilic airway inflammation. Further study is necessary to clarify the role of FeNO in patients with chronic obstructive pulmonary disease (COPD). This study aimed to determine the association between FeNO levels and clinical outcomes. METHODS A prospective observational study was conducted at Songklanagarind Hospital from October 2020 to November 2022. FeNO testing and spirometry were performed at the initial visit and 12-month follow-up. Exacerbation, hospitalization, lung function decline, and all-cause mortality were analyzed to determine the association between FeNO levels and clinical outcomes. RESULTS A total of 60 patients with COPD were enrolled, 88.3 % of whom were male, with a mean age of 71.3 ± 9.5 years. There were 18 patients (30 %) in the high FeNO group (≥25 ppb) and 42 patients (70 %) in the low (<25 ppb) FeNO group. The mean blood eosinophil count (BEC) was significantly higher in the high FeNO group (p < 0.001). After a 12-month follow-up period, high FeNO group had higher exacerbation events (HR of 1.26, 95 % confidence interval (CI), 1.10-1.97, p= 0.025). Hospitalization and mortality rates were significantly higher in the high FeNO group. Regardless of the inhaled corticosteroids used, patients with high BEC and FeNO levels tended to have a greater risk of exacerbation. CONCLUSION In patients with COPD, FeNO levels are strongly correlated with BEC. Poor clinical outcomes were reported in patients with high FeNO levels. FeNO may be a useful biomarker for predicting clinical outcomes in patients with COPD.
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Affiliation(s)
- Warangkana Keeratichananont
- Respiratory and Respiratory Critical Care Medicine Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
| | - Punchalee Kaenmuang
- Respiratory and Respiratory Critical Care Medicine Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand.
| | - Sarayut Lucien Geater
- Respiratory and Respiratory Critical Care Medicine Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
| | - Ratikorn Denyuk
- Respiratory and Respiratory Critical Care Medicine Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
| | - Chitsanupong Kanchanakanok
- Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
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Gao J, Yang Y, Xiang X, Zheng H, Yi X, Wang F, Liang Z, Chen D, Shi W, Wang L, Wu D, Feng S, Huang Q, Li X, Shu W, Chen R, Zhong N, Wang Z. Human genetic associations of the airway microbiome in chronic obstructive pulmonary disease. Respir Res 2024; 25:165. [PMID: 38622589 DOI: 10.1186/s12931-024-02805-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 04/04/2024] [Indexed: 04/17/2024] Open
Abstract
Little is known about the relationships between human genetics and the airway microbiome. Deeply sequenced airway metagenomics, by simultaneously characterizing the microbiome and host genetics, provide a unique opportunity to assess the microbiome-host genetic associations. Here we performed a co-profiling of microbiome and host genetics with the identification of over 5 million single nucleotide polymorphisms (SNPs) through deep metagenomic sequencing in sputum of 99 chronic obstructive pulmonary disease (COPD) and 36 healthy individuals. Host genetic variation was the most significant factor associated with the microbiome except for geography and disease status, with its top 5 principal components accounting for 12.11% of the microbiome variability. Within COPD individuals, 113 SNPs mapped to candidate genes reported as genetically associated with COPD exhibited associations with 29 microbial species and 48 functional modules (P < 1 × 10-5), where Streptococcus salivarius exhibits the strongest association to SNP rs6917641 in TBC1D32 (P = 9.54 × 10-8). Integration of concurrent host transcriptomic data identified correlations between the expression of host genes and their genetically-linked microbiome features, including NUDT1, MAD1L1 and Veillonella parvula, TTLL9 and Stenotrophomonas maltophilia, and LTA4H and Haemophilus influenzae. Mendelian randomization analyses revealed a potential causal link between PARK7 expression and microbial type III secretion system, and a genetically-mediated association between COPD and increased relative abundance of airway Streptococcus intermedius. These results suggest a previously underappreciated role of host genetics in shaping the airway microbiome and provide fresh hypotheses for genetic-based host-microbiome interactions in COPD.
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Affiliation(s)
- Jingyuan Gao
- Institute of Ecological Sciences, School of Life Sciences, South China Normal University, Guangzhou, Guangdong Province, China
| | - Yuqiong Yang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Xiaopeng Xiang
- The Hong Kong Polytechnic University, Hong Kong, Hung Hom Kowloon, China
| | - Huimin Zheng
- Department of Obstetrics and Gynecology, The First People's Hospital of Foshan, Foshan, Guangdong Province, China
| | - Xinzhu Yi
- Institute of Ecological Sciences, School of Life Sciences, South China Normal University, Guangzhou, Guangdong Province, China
| | - Fengyan Wang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Zhenyu Liang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Dandan Chen
- Department of Pulmonary and Critical Care Medicine, Shenzhen Institute of Respiratory Diseases, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong Province, China
| | - Weijuan Shi
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Lingwei Wang
- Department of Pulmonary and Critical Care Medicine, Shenzhen Institute of Respiratory Diseases, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong Province, China
| | - Di Wu
- Department of Pulmonary and Critical Care Medicine, Shenzhen Institute of Respiratory Diseases, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong Province, China
| | - Shengchuan Feng
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Qiaoyun Huang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Xueping Li
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Wensheng Shu
- Institute of Ecological Sciences, School of Life Sciences, South China Normal University, Guangzhou, Guangdong Province, China.
| | - Rongchang Chen
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong Province, China.
- Department of Pulmonary and Critical Care Medicine, Shenzhen Institute of Respiratory Diseases, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong Province, China.
| | - Nanshan Zhong
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong Province, China.
| | - Zhang Wang
- Institute of Ecological Sciences, Biomedical Research Center, School of Life Sciences, State Key Laboratory of Respiratory Disease, South China Normal University, Guangzhou, Guangdong Province, China.
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Celis-Preciado CA, Leclerc S, Duval M, Cliche DO, Larivée P, Lemaire-Paquette S, Lévesque S, Côté A, Lachapelle P, Couillard S. Phenotyping the Responses to Systemic Corticosteroids in the Management of Asthma Attacks (PRISMA): protocol for an observational and translational pilot study. BMJ Open Respir Res 2023; 10:e001932. [PMID: 37940357 PMCID: PMC10632890 DOI: 10.1136/bmjresp-2023-001932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 10/27/2023] [Indexed: 11/10/2023] Open
Abstract
INTRODUCTION Asthma and its associated exacerbation are heterogeneous. Although severe asthma attacks are systematically prescribed corticosteroids and often antibiotics, little is known about the variability of response to these therapies. Blood eosinophils and fractional exhaled nitric oxide (FeNO) are type 2 inflammation biomarkers that have established mechanistic, prognostic and theragnostic values in chronic asthma, but their utility in acute asthma is unclear. We speculate that the clinical and biological response to those treatments varies according to inflammometry and microbiological test results. METHODS AND ANALYSIS An observational longitudinal pilot study with multimodal clinical and translational assessments will be performed on 50 physician-diagnosed ≥12-year-old asthmatics presenting with an asthma attack and 12 healthy controls, including blood eosinophil count (venous and point-of-care (POC) capillary blood), FeNO and testing for airway infection (sputum cultures and POC nasopharyngeal swabs). People with asthma will be assessed on day 0 and after a 7-day corticosteroid course, with home monitoring performed in between. The primary analysis will be the change in the forced expiratory volume in 1 s according to type 2 inflammatory status (blood eosinophils ≥0.15×109/L and/or FeNO ≥25 ppb) after treatment. Key secondary analyses will compare changes in symptom scores and the proportion of patients achieving a minimal clinically important difference. Exploratory analyses will assess the relationship between clinical, lung function, inflammatory and microbiome parameters; satisfaction plus reliability indices of POC tests; and sex-gender variability in treatment response. Ultimately, this pilot study will serve to plan a larger trial comparing the clinical and biological response to systemic corticosteroids according to inflammatory biomarkers, offering valuable guidance for more personalised therapeutic strategies in asthma attacks. ETHICS AND DISSEMINATION The protocol has been approved by the Research Ethics Committee of the CIUSSS de l'Estrie-CHUS, Sherbrooke, Quebec, Canada (#2023-4687). Results will be communicated in an international meeting and submitted to a peer-reviewed journal. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT05870215).
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Affiliation(s)
- Carlos Andrés Celis-Preciado
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Quebec, Canada
- Internal Medicine-Pulmonary Unit, Faculty of Medicine, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogota, Colombia
| | - Simon Leclerc
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Martine Duval
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Dominic O Cliche
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Pierre Larivée
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Samuel Lemaire-Paquette
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Simon Lévesque
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Quebec, Canada
- Laboratoire de Microbiologie, CIUSSS de l'Estrie-CHUS, Sherbrooke, Quebec, Canada
| | - Andréanne Côté
- Department of Medicine, Faculty of Medicine, Centre de Recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, Quebec City, Quebec, Canada
| | - Philippe Lachapelle
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Simon Couillard
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Quebec, Canada
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Lin L, Yi X, Liu H, Meng R, Li S, Liu X, Yang J, Xu Y, Li C, Wang Y, Xiao N, Li H, Liu Z, Xiang Z, Shu W, Guan WJ, Zheng XY, Sun J, Wang Z. The airway microbiome mediates the interaction between environmental exposure and respiratory health in humans. Nat Med 2023:10.1038/s41591-023-02424-2. [PMID: 37349537 DOI: 10.1038/s41591-023-02424-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 05/26/2023] [Indexed: 06/24/2023]
Abstract
Exposure to environmental pollution influences respiratory health. The role of the airway microbial ecosystem underlying the interaction of exposure and respiratory health remains unclear. Here, through a province-wide chronic obstructive pulmonary disease surveillance program, we conducted a population-based survey of bacterial (n = 1,651) and fungal (n = 719) taxa and metagenomes (n = 1,128) from induced sputum of 1,651 household members in Guangdong, China. We found that cigarette smoking and higher PM2.5 concentration were associated with lung function impairment through the mediation of bacterial and fungal communities, respectively, and that exposure was associated with an enhanced inter-kingdom microbial interaction resembling the pattern seen in chronic obstructive pulmonary disease. Enrichment of Neisseria was associated with a 2.25-fold increased risk of high respiratory symptom burden, coupled with an elevation in Aspergillus, in association with occupational pollution. We developed an individualized microbiome-based health index, which covaried with exposure, respiratory symptoms and diseases, with potential generalizability to global datasets. Our results may inform environmental risk prevention and guide interventions that harness airway microbiome.
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Affiliation(s)
- Lifeng Lin
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China.
| | - Xinzhu Yi
- Institute of Ecological Sciences, School of Life Sciences, South China Normal University, Guangzhou, China
| | - Haiyue Liu
- Xiamen Key Laboratory of Genetic Testing, Department of Laboratory Medicine, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Ruilin Meng
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Saiqiang Li
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Xiaomin Liu
- Institute of Ecological Sciences, School of Life Sciences, South China Normal University, Guangzhou, China
| | - Junhao Yang
- Institute of Ecological Sciences, School of Life Sciences, South China Normal University, Guangzhou, China
| | - Yanjun Xu
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Chuan Li
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Ye Wang
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Ni Xiao
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Huimin Li
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute for Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zuheng Liu
- Xiamen Key Laboratory of Cardiac Electrophysiology, Department of Cardiology, Xiamen Institute of Cardiovascular Diseases, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Zhiming Xiang
- Department of Radiology, Panyu Central Hospital, Guangzhou, China
| | - Wensheng Shu
- Institute of Ecological Sciences, School of Life Sciences, South China Normal University, Guangzhou, China
| | - Wei-Jie Guan
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute for Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
- Department of Thoracic Surgery, Guangzhou Institute for Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
| | - Xue-Yan Zheng
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China.
| | - Jiufeng Sun
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China.
| | - Zhang Wang
- Institute of Ecological Sciences, School of Life Sciences, South China Normal University, Guangzhou, China.
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5
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Liang W, Yang Y, Gong S, Wei M, Ma Y, Feng R, Gao J, Liu X, Tu F, Ma W, Yi X, Liang Z, Wang F, Wang L, Chen D, Shu W, Miller BE, Tal-Singer R, Donaldson GC, Wedzicha JA, Singh D, Wilkinson TMA, Brightling CE, Chen R, Zhong N, Wang Z. Airway dysbiosis accelerates lung function decline in chronic obstructive pulmonary disease. Cell Host Microbe 2023; 31:1054-1070.e9. [PMID: 37207649 DOI: 10.1016/j.chom.2023.04.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 03/23/2023] [Accepted: 04/17/2023] [Indexed: 05/21/2023]
Abstract
Progressive lung function decline is a hallmark of chronic obstructive pulmonary disease (COPD). Airway dysbiosis occurs in COPD, but whether it contributes to disease progression remains unknown. Here, we show, through a longitudinal analysis of two cohorts involving four UK centers, that baseline airway dysbiosis in COPD patients, characterized by the enrichment of opportunistic pathogenic taxa, associates with a rapid forced expiratory volume in 1 s (FEV1) decline over 2 years. Dysbiosis associates with exacerbation-related FEV1 fall and sudden FEV1 fall at stability, contributing to long-term FEV1 decline. A third cohort in China further validates the microbiota-FEV1-decline association. Human multi-omics and murine studies show that airway Staphylococcus aureus colonization promotes lung function decline through homocysteine, which elicits a neutrophil apoptosis-to-NETosis shift via the AKT1-S100A8/A9 axis. S. aureus depletion via bacteriophages restores lung function in emphysema mice, providing a fresh approach to slow COPD progression by targeting the airway microbiome.
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Affiliation(s)
- Weijie Liang
- Institute of Ecological Sciences, School of Life Sciences, South China Normal University, Guangzhou, Guangdong Province, China
| | - Yuqiong Yang
- First Affiliated Hospital of Guangzhou Medical University, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, Guangzhou, Guangdong Province, China
| | - Shenhai Gong
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Mingyuan Wei
- Institute of Ecological Sciences, School of Life Sciences, South China Normal University, Guangzhou, Guangdong Province, China
| | - Yingfei Ma
- Shenzhen Key Laboratory of Synthetic Genomics, Guangdong Provincial Key Laboratory of Synthetic Genomics, CAS Key Laboratory of Quantitative Engineering Biology, Shenzhen Institute of Synthetic Biology, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong Province, China
| | - Ruipei Feng
- Institute of Ecological Sciences, School of Life Sciences, South China Normal University, Guangzhou, Guangdong Province, China
| | - Jingyuan Gao
- Institute of Ecological Sciences, School of Life Sciences, South China Normal University, Guangzhou, Guangdong Province, China
| | - Xiaomin Liu
- Institute of Ecological Sciences, School of Life Sciences, South China Normal University, Guangzhou, Guangdong Province, China
| | - Fuyi Tu
- Institute of Statistics and Big Data, Renmin University of China, Beijing, China
| | - Wei Ma
- Institute of Statistics and Big Data, Renmin University of China, Beijing, China
| | - Xinzhu Yi
- Institute of Ecological Sciences, School of Life Sciences, South China Normal University, Guangzhou, Guangdong Province, China
| | - Zhenyu Liang
- First Affiliated Hospital of Guangzhou Medical University, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, Guangzhou, Guangdong Province, China
| | - Fengyan Wang
- First Affiliated Hospital of Guangzhou Medical University, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, Guangzhou, Guangdong Province, China
| | - Lingwei Wang
- Pulmonary and Critical Care Department, Shenzhen Institute of Respiratory Diseases, Shenzhen People's Hospital, Shenzhen, Guangdong Province, China
| | - Dandan Chen
- Pulmonary and Critical Care Department, Shenzhen Institute of Respiratory Diseases, Shenzhen People's Hospital, Shenzhen, Guangdong Province, China
| | - Wensheng Shu
- Institute of Ecological Sciences, School of Life Sciences, South China Normal University, Guangzhou, Guangdong Province, China
| | | | | | - Gavin C Donaldson
- National Heart and Lung Institute, Imperial College London, London, UK
| | | | - Dave Singh
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester University NHS Foundation Trust, Manchester, UK
| | - Tom M A Wilkinson
- NIHR Southampton Respiratory Biomedical Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Christopher E Brightling
- Institute for Lung Health, Leicester NIHR Biomedical Research Centre, Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Rongchang Chen
- First Affiliated Hospital of Guangzhou Medical University, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, Guangzhou, Guangdong Province, China; Pulmonary and Critical Care Department, Shenzhen Institute of Respiratory Diseases, Shenzhen People's Hospital, Shenzhen, Guangdong Province, China
| | - Nanshan Zhong
- First Affiliated Hospital of Guangzhou Medical University, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, Guangzhou, Guangdong Province, China
| | - Zhang Wang
- Institute of Ecological Sciences, School of Life Sciences, South China Normal University, Guangzhou, Guangdong Province, China.
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Frøssing L, Klein DK, Hvidtfeldt M, Obling N, Telg G, Erjefält JS, Bodtger U, Porsbjerg C. Distribution of type 2 biomarkers and association with severity, clinical characteristics and comorbidities in the BREATHE real-life asthma population. ERJ Open Res 2023; 9:00483-2022. [PMID: 36949964 PMCID: PMC10026007 DOI: 10.1183/23120541.00483-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 09/30/2022] [Indexed: 11/05/2022] Open
Abstract
Background Type 2 (T2) high asthma is recognised as a heterogenous entity consisting of several endotypes; however, the prevalence and distribution of the T2 biomarkers in the general asthma population, across asthma severity, and across compartments is largely unknown. The objective of the present study was to describe expression and overlaps of airway and systemic T2 biomarkers in a clinically representative asthma population. Methods Patients with asthma from the real-life BREATHE cohort referred to a specialist centre were included and grouped according to T2 biomarkers: blood and sputum eosinophilia (≥0.3×109 cells·L-1 and 3% respectively), total IgE (≥150 U·mL-1), and fractional exhaled nitric oxide (≥25 ppb). Results Patients with mild-to-moderate asthma were younger (41 versus 49 years, p<0.001), had lower body mass index (25.9 versus 28.0 kg·m-2, p=0.002) and less atopy (47% versus 58%, p=0.05), higher forced expiratory volume in 1 s (3.2 versus 2.8 L, p<0.001) and forced vital capacity (4.3 versus 3.9 L, p<0.001) compared with patients with severe asthma, who had higher blood (0.22×109 versus 0.17×109 cells·L-1, p=0.01) and sputum (3.0% versus 1.5%, p=0.01) eosinophils. Co-expression of all T2 biomarkers was a particular characteristic of severe asthma (p<0.001). In patients with eosinophilia, sputum eosinophilia without blood eosinophilia was present in 45% of patients with mild-to-moderate asthma and 35% with severe asthma. Conclusion Severe asthma is more commonly associated with activation of several T2 pathways, indicating that treatments targeting severe asthma may need to act more broadly on T2 inflammatory pathways. Implementation of airway inflammometry in clinical care is of paramount importance, as the best treatable trait is otherwise is overlooked in a large proportion of patients irrespective of disease severity.
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Affiliation(s)
- Laurits Frøssing
- Respiratory Research Unit, Dept of Respiratory Medicine, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
- Contributed equally
- Corresponding author: Laurits Frøssing ()
| | - Ditte K. Klein
- Respiratory Research Unit, Dept of Respiratory Medicine, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
- Contributed equally
| | - Morten Hvidtfeldt
- Respiratory Research Unit, Dept of Respiratory Medicine, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
| | - Nicolai Obling
- Respiratory Research Unit PLUZ, Dept of Respiratory Medicine, Zealand University Hospital, Naestved, Denmark
| | | | | | - Uffe Bodtger
- Respiratory Research Unit PLUZ, Dept of Respiratory Medicine, Zealand University Hospital, Naestved, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Celeste Porsbjerg
- Respiratory Research Unit, Dept of Respiratory Medicine, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
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7
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Frøssing L, Von Bülow A, Porsbjerg C. Bronchiectasis in severe asthma is associated with eosinophilic airway inflammation and activation. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. GLOBAL 2023; 2:36-42. [PMID: 37780108 PMCID: PMC10509871 DOI: 10.1016/j.jacig.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 09/14/2022] [Accepted: 10/02/2022] [Indexed: 10/03/2023]
Abstract
Background Bronchiectasis is a common comorbidity in severe asthma; causative pathogenic mechanisms are not fully understood but may differ from other causes of bronchiectasis. The role of eosinophilic airway inflammation, a classic feature of asthma predominantly driven by IL-5 and IL-13, in bronchiectasis is unclear, but association with disruption of the airway epithelium through eosinophil degranulation and increased mucus production is plausible. Objective We sought to describe the prevalence of bronchiectasis in an unselected population of patients with severe asthma, and the association with the airway eosinophilic inflammation and activation. Methods All patients with severe asthma according to European Respiratory Society/American Thoracic Society criteria (high-dose inhaled corticosteroids/oral corticosteroids), attending 4 respiratory clinics over a 1-year period, were included. All patients underwent high-resolution computed tomography and induced sputum was collected and analyzed for a cell differential count, free eosinophilic granules, and airway messenger RNA expression of T2 inflammatory pathways. Results Bronchiectasis was present in 31% (34 of 108) of patients with severe asthma, and half (52%) of these patients had airway eosinophilia whereas only 16% of patients without bronchiectasis had airway eosinophilia. Patients with bronchiectasis had a significantly higher sputum eosinophil count (5.3 vs 0.8; P = .001) as well as more extensive eosinophil degranulation, compared with those without bronchiectasis (13% vs 2%; P = .05), suggesting a higher degree of eosinophil activation. Pairwise analyses identified significantly higher messenger RNA expression of Charcot-Leyden crystal galectin in patients with bronchiectasis (P = .02). Conclusions Bronchiectasis in severe asthma was associated with eosinophilic airway inflammation and eosinophilic degranulation as well as messenger RNA expression of Charcot-Leyden crystal galectin.
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Affiliation(s)
- Laurits Frøssing
- Respiratory Research Unit, Department of Respiratory Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Copenhagen Center for Translational Research, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Anna Von Bülow
- Respiratory Research Unit, Department of Respiratory Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Celeste Porsbjerg
- Respiratory Research Unit, Department of Respiratory Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Copenhagen Center for Translational Research, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
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8
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Diver S, Haldar K, McDowell PJ, Busby J, Mistry V, Micieli C, Brown V, Cox C, Yang F, Borg C, Shrimanker R, Ramsheh MY, Hardman T, Arron J, Bradding P, Cowan D, Mansur AH, Fowler SJ, Lordan J, Menzies-Gow A, Robinson D, Matthews J, Pavord ID, Chaudhuri R, Heaney LG, Barer MR, Brightling C. Relationship between inflammatory status and microbial composition in severe asthma and during exacerbation. Allergy 2022; 77:3362-3376. [PMID: 35778780 DOI: 10.1111/all.15425] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 05/24/2022] [Accepted: 05/30/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND In T2-mediated severe asthma, biologic therapies, such as mepolizumab, are increasingly used to control disease. Current biomarkers can indicate adequate suppression of T2 inflammation, but it is unclear whether they provide information about airway microbial composition. We investigated the relationships between current T2 biomarkers and microbial profiles, characteristics associated with a ProteobacteriaHIGH microbial profile and the effects of mepolizumab on airway ecology. METHODS Microbiota sequencing was performed on sputum samples obtained at stable and exacerbation state from 140 subjects with severe asthma participating in two clinical trials. Inflammatory subgroups were compared on the basis of biomarkers, including FeNO and sputum and blood eosinophils. ProteobacteriaHIGH subjects were identified by Proteobacteria to Firmicutes ratio ≥0.485. Where paired sputum from stable visits was available, we compared microbial composition at baseline and following ≥12 weeks of mepolizumab. RESULTS Microbial composition was not related to inflammatory subgroup based on sputum or blood eosinophils. FeNO ≥50 ppb when stable and at exacerbation indicated a group with less dispersed microbial profiles characterised by high alpha-diversity and low Proteobacteria. ProteobacteriaHIGH subjects were neutrophilic and had a longer time from asthma diagnosis than ProteobacteriaLOW subjects. In those studied, mepolizumab did not alter airway bacterial load or lead to increased Proteobacteria. CONCLUSION High FeNO could indicate a subgroup of severe asthma less likely to benefit from antimicrobial strategies at exacerbation or in the context of poor control. Where FeNO is <50 ppb, biomarkers of microbial composition are required to identify those likely to respond to microbiome-directed strategies. We found no evidence that mepolizumab alters airway microbial composition.
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Affiliation(s)
- Sarah Diver
- Department of Respiratory Sciences, Leicester NIHR BRC, Institute for Lung Health, University of Leicester, Leicester, UK
| | - Koirobi Haldar
- Department of Respiratory Sciences, Leicester NIHR BRC, Institute for Lung Health, University of Leicester, Leicester, UK
| | - Pamela Jane McDowell
- Wellcome-Wolfson Centre for Experimental Medicine, School of Medicine, Dentistry, and Biological Sciences, Belfast, UK
- Queen's University Belfast, Belfast, UK
| | - John Busby
- Wellcome-Wolfson Centre for Experimental Medicine, School of Medicine, Dentistry, and Biological Sciences, Belfast, UK
- Queen's University Belfast, Belfast, UK
| | - Vijay Mistry
- Department of Respiratory Sciences, Leicester NIHR BRC, Institute for Lung Health, University of Leicester, Leicester, UK
| | - Claudia Micieli
- Department of Respiratory Sciences, Leicester NIHR BRC, Institute for Lung Health, University of Leicester, Leicester, UK
| | - Vanessa Brown
- Wellcome-Wolfson Centre for Experimental Medicine, School of Medicine, Dentistry, and Biological Sciences, Belfast, UK
- Queen's University Belfast, Belfast, UK
| | - Ciara Cox
- Regional Virus Laboratory, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, UK
| | - Freda Yang
- Division of Immunology, Infection and Inflammation, University of Glasgow, Glasgow, UK
| | - Catherine Borg
- Oxford Respiratory NIHR BRC, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Rahul Shrimanker
- Oxford Respiratory NIHR BRC, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Mohammadali Yavari Ramsheh
- Department of Respiratory Sciences, Leicester NIHR BRC, Institute for Lung Health, University of Leicester, Leicester, UK
| | - Tim Hardman
- Niche Science & Technology Ltd., Unit 26, Falstaff House, Richmond, UK
| | - Joseph Arron
- Genentech Inc., South San Francisco, California, USA
| | - Peter Bradding
- Department of Respiratory Sciences, Leicester NIHR BRC, Institute for Lung Health, University of Leicester, Leicester, UK
| | - Douglas Cowan
- NHS Greater Glasgow and Clyde, Stobhill Hospital, Glasgow, UK
| | - Adel Hasan Mansur
- University of Birmingham and Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Stephen J Fowler
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre and NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Jim Lordan
- The Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | | | - John Matthews
- Department of Respiratory Sciences, Leicester NIHR BRC, Institute for Lung Health, University of Leicester, Leicester, UK
- 23andMe, Sunnyvale, California, USA
| | - Ian D Pavord
- Oxford Respiratory NIHR BRC, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Rekha Chaudhuri
- Division of Immunology, Infection and Inflammation, University of Glasgow, Glasgow, UK
| | - Liam G Heaney
- Wellcome-Wolfson Centre for Experimental Medicine, School of Medicine, Dentistry, and Biological Sciences, Belfast, UK
- Queen's University Belfast, Belfast, UK
| | - Michael R Barer
- Department of Respiratory Sciences, Leicester NIHR BRC, Institute for Lung Health, University of Leicester, Leicester, UK
| | - Christopher Brightling
- Department of Respiratory Sciences, Leicester NIHR BRC, Institute for Lung Health, University of Leicester, Leicester, UK
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9
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Martínez-García MÁ, Oscullo G, García-Ortega A, Matera MG, Rogliani P, Cazzola M. Inhaled Corticosteroids in Adults with Non-cystic Fibrosis Bronchiectasis: From Bench to Bedside. A Narrative Review. Drugs 2022; 82:1453-1468. [PMID: 36264441 PMCID: PMC9626424 DOI: 10.1007/s40265-022-01785-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2022] [Indexed: 11/06/2022]
Abstract
Due to their potent anti-inflammatory capacity (particularly in predominantly eosinophilic inflammation) and immunosuppressive properties, inhaled corticosteroids (ICSs) are widely used in asthmatic patients and also in individuals with chronic obstructive pulmonary disease (COPD) who suffer multiple exacerbations or have peripheral eosinophilia. However, there is little evidence for their use in non-cystic fibrosis bronchiectasis (hereafter, bronchiectasis). According to data extracted from large databases of bronchiectasis in adults, ICSs are used in more than 50% of patients without any scientific evidence to justify their efficacy and contrary to the recommendations of international guidelines on bronchiectasis that generally advise against their use. Indeed, bronchiectasis is a disease with predominantly neutrophilic inflammation and a high likelihood of chronic bacterial bronchial infection. Furthermore, it is known that due to their immunosuppressive properties, ICSs can induce an increase in bacterial infections. This manuscript aims to review the basic properties of ICSs, how they impact bronchiectasis in adults, the current position of international guidelines on this treatment, and the current indications and future challenges related to ICS use in bronchiectasis.
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Affiliation(s)
- Miguel Ángel Martínez-García
- Respiratory Department, Politechnic and University La Fe Hospital, Valencia, Spain.,CIBERES de Enfermedades Respiratorias, Madrid, Spain
| | - Grace Oscullo
- Respiratory Department, Politechnic and University La Fe Hospital, Valencia, Spain
| | | | - Maria Gabriella Matera
- Unit of Pharmacology, Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Paola Rogliani
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Mario Cazzola
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy.
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10
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Identification of COPD Inflammatory Endotypes Using Repeated Sputum Eosinophil Counts. Biomedicines 2022; 10:biomedicines10102611. [PMID: 36289873 PMCID: PMC9599170 DOI: 10.3390/biomedicines10102611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/10/2022] [Accepted: 10/13/2022] [Indexed: 11/16/2022] Open
Abstract
Higher blood and sputum eosinophil counts are associated with a greater response to corticosteroids in COPD. Low blood eosinophil counts exhibit greater stability over time whereas higher counts demonstrate more variability. Stability of airway eosinophil levels is less well understood. We have studied the stability of sputum eosinophil counts. Differential cell count data for COPD patients (n = 100) were analysed. Subjects with two sputum eosinophil counts, 6 months apart, were included in the analysis. Patients were stratified based on baseline sputum eosinophil count into ‘low’, ‘intermediate’ and ‘high’ groups: eosinophilLOW (<1%), eosinophilINT (1−3%) and eosinophilHIGH (≥3%). Sputum eosinophil counts showed good stability (rho = 0.61, p < 0.0001, ICC of 0.77), with 67.4% of eosinophilLOW patients remaining in the same category on repeat sampling. Bland−Altman analysis of the whole cohort (median difference between measurements = 0.00%, 90th percentile = −1.4 and 4.7%) showed greater variation at higher counts. This was confirmed by the wider 90th centiles in the eosinophilINT (−1.50 to 5.65) and eosinophilHIGH groups (−5.33 to 9.80) compared to the eosinophilLOW group (−0.40 to 1.40). The repeatability of sputum eosinophil counts was related to the baseline eosinophil count; sputum eosinophilLOW COPD patients were relatively stable over time, while the eosinophilHIGH group showed greater variability. These results can facilitate the identification of COPD endotypes with differential responses to treatment.
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11
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Azim A, Rezwan FI, Barber C, Harvey M, Kurukulaaratchy RJ, Holloway JW, Howarth PH. Measurement of Exhaled Volatile Organic Compounds as a Biomarker for Personalised Medicine: Assessment of Short-Term Repeatability in Severe Asthma. J Pers Med 2022; 12:jpm12101635. [PMID: 36294774 PMCID: PMC9604907 DOI: 10.3390/jpm12101635] [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: 08/12/2022] [Revised: 09/14/2022] [Accepted: 09/26/2022] [Indexed: 11/07/2022] Open
Abstract
The measurement of exhaled volatile organic compounds (VOCs) in exhaled breath (breathomics) represents an exciting biomarker matrix for airways disease, with early research indicating a sensitivity to airway inflammation. One of the key aspects to analytical validity for any clinical biomarker is an understanding of the short-term repeatability of measures. We collected exhaled breath samples on 5 consecutive days in 14 subjects with severe asthma who had undergone extensive clinical characterisation. Principal component analysis on VOC abundance across all breath samples revealed no variance due to the day of sampling. Samples from the same patients clustered together and there was some separation according to T2 inflammatory markers. The intra-subject and between-subject variability of each VOC was calculated across the 70 samples and identified 30.35% of VOCs to be erratic: variable between subjects but also variable in the same subject. Exclusion of these erratic VOCs from machine learning approaches revealed no apparent loss of structure to the underlying data or loss of relationship with salient clinical characteristics. Moreover, cluster evaluation by the silhouette coefficient indicates more distinct clustering. We are able to describe the short-term repeatability of breath samples in a severe asthma population and corroborate its sensitivity to airway inflammation. We also describe a novel variance-based feature selection tool that, when applied to larger clinical studies, could improve machine learning model predictions.
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Affiliation(s)
- Adnan Azim
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, Southampton SO16 6YD, UK
- Correspondence:
| | - Faisal I. Rezwan
- Department of Computer Science, Aberystwyth University, Aberystwyth SY23 3DB, UK
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
| | - Clair Barber
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, Southampton SO16 6YD, UK
| | - Matthew Harvey
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, Southampton SO16 6YD, UK
| | - Ramesh J. Kurukulaaratchy
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, Southampton SO16 6YD, UK
- David Hide Asthma and Allergy Research Centre, Isle of Wight NHS Trust, Newport PO30 5TG, UK
| | - John W. Holloway
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, Southampton SO16 6YD, UK
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
| | - Peter H. Howarth
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, Southampton SO16 6YD, UK
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12
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Mohan A, Lugogo NL. Phenotyping, Precision Medicine, and Asthma. Semin Respir Crit Care Med 2022; 43:739-751. [PMID: 36220058 DOI: 10.1055/s-0042-1750130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The traditional one-size-fits all approach based on asthma severity is archaic. Asthma is a heterogenous syndrome rather than a single disease entity. Studies evaluating observable characteristics called phenotypes have elucidated this heterogeneity. Asthma clusters demonstrate overlapping features, are generally stable over time and are reproducible. What the identification of clusters may have failed to do, is move the needle of precision medicine meaningfully in asthma. This may be related to the lack of a straightforward and clinically meaningful way to apply what we have learned about asthma clusters. Clusters are based on both clinical factors and biomarkers. The use of biomarkers is slowly gaining popularity, but phenotyping based on biomarkers is generally greatly underutilized even in subspecialty care. Biomarkers are more often used to evaluate type 2 (T2) inflammatory signatures and eosinophils (sputum and blood), fractional exhaled nitric oxide (FeNO) and serum total and specific immunoglobulin (Ig) E reliably characterize the underlying inflammatory pathways. Biomarkers perform variably and clinicians must be familiar with their advantages and disadvantages to accurately apply them in clinical care. In addition, it is increasingly clear that clinical features are critical in understanding not only phenotypic characterization but in predicting response to therapy and future risk of poor outcomes. Strategies for asthma management will need to leverage our knowledge of biomarkers and clinical features to create composite scores and risk prediction tools that are clinically applicable. Despite significant progress, many questions remain, and more work is required to accurately identify non-T2 biomarkers. Adoption of phenotyping and more consistent use of biomarkers is needed, and we should continue to encourage this incorporation into practice.
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Affiliation(s)
- Arjun Mohan
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Njira L Lugogo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
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13
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Multi-omics analyses of airway host-microbe interactions in chronic obstructive pulmonary disease identify potential therapeutic interventions. Nat Microbiol 2022; 7:1361-1375. [PMID: 35995842 DOI: 10.1038/s41564-022-01196-8] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 07/05/2022] [Indexed: 11/08/2022]
Abstract
The mechanistic role of the airway microbiome in chronic obstructive pulmonary disease (COPD) remains largely unexplored. We present a landscape of airway microbe-host interactions in COPD through an in-depth profiling of the sputum metagenome, metabolome, host transcriptome and proteome from 99 patients with COPD and 36 healthy individuals in China. Multi-omics data were integrated using sequential mediation analysis, to assess in silico associations of the microbiome with two primary COPD inflammatory endotypes, neutrophilic or eosinophilic inflammation, mediated through microbial metabolic interaction with host gene expression. Hypotheses of microbiome-metabolite-host interaction were identified by leveraging microbial genetic information and established metabolite-human gene pairs. A prominent hypothesis for neutrophil-predominant COPD was altered tryptophan metabolism in airway lactobacilli associated with reduced indole-3-acetic acid (IAA), which was in turn linked to perturbed host interleukin-22 signalling and epithelial cell apoptosis pathways. In vivo and in vitro studies showed that airway microbiome-derived IAA mitigates neutrophilic inflammation, apoptosis, emphysema and lung function decline, via macrophage-epithelial cell cross-talk mediated by interleukin-22. Intranasal inoculation of two airway lactobacilli restored IAA and recapitulated its protective effects in mice. These findings provide the rationale for therapeutically targeting microbe-host interaction in COPD.
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14
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Mulvanny A, Pattwell C, Beech A, Southworth T, Singh D. Validation of Sputum Biomarker Immunoassays and Cytokine Expression Profiles in COPD. Biomedicines 2022; 10:biomedicines10081949. [PMID: 36009496 PMCID: PMC9405928 DOI: 10.3390/biomedicines10081949] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 08/02/2022] [Accepted: 08/08/2022] [Indexed: 11/16/2022] Open
Abstract
Immunoassays are commonly used to assess airway inflammation in sputum samples from chronic obstructive pulmonary disease (COPD) patients. However, assay performance and validation in this complex matrix is inconsistently reported. The aim of this study was to assess the suitability of various immunoassays for use with sputum samples, followed by use of validated immunoassays to evaluate biomarker levels in COPD patients. Assays were assessed for recombinant reference standard suitability, optimal sample dilution, standard recovery in the biological matrix and reproducibility. Validated assays were used to assess sputum supernatants in Cohort A (n = 30 COPD, n = 10 smokers, n = 10 healthy) and Cohort B (n = 81 COPD, n = 15 smokers, n = 26 healthy). Paired baseline and exacerbation samples from 14 COPD patients were assessed in cohort A, and associations with sputum cell counts and bacterial colonisation investigated in cohort B. 25/32 assays passed validation; the primary reason for validation failure was recombinant reference standard suitability and sample dilution effects. Interleukin (IL-)6 and IL-8 were significantly increased in COPD patients compared to healthy subjects and smokers for both cohorts. Tumour necrosis factor (TNF)α and IL-1β were higher in COPD compared to smokers using one immunoassay but not another, partly explained by different absolute recovery rates. IL-1β, IL-2, IL-4, IL-8, IL-17A, Granulocyte colony stimulating factor (G-CSF), Interferon (IFN-)γ, Interferon gamma induced protein (IP-)10, Macrophage inflammatory protein (MIP)-1α, MIP-1β and TNF-α levels correlated with sputum neutrophil percentage in COPD patients. IL-1β, IL-4, IL-8, G-CSF and IFN-γ levels were associated with Haemophilus influenzae colonisation in COPD patients. Current smokers had lower levels of IL-1β, IL-4, IL-8, G-CSF, IFN-γ, IP-10, Monocyte chemoattractant protein (MCP)-1, MIP-1α, MIP-1β and TNF-α. Validated immunoassays applied to sputum supernatants demonstrated differences between COPD patients and controls, the effects of current smoking and associations between Haemophilus influenzae colonisation and higher levels of selected cytokines. Immunoassay validation enabled inflammatory mediators associated with different COPD characteristics to be determined.
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Affiliation(s)
- Alex Mulvanny
- Division of Immunology, Immunity to Infection and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester and Manchester University NHS Foundation Trust, Manchester M13 9PL, UK
- Medicines Evaluation Unit, Manchester University NHS Foundation Trust, Manchester M23 9QZ, UK
- Correspondence: ; Tel.: +44-0161-946-4050
| | - Caroline Pattwell
- Medicines Evaluation Unit, Manchester University NHS Foundation Trust, Manchester M23 9QZ, UK
| | - Augusta Beech
- Division of Immunology, Immunity to Infection and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester and Manchester University NHS Foundation Trust, Manchester M13 9PL, UK
| | - Thomas Southworth
- Division of Immunology, Immunity to Infection and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester and Manchester University NHS Foundation Trust, Manchester M13 9PL, UK
- Medicines Evaluation Unit, Manchester University NHS Foundation Trust, Manchester M23 9QZ, UK
| | - Dave Singh
- Division of Immunology, Immunity to Infection and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester and Manchester University NHS Foundation Trust, Manchester M13 9PL, UK
- Medicines Evaluation Unit, Manchester University NHS Foundation Trust, Manchester M23 9QZ, UK
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15
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Toraldo DM, Rizzo E, Conte L. Effects of inhaled corticosteroids (ICS) on lung microbiota and local immune response in long-term treatment of chronic obstructive pulmonary disease (COPD): utility of titration and therapeutic index. Naunyn Schmiedebergs Arch Pharmacol 2022; 395:849-858. [PMID: 35435466 DOI: 10.1007/s00210-022-02237-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 03/28/2022] [Indexed: 10/18/2022]
Abstract
Administration of inhaled corticosteroids (ICS) is one of the most controversial issues in the treatment of stable chronic obstructive pulmonary disease (COPD). Associations between these drugs and increased incidence of severe pneumonia and other respiratory infections have already been reported in literature, as well as effects on the immune system and on the lung microbiota. ICS vary in their pharmacodynamic and pharmacokinetic properties, despite being widely considered therapeutically similar. The use of ICS requires, therefore, a deep knowledge of their pharmacokinetics and pharmacodynamics to obtain the maximum benefit and the least side effects. Defining new phenotypes-endotypes of COPD may lead to novel pharmacological and therapeutic scenarios while define the correct indications for prescription of ICS. Titration is certainly an important means by which these objectives can be achieved.
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Affiliation(s)
- Domenico Maurizio Toraldo
- Cardiorespiratory Rehabilitation Unit, Department of Rehabilitation, "V. Fazzi" Hospital, Lecce, Italy.
| | - Emanuele Rizzo
- Department of Prevention, Local Health Authority of Lecce (ASL Lecce), Lecce, Italy
| | - Luana Conte
- Laboratory of Interdisciplinary Research Applied to Medicine (DReAM), University of Salento and Local Health Authority of Lecce (ASL Lecce), "V. Fazzi" Hospital, Lecce, Italy.,Laboratory of Biomedical Physics and Environment, Department of Mathematics and Physics, University of Salento, Lecce, Italy
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16
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Diver S, Brightling CE, Greening NJ. Novel Therapeutic Strategies in Asthma-Chronic Obstructive Pulmonary Disease Overlap. Immunol Allergy Clin North Am 2022; 42:671-690. [DOI: 10.1016/j.iac.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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17
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Obling N, Backer V, Hurst JR, Bodtger U. Nasal and systemic inflammation in Chronic Obstructive Pulmonary Disease (COPD). Respir Med 2022; 195:106774. [DOI: 10.1016/j.rmed.2022.106774] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 02/06/2022] [Accepted: 02/13/2022] [Indexed: 11/29/2022]
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18
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Deng K, Luo Q, Liang Z, Long F, Han Q, Wang F, Huang S, Liao L, Lin T, Chen R. Are sputum autoantibodies more clinically relevant in idiopathic pulmonary fibrosis than serum autoantibodies? JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2022; 27:3. [PMID: 35342449 PMCID: PMC8943581 DOI: 10.4103/jrms.jrms_219_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 06/25/2019] [Accepted: 08/11/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND The adaptive immune system plays a role in the pathogenesis of idiopathic pulmonary fibrosis (IPF) has been reported previously. However, the association between airway and circulating autoantibodies (AAbs) levels is unclear. The aim of this study is to investigate the link between the AAb levels in airway and circulation in stable patients with IPF. MATERIALS AND METHODS From June 2016 to March 2017, 21 stable IPF patients and 22 healthy volunteers were recruited. We established Luminex interacting AAbs with bead-antigen complex to detect the immunoglobulin G antibodies levels of ten autoantigens which were matched serum (Se) and sputum (Sp) samples collected from recruited subjects, including Smith (Sm), Anti-ribosomal P antibody (P0), Sjögren syndrome type A antigen (SSA), La/Sjögren syndrome type B antigen (SSB), DNA topoisomerase (Scl-70), histidyl-tRNA synthetase (Jo-1), U1 small nuclear ribonucleoprotein (U1-SnRNP), thyroid peroxidase, Proteinase 3, and Myeloperoxidase. Spearman's rank correlation matrix was applied to explore the associations of Ab profiles between Se and Sp. RESULTS For IPF patients, Spearman's correlation matrix showed multiple intercorrelations among Sp-AAbs and Sp-AAbs (P < 0.05), while only the levels of AAb against Sm and anti-La in Se were correlated with those Sp-AAb counterparts (P < 0.05). For healthy individuals, only anti-La in Se was associated with those Sp-AAb counterparts (P < 0.05). For IPF patients, there was a positive correlation between carbon monoxide diffusing capacity (DLCO)% predicted and Sp-anti-P0 level (r = 0.464, P = 0.034). Forced vital capacity% predicted was positively correlated with Sp-anti-Scl-70 level (r = 0.466, P = 0.033). CONCLUSION Comparing to Se-AAbs, Sp-AAbs are more associated with clinical parameters in the patients with IPF. In order to better understand the role of autoimmunity in the pathogenesis of IPF, detection of Sp-AAbs for local autoimmune responses may be a good choice.
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Affiliation(s)
- Kuimiao Deng
- National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Qun Luo
- National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhenyu Liang
- National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Fei Long
- State Key Laboratory of Respiratory Disease, School of Basic Medical Science, Sino-French Hoffmann Institute, Guangzhou Medical University, Guangzhou, China
| | - Qian Han
- National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Fengyan Wang
- National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Shuyu Huang
- National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Liyue Liao
- National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Tingting Lin
- School of Nursing, Guangzhou Medical University, Guangzhou, China
| | - Rongchang Chen
- National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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19
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Concepts of advanced therapeutic delivery systems for the management of remodeling and inflammation in airway diseases. Future Med Chem 2022; 14:271-288. [PMID: 35019757 PMCID: PMC8890134 DOI: 10.4155/fmc-2021-0081] [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] [Indexed: 12/13/2022] Open
Abstract
Chronic respiratory disorders affect millions of people worldwide. Pathophysiological changes to the normal airway wall structure, including changes in the composition and organization of its cellular and molecular constituents, are referred to as airway remodeling. The inadequacy of effective treatment strategies and scarcity of novel therapies available for the treatment and management of chronic respiratory diseases have given rise to a serious impediment in the clinical management of such diseases. The progress made in advanced drug delivery, has offered additional advantages to fight against the emerging complications of airway remodeling. This review aims to address the gaps in current knowledge about airway remodeling, the relationships between remodeling, inflammation, clinical phenotypes and the significance of using novel drug delivery methods.
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20
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Cass SP, McGrath JJ, Son K, Radford K, LaVigne N, Klein DK, Ditlev SB, Porsbjerg C, Nair P, Stampfli MR, Mukherjee M. Detecting immunoglobulins in processed sputa. Allergy 2021; 76:3798-3800. [PMID: 34390600 DOI: 10.1111/all.15049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 05/27/2021] [Accepted: 08/11/2021] [Indexed: 01/22/2023]
Affiliation(s)
- Steven P Cass
- Medical Sciences Graduate Program McMaster University Hamilton ON Canada
| | | | - Kiho Son
- Firestone Institute of Respiratory Health at St. Joseph's Healthcare Department of Medicine McMaster University Hamilton ON Canada
| | - Katherine Radford
- Firestone Institute of Respiratory Health at St. Joseph's Healthcare Department of Medicine McMaster University Hamilton ON Canada
| | - Nicola LaVigne
- Firestone Institute of Respiratory Health at St. Joseph's Healthcare Department of Medicine McMaster University Hamilton ON Canada
| | - Ditte K Klein
- Respiratory Research Unit Department of Respiratory Medicine Copenhagen University Hospital Bispebjerg and Frederiksberg Copenhagen Denmark
- Copenhagen Center for Translational Research Copenhagen University Hospital Bispebjerg and Frederiksberg Copenhagen Denmark
| | - Sisse B Ditlev
- Respiratory Research Unit Department of Respiratory Medicine Copenhagen University Hospital Bispebjerg and Frederiksberg Copenhagen Denmark
- Copenhagen Center for Translational Research Copenhagen University Hospital Bispebjerg and Frederiksberg Copenhagen Denmark
| | - Celeste Porsbjerg
- Respiratory Research Unit Department of Respiratory Medicine Copenhagen University Hospital Bispebjerg and Frederiksberg Copenhagen Denmark
- Copenhagen Center for Translational Research Copenhagen University Hospital Bispebjerg and Frederiksberg Copenhagen Denmark
| | - Parameswaran Nair
- Firestone Institute of Respiratory Health at St. Joseph's Healthcare Department of Medicine McMaster University Hamilton ON Canada
| | - Martin R. Stampfli
- Firestone Institute of Respiratory Health at St. Joseph's Healthcare Department of Medicine McMaster University Hamilton ON Canada
- Department of Medicine McMaster Immunology Research Centre McMaster University Hamilton ON Canada
| | - Manali Mukherjee
- Firestone Institute of Respiratory Health at St. Joseph's Healthcare Department of Medicine McMaster University Hamilton ON Canada
- Department of Medicine McMaster Immunology Research Centre McMaster University Hamilton ON Canada
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21
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Evaluation of airway inflammation in mechanically ventilated patients using cell count and protein concentration. Sci Rep 2021; 11:19803. [PMID: 34611262 PMCID: PMC8492721 DOI: 10.1038/s41598-021-99262-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 09/16/2021] [Indexed: 11/13/2022] Open
Abstract
Mechanically ventilated (MV) patients may present airway inflammation and elevated secretion production. However, it is unknown whether cell and/or protein counts in bronchial samples may be useful to evaluate their clinical condition. Our aim was to standardize sampling and propose a new mechanical mucus dissolution in Tracheal-Bronchial secretions. In all patients, bronchial lining fluid aspiration (BLF), Bronchoalveolar lavage (BAL) and Bronchial Washings (BW40, BW5) were performed, while visible bronchial secretions were obtained via bronchoscopy (VBS) and blinded, via a common catheter for tracheobronchial aspiration (AC). Mucus was mechanically or DTT dissolved and cell number was count. Protein, albumin and TNF-α levels were measured, in mucus dissolved samples from control and MV patients. Cell number and protein levels were elevated in mucus dissolved compared to non-dissolved, or DTT dissolved. Cell number and TNF-α levels were elevated in MV patients compared to controls, while protein levels were lower in MV patients. Differences in cell and protein levels were observed in samples acquired using different sampling technics. Therefore, mechanical mucus dissolution provides a proper sample for evaluation, and the sampling technic used can influence the sample’s characteristics.
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22
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Beech A, Lea S, Li J, Jackson N, Mulvanny A, Singh D. Airway Bacteria Quantification Using Polymerase Chain Reaction Combined with Neutrophil and Eosinophil Counts Identifies Distinct COPD Endotypes. Biomedicines 2021; 9:1337. [PMID: 34680454 PMCID: PMC8533560 DOI: 10.3390/biomedicines9101337] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/21/2021] [Accepted: 09/22/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) inflammatory endotypes are associated with different airway microbiomes. We used quantitative polymerase chain reaction (qPCR) analysis of sputum samples to establish the bacterial load upper limit in healthy controls; these values determined the bacterial colonisation prevalence in a longitudinal COPD cohort. Bacteriology combined with sputum inflammatory cells counts were used to investigate COPD endotypes. METHODS Sixty COPD patients and 15 healthy non-smoking controls were recruited. Sputum was analysed by qPCR (for Haemophilus influenzae, Moraxella catarrhalis, Streptococcus pneumoniae and Psuedomonas aeruginosa) and sputum differential cell counts at baseline and 6 months. RESULTS At baseline and 6 months, 23.1% and 25.6% of COPD patients were colonised with H. influenzae, while colonisation with other bacterial species was less common, e.g., S. pneumoniae-1.9% and 5.1%, respectively. H. influenzae + ve patients had higher neutrophil counts at baseline (90.1% vs. 67.3%, p < 0.01), with similar results at 6 months. COPD patients with sputum eosinophil counts ≥3% at ≥1 visit rarely showed bacterial colonisation. CONCLUSIONS The prevalence of H. influenzae colonisation was approximately 25%, with low colonisation for other bacterial species. H. influenzae colonisation was associated with sputum neutrophilia, while eosinophilic inflammation and H. influenzae colonisation rarely coexisted.
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Affiliation(s)
- Augusta Beech
- Manchester Academic Health Science Centre, Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, UK; (S.L.); (J.L.); (A.M.); (D.S.)
- Medicines Evaluation Unit, Manchester University NHS Foundation Trust, Manchester M23 9QZ, UK;
| | - Simon Lea
- Manchester Academic Health Science Centre, Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, UK; (S.L.); (J.L.); (A.M.); (D.S.)
| | - Jian Li
- Manchester Academic Health Science Centre, Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, UK; (S.L.); (J.L.); (A.M.); (D.S.)
| | - Natalie Jackson
- Medicines Evaluation Unit, Manchester University NHS Foundation Trust, Manchester M23 9QZ, UK;
| | - Alex Mulvanny
- Manchester Academic Health Science Centre, Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, UK; (S.L.); (J.L.); (A.M.); (D.S.)
- Medicines Evaluation Unit, Manchester University NHS Foundation Trust, Manchester M23 9QZ, UK;
| | - Dave Singh
- Manchester Academic Health Science Centre, Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, UK; (S.L.); (J.L.); (A.M.); (D.S.)
- Medicines Evaluation Unit, Manchester University NHS Foundation Trust, Manchester M23 9QZ, UK;
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23
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Alcázar-Navarrete B, García-Rio F, Sánchez G, Mariscal E, García A, Cuesta M, Uría E, Miravitlles M. Burden of Disease Among Exacerbating Patients with COPD Treated with Triple Therapy in Spain. Int J Chron Obstruct Pulmon Dis 2021; 16:2149-2161. [PMID: 34321874 PMCID: PMC8312318 DOI: 10.2147/copd.s310319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 06/19/2021] [Indexed: 12/28/2022] Open
Abstract
Background The cost of chronic obstructive pulmonary disease (COPD) in Spain has been studied from different perspectives, but parameters such as the patient's phenotype have seldom been considered. Our aim was to describe the disease burden of COPD patients with frequent exacerbator phenotype, treated with triple therapy. Methods An observational, multicenter study was carried out from December 2017 to November 2018 in pulmonology services among patients ≥40 years with COPD confirmed diagnosis receiving triple therapy (ICS/LAMA/LABA) and history of ≥2 moderate or ≥1 severe exacerbation in the 12 months prior to the inclusion visit. COPD-related healthcare resources were collected over a 12-months period prior to the inclusion visit: pharmacological and non-pharmacological treatments, medical and ER visits, hospitalizations, tests and productivity loss. Costs were updated to €2019. Patients were classified according to blood eosinophil levels: <150 cells/µL and ≥150 cells/µL. Results A total of 306 patients were included (77.1% men), with mean age of 69.9 years. Mean COPD exacerbation rate was 2.5/patient/year and 51.3% of patients had ≥150 cells/µL eosinophil level. On average, for the total population, COPD-related visits/patients/year were 6.2. Resource use in moderate exacerbation was higher in patients with eosinophils ≥150 cells/µL, whereas in severe exacerbation was higher in patients with eosinophils <150cells/µL. According to eosinophil levels, total annual mean (SD) costs/patient accounted for €8382 (9863) and €5144 (5444) for patients with eosinophils <150 cells/µL and ≥150 cells/µL, respectively. Conclusion The impact of exacerbating COPD patients treated with triple therapy in Spain is large, especially among those with eosinophils <150 cells/µL.
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Affiliation(s)
- Bernardino Alcázar-Navarrete
- Respiratory Department. Hospital Universitario Virgen de las Nieves, Granada, Spain
- CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Francisco García-Rio
- CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | | | | | | | | | | | - Marc Miravitlles
- CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Pneumology Department, Hospital Universitari Vall d’Hebron, Vall D’Hebron Institut de Recerca (VHIR), Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
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24
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Obling N, Backer V, Hurst JR, Bodtger U. Upper airway symptoms associate with the eosinophilic phenotype of COPD. ERJ Open Res 2021; 7:00184-2021. [PMID: 34350281 PMCID: PMC8326684 DOI: 10.1183/23120541.00184-2021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 06/08/2021] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND There is growing evidence that upper airway symptoms coexist with lower airway symptoms in COPD. Still, the prevalence and impact of upper airway disease on the nature and course of COPD remain unclear. We aimed to describe this in a cross-sectional study. METHODS We examined a cohort of COPD patients with pulmonary function tests, induced sputum, blood eosinophils, atopy tests and computed tomography (CT) of the paranasal sinuses. Lower airway symptoms were assessed using the COPD Assessment Test (CAT), and upper airway symptoms were assessed using the nasal subdomain of the 22-item Sino Nasal Outcome Test (SNOT22nasal). We recruited patients from five sites in Denmark and Sweden. We excluded patients with a history of asthma. FINDINGS In total, 180 patients (female 55%, age 67±8 years, forced expiratory volume in 1 s (FEV1 %) 52.4±16.6, Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage: A: 18%, B: 54%, C: 3%, D: 25%) were included in the study. Seventy-four patients (41%) reported high upper airway symptoms (UAS, defined as SNOT22nasal≥6) with a median score of 10 (IQR 8-13). Patients with high UAS reported higher CAT scores (17.4±7.5 versus 14.9±6.6, p<0.05) and displayed higher fractions of eosinophils in blood (median 3.0% (IQR 1.6-4.2%) versus 2.3% (IQR 1.4-3.1%), p<0.05) and in induced sputum (median 1.8% (IQR 0.3-7.1%) versus median 0.5% (IQR 0-1.7%), p<0.05). No differences in atopy, CT findings or exacerbation rates were observed. CONCLUSION COPD patients with upper airway disease showed increased evidence of eosinophilic disease and increased lower airway symptom burden.
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Affiliation(s)
- Nicolai Obling
- Dept of Respiratory Medicine, Zealand University Hospital, Næstved, Denmark
- Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Vibeke Backer
- Center for Physical Activity Research, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
- Dept of ENT, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
| | - John R. Hurst
- UCL Respiratory, University College London, London, UK
| | - Uffe Bodtger
- Dept of Respiratory Medicine, Zealand University Hospital, Næstved, Denmark
- Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark
- Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark
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25
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Niessen NM, Gibson PG, Baines KJ, Barker D, Yang IA, Upham JW, Reynolds PN, Hodge S, James AL, Jenkins C, Peters MJ, Marks GB, Baraket M, Simpson JL, Fricker M. Sputum TNF markers are increased in neutrophilic and severe asthma and are reduced by azithromycin treatment. Allergy 2021; 76:2090-2101. [PMID: 33569770 DOI: 10.1111/all.14768] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 01/06/2021] [Accepted: 01/10/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND The AMAZES randomized controlled trial demonstrated that long-term low-dose azithromycin treatment reduces exacerbations of poorly controlled asthma, but the therapeutic mechanisms remain unclear. Dysregulation of the inflammatory tumour necrosis factor (TNF) pathway is implicated in asthma and could be suppressed by azithromycin. We aimed to determine the inflammatory and clinical associations of soluble TNF signalling proteins (TNF receptors [TNFR] 1 and 2, TNF) in sputum and serum, and to test the effect of 48 weeks of azithromycin vs placebo on TNF markers. METHODS Sputum supernatant and serum TNFR1, TNFR2 (n = 142; 75 azithromycin-treated, 67 placebo-treated) and TNF (n = 48; 22 azithromycin-treated, 26 placebo-treated) were measured by ELISA in an AMAZES trial sub-population at baseline and end of treatment. Baseline levels were compared between sputum inflammatory phenotypes, severe/non-severe asthma and frequent/non-frequent exacerbators. Effect of azithromycin on markers was tested using linear mixed models. RESULTS Baseline sputum TNFR1 and TNFR2 were significantly increased in neutrophilic vs non-neutrophilic asthma phenotypes, while serum markers did not differ. Sputum TNFR1 and TNFR2 were increased in severe asthma and correlated with poorer lung function, worse asthma control and increasing age. Serum TNFR1 was also increased in severe asthma. Sputum and serum TNFR2 were increased in frequent exacerbators. Azithromycin treatment significantly reduced sputum TNFR2 and TNF relative to placebo, specifically in non-eosinophilic participants. CONCLUSIONS We demonstrate dysregulation of TNF markers, particularly in the airways, that relates to clinically important phenotypes of asthma including neutrophilic and severe asthma. Suppression of dysregulated TNF signalling by azithromycin could contribute to its therapeutic mechanism.
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Affiliation(s)
- Natalie M. Niessen
- Faculty of Health and Medicine and Priority Research Centre for Healthy Lungs School of Medicine and Public Health The University of Newcastle Newcastle NSW Australia
- National Health and Medical Research Council Centre for Excellence in Severe Asthma Newcastle NSW Australia
- Hunter Medical Research Institute Newcastle NSW Australia
| | - Peter G. Gibson
- Faculty of Health and Medicine and Priority Research Centre for Healthy Lungs School of Medicine and Public Health The University of Newcastle Newcastle NSW Australia
- National Health and Medical Research Council Centre for Excellence in Severe Asthma Newcastle NSW Australia
- Hunter Medical Research Institute Newcastle NSW Australia
- Department of Respiratory and Sleep Medicine John Hunter Hospital Newcastle NSW Australia
| | - Katherine J. Baines
- Faculty of Health and Medicine and Priority Research Centre for Healthy Lungs School of Medicine and Public Health The University of Newcastle Newcastle NSW Australia
- Hunter Medical Research Institute Newcastle NSW Australia
| | - Daniel Barker
- Hunter Medical Research Institute Newcastle NSW Australia
| | - Ian A. Yang
- Faculty of Medicine Department of Thoracic Medicine The Prince Charles Hospital The University of Queensland Brisbane Qld Australia
| | - John W. Upham
- Diamantina Institute The University of Queensland Brisbane Qld Australia
- Department of Respiratory Medicine Princess Alexandra Hospital Brisbane Qld Australia
| | - Paul N. Reynolds
- Department of Thoracic Medicine Royal Adelaide Hospital Adelaide SA Australia
- Lung Research Laboratory Hanson Institute Adelaide SA Australia
- School of Medicine University of Adelaide Adelaide SA Australia
| | - Sandra Hodge
- Department of Thoracic Medicine Royal Adelaide Hospital Adelaide SA Australia
- Lung Research Laboratory Hanson Institute Adelaide SA Australia
- School of Medicine University of Adelaide Adelaide SA Australia
| | - Alan L. James
- Department of Pulmonary Physiology and Sleep Medicine Sir Charles Gairdner Hospital Perth WA Australia
- Medical School The University of Western Australia Perth WA Australia
| | - Christine Jenkins
- Respiratory Trials The George Institute for Global Health Sydney NSW Australia
- Department of Thoracic Medicine Concord General Hospital Sydney NSW Australia
| | - Matthew J. Peters
- Department of Thoracic Medicine Concord General Hospital Sydney NSW Australia
- Faculty of Medicine and Health Sciences Macquarie University Sydney NSW Australia
| | - Guy B. Marks
- Woolcock Institute of Medical Research Sydney NSW Australia
- South Western Sydney Clinical School University of New South Wales Sydney NSW Australia
| | - Melissa Baraket
- Medicine Faculty Respiratory Medicine Department and Ingham Institute Liverpool Hospital University of New South Wales Sydney NSW Australia
| | - Jodie L. Simpson
- Faculty of Health and Medicine and Priority Research Centre for Healthy Lungs School of Medicine and Public Health The University of Newcastle Newcastle NSW Australia
- Hunter Medical Research Institute Newcastle NSW Australia
- Department of Respiratory and Sleep Medicine John Hunter Hospital Newcastle NSW Australia
| | - Michael Fricker
- Faculty of Health and Medicine and Priority Research Centre for Healthy Lungs School of Medicine and Public Health The University of Newcastle Newcastle NSW Australia
- National Health and Medical Research Council Centre for Excellence in Severe Asthma Newcastle NSW Australia
- Hunter Medical Research Institute Newcastle NSW Australia
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26
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Frøssing L, Silberbrandt A, Von Bülow A, Kjaersgaard Klein D, Ross Christensen M, Backer V, Baines KJ, Porsbjerg C. Airway gene expression identifies subtypes of type 2 inflammation in severe asthma. Clin Exp Allergy 2021; 52:59-69. [PMID: 34142396 DOI: 10.1111/cea.13966] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 05/26/2021] [Accepted: 06/04/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Type 2 inflammation is characterized by enhanced activity of interleukin (IL)-4, -5 and -13, and treatments targeting these pathways are available for treatment of severe asthma. At present, the pattern of pathway activity and the implications overlapping of pathway activity are unknown. OBJECTIVE We hypothesized that clustering of airway mRNA expression would identify distinct molecular subtypes of severe asthma and thereby uncover the prevalence and overlap of pathway activity. METHODS Sputum mRNA expression of genes related to expression of IL-5(CLC, CPA3 and DNASE1L3), IL-13(IL13Ra1, TNFSF14 and SERPINB2), T1/Th17 activity(IL1B, ALPL and CXCR2) and in vitro response to corticosteroids (FKBP512) and mepolizumab (ARAP3) was analysed in patients (n = 109) with severe asthma and healthy controls (n = 22). A cluster analysis of gene expression was performed. The response to a short course of OCS was assessed in a subset of patients (n = 29). RESULTS Five molecular clusters were identified. Three had abundant T2 gene expression of which two (n = 39 and n = 9) were characterized by abundant expression of both IL-13- and IL-5-related genes. The last (n = 6) had only abundant IL-5-related gene expression. These T2-high molecular clusters could not be distinguished using T2 biomarkers. T2- and Th1/Th17-related mRNA expression were co-expressed across all clusters. OCS significantly reduced T2 gene expression (CLC, IL13Ra1, SERPINB2 and ARAP3) and significantly increase expression of Th1/Th17-related genes (ALPL and CXCR2). CONCLUSIONS AND CLINICAL RELEVANCE Clustering of airway mRNA expression identified five molecular clusters of severe asthma of which three were considered T2 high. Co-expression of IL-5- and IL-13-related genes at moderate levels was present in almost half of patients, while marked elevated expression of both was rare. In contrast to IL-5, clusters with isolated IL-13- and Th1/Th17-related gene expression were not identified.
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Affiliation(s)
- Laurits Frøssing
- Respiratory Research Unit, Department of Respiratory Medicine, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark.,Copenhagen Center for Translational Research, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Alexander Silberbrandt
- Respiratory Research Unit, Department of Respiratory Medicine, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark.,Copenhagen Center for Translational Research, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Anna Von Bülow
- Respiratory Research Unit, Department of Respiratory Medicine, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Ditte Kjaersgaard Klein
- Respiratory Research Unit, Department of Respiratory Medicine, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark.,Copenhagen Center for Translational Research, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Marcus Ross Christensen
- Respiratory Research Unit, Department of Respiratory Medicine, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Vibeke Backer
- Centre for Physical Activity Research, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Katherine J Baines
- The Priority Research Centre for Asthma and Respiratory Diseases, Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia
| | - Celeste Porsbjerg
- Respiratory Research Unit, Department of Respiratory Medicine, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark.,Copenhagen Center for Translational Research, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
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27
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Pavord ID, Chapman KR, Bafadhel M, Sciurba FC, Bradford ES, Schweiker Harris S, Mayer B, Rubin DB, Yancey SW, Paggiaro P. Mepolizumab for Eosinophil-Associated COPD: Analysis of METREX and METREO. Int J Chron Obstruct Pulmon Dis 2021; 16:1755-1770. [PMID: 34163157 PMCID: PMC8215850 DOI: 10.2147/copd.s294333] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 05/09/2021] [Indexed: 12/05/2022] Open
Abstract
Background A pre-specified meta-analysis of individual patient data from the 52-week METREX and METREO trials, which investigated mepolizumab for chronic obstructive pulmonary disease (COPD) in patients with blood eosinophil counts ≥150 cells/µL (screening) or ≥300 cells/µL (prior year) and frequent exacerbations, enables more robust characterization of mepolizumab efficacy in COPD and exploration of the relationship between blood eosinophil count and treatment responses. Methods In METREX (117106/NCT02105948) and METREO (117113/NCT02105961), randomized patients received mepolizumab or placebo added to existing inhaled corticosteroid (ICS)–based triple maintenance therapy. The annual rate of moderate/severe exacerbations (primary endpoint) was compared between subcutaneous (SC) mepolizumab 100 mg versus placebo (primary comparison of interest) and all doses (100 mg and 300 mg SC) versus placebo in patients with blood eosinophil counts ≥150 cells/µL at screening or ≥300 cells/µL in the prior year. Secondary/other endpoints included time to first moderate/severe exacerbation, exacerbations leading to emergency department visit/hospitalization and health-related quality of life (HRQoL). A predictive model of the relationship between screening blood eosinophil counts and exacerbation rates included data from all randomized patients. Results In total, 1510 patients were randomized in METREX and METREO and 1136 patients were included in the pre-specified meta-analysis. From the meta-analysis, mepolizumab 100 mg SC significantly reduced annual moderate/severe exacerbation rates versus placebo by 18% (rate ratio: 0.82; 95% confidence interval: 0.71, 0.95; p=0.006) and delayed time to first moderate/severe exacerbation (hazard ratio: 0.80 [0.68, 0.94]; p=0.006). Mepolizumab 100 mg SC versus placebo numerically reduced exacerbations leading to ED visits/hospitalization and improved HRQoL. A modelling approach demonstrated increasing efficacy for moderate/severe exacerbations with increasing screening blood eosinophil count; this relationship was more pronounced for exacerbations requiring oral corticosteroids (post hoc). The all-doses comparison had similar results. Conclusion Mepolizumab reduces exacerbations in patients with eosinophil-associated COPD. Results suggest that blood eosinophil counts (≥150 cells/µL at screening or ≥300 cells/µL in the prior year) allow for identification of patients with COPD who experience exacerbations while treated with maximal ICS-based triple maintenance therapy who are likely to benefit from mepolizumab. ![]()
Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/YCq1mqQ5Xl4
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Affiliation(s)
- Ian D Pavord
- Nuffield Department of Medicine and Oxford Respiratory NIHR BRC, University of Oxford, Oxford, UK
| | - Kenneth R Chapman
- Asthma & Airway Centre, UHN and University of Toronto, Toronto, ON, Canada
| | - Mona Bafadhel
- Nuffield Department of Medicine and Oxford Respiratory NIHR BRC, University of Oxford, Oxford, UK
| | - Frank C Sciurba
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Eric S Bradford
- Respiratory Therapeutic Area, GSK, Research Triangle Park, NC, USA
| | | | | | - David B Rubin
- Respiratory Therapeutic Area, GSK, Research Triangle Park, NC, USA
| | - Steven W Yancey
- Respiratory Therapeutic Area, GSK, Research Triangle Park, NC, USA
| | - Pierluigi Paggiaro
- Department of Surgery, Medicine, Molecular Biology, and Critical Care, University of Pisa, Pisa, Italy
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28
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Cass SP, Dvorkin-Gheva A, Yang Y, McGrath JJC, Thayaparan D, Xiao J, Wang F, Mukherjee M, Long F, Peng T, Nair P, Liang Z, Stevenson CS, Li QZ, Chen R, Stampfli MR. Differential expression of sputum and serum autoantibodies in patients with chronic obstructive pulmonary disease. Am J Physiol Lung Cell Mol Physiol 2021; 320:L1169-L1182. [PMID: 33908260 DOI: 10.1152/ajplung.00518.2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a complex and progressive respiratory disease. Autoimmune processes have been hypothesized to contribute to disease progression; however, the presence of autoantibodies in the serum has been variable. Given that COPD is a lung disease, we sought to investigate whether autoantibodies in sputum supernatant would better define pulmonary autoimmune processes. Matched sputum and serum samples were obtained from the Airways Disease Endotyping for Personalized Therapeutics (ADEPT) study and at the Guangzhou Institute of Respiratory Health (GIRH). Samples were collected from patients with varying severity of COPD, asymptomatic smokers, and healthy control subjects. IgG and IgM autoantibodies were detected in sputum and serum of all subjects in both cohorts using a broad-spectrum autoantigen array. No differences were observed in sputum autoantibodies between COPD and asymptomatic smokers in either cohort. In contrast, 16% of detectable sputum IgG autoantibodies were decreased in subjects with COPD compared to healthy controls in the ADEPT cohort. Compared to asymptomatic smokers, approximately 13% of detectable serum IgG and 40% of detectable serum IgM autoantibodies were differentially expressed in GIRH COPD subjects. Of the differentially expressed specificities, anti-nuclear autoantibodies were predominately decreased. A weak correlation between increased serum IgM anti-tissue autoantibodies and a measure of airspace enlargement was observed. The differential expression of specificities varied between the cohorts. In closing, using a comprehensive autoantibody array, we demonstrate that autoantibodies are present in subjects with COPD, asymptomatic smokers, and healthy controls. Cohorts displayed high levels of heterogeneity, precluding the utilization of autoantibodies for diagnostic purposes.
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Affiliation(s)
- Steven P Cass
- Medical Sciences Graduate Program, McMaster University, Hamilton, Ontario, Canada
| | - Anna Dvorkin-Gheva
- Department of Pathology and Molecular Medicine, McMaster Immunology Research Centre, McMaster University, Hamilton, Ontario, Canada
| | - Yuqiong Yang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Joshua J C McGrath
- Medical Sciences Graduate Program, McMaster University, Hamilton, Ontario, Canada
| | - Danya Thayaparan
- Medical Sciences Graduate Program, McMaster University, Hamilton, Ontario, Canada
| | - Jing Xiao
- State Key Laboratory of Respiratory Disease, Sino-French Hoffmann Institute, College of Basic Medical Science, Guangzhou Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Fengyan Wang
- State Key Laboratory of Respiratory Disease, Sino-French Hoffmann Institute, College of Basic Medical Science, Guangzhou Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Manali Mukherjee
- Department of Medicine, Firestone Institute of Respiratory Health at St. Joseph's Health Care, McMaster University, Hamilton, Ontario, Canada
| | - Fei Long
- State Key Laboratory of Respiratory Disease, Sino-French Hoffmann Institute, College of Basic Medical Science, Guangzhou Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Tao Peng
- State Key Laboratory of Respiratory Disease, Sino-French Hoffmann Institute, College of Basic Medical Science, Guangzhou Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Parameswaran Nair
- Department of Medicine, Firestone Institute of Respiratory Health at St. Joseph's Health Care, McMaster University, Hamilton, Ontario, Canada
| | - Zhenyu Liang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Christopher S Stevenson
- Janssen Disease Interception Accelerator, Janssen Pharmaceutical Companies of Johnson and Johnson, Raritan, New Jersey
| | - Quan-Zhen Li
- Department of Immunology and Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Rongchang Chen
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, People's Republic of China.,Shenzhen Institute of Respiratory Diseases, Shenzhen People's Hospital, Shenzhen, Guangdong, People's Republic of China
| | - Martin R Stampfli
- Department of Pathology and Molecular Medicine, McMaster Immunology Research Centre, McMaster University, Hamilton, Ontario, Canada.,State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, People's Republic of China.,Department of Medicine, Firestone Institute of Respiratory Health at St. Joseph's Health Care, McMaster University, Hamilton, Ontario, Canada
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29
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Barber C, Lau L, Ward JA, Daniels T, Watson A, Staples KJ, Wilkinson TMA, Howarth PH. Sputum processing by mechanical dissociation: A rapid alternative to traditional sputum assessment approaches. CLINICAL RESPIRATORY JOURNAL 2021; 15:800-807. [PMID: 33749082 DOI: 10.1111/crj.13365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 03/12/2021] [Accepted: 03/17/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Sputum cytology is currently the gold standard to evaluate cellular inflammation in the airways and phenotyping patients with airways diseases. Sputum eosinophil proportions have been used to guide treatment for moderate to severe asthma. Furthermore, raised sputum neutrophils are associated with poor disease control and impaired lung function in both asthma and COPD and small airways disease in cystic fibrosis. However, induced-sputum analysis is subjective and resource heavy, requiring dedicated specialist processing and assessment; this limits its utility in most clinical settings. Indirect blood eosinophil measures have been adopted in clinical care. However, there are currently no good peripheral blood biomarkers of airway neutrophils. A resource-light sputum processing approach could thus help integrate induced sputum more readily into routine clinical care. New mechanical disruption (MD) methods can rapidly obtain viable single cell suspensions from sputum samples. AIMS The aim of this study was to compare MD sputum processing to traditional methods for cell viability, granulocyte proportions and sputum cytokine analysis. METHODS Sputum plugs were split and processed using traditional methods and the MD method, and samples were then compared. RESULTS The MD method produced a homogeneous cell suspension in 62 s; 70 min faster than the standard method used. No significant difference was seen between the cell viability (p = 0.09), or the concentration of eosinophils (p = 0.83), neutrophils (p = 0.99) or interleukin-8 (p = 0.86) using MD. CONCLUSION This cost-effective method of sputum processing could provide a more pragmatic, sustainable means of directly monitoring the airway milieu. Therefore, we recommend this method be taken forward for further investigation.
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Affiliation(s)
- Clair Barber
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, Southampton Centre for Biomedical Research, Southampton, UK
| | - Laurie Lau
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Jonathan A Ward
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Thomas Daniels
- Cystic Fibrosis Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Alastair Watson
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, Southampton Centre for Biomedical Research, Southampton, UK
| | - Karl J Staples
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, Southampton Centre for Biomedical Research, Southampton, UK
| | - Tom M A Wilkinson
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, Southampton Centre for Biomedical Research, Southampton, UK
| | - Peter H Howarth
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,Cystic Fibrosis Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Respiratory Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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30
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Airway bacterial and fungal microbiome in chronic obstructive pulmonary disease. MEDICINE IN MICROECOLOGY 2021. [DOI: 10.1016/j.medmic.2021.100035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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31
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Cass SP, Yang Y, Xiao J, McGrath JJC, Fantauzzi MF, Thayaparan D, Wang F, Liang Z, Long F, Stevenson CS, Chen R, Stampfli MR. Current smoking status is associated with reduced sputum immunoglobulin M and G expression in COPD. Eur Respir J 2021; 57:13993003.02338-2019. [PMID: 32883677 DOI: 10.1183/13993003.02338-2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 08/13/2020] [Indexed: 11/05/2022]
Affiliation(s)
- Steven P Cass
- Medical Sciences Graduate Program, McMaster University, Hamilton, ON, Canada
| | - Yuqiong Yang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, P.R. China
| | - Jing Xiao
- State Key Laboratory of Respiratory Disease, Sino-French Hoffmann Institute, College of Basic Medical Science, Guangzhou Medical University, Guangzhou, P.R. China
| | - Joshua J C McGrath
- Medical Sciences Graduate Program, McMaster University, Hamilton, ON, Canada
| | - Matthew F Fantauzzi
- Medical Sciences Graduate Program, McMaster University, Hamilton, ON, Canada
| | - Danya Thayaparan
- Medical Sciences Graduate Program, McMaster University, Hamilton, ON, Canada
| | - Fengyan Wang
- State Key Laboratory of Respiratory Disease, Sino-French Hoffmann Institute, College of Basic Medical Science, Guangzhou Medical University, Guangzhou, P.R. China
| | - Zhenyu Liang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, P.R. China
| | - Fei Long
- State Key Laboratory of Respiratory Disease, Sino-French Hoffmann Institute, College of Basic Medical Science, Guangzhou Medical University, Guangzhou, P.R. China
| | - Christopher S Stevenson
- Janssen Disease Interception Accelerator, Janssen Pharmaceutical Companies of Johnson and Johnson, Raritan, NJ, USA
| | - Rongchang Chen
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, P.R. China.,Shenzhen Institute of Respiratory Diseases, Shenzhen People's Hospital, Shenzhen, P.R. China
| | - Martin R Stampfli
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, P.R. China.,Dept of Pathology and Molecular Medicine, McMaster Immunology Research Centre, McMaster University, Hamilton, ON, Canada.,Dept of Medicine, Firestone Institute of Respiratory Health at St. Joseph's Health Care, McMaster University, Hamilton, ON, Canada
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32
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Frøssing L, Hartvig Lindkaer Jensen T, Østrup Nielsen J, Hvidtfeldt M, Silberbrandt A, Parker D, Porsbjerg C, Backer V. Automated cell differential count in sputum is feasible and comparable to manual cell count in identifying eosinophilia. J Asthma 2021; 59:552-560. [PMID: 33356683 DOI: 10.1080/02770903.2020.1868498] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Cell differential count (CDC) of induced sputum is considered the gold standard for inflammatory phenotyping of asthma but is not implemented in routine care due to its heavy time- and staff demands. Digital Cell Morphology is a technique where digital images of cells are captured and presented preclassified as white blood cells (neutrophils, eosinophils, lymphocytes, macrophages, and unidentified) and nonwhite blood cells for review. With this study, we wanted to assess the accuracy of an automated CDC in identifying the key inflammatory cells in induced sputum. METHODS Sputum from 50 patients with asthma was collected and processed using the standard processing protocol with one drop 20% albumin added to hinder cell smudging. Each slide was counted automatically using the CellaVision DM96 and manually by an experienced lab technician. Sputum was classified as eosinophilic or neutrophilic using 3% and 61% cutoffs, respectively. RESULTS We found a good agreement using intraclass correlation for all target cells, despite significant differences in the cell count rate. The automated CDC had a sensitivity of 65%, a specificity of 93%, and a kappa-coefficient of 0.61 for identification of sputum eosinophilia. In contrast, the automated CDC had a sensitivity of 29%, a specificity of 100%, and a kappa-coefficient of 0.23 for identification of sputum neutrophilia. CONCLUSION Automated- and manual cell counts of sputum agree with regards to the key inflammatory cells. The automated cell count had a modest sensitivity but a high specificity for the identification of both neutrophil and eosinophil asthma.
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Affiliation(s)
- Laurits Frøssing
- Respiratory Research Unit, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
| | | | - Jesper Østrup Nielsen
- Department of Clinical Biochemistry, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Morten Hvidtfeldt
- Respiratory Research Unit, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
| | - Alexander Silberbrandt
- Respiratory Research Unit, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
| | - Deborah Parker
- Leicester Respiratory Biomedical Research Unit, University of Leicester, Leicester, United Kingdom
| | - Celeste Porsbjerg
- Respiratory Research Unit, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
| | - Vibeke Backer
- Center for Physical Activity Research, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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33
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Lombardelli L, Logiodice F, Kullolli O, Piccinni MP. Evaluation of Secreted Cytokines by Multiplex Bead-Based Assay (X MAP Technology, Luminex). Methods Mol Biol 2021; 2285:121-130. [PMID: 33928548 DOI: 10.1007/978-1-0716-1311-5_10] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The Luminex XMAP technology permits the simultaneous evaluation of numerous cytokines in several types of biological fluids (plasma, serum, liquor, follicular fluids, etc.) and in cell supernatants. Thus, multiplexing allows to achieve a time/cost economy and ensures that all the measurements are performed in the same conditions. Simultaneous measurement of cytokines with a multiplex bead-based assay has some similarities with ELISA, in particular the use of anti-cytokine antibodies, but shows an important difference, the use of magnetic fluorescent beads coupled to anti-cytokine monoclonal antibodies. The magnetic microspheres (dyed internally with two florescent dyes) coupled with anti-cytokine monoclonal antibodies are incubated with samples and standards; after washing, the samples/standards are incubated with biotinylated anti-cytokine monoclonal antibodies; and finally, after other washings, with streptavidin-phycoerythrin solution. Luminex instrument identifies the different cytokines present in each well and converts the mean fluorescence intensity (MFI) of each measured cytokine in pg/ml, thanks to the software and the standard curves. This technique is applicable in basic and clinical research.
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Affiliation(s)
- Letizia Lombardelli
- Department of Experimental and Clinical Medicine and DENOTHE Excellence Center, University of Florence, Florence, Italy
| | - Federica Logiodice
- Department of Experimental and Clinical Medicine and DENOTHE Excellence Center, University of Florence, Florence, Italy
| | - Ornela Kullolli
- Department of Experimental and Clinical Medicine and DENOTHE Excellence Center, University of Florence, Florence, Italy
| | - Marie-Pierre Piccinni
- Department of Experimental and Clinical Medicine and DENOTHE Excellence Center, University of Florence, Florence, Italy.
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34
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Fu L, Fei J, Tan ZX, Chen YH, Hu B, Xiang HX, Zhao H, Xu DX. Low Vitamin D Status Is Associated with Inflammation in Patients with Chronic Obstructive Pulmonary Disease. THE JOURNAL OF IMMUNOLOGY 2020; 206:515-523. [PMID: 33361208 DOI: 10.4049/jimmunol.2000964] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 11/11/2020] [Indexed: 02/06/2023]
Abstract
Vitamin D deficiency is associated with increased risks of chronic obstructive pulmonary disease (COPD). Nevertheless, the mechanisms remain unknown. This study analyzed the correlations between vitamin D levels and inflammation in COPD patients. One hundred and one patients with COPD and 202 control subjects were enrolled. Serum 25(OH)D level and inflammatory cytokines were detected. Serum 25(OH)D was decreased and inflammatory cytokines were increased in COPD patients. According to forced expiratory volume in 1 s, COPD patients were divided into three grades. Furthermore, serum 25(OH)D was gradually decreased in COPD patients ranging from grade 1-2 to 4. Serum 25(OH)D was inversely associated with inflammatory cytokines in COPD patients. Further analysis found that NF-κB and AP-1 signaling were activated in COPD patients. Besides, inflammatory signaling was gradually increased in parallel with the severity of COPD. By contrast, pulmonary nuclear vitamin D receptor was decreased in COPD patients. In vitro experiments showed that 1,25(OH)2D3 inhibited LPS-activated inflammatory signaling in A549 cells (human lung adenocarcinoma cell). Mechanically, 1,25(OH)2D3 reinforced physical interactions between vitamin D receptor with NF-κB p65 and c-Jun. Our results indicate that vitamin D is inversely correlated with inflammatory signaling in COPD patients. Inflammation may be a vital mediator of COPD progress in patients with low vitamin D levels.
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Affiliation(s)
- Lin Fu
- The Second Affiliated Hospital, Anhui Medical University, Hefei 230032, China.,Department of Toxicology, Anhui Medical University, Hefei 230032, China; and
| | - Jun Fei
- The Second Affiliated Hospital, Anhui Medical University, Hefei 230032, China
| | - Zhu-Xia Tan
- The Second Affiliated Hospital, Anhui Medical University, Hefei 230032, China
| | - Yuan-Hua Chen
- Department of Toxicology, Anhui Medical University, Hefei 230032, China; and.,Department of Histology and Embryology, Anhui Medical University, Hefei 230032, China
| | - Biao Hu
- The Second Affiliated Hospital, Anhui Medical University, Hefei 230032, China
| | - Hui-Xiang Xiang
- The Second Affiliated Hospital, Anhui Medical University, Hefei 230032, China
| | - Hui Zhao
- The Second Affiliated Hospital, Anhui Medical University, Hefei 230032, China;
| | - De-Xiang Xu
- Department of Toxicology, Anhui Medical University, Hefei 230032, China; and
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35
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Kaur D, Chachi L, Gomez E, Sylvius N, Singh SR, Ramsheh MY, Saunders R, Brightling CE. ST2 expression and release by the bronchial epithelium is downregulated in asthma. Allergy 2020; 75:3184-3194. [PMID: 32516479 DOI: 10.1111/all.14436] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 05/01/2020] [Accepted: 05/04/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND The airway epithelium plays an important role in wound repair, host defense and is involved in the immunopathogenesis of asthma. Genome wide association studies have described associations between ST2/Interleukin (IL)-33 genes in asthma, but its role in bronchial epithelium is unclear. METHODS ST2 expression was examined in subjects with asthma and healthy controls in bronchial epithelium from biopsies (n = 27 versus n = 9) and brushings (n = 34 versus n = 20) by immunohistochemistry and RNA-Seq. In human primary bronchial epithelial cells ST2 mRNA and protein expression were assessed by qPCR, flow cytometry, Western blotting, and immunofluorescence. IL-33 function in epithelial cells was examined by intracellular calcium measurements, wound healing assays, and synthetic activation by gene array and ELISA. RESULTS Bronchial epithelial ST2 protein expression was significantly decreased in biopsies in subjects with asthma compared to healthy controls (P = .039). IL1RL1 gene expression in bronchial brushes was not different between health and disease. In vitro primary bronchial epithelial cells expressed ST2 and IL-33 stimulation led to an increase in intracellular calcium, altered gene expression, but had no effect upon wound repair. Epithelial cells released sST2 spontaneously, which was reduced following stimulation with TNFα or poly-IC. Stimulation by TNFα or poly-IC did not affect the total ST2 expression by epithelial cell whereas surface ST2 decreased in response to TNFα, but not poly-IC. CONCLUSION In asthma, bronchial epithelium protein expression of ST2 is decreased. Our in vitro findings suggest that this decrease might be a consequence of the pro-inflammatory environment in asthma or in response to viral infection.
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Affiliation(s)
- Davinder Kaur
- Institute for Lung Health Department of Respiratory Sciences University of Leicester Leicester UK
| | - Latifa Chachi
- Institute for Lung Health Department of Respiratory Sciences University of Leicester Leicester UK
| | - Edith Gomez
- Institute for Lung Health Department of Respiratory Sciences University of Leicester Leicester UK
| | - Nicolas Sylvius
- Genomic Core Facility Department of Genetics University of Leicester Leicester UK
| | - Shailendra R. Singh
- Institute for Lung Health Department of Respiratory Sciences University of Leicester Leicester UK
| | - Mohammadali Y. Ramsheh
- Institute for Lung Health Department of Respiratory Sciences University of Leicester Leicester UK
| | - Ruth Saunders
- Institute for Lung Health Department of Respiratory Sciences University of Leicester Leicester UK
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36
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Wang Z, Yang Y, Yan Z, Liu H, Chen B, Liang Z, Wang F, Miller BE, Tal-Singer R, Yi X, Li J, Stampfli MR, Zhou H, Brightling CE, Brown JR, Wu M, Chen R, Shu W. Multi-omic meta-analysis identifies functional signatures of airway microbiome in chronic obstructive pulmonary disease. THE ISME JOURNAL 2020; 14:2748-2765. [PMID: 32719402 PMCID: PMC7784873 DOI: 10.1038/s41396-020-0727-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/13/2020] [Accepted: 07/20/2020] [Indexed: 12/22/2022]
Abstract
The interaction between airway microbiome and host in chronic obstructive pulmonary disease (COPD) is poorly understood. Here we used a multi-omic meta-analysis approach to characterize the functional signature of airway microbiome in COPD. We retrieved all public COPD sputum microbiome datasets, totaling 1640 samples from 16S rRNA gene datasets and 26 samples from metagenomic datasets from across the world. We identified microbial taxonomic shifts using random effect meta-analysis and established a global classifier for COPD using 12 microbial genera. We inferred the metabolic potentials for the airway microbiome, established their molecular links to host targets, and explored their effects in a separate meta-analysis on 1340 public human airway transcriptome samples for COPD. 29.6% of differentially expressed human pathways were predicted to be targeted by microbiome metabolism. For inferred metabolite-host interactions, the flux of disease-modifying metabolites as predicted from host transcriptome was generally concordant with their predicted metabolic turnover in microbiome, suggesting a synergistic response between microbiome and host in COPD. The meta-analysis results were further validated by a pilot multi-omic study on 18 COPD patients and 10 controls, in which airway metagenome, metabolome, and host transcriptome were simultaneously characterized. 69.9% of the proposed "microbiome-metabolite-host" interaction links were validated in the independent multi-omic data. Butyrate, homocysteine, and palmitate were the microbial metabolites showing strongest interactions with COPD-associated host genes. Our meta-analysis uncovered functional properties of airway microbiome that interacted with COPD host gene signatures, and demonstrated the possibility of leveraging public multi-omic data to interrogate disease biology.
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Affiliation(s)
- Zhang Wang
- Institute of Ecological Science, School of Life Science, South China Normal University, Guangzhou, Guangdong Province, China.
| | - Yuqiong Yang
- Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Zhengzheng Yan
- State Key Laboratory of Organ Failure Research, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Haiyue Liu
- State Key Laboratory of Organ Failure Research, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Boxuan Chen
- Institute of Ecological Science, School of Life Science, South China Normal University, Guangzhou, Guangdong Province, China
| | - Zhenyu Liang
- Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Fengyan Wang
- Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Bruce E Miller
- Medical Innovation, Value Evidence and Outcomes, GlaxoSmithKline R&D, Collegeville, PA, USA
| | - Ruth Tal-Singer
- Medical Innovation, Value Evidence and Outcomes, GlaxoSmithKline R&D, Collegeville, PA, USA
| | - Xinzhu Yi
- Institute of Ecological Science, School of Life Science, South China Normal University, Guangzhou, Guangdong Province, China
| | - Jintian Li
- Institute of Ecological Science, School of Life Science, South China Normal University, Guangzhou, Guangdong Province, China
| | - Martin R Stampfli
- Department of Medicine, Firestone Institute of Respiratory Health at St. Joseph's Healthcare, McMaster University, Hamilton, ON, Canada
| | - Hongwei Zhou
- State Key Laboratory of Organ Failure Research, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Christopher E Brightling
- Institute for Lung Health, Leicester NIHR Biomedical Research Centre, Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - James R Brown
- Human Genetics, GlaxoSmithKline R&D, Collegeville, PA, USA
| | - Martin Wu
- Department of Biology, University of Virginia, Charlottesville, VA, USA
| | - Rongchang Chen
- Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong Province, China
- Pulmonary and Critical Care Department, Shenzhen Institute of Respiratory Diseases, Shenzhen People's Hospital, Shenzhen, Guangdong Province, China
| | - Wensheng Shu
- Institute of Ecological Science, School of Life Science, South China Normal University, Guangzhou, Guangdong Province, China
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Beech AS, Lea S, Kolsum U, Wang Z, Miller BE, Donaldson GC, Wedzicha JA, Brightling CE, Singh D. Bacteria and sputum inflammatory cell counts; a COPD cohort analysis. Respir Res 2020; 21:289. [PMID: 33131502 PMCID: PMC7603729 DOI: 10.1186/s12931-020-01552-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 10/20/2020] [Indexed: 01/08/2023] Open
Abstract
Background There is evidence that bacterial colonisation in chronic obstructive pulmonary disease (COPD) is associated with increased neutrophilic airway inflammation. This study tested the hypothesis that different bacterial phyla and species cause different inflammatory profiles in COPD patients. Methods Sputum was analysed by quantitative polymerase chain reaction (qPCR) to quantify bacterial load and 16S rRNA gene sequencing to identify taxonomic composition. Sputum differential cell counts (DCC) and blood DCC were obtained at baseline and 6 months. Patients were categorised into five groups based on bacterial load defined by genome copies/ml of ≥ 1 × 104, no colonisation and colonisation by Haemophilus influenzae (H. influenzae), Moraxella catarrhalis (M. catarrhalis), Streptococcus pneumoniae (S. pneumoniae), or > 1 potentially pathogenic microorganism (PPM). Results We observed an increase in sputum neutrophil (%), blood neutrophil (%) and neutrophil–lymphocyte ratio (NLR) in patients colonised with H. influenzae (82.6, 67.1, and 3.29 respectively) compared to those without PPM colonisation at baseline (69.5, 63.51 and 2.56 respectively) (p < 0.05 for all analyses), with similar findings at 6 months. The bacterial load of H. influenzae and Haemophilus determined by qPCR and 16s rRNA gene sequencing respectively, and sputum neutrophil % were positively correlated between baseline and 6 months visits (p < 0.0001, 0.0150 and 0.0002 with r = 0.53, 0.33 and 0.44 respectively). Conclusions These results demonstrate a subgroup of COPD patients with persistent H. influenzae colonisation that is associated with increased airway and systemic neutrophilic airway inflammation, and less eosinophilic airway inflammation.
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Affiliation(s)
- Augusta S Beech
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK. .,Medicines Evaluation Unit, University of Manchester, Manchester University NHS Foundation Trust, Southmoor Road, Manchester, M23 9QZ, UK.
| | - Simon Lea
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Umme Kolsum
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Zhang Wang
- Institute of Ecological Sciences, School of Life Sciences, South China Normal University, Guangzhou, China
| | - Bruce E Miller
- Medical Innovation, Value Evidence and Outcomes, GSK R&D, Collegeville, PA, USA
| | - Gavin C Donaldson
- National Heart and Lung Institute, Imperial College London, London, UK
| | | | | | - Dave Singh
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.,Medicines Evaluation Unit, University of Manchester, Manchester University NHS Foundation Trust, Southmoor Road, Manchester, M23 9QZ, UK
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38
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David B, Bafadhel M, Koenderman L, De Soyza A. Eosinophilic inflammation in COPD: from an inflammatory marker to a treatable trait. Thorax 2020; 76:188-195. [PMID: 33122447 PMCID: PMC7815887 DOI: 10.1136/thoraxjnl-2020-215167] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/28/2020] [Accepted: 10/01/2020] [Indexed: 12/20/2022]
Abstract
The heterogeneity of chronic obstructive pulmonary disease (COPD) creates many diagnostic, prognostic, treatment and management challenges, as the pathogenesis of COPD is highly complex and the underlying cellular and molecular mechanisms remain poorly understood. A reliable, easy-to-measure, clinically relevant biomarker would be invaluable for improving outcomes for patients. International and national guidance for COPD suggests using blood eosinophil counts as a biomarker to help estimate likely responsiveness to inhaled corticosteroids (ICS) and, potentially, to aid effective management strategies. However, with the mechanism underlying the association between higher eosinophil levels and ICS effect unknown, use of the blood eosinophil count in COPD continues to be widely debated by the respiratory community. Two international meetings involving respiratory medicine specialists, immunologists and primary and secondary care clinicians were held in November 2018 and March 2019, facilitated and funded by GlaxoSmithKline plc. The aims of these meetings were to explore the role of eosinophils in the disease processes of COPD and as prognostic and diagnostic markers, and to identify areas of deficient knowledge that warrant further research. The consensus views of the attendees on key topics, contextualised with current literature, are summarised in this review article, with the aim of aiding ongoing research into the disease processes of COPD and the development of biomarkers to aid clinical management. Under certain conditions, eosinophils can be recruited to the lung, and increasing evidence supports a role for eosinophilic inflammation in some patients with COPD. Infiltration of eosinophils across the bronchial vascular epithelium into the airways is promoted by the actions of immunoregulatory cells, cytokines and chemokines, where eosinophil-mediated inflammation is driven by the release of proinflammatory mediators. Multiple studies and two meta-analyses suggest peripheral blood eosinophils may correlate positively with an increased likelihood of exacerbation reduction benefits of ICS in COPD. The studies, however, vary in design and duration and by which eosinophil levels are viewed as predictive of an ICS response. Generally, the response was seen when eosinophil levels were 100–300 cells/µL (or higher), levels which are traditionally viewed within the normal range. Some success with interleukin-5-targeted therapy suggests that the eosinophilic phenotype may be a treatable trait. The use of biomarkers could help to stratify treatment for COPD—the goal of which is to improve patient outcomes. Some evidence supports eosinophils as a potential biomarker of a treatable trait in COPD, though it is still lacking and research is ongoing. A unified consensus and a practical, accessible and affordable method of utilising any biomarker for COPD was thought to be of most importance. Challenges around its utilisation may include presenting a clear and pragmatic rationale for biomarker-driven therapy, guidance on ICS withdrawal between primary and secondary care and a lack of financial incentives supporting broad application in clinical practice. Future treatments should, perhaps, be more targeted rather than assuming the primary disease label (COPD or asthma) will define treatment response.
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Affiliation(s)
- Benjamin David
- Research & Development, GlaxoSmithKline plc, Middlesex, UK
| | - Mona Bafadhel
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Leo Koenderman
- Department of Respiratory Medicine and Center for Translational Immunology (CTI), University Medical Center Utrecht, Utrecht, The Netherlands
| | - Antony De Soyza
- Institute of Cellular Medicine, NIHR Biomedical Research Centre for Aging and Department of Respiratory Medicine, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
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39
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Frøssing L, Silberbrandt A, Von Bülow A, Backer V, Porsbjerg C. The Prevalence of Subtypes of Type 2 Inflammation in an Unselected Population of Patients with Severe Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 9:1267-1275. [PMID: 33039645 DOI: 10.1016/j.jaip.2020.09.051] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 09/07/2020] [Accepted: 09/29/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND With the introduction of different targeted therapies for type 2 (T2)-high asthma, there is an urgent need for markers to guide the choice of treatment. T2-high asthma includes different clinical phenotypes of asthma, but the prevalence and impact of activation of different T2 inflammatory pathways is unknown. OBJECTIVE To describe the level of coexpression of clinically available T2 inflammatory markers in patients with severe asthma, and the relationship with clinical characteristics and comorbidities. METHODS Patients with severe asthma according to European Respiratory Society/American Thoracic Society guidelines were examined prospectively including sputum induction and grouped according to T2 biomarkers: blood eosinophilia (≥0.3 × 109/L), total IgE (≥150 U/mL), and fractional exhaled nitric oxide (≥25 parts per billion). RESULTS We found 116 (70%) of the 166 patients to have at least 1 T2 biomarker elevated: 39% had 2 or more elevated biomarkers, whereas 31% had only 1 biomarker elevated. Concomitant airway and systemic eosinophilia was present in 28% of all patients, corresponding to half (53%) of the patients with either. Expression patterns of the T2 biomarkers were associated with differences in allergic sensitization and the coexistence of nasal polyposis. CONCLUSIONS Most patients with severe asthma showed at least 1 T2 inflammatory trait. Coexpression of T2 biomarkers was highly heterogeneous, and different expression patterns were associated with distinct clinical characteristics.
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Affiliation(s)
- Laurits Frøssing
- Respiratory Research Unit, Department of Respiratory Medicine L, Copenhagen University Hospital, Bispbjerg and Frederiksberg, Denmark.
| | - Alexander Silberbrandt
- Respiratory Research Unit, Department of Respiratory Medicine L, Copenhagen University Hospital, Bispbjerg and Frederiksberg, Denmark
| | - Anna Von Bülow
- Respiratory Research Unit, Department of Respiratory Medicine L, Copenhagen University Hospital, Bispbjerg and Frederiksberg, Denmark
| | - Vibeke Backer
- Center for Physical Activity Research, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Celeste Porsbjerg
- Respiratory Research Unit, Department of Respiratory Medicine L, Copenhagen University Hospital, Bispbjerg and Frederiksberg, Denmark
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40
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Liang Z, Long F, Deng K, Wang F, Xiao J, Yang Y, Zhang D, Gu W, Xu J, Jian W, Shi W, Zheng J, Chen X, Gao Y, Luo Q, Stampfli MR, Peng T, Chen R. Dissociation between airway and systemic autoantibody responses in chronic obstructive pulmonary disease. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:918. [PMID: 32953718 PMCID: PMC7475442 DOI: 10.21037/atm-20-944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background Autoimmune processes have been implicated in the pathogenesis of chronic obstructive pulmonary disease (COPD). However, the relationship between airway and systemic autoantibody responses remains unclear. The aim of this study was to elucidate this relationship in patients with stable COPD by investigating the correlation patterns between sputum and serum autoantibodies. Methods In this cross-sectional study, sputum supernatant and serum obtained from 47 patients with stable COPD were assayed for the presence of IgG antibodies against ten autoantigens: Smith antigen (Sm), ribosomal phosphoprotein P0 (P0), Ro/Sjögren syndrome type A antigen (Ro/SSA), La/Sjögren syndrome type B antigen (La/SSB), DNA topoisomerase I (Scl-70), histidyl-tRNA synthetase (Jo-1), U1 small nuclear ribonucleoprotein (U1-SnRNP), thyroid peroxidase (TPO), proteinase-3 (PR3), and myeloperoxidase (MPO). A second cohort of 55 stable COPD patients was recruited for validation, and a group of 59 non-COPD controls and a group of 20 connective-tissue disease-associated interstitial lung disease (CTD-ILD) patients were also recruited for comparison. Hierarchical clustering and network analysis were used to evaluate the correlation patterns between sputum and serum autoantibody profiles. Results Both hierarchical clustering and network analysis showed that sputum and serum autoantibody profiles were distinct in either analytic COPD cohort or validation cohort. In contrast, the autoantibodies of the two compartments in non-COPD controls and CTD-ILD patients were inadequately distinguished using either hierarchical clustering or network analysis. Many autoantibodies in the sputum were found to have significant correlations with lung function, symptom score and frequency of prior exacerbations in COPD patients, but the antibodies in the serum were not. Conclusions We observed a dissociation between sputum autoantibodies and serum autoantibodies in patients with stable COPD, suggesting that airway and systemic immune status may play very different roles in the disease. Sputum autoantibodies are more clinically relevant than serum autoantibodies. Focusing on airway autoimmunity may help improve understanding of the immunopathological mechanism of COPD.
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Affiliation(s)
- Zhenyu Liang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Fei Long
- State Key Laboratory of Respiratory Disease, Sino-French Hoffmann Institute, School of Basic Medical Science, Guangzhou Medical University, Guangzhou, China
| | - Kuimiao Deng
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Fengyan Wang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jing Xiao
- State Key Laboratory of Respiratory Disease, Sino-French Hoffmann Institute, School of Basic Medical Science, Guangzhou Medical University, Guangzhou, China
| | - Yuqiong Yang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Dongying Zhang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Weili Gu
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jiaxuan Xu
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wenhua Jian
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Weijuan Shi
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jinping Zheng
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xin Chen
- Department of Respiratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Yang Gao
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Qun Luo
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Martin R Stampfli
- Department of Medicine, Firestone Institute of Respiratory Health at St. Joseph's Healthcare, McMaster University, Hamilton, ON, Canada
| | - Tao Peng
- State Key Laboratory of Respiratory Disease, Sino-French Hoffmann Institute, School of Basic Medical Science, Guangzhou Medical University, Guangzhou, China
| | - Rongchang Chen
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Pulmonary and Critical Care Department, Shenzhen Institute of Respiratory Disease, Shenzhen People's Hospital, Shenzhen, China
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41
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Wang Z, Liu H, Wang F, Yang Y, Wang X, Chen B, Stampfli MR, Zhou H, Shu W, Brightling CE, Liang Z, Chen R. A Refined View of Airway Microbiome in Chronic Obstructive Pulmonary Disease at Species and Strain-Levels. Front Microbiol 2020; 11:1758. [PMID: 32849386 PMCID: PMC7406711 DOI: 10.3389/fmicb.2020.01758] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 07/06/2020] [Indexed: 12/12/2022] Open
Abstract
Little is known about the underlying airway microbiome diversity in chronic obstructive pulmonary disease (COPD) at in-depth taxonomic levels. Here we present the first insights on the COPD airway microbiome at species and strain-levels. The full-length 16S rRNA gene was characterized from sputum in 98 COPD patients and 27 age-matched healthy controls, using the Pacific Biosciences sequencing platform. Individual species within the same genus exhibited reciprocal relationships with COPD and disease severity. Species dominant in health can be taken over by another species within the same genus but with potentially increasing pathogenicity in severe COPD patients. Ralstonia mannitolilytica, an opportunistic pathogen, was significantly increased in frequent exacerbators (fold-change = 4.94, FDR P = 0.005). There were distinct patterns of interaction between bacterial species and host inflammatory mediators according to neutrophilic or eosinophilic inflammations, two major airway inflammatory phenotypes in COPD. Haemophilus influenzae, Moraxella catarrhalis, Pseudomonas aeruginosa, and Neisseria meningitidis were associated with enhanced Th1, Th17 and pro-inflammatory mediators, while a group of seven species including Tropheryma whipplei were specifically associated with Th2 mediators related to eosinophilia. We developed an automated pipeline to assign strain-level taxonomy leveraging bacterial intra-genomic 16S allele frequency. Using this pipeline we further resolved three non-typeable H. influenzae strains PittEE, PittGG and 86-028NP with reasonable precision and uncovered strain-level variation related to airway inflammation. In particular, 86-028NP and PittGG strains exhibited inverse associations with Th2 chemokines CCL17 and CCL13, suggesting their abundances may inversely predict eosinophilic inflammation. A systematic comparison of 16S hypervariable regions indicated V1V3 instead of the commonly used V4 region was the best surrogate for airway microbiome. The full-length 16S data augmented the power of functional inference, which slightly better recapitulated the actual metagenomes. This led to the unique identification of butyrate-producing and nitrate reduction pathways as depleted in COPD. Our analysis uncovered finer-scale airway microbial diversity that was previously underappreciated, thus enabled a refined view of the airway microbiome in COPD.
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Affiliation(s)
- Zhang Wang
- Institute of Ecological Science, School of Life Sciences, South China Normal University, Guangzhou, China
| | - Haiyue Liu
- State Key Laboratory of Organ Failure Research, Microbiome Medicine Center, Division of Laboratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Fengyan Wang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yuqiong Yang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiaojuan Wang
- Institute of Ecological Science, School of Life Sciences, South China Normal University, Guangzhou, China
| | - Boxuan Chen
- Institute of Ecological Science, School of Life Sciences, South China Normal University, Guangzhou, China
| | - Martin R. Stampfli
- Department of Medicine, Firestone Institute for Respiratory Health at St. Joseph’s Healthcare, McMaster University, Hamilton, ON, Canada
| | - Hongwei Zhou
- State Key Laboratory of Organ Failure Research, Microbiome Medicine Center, Division of Laboratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Wensheng Shu
- Institute of Ecological Science, School of Life Sciences, South China Normal University, Guangzhou, China
| | - Christopher E. Brightling
- Institute for Lung Health, NIHR Leicester Biomedical Research Centre, Department of Respiratory Sciences, University of Leicester, Leicester, United Kingdom
| | - Zhenyu Liang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Rongchang Chen
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Pulmonary and Critical Care Department, Shenzhen Institute of Respiratory Diseases, Shenzhen People’s Hospital, Shenzhen, China
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42
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Association of sputum microbiome with clinical outcome of initial antibiotic treatment in hospitalized patients with acute exacerbations of COPD. Pharmacol Res 2020; 160:105095. [PMID: 32730904 DOI: 10.1016/j.phrs.2020.105095] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/17/2020] [Accepted: 07/19/2020] [Indexed: 12/14/2022]
Abstract
Identification of risk factors for antibiotic treatment failure is urgently needed in acute exacerbations of chronic obstructive pulmonary disease (AECOPD). Here we investigated the relationship between sputum microbiome and clinical outcome of choice of initial antibiotics during hospitalization of AECOPD patients. Sputum samples of 41 AECOPD patients and 26 healthy controls were collected from Guangzhou Medical University, China. Samples were processed for 16S rRNA gene-based microbiome profiling. Thirty patients recovered with initial antibiotic treatment (antibiotic success or AS), while 11 patients showed poor outcome (antibiotic failure or AF). Substantial differences in microbiome were observed in AF versus AS patients and healthy controls. There was significantly decreased alpha diversity and increased relative abundances of Pseudomonas, Achromobacter, Stenotrophomonas and Ralstonia in AF patients. Conversely, Prevotella, Peptostreptococcus, Leptotrichia and Selenomonas were depleted. The prevalence of Selenomonas was markedly reduced in AF versus AS patients (9.1 % versus 60.0 %, P = 0.004). The AF patients with similar microbiome profiles in general responded well to the same new antibiotics in the adjusted therapy, indicating sputum microbiome may help guide the adjustment of antibiotics. Random forest analysis identified five microbiome operational taxonomic units together with C-reactive protein, procalcitonin and blood neutrophil count showing best predictability for antibiotic treatment outcome (area under curve 0.885). Functional inference revealed an enrichment of microbial genes in xenobiotic metabolism and antimicrobial resistance in AF patients, whereas genes in DNA repair and amino acid metabolism were depleted. Sputum microbiome may determine the clinical outcome of initial antibiotic treatment and be considered in the risk management of antibiotics in AECOPD.
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43
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Liang Z, Wang F, Zhang D, Long F, Yang Y, Gu W, Deng K, Xu J, Jian W, Zhou L, Shi W, Zheng J, Chen X, Chen R. Sputum and serum autoantibody profiles and their clinical correlation patterns in COPD patients with and without eosinophilic airway inflammation. J Thorac Dis 2020; 12:3085-3100. [PMID: 32642231 PMCID: PMC7330801 DOI: 10.21037/jtd-20-545] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background Autoimmunity plays a role in the pathogenesis of chronic obstructive pulmonary disease (COPD). However, the autoantibody responses and their clinical correlation patterns in COPD patients with and without airway eosinophilic inflammation are unknown. The aim of this study was to compare the autoantibody profiles and their clinical associations in stable COPD patients, stratified by airway inflammatory phenotypes. Methods Matched sputum and serum, obtained from 62 stable COPD patients and 14 age-matched controls, were assayed for the presence of IgG and IgM antibodies against 13 autoantigens using protein array. A sputum eosinophil count ≥3% was used as cut-off value to stratify COPD patients into eosinophilic and non-eosinophilic groups. Correlation network analysis was used to evaluate the correlation patterns among autoantibody and clinical variables in each group. Results There were no significant differences of clinical parameters and autoantibody levels between the two COPD groups. In non-eosinophilic COPD, sputum anti-CytochromeC_IgG and anti-Aggrecan_IgM were significantly higher than those in healthy controls, and prior exacerbation was positively associated with lung function and sputum anti-Collagen-IV_IgG. While in eosinophilic COPD, sputum/serum anti-heat shock protein (HSP)47_IgG, serum anti-HSP70_IgG and serum anti-Amyloid-beta_IgG were significantly lower than those in healthy controls, and no significant correlation between prior exacerbations and lung function was found. Differences were also observed in network hubs, with the network for non-eosinophilic COPD possessing 9 hubs comprising two lung function parameters and seven autoantibodies, compared with eosinophilic COPD possessing 12 hubs all comprising autoantibodies. Conclusions Autoantibody responses were heterogeneous and differentially correlated with the exacerbation risk and other clinical parameters in COPD patients of different inflammatory phenotypes. These findings provide useful insight into the need for personalized management for preventing COPD exacerbations.
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Affiliation(s)
- Zhenyu Liang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Fengyan Wang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Dongying Zhang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Fei Long
- State Key Laboratory of Respiratory Disease, Sino-French Hoffmann Institute, School of Basic Medical Science, Guangzhou Medical University, Guangzhou, China
| | - Yuqiong Yang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Weili Gu
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Kuimiao Deng
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jiaxuan Xu
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wenhua Jian
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Luqian Zhou
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Weijuan Shi
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jinping Zheng
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xin Chen
- Department of Respiratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Rongchang Chen
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Pulmonary and Critical Care Department, Shenzhen Institute of Respiratory Disease, Shenzhen People's Hospital, Shenzhen, China
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Diver S, Richardson M, Haldar K, Ghebre MA, Ramsheh MY, Bafadhel M, Desai D, Cohen ES, Newbold P, Rapley L, Rugman P, Pavord ID, May RD, Barer M, Brightling C. Sputum microbiomic clustering in asthma and chronic obstructive pulmonary disease reveals a Haemophilus-predominant subgroup. Allergy 2020; 75:808-817. [PMID: 31556120 PMCID: PMC7217013 DOI: 10.1111/all.14058] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 08/13/2019] [Accepted: 08/27/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Airway ecology is altered in asthma and chronic obstructive pulmonary disease (COPD). Anti-microbial interventions might have benefit in subgroups of airway disease. Differences in sputum microbial profiles at acute exacerbation of airways disease are reflected by the γProteobacteria:Firmicutes (γP:F) ratio. We hypothesized that sputum microbiomic clusters exist in stable airways disease, which can be differentiated by the sputum γP:F ratio. METHODS Sputum samples were collected from 63 subjects with severe asthma and 78 subjects with moderate-to-severe COPD in a prospective single centre trial. Microbial profiles were obtained through 16S rRNA gene sequencing. Topological data analysis was used to visualize the data set and cluster analysis performed at genus level. Clinical characteristics and sputum inflammatory mediators were compared across the clusters. RESULTS Two ecological clusters were identified across the combined airways disease population. The smaller cluster was predominantly COPD and was characterized by dominance of Haemophilus at genus level (n = 20), high γP:F ratio, increased H influenzae, low diversity measures and increased pro-inflammatory mediators when compared to the larger Haemophilus-low cluster (n = 121), in which Streptococcus demonstrated the highest relative abundance at the genus level. Similar clusters were identified within disease groups individually and the γP:F ratio consistently differentiated between clusters. CONCLUSION Cluster analysis by airway ecology of asthma and COPD in stable state identified two subgroups differentiated according to dominance of Haemophilus. The γP:F ratio was able to distinguish the Haemophilus-high versus Haemophilus-low subgroups, whether the Haemophilus-high group might benefit from treatment strategies to modulate the airway ecology warrants further investigation.
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Affiliation(s)
- Sarah Diver
- Institute for Lung HealthNIHR Leicester Biomedical Research CentreDepartment of Respiratory SciencesCollege of Life SciencesUniversity of Leicester and University Hospitals of Leicester NHS TrustLeicesterUK
| | - Matt Richardson
- Institute for Lung HealthNIHR Leicester Biomedical Research CentreDepartment of Respiratory SciencesCollege of Life SciencesUniversity of Leicester and University Hospitals of Leicester NHS TrustLeicesterUK
| | - Koirobi Haldar
- Institute for Lung HealthNIHR Leicester Biomedical Research CentreDepartment of Respiratory SciencesCollege of Life SciencesUniversity of Leicester and University Hospitals of Leicester NHS TrustLeicesterUK
| | | | - Mohammadali Y. Ramsheh
- Institute for Lung HealthNIHR Leicester Biomedical Research CentreDepartment of Respiratory SciencesCollege of Life SciencesUniversity of Leicester and University Hospitals of Leicester NHS TrustLeicesterUK
| | - Mona Bafadhel
- Respiratory Medicine UnitNuffield Department of MedicineUniversity of OxfordOxfordUK
| | - Dhananjay Desai
- Institute for Lung HealthNIHR Leicester Biomedical Research CentreDepartment of Respiratory SciencesCollege of Life SciencesUniversity of Leicester and University Hospitals of Leicester NHS TrustLeicesterUK
| | | | | | | | | | - Ian D. Pavord
- Respiratory Medicine UnitNuffield Department of MedicineUniversity of OxfordOxfordUK
| | | | - Michael Barer
- Institute for Lung HealthNIHR Leicester Biomedical Research CentreDepartment of Respiratory SciencesCollege of Life SciencesUniversity of Leicester and University Hospitals of Leicester NHS TrustLeicesterUK
| | - Christopher.E. Brightling
- Institute for Lung HealthNIHR Leicester Biomedical Research CentreDepartment of Respiratory SciencesCollege of Life SciencesUniversity of Leicester and University Hospitals of Leicester NHS TrustLeicesterUK
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45
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Backer V, Klein DK, Bodtger U, Romberg K, Porsbjerg C, Erjefält JS, Kristiansen K, Xu R, Silberbrandt A, Frøssing L, Hvidtfeldt M, Obling N, Jarenbäck L, Nasr A, Tufvesson E, Mori M, Winther-Jensen M, Karlsson L, Nihlén U, Veje Flintegaard T, Bjermer L. Clinical characteristics of the BREATHE cohort - a real-life study on patients with asthma and COPD. Eur Clin Respir J 2020; 7:1736934. [PMID: 32284828 PMCID: PMC7144315 DOI: 10.1080/20018525.2020.1736934] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 02/24/2020] [Indexed: 01/06/2023] Open
Abstract
Background: The BREATHE study is a cross-sectional study of real-life patients with asthma and/or COPD in Denmark and Sweden aiming to increase the knowledge across severities and combinations of obstructive airway disease. Design: Patients with suspicion of asthma and/or COPD and healthy controls were invited to participate in the study and had a standard evaluation performed consisting of questionnaires, physical examination, FeNO and lung function, mannitol provocation test, allergy test, and collection of sputum and blood samples. A subgroup of patients and healthy controls had a bronchoscopy performed with a collection of airway samples. Results: The study population consisted of 1403 patients with obstructive airway disease (859 with asthma, 271 with COPD, 126 with concurrent asthma and COPD, 147 with other), and 89 healthy controls (smokers and non-smokers). Of patients with asthma, 54% had moderate-to-severe disease and 46% had mild disease. In patients with COPD, 82% had groups A and B, whereas 18% had groups C and D classified disease. Patients with asthma more frequently had childhood asthma, atopic dermatitis, and allergic rhinitis, compared to patients with COPD, asthma + COPD and Other, whereas FeNO levels were higher in patients with asthma and asthma + COPD compared to COPD and Other (18 ppb and 16 ppb vs 12.5 ppb and 14 ppb, p < 0.001). Patients with asthma, asthma + COPD and Other had higher sputum eosinophilia (1.5%, 1.5%, 1.2% vs 0.75%, respectively, p < 0.001) but lower sputum neutrophilia (39.3, 43.5%, 40.8% vs 66.8%, p < 0.001) compared to patients with COPD. Conclusions: The BREATHE study provides a unique database and biobank with clinical information and samples from 1403 real-life patients with asthma, COPD, and overlap representing different severities of the diseases. This research platform is highly relevant for disease phenotype- and biomarker studies aiming to describe a broad spectrum of obstructive airway diseases.
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Affiliation(s)
- Vibeke Backer
- Centre for Physical Activity Research, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
| | - Ditte K Klein
- Respiratory Research Unit, Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Uffe Bodtger
- Department of Respiratory and Internal Medicine, Naestved Hospital, Naestved, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Kerstin Romberg
- Health Care Centre, Näsets Läkargrupp, Höllviken, Sweden.,Respiratory Medicine and Allergology, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Celeste Porsbjerg
- Respiratory Research Unit, Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen, Denmark
| | | | - Karsten Kristiansen
- Laboratory of Genomics and Molecular Biomedicine, Department of Biology, University of Copenhagen, Copenhagen, Denmark
| | - Ruiqi Xu
- North Europe Regional Department, BGI-Europe, Copenhagen, Denmark
| | - Alexander Silberbrandt
- Respiratory Research Unit, Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Laurits Frøssing
- Respiratory Research Unit, Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Morten Hvidtfeldt
- Respiratory Research Unit, Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Nicolai Obling
- Department of Respiratory and Internal Medicine, Naestved Hospital, Naestved, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Linnea Jarenbäck
- Respiratory Medicine and Allergology, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Abir Nasr
- Respiratory Medicine and Allergology, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Ellen Tufvesson
- Respiratory Medicine and Allergology, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Michiko Mori
- Unit of Airway Inflammation, Lund University, Lund, Sweden
| | - Matilde Winther-Jensen
- Centre for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Lisa Karlsson
- Unit of Airway Inflammation, Lund University, Lund, Sweden
| | - Ulf Nihlén
- Respiratory Medicine and Allergology, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Thomas Veje Flintegaard
- Respiratory Research Unit, Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Leif Bjermer
- Respiratory Medicine and Allergology, Clinical Sciences Lund, Lund University, Lund, Sweden
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46
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Sedeh FB, Von Bülow A, Backer V, Bodtger U, Petersen US, Vest S, Hull JH, Porsbjerg C. The impact of dysfunctional breathing on the level of asthma control in difficult asthma. Respir Med 2020; 163:105894. [PMID: 32056838 DOI: 10.1016/j.rmed.2020.105894] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 02/04/2020] [Accepted: 02/05/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Difficult asthma is defined as asthma requiring high dose treatment. However, systematic assessment is required to differentiate severe asthma from difficult-to-treat asthma. Dysfunctional breathing (DB) is a common comorbidity in difficult asthma, which may contribute to symptoms, but how it affects commonly used measures of symptom control is unclear. METHODS All adult asthma patients seen in four respiratory clinics over one year were screened prospectively, and patients with possible severe asthma according to ERS/ATS criteria ('Difficult asthma': high-dose inhaled corticosteroids/oral corticosteroids), underwent systematic assessment. Symptoms of DB were assessed utilizing a symptom based subjective tool, Nijmegen questionnaire (NQ), and objective signs of DB with the Breathing Pattern Assessment Tool (BPAT). Asthma control and quality of life were evaluated with the Asthma Control Questionnaire (ACQ) and the mini Asthma Quality of Life Questionnaire (AQLQ). RESULTS A total of 117 patients were included. Among these, 29.9% (35/117) had DB according to the NQ. Patients with DB had a poorer asthma control (ACQ: Mean (SD) 2.86 ± 1.05 vs. 1.46 ± 0.93) and lower quality of life (AQLQ score: Mean (SD) 4.2 ± 1.04 vs. 5.49 ± 0.85) compared to patients without DB. Similarly, patients with objective signs of DB according to the BPAT score had worse asthma control: BPAT >4 vs < 4: (ACQ: Mean (SD) 3.15 ± 0.93 vs 2.03 ± 1.15). CONCLUSION DB is common among patients with difficult asthma, and is associated with significantly poorer asthma control and lower quality of life. Assessment and treatment of DB is an important part of the management of difficult asthma.
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Affiliation(s)
- Farnam Barati Sedeh
- Respiratory Research Unit, Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen, Denmark.
| | - Anna Von Bülow
- Respiratory Research Unit, Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Vibeke Backer
- Respiratory Research Unit, Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Uffe Bodtger
- Department of Respiratory and Internal Medicine, Naestved Hospital, Institute for Regional Health Research, University of Southern, Denmark; Institute for Regional Health Research, University of Southern, Denmark; Department of Respiratory of and Internal Medicine, Roskilde Hospital, Denmark
| | - Ulrik Søes Petersen
- Department of Respiratory of and Internal Medicine, Roskilde Hospital, Denmark
| | - Susanne Vest
- Department of Respiratory and Infection Medicine, Hilleroed Hospital, Denmark
| | - James H Hull
- Department of Respiratory Medicine, Royal Brompton Hospital, London, UK
| | - Celeste Porsbjerg
- Respiratory Research Unit, Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen, Denmark
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Frøssing L, Kjærsgaard Klein D, Backer V, Baines KJ, Porsbjerg C. The six-gene expression signature in whole sampled sputum provides clinically feasible inflammatory phenotyping of asthma. ERJ Open Res 2020; 6:00280-2019. [PMID: 32166086 PMCID: PMC7061201 DOI: 10.1183/23120541.00280-2019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 12/17/2019] [Indexed: 11/05/2022] Open
Abstract
Processing of induced sputum is time consuming and requires trained personnel, and consequently the use of induced sputum is limited to few sites globally. The six-gene signature (6GS) is an mRNA-based gene signature that was developed to provide a clinically feasible method for inflammatory phenotyping. In this study, we assessed whether the 6GS would perform similarly in induced sputum sampled using a simplified method, by which induced sputum can be sampled and stored directly for later qPCR analyses, to the conventional method of manual plug selection. Two separate sputum samples were collected from 27 patients with asthma; one processed as a whole sample in an Oragene-RNA RE 100 vial and one processed using manual plug selection. Expression of 6GS was measured in both samples, of which 20 pairs (74%) had enough samples and results of sufficient quality of gene expression for further analyses. We found a significantly higher median RNA concentration in whole sampled sputum and consistently stronger gene expression compared to the plug method. Further, we found the two methods to agree, as 97% of observations were within the limits of agreement, as well as having a good-to-excellent reliability using intraclass correlation. Finally, we found 6GS in the whole sampled sputum to perform equal to or better than the manually selected plugs for discriminating inflammatory phenotypes defined by sputum differential count. In conclusion, whole sampling of induced sputum provides a clinically feasible method for inflammatory phenotyping.
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Affiliation(s)
- Laurits Frøssing
- Respiratory Research Unit, Bispebjerg University Hospital, Copenhagen, Denmark
- Copenhagen Center for Translational Research, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Ditte Kjærsgaard Klein
- Respiratory Research Unit, Bispebjerg University Hospital, Copenhagen, Denmark
- Copenhagen Center for Translational Research, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Vibeke Backer
- Center for Physical Activity Research, Rigshospitalet, Copenhagen, Denmark
| | | | - Celeste Porsbjerg
- Respiratory Research Unit, Bispebjerg University Hospital, Copenhagen, Denmark
- Copenhagen Center for Translational Research, Bispebjerg University Hospital, Copenhagen, Denmark
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48
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Fernandes L, Rane S, Mandrekar S, Mesquita AM. Eosinophilic Airway Inflammation in Patients with Stable Biomass Smoke- versus Tobacco Smoke-Associated Chronic Obstructive Pulmonary Disease. J Health Pollut 2019; 9:191209. [PMID: 31893170 PMCID: PMC6905135 DOI: 10.5696/2156-9614-9.24.191209] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 09/30/2019] [Indexed: 05/11/2023]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is an inflammatory disease with predominant involvement of neutrophils, macrophages and CD8+ lymphocytes. Eosinophilic airway inflammations are reported in stable state and during acute exacerbations of tobacco smoke-associated COPD (TS-COPD). Women exposed to biomass fuel smoke are known to have eosinophils in sputum. However, little is known about the sputum cellular inflammatory profile in biomass fuel smoke-associated COPD (BMS-COPD). We therefore aimed to compare the sputum cellular inflammatory profile in tobacco smoke- and biomass smoke-associated COPD. METHODS The study was conducted in a tertiary care hospital in Goa, India. A total of 113 patients with stable COPD reporting to the outpatient pulmonary clinic were recruited. All participants were ≥ 40 years of age. Sputum induction studies were performed by the method of Pizzichini et al. after baseline subject characterization. Significant eosinophilia was defined as induced sputum eosinophils ≥ 3%. RESULTS There were 85 TS-COPD and 28 BMS-COPD patients. The mean age [standard deviation (SD)] was 64.7 (7.8) and 63.0 years (8.3), p = 0.32 in TS and BMS-COPD, respectively. Eighteen subjects (21.1%) were female smokers. The smoking pack-year median [interquartile range (IQR)] was 36 (20, 58) and hour-years of biomass smoke exposure mean (SD) was 192.4 (61). The TS-COPD and BMS-COPD cases showed a post-bronchodilator forced expiratory volume in one second (FEV1%) mean (SD) of 57.9 (17.1), and 62.6 (19.4), p= 0.22, respectively. Both groups had similar symptoms and severity of disease. Induced sputum total cell count per gram of sputum × 106 mean (SD) was 3.05 (1.53) for TS-COPD, and 2.55(1.37) for BMS-COPD p=0.12. The neutrophils % mean (SD) was 86.4 (16.5) and 87.9 (10.2), p = 0.64; eosinophils % median (IQR) was 2.5 (1, 10) and 8 (2, 12.8), p = 0.07; lymphocytes % median (IQR) was 0 (0, 0.75) and 0 (0, 1) p = 0.13; macrophages % median (IQR) was 2.5 (0.75, 5.7) and 1 (0, 4.7) p = 0.13; and significant eosinophilia (eosinophils ≥3%) was 42 (49.4%) and 20 (71%), p=0.04, for TS-COPD and BMS-COPD, respectively. CONCLUSIONS For similar severity of disease and clinical symptoms, significant eosinophilic inflammation was observed in stable BMS-COPD, while both groups had similar neutrophilic inflammation. PARTICIPANT CONSENT Obtained. ETHICS APPROVAL The study was approved by the Institutional Ethics Committee of the Goa Medical College, Goa, India. COMPETING INTERESTS The authors declare no competing financial interests.
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Affiliation(s)
- Lalita Fernandes
- Department of Pulmonary Medicine, Goa Medical College, Goa, India
| | - Shraddha Rane
- Department of Pulmonary Medicine, Goa Medical College, Goa, India
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Wang W, Zha G, Zou JJ, Wang X, Li CN, Wu XJ. Berberine Attenuates Cigarette Smoke Extract-induced Airway Inflammation in Mice: Involvement of TGF-β1/Smads Signaling Pathway. Curr Med Sci 2019; 39:748-753. [PMID: 31612392 DOI: 10.1007/s11596-019-2101-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 09/02/2019] [Indexed: 02/06/2023]
Abstract
Although several studies confirmed that berberine may attenuate airway inflammation in mice with chronic obstructive pulmonary disease (COPD), its underlying mechanisms were not clear until now. We aimed to establish an experiment mouse model for COPD and to investigate the effects of berberine on airway inflammation and its possible mechanism in COPD model mice induced by cigarette smoke extract (CSE). Twenty SPF C57BL/6 mice were randomly divided into PBS control group, COPD model group, low-dose berberine group and high-dose berberine group, 5 mice in each group. The neutrophils and macrophages were examined by Wright's staining. The levels of inflammatory cytokines TNF-α and IL-6 in bronchoalveolar lavage fluid (BALF) were determined by enzyme-linked immunosorbent assay. The expression levels of TGF-β1, Smad2 and Smad3 mRNA and proteins in lung tissues were respectively detected by quantitative real-time polymerase chain reaction and Western blotting. It was found that CSE increased the number of inflammation cells in BALF, elevated lung inflammation scores, and enhanced the TGF-β1/Smads signaling activity in mice. High-dose berberine restrained the alterations in the COPD mice induced by CSE. It was concluded that high-dose berberine ameliorated CSE-induced airway inflammation in COPD mice. TGF-β1/Smads signaling pathway might be involved in the mechanism. These findings suggested a therapeutic potential of high-dose berberine on the CSE-induced airway inflammation.
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Affiliation(s)
- Wen Wang
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Gan Zha
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Jin-Jing Zou
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Xun Wang
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Chun-Nian Li
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Xiao-Jun Wu
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, 430060, China.
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50
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López-Campos JL, Rodríguez DA, Quintana-Gallego E, Martínez-Llorens J, Carrasco Hernández L, Barreiro E. Ten Research Questions for Improving COPD Care in the Next Decade. COPD 2019; 16:311-320. [PMID: 31576763 DOI: 10.1080/15412555.2019.1668919] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
With the 60th anniversary of the CIBA symposium, it is worth evaluating research questions that should be prioritized in the future. Coming research initiatives can be summarized in 10 main areas. (1) From epidemiology the impact of new forms of electronic cigarettes on prevalence and mortality of COPD will be sought. (2) The study of the disease endotypes and its relationship phenotypes will have to be unraveled in the next decade. (3) Diagnosis of COPD faces several challenges opening the possibility of a change in the definition of the disease itself. (4) Patients' classification and risk stratification will need to be clarified and reassessed. (5) The asthma-COPD overlap dilemma will have to be clarified and define whether both conditions represent one only chronic airway disease again. (6) Integrating comorbidities in COPD care will be key in a progressively ageing population to improve clinical care in a chronic care model. (7) Nonpharmacological management have areas for research including pulmonary rehabilitation and vaccines. (8) Improving physical activity should focus research because of the clear prognostic impact. (9). Pharmacological therapies present several challenges including efficacy and safety issues with current medications and the development of biological therapy. (10) The definition, identification, categorization and specific therapy of exacerbations will also be an area of research development. During the next decade, we have a window of opportunity to address these research questions that will put us on the path for precision medicine.
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Affiliation(s)
- José Luis López-Campos
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias. Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen Del Rocío/Universidad de Sevilla, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES). Instituto de Salud Carlos III, Madrid, Spain
| | - Diego A Rodríguez
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES). Instituto de Salud Carlos III, Madrid, Spain.,Pulmonology Department-Lung Cancer & Muscle Research Group, IMIM (Hospital Del Mar Medical Research Institute), Pompeu Fabra University, Barcelona, Spain
| | - Esther Quintana-Gallego
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias. Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen Del Rocío/Universidad de Sevilla, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES). Instituto de Salud Carlos III, Madrid, Spain
| | - Juana Martínez-Llorens
- Pulmonology Department-Lung Cancer & Muscle Research Group, IMIM (Hospital Del Mar Medical Research Institute), Pompeu Fabra University, Barcelona, Spain
| | - Laura Carrasco Hernández
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias. Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen Del Rocío/Universidad de Sevilla, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES). Instituto de Salud Carlos III, Madrid, Spain
| | - Esther Barreiro
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES). Instituto de Salud Carlos III, Madrid, Spain.,Pulmonology Department-Lung Cancer & Muscle Research Group, IMIM (Hospital Del Mar Medical Research Institute), Pompeu Fabra University, Barcelona, Spain
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