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Rosser F. Outdoor Air Pollution and Pediatric Respiratory Disease. Clin Chest Med 2024; 45:531-541. [PMID: 39069319 PMCID: PMC11286236 DOI: 10.1016/j.ccm.2024.02.025] [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] [Indexed: 07/30/2024]
Abstract
Outdoor air pollution is ubiquitous, and no safe level of exposure has been identified for the most common air pollutants such as ozone and particle pollution. Children are uniquely more susceptible to the harms of outdoor air pollution, which can cause and exacerbate respiratory disease. Although challenging to identify the effects of outdoor air pollution on individual patients, understanding the basics of outdoor air pollution is essential for pediatric respiratory health care providers. This review covers basic information regarding outdoor air pollution, unique considerations for children, mechanisms for increased susceptibility, and association with incident and exacerbation of respiratory disease in children.
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Affiliation(s)
- Franziska Rosser
- Division of Pulmonary Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, 4401 Penn Avenue, Pittsburgh, PA 15224, USA.
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2
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Everman JL, Sajuthi SP, Liegeois MA, Jackson ND, Collet EH, Peters MC, Chioccioli M, Moore CM, Patel BB, Dyjack N, Powell R, Rios C, Montgomery MT, Eng C, Elhawary JR, Mak ACY, Hu D, Huntsman S, Salazar S, Feriani L, Fairbanks-Mahnke A, Zinnen GL, Michel CR, Gomez J, Zhang X, Medina V, Chu HW, Cicuta P, Gordon ED, Zeitlin P, Ortega VE, Reisdorph N, Dunican EM, Tang M, Elicker BM, Henry TS, Bleecker ER, Castro M, Erzurum SC, Israel E, Levy BD, Mauger DT, Meyers DA, Sumino K, Gierada DS, Hastie AT, Moore WC, Denlinger LC, Jarjour NN, Schiebler ML, Wenzel SE, Woodruff PG, Rodriguez-Santana J, Pearson CG, Burchard EG, Fahy JV, Seibold MA. A common polymorphism in the Intelectin-1 gene influences mucus plugging in severe asthma. Nat Commun 2024; 15:3900. [PMID: 38724552 PMCID: PMC11082194 DOI: 10.1038/s41467-024-48034-5] [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: 08/04/2022] [Accepted: 04/16/2024] [Indexed: 05/12/2024] Open
Abstract
By incompletely understood mechanisms, type 2 (T2) inflammation present in the airways of severe asthmatics drives the formation of pathologic mucus which leads to airway mucus plugging. Here we investigate the molecular role and clinical significance of intelectin-1 (ITLN-1) in the development of pathologic airway mucus in asthma. Through analyses of human airway epithelial cells we find that ITLN1 gene expression is highly induced by interleukin-13 (IL-13) in a subset of metaplastic MUC5AC+ mucus secretory cells, and that ITLN-1 protein is a secreted component of IL-13-induced mucus. Additionally, we find ITLN-1 protein binds the C-terminus of the MUC5AC mucin and that its deletion in airway epithelial cells partially reverses IL-13-induced mucostasis. Through analysis of nasal airway epithelial brushings, we find that ITLN1 is highly expressed in T2-high asthmatics, when compared to T2-low children. Furthermore, we demonstrate that both ITLN-1 gene expression and protein levels are significantly reduced by a common genetic variant that is associated with protection from the formation of mucus plugs in T2-high asthma. This work identifies an important biomarker and targetable pathways for the treatment of mucus obstruction in asthma.
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Affiliation(s)
- Jamie L Everman
- Center for Genes, Environment, and Health, National Jewish Health, Denver, CO, USA
| | - Satria P Sajuthi
- Center for Genes, Environment, and Health, National Jewish Health, Denver, CO, USA
| | - Maude A Liegeois
- Department of Medicine, University of California-San Francisco, San Francisco, CA, USA
| | - Nathan D Jackson
- Center for Genes, Environment, and Health, National Jewish Health, Denver, CO, USA
| | - Erik H Collet
- Department of Cell and Developmental Biology, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
| | - Michael C Peters
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine, University of California-San Francisco, San Francisco, CA, USA
| | - Maurizio Chioccioli
- Department of Genetics and Comparative Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Camille M Moore
- Center for Genes, Environment, and Health, National Jewish Health, Denver, CO, USA
| | - Bhavika B Patel
- Center for Genes, Environment, and Health, National Jewish Health, Denver, CO, USA
| | - Nathan Dyjack
- Center for Genes, Environment, and Health, National Jewish Health, Denver, CO, USA
| | - Roger Powell
- Department of Pharmaceutical Sciences, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
| | - Cydney Rios
- Center for Genes, Environment, and Health, National Jewish Health, Denver, CO, USA
| | - Michael T Montgomery
- Center for Genes, Environment, and Health, National Jewish Health, Denver, CO, USA
| | - Celeste Eng
- Department of Medicine, University of California-San Francisco, San Francisco, CA, USA
| | - Jennifer R Elhawary
- Department of Medicine, University of California-San Francisco, San Francisco, CA, USA
| | - Angel C Y Mak
- Department of Medicine, University of California-San Francisco, San Francisco, CA, USA
| | - Donglei Hu
- Department of Medicine, University of California-San Francisco, San Francisco, CA, USA
| | - Scott Huntsman
- Department of Medicine, University of California-San Francisco, San Francisco, CA, USA
| | - Sandra Salazar
- Department of Medicine, University of California-San Francisco, San Francisco, CA, USA
| | - Luigi Feriani
- Biological and Soft Systems Sector, Cavendish Laboratory, University of Cambridge, Cambridge, UK
| | - Ana Fairbanks-Mahnke
- Center for Genes, Environment, and Health, National Jewish Health, Denver, CO, USA
| | - Gianna L Zinnen
- Center for Genes, Environment, and Health, National Jewish Health, Denver, CO, USA
| | - Cole R Michel
- Department of Pharmaceutical Sciences, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
| | - Joe Gomez
- Department of Pharmaceutical Sciences, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
| | - Xing Zhang
- Department of Pharmaceutical Sciences, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
| | | | - Hong Wei Chu
- Department of Medicine, National Jewish Health, Denver, CO, USA
| | - Pietro Cicuta
- Biological and Soft Systems Sector, Cavendish Laboratory, University of Cambridge, Cambridge, UK
| | - Erin D Gordon
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine, University of California-San Francisco, San Francisco, CA, USA
| | - Pamela Zeitlin
- Department of Pediatrics, National Jewish Health, Denver, CO, USA
| | | | - Nichole Reisdorph
- Department of Pharmaceutical Sciences, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
| | - Eleanor M Dunican
- School of Medicine, St. Vincent's University Hospital, University College Dublin, Dublin, Ireland
| | - Monica Tang
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine, University of California-San Francisco, San Francisco, CA, USA
| | - Brett M Elicker
- University of California-San Francisco, San Francisco, CA, USA
| | | | | | - Mario Castro
- University of Kansas Medical Center, Kansas City, KS, USA
| | | | | | - Bruce D Levy
- Brigham and Women's Hospital and Harvard University, Cambridge, MA, USA
| | | | | | - Kaharu Sumino
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | | | - Annette T Hastie
- Wake Forest University School of Medicine, Department of Internal Medicine, Section on Pulmonary, Critical Care, Allergy and Immunologic Diseases, Winston Salem, NC, USA
| | - Wendy C Moore
- Wake Forest University School of Medicine, Department of Internal Medicine, Section on Pulmonary, Critical Care, Allergy and Immunologic Diseases, Winston Salem, NC, USA
| | | | | | | | | | - Prescott G Woodruff
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine, University of California-San Francisco, San Francisco, CA, USA
| | | | - Chad G Pearson
- Department of Cell and Developmental Biology, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
| | - Esteban G Burchard
- Department of Medicine, University of California-San Francisco, San Francisco, CA, USA
| | - John V Fahy
- Department of Medicine, University of California-San Francisco, San Francisco, CA, USA
| | - Max A Seibold
- Center for Genes, Environment, and Health, National Jewish Health, Denver, CO, USA.
- Department of Pediatrics, National Jewish Health, Denver, CO, USA.
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA.
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Hazlehurst MF, Dearborn LC, Sherris AR, Loftus CT, Adgent MA, Szpiro AA, Ni Y, Day DB, Kaufman JD, Thakur N, Wright RJ, Sathyanarayana S, Carroll KN, Moore PE, Karr CJ. Long-term ozone exposure and lung function in middle childhood. ENVIRONMENTAL RESEARCH 2024; 241:117632. [PMID: 37967704 PMCID: PMC11067856 DOI: 10.1016/j.envres.2023.117632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/07/2023] [Accepted: 11/08/2023] [Indexed: 11/17/2023]
Abstract
BACKGROUND Ozone (O3) exposure interrupts normal lung development in animal models. Epidemiologic evidence further suggests impairment with higher long-term O3 exposure across early and middle childhood, although study findings to date are mixed and few have investigated vulnerable subgroups. METHODS Participants from the CANDLE study, a pregnancy cohort in Shelby County, TN, in the ECHO-PATHWAYS Consortium, were included if children were born at gestational age >32 weeks, completed a spirometry exam at age 8-9, and had a valid residential history from birth to age 8. We estimated lifetime average ambient O3 exposure based on each child's residential history from birth to age 8, using a validated fine-resolution spatiotemporal model. Spirometry was performed at the age 8-9 year study visit to assess Forced Expiratory Volume in the first second (FEV1) and Forced Vital Capacity (FVC) as primary outcomes; z-scores were calculated using sex-and-age-specific reference equations. Linear regression with robust variance estimators was used to examine associations between O3 exposure and continuous lung function z-scores, adjusted for child, sociodemographic, and home environmental factors. Potential susceptible subgroups were explored using a product term in the regression model to assess effect modification by child sex, history of bronchiolitis in infancy, and allergic sensitization. RESULTS In our sample (n = 648), O3 exposure averaged from birth to age 8 was modest (mean 26.6 [SD 1.1] ppb). No adverse associations between long-term postnatal O3 exposure were observed with either FEV1 (β = 0.12, 95% CI: -0.04, 0.29) or FVC (β = 0.03, 95% CI: -0.13, 0.19). No effect modification by child sex, history of bronchiolitis in infancy, or allergic sensitization was detected for associations with 8-year average O3. CONCLUSIONS In this sample with low O3 concentrations, we did not observe adverse associations between O3 exposures averaged from birth to age 8 and lung function in middle childhood.
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Affiliation(s)
- Marnie F Hazlehurst
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, USA.
| | - Logan C Dearborn
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, USA
| | - Allison R Sherris
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, USA
| | - Christine T Loftus
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, USA
| | - Margaret A Adgent
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Adam A Szpiro
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, WA, USA
| | - Yu Ni
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, USA; School of Public Health, College of Health and Human Services, San Diego State University, San Diego, CA, USA
| | - Drew B Day
- Center for Child Health, Behavior, and Development of Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, USA
| | - Joel D Kaufman
- Departments of Epidemiology and of Environmental and Occupational Health Sciences, School of Public Health, and Department of Medicine, School of Medicine, University of Washington, Seattle, WA, USA
| | - Neeta Thakur
- Division of Pulmonary and Critical Care Medicine, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Rosalind J Wright
- Departments of Pediatrics and of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sheela Sathyanarayana
- Department of Pediatrics, School of Medicine and Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, and Seattle Children's Research Institute, Seattle, WA, USA
| | - Kecia N Carroll
- Departments of Pediatrics and of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Paul E Moore
- Division of Allergy, Immunology, and Pulmonary Medicine, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Catherine J Karr
- Department of Pediatrics, School of Medicine and Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, USA
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Piekos JA, Kim J, Keaton JM, Hellwege JN, Edwards TL, Velez Edwards DR. EVALUATING THE RELATIONSHIPS BETWEEN GENETIC ANCESTRY AND THE CLINICAL PHENOME. PACIFIC SYMPOSIUM ON BIOCOMPUTING. PACIFIC SYMPOSIUM ON BIOCOMPUTING 2024; 29:389-403. [PMID: 38160294 PMCID: PMC10802858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
There is a desire in research to move away from the concept of race as a clinical factor because it is a societal construct used as an imprecise proxy for geographic ancestry. In this study, we leverage the biobank from Vanderbilt University Medical Center, BioVU, to investigate relationships between genetic ancestry proportion and the clinical phenome. For all samples in BioVU, we calculated six ancestry proportions based on 1000 Genomes references: eastern African (EAFR), western African (WAFR), northern European (NEUR), southern European (SEUR), eastern Asian (EAS), and southern Asian (SAS). From PheWAS, we found phecode categories significantly enriched neoplasms for EAFR, WAFR, and SEUR, and pregnancy complication in SEUR, NEUR, SAS, and EAS (p < 0.003). We then selected phenotypes hypertension (HTN) and atrial fibrillation (AFib) to further investigate the relationships between these phenotypes and EAFR, WAFR, SEUR, and NEUR using logistic regression modeling and non-linear restricted cubic spline modeling (RCS). For EAS and SAS, we chose renal failure (RF) for further modeling. The relationships between HTN and AFib and the ancestries EAFR, WAFR, and SEUR were best fit by the linear model (beta p < 1x10-4 for all) while the relationships with NEUR were best fit with RCS (HTN ANOVA p = 0.001, AFib ANOVA p < 1x10-4). For RF, the relationship with SAS was best fit with a linear model (beta p < 1x10-4) while RCS model was a better fit for EAS (ANOVA p < 1x10-4). In this study, we identify relationships between genetic ancestry and phenotypes that are best fit with non-linear modeling techniques. The assumption of linearity for regression modeling is integral for proper fitting of a model and there is no knowing a priori to modeling if the relationship is truly linear.
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Affiliation(s)
- Jacqueline A Piekos
- Vanderbilt Genetics Institute, Vanderbilt University, Nashville, Tennessee 37203, United States2Department of Obstetrics and Gynecology, Vanderbilt University Medical Center Nashville, Tennessee 37232, United States3Department of Biomedical Informatics, Vanderbilt University Medical Center Nashville, Tennessee 37232, United States^Work partially supported by T32GM080178
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5
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Perez-Garcia J, Pino-Yanes M, Plender EG, Everman JL, Eng C, Jackson ND, Moore CM, Beckman KB, Medina V, Sharma S, Winnica DE, Holguin F, Rodríguez-Santana J, Villar J, Ziv E, Seibold MA, Burchard EG. Epigenomic response to albuterol treatment in asthma-relevant airway epithelial cells. Clin Epigenetics 2023; 15:156. [PMID: 37784136 PMCID: PMC10546710 DOI: 10.1186/s13148-023-01571-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 09/25/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Albuterol is the first-line asthma medication used in diverse populations. Although DNA methylation (DNAm) is an epigenetic mechanism involved in asthma and bronchodilator drug response (BDR), no study has assessed whether albuterol could induce changes in the airway epithelial methylome. We aimed to characterize albuterol-induced DNAm changes in airway epithelial cells, and assess potential functional consequences and the influence of genetic variation and asthma-related clinical variables. RESULTS We followed a discovery and validation study design to characterize albuterol-induced DNAm changes in paired airway epithelial cultures stimulated in vitro with albuterol. In the discovery phase, an epigenome-wide association study using paired nasal epithelial cultures from Puerto Rican children (n = 97) identified 22 CpGs genome-wide associated with repeated-use albuterol treatment (p < 9 × 10-8). Albuterol predominantly induced a hypomethylation effect on CpGs captured by the EPIC array across the genome (probability of hypomethylation: 76%, p value = 3.3 × 10-5). DNAm changes on the CpGs cg23032799 (CREB3L1), cg00483640 (MYLK4-LINC01600), and cg05673431 (KSR1) were validated in nasal epithelia from 10 independent donors (false discovery rate [FDR] < 0.05). The effect on the CpG cg23032799 (CREB3L1) was cross-tissue validated in bronchial epithelial cells at nominal level (p = 0.030). DNAm changes in these three CpGs were shown to be influenced by three independent genetic variants (FDR < 0.05). In silico analyses showed these polymorphisms regulated gene expression of nearby genes in lungs and/or fibroblasts including KSR1 and LINC01600 (6.30 × 10-14 ≤ p ≤ 6.60 × 10-5). Additionally, hypomethylation at the CpGs cg10290200 (FLNC) and cg05673431 (KSR1) was associated with increased gene expression of the genes where they are located (FDR < 0.05). Furthermore, while the epigenetic effect of albuterol was independent of the asthma status, severity, and use of medication, BDR was nominally associated with the effect on the CpG cg23032799 (CREB3L1) (p = 0.004). Gene-set enrichment analyses revealed that epigenomic modifications of albuterol could participate in asthma-relevant processes (e.g., IL-2, TNF-α, and NF-κB signaling pathways). Finally, nine differentially methylated regions were associated with albuterol treatment, including CREB3L1, MYLK4, and KSR1 (adjusted p value < 0.05). CONCLUSIONS This study revealed evidence of epigenetic modifications induced by albuterol in the mucociliary airway epithelium. The epigenomic response induced by albuterol might have potential clinical implications by affecting biological pathways relevant to asthma.
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Grants
- R01 ES015794 NIEHS NIH HHS
- R01 HL120393 NHLBI NIH HHS
- R01ES015794, R21ES24844 NIEHS NIH HHS
- UM1 HG008901 NHGRI NIH HHS
- R01MD010443, R56MD013312 NIMHD NIH HHS
- R01 HL135156 NHLBI NIH HHS
- R01 HL128439 NHLBI NIH HHS
- R01 HL117004 NHLBI NIH HHS
- R21 ES024844 NIEHS NIH HHS
- R01 HL117626 NHLBI NIH HHS
- R56 MD013312 NIMHD NIH HHS
- R01 MD010443 NIMHD NIH HHS
- R01 HL155024 NHLBI NIH HHS
- R01HL155024-01, HHSN268201600032I, 3R01HL-117626-02S1, HHSN268201800002I, 3R01HL117004-02S3, 3R01HL-120393-02S1, R01HL117004, R01HL128439, R01HL135156, X01HL134589 NHLBI NIH HHS
- HHSN268201600032C NHLBI NIH HHS
- U24 HG008956 NHGRI NIH HHS
- Ministerio de Universidades
- Ministerio de Ciencia e Innovación
- Instituto de Salud Carlos III
- National Heart, Lung, and Blood Institute
- National Human Genome Research Institute
- National Institute of Environmental Health Sciences
- National Institute on Minority Health and Health Disparities
- The Centers for Common Disease Genomics of the Genome Sequencing Program
- Tobacco-Related Disease Research Program
- Sandler Family Foundation
- American Asthma Foundation
- Amos Medical Faculty Development Program from the Robert Wood Johnson Foundation
- Harry Wm. and Diana V. Hind Distinguished Professor in Pharmaceutical Sciences II
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Affiliation(s)
- Javier Perez-Garcia
- Genomics and Health Group, Department of Biochemistry, Microbiology, Cell Biology, and Genetics, Universidad de La Laguna (ULL), La Laguna, Tenerife, Canary Islands, Spain.
| | - Maria Pino-Yanes
- Genomics and Health Group, Department of Biochemistry, Microbiology, Cell Biology, and Genetics, Universidad de La Laguna (ULL), La Laguna, Tenerife, Canary Islands, Spain.
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.
- Instituto de Tecnologías Biomédicas (ITB), Universidad de La Laguna (ULL), La Laguna, Spain.
| | - Elizabeth G Plender
- Center for Genes, Environment, and Health, National Jewish Health, Denver, CO, USA
| | - Jamie L Everman
- Center for Genes, Environment, and Health, National Jewish Health, Denver, CO, USA
| | - Celeste Eng
- Department of Medicine, University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Nathan D Jackson
- Center for Genes, Environment, and Health, National Jewish Health, Denver, CO, USA
| | - Camille M Moore
- Center for Genes, Environment, and Health, National Jewish Health, Denver, CO, USA
- Department of Biomedical Research, National Jewish Health, Denver, CO, USA
- Department of Biostatistics and Informatics, University of Colorado, Denver, CO, USA
| | - Kenneth B Beckman
- University of Minnesota Genomics Center (UMNGC), Minneapolis, MN, USA
| | | | - Sunita Sharma
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Daniel Efrain Winnica
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Fernando Holguin
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Jesús Villar
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
- Multidisciplinary Organ Dysfunction Evaluation Research Network (MODERN), Research Unit, Hospital Universitario Dr. Negrín, Las Palmas de Gran Canaria, Spain
- Li Ka Shing Knowledge Institute at the St. Michael's Hospital, Toronto, ON, Canada
| | - Elad Ziv
- Institute for Human Genetics, University of California San Francisco (UCSF), San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | - Max A Seibold
- Center for Genes, Environment, and Health, National Jewish Health, Denver, CO, USA
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado School of Medicine, Aurora, CO, USA
- Department of Pediatrics, National Jewish Health, Denver, CO, USA
| | - Esteban G Burchard
- Department of Medicine, University of California San Francisco (UCSF), San Francisco, CA, USA
- Department of Bioengineering and Therapeutic Sciences, University of California San Francisco (UCSF), San Francisco, CA, USA
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Moore CM, Thornburg J, Secor EA, Hamlington KL, Schiltz AM, Freeman KL, Everman JL, Fingerlin TE, Liu AH, Seibold MA. Breathing zone pollutant levels are associated with asthma exacerbations in high-risk children. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.09.22.23295971. [PMID: 37790375 PMCID: PMC10543064 DOI: 10.1101/2023.09.22.23295971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Background Indoor and outdoor air pollution levels are associated with poor asthma outcomes in children. However, few studies have evaluated whether breathing zone pollutant levels associate with asthma outcomes. Objective Determine breathing zone exposure levels of NO 2 , O 3 , total PM 10 and PM 10 constituents among children with exacerbation-prone asthma, and examine correspondence with in-home and community measurements and associations with outcomes. Methods We assessed children's personal breathing zone exposures using wearable monitors. Personal exposures were compared to in-home and community measurements and tested for association with lung function, asthma control, and asthma exacerbations. Results 81 children completed 219 monitoring sessions. Correlations between personal and community levels of PM 10 , NO 2 , and O 3 were poor, whereas personal PM 10 and NO 2 levels correlated with in-home measurements. However, in-home monitoring underdetected brown carbon (Personal:79%, Home:36.8%) and ETS (Personal:83.7%, Home:4.1%) personal exposures, and detected black carbon in participants without these personal exposures (Personal: 26.5%, Home: 96%). Personal exposures were not associated with lung function or asthma control. Children experiencing an asthma exacerbation within 60 days of personal exposure monitoring had 1.98, 2.21 and 2.04 times higher brown carbon (p<0.001), ETS (p=0.007), and endotoxin (p=0.012), respectively. These outcomes were not associated with community or in-home exposure levels. Conclusions Monitoring pollutant levels in the breathing zone is essential to understand how exposures influence asthma outcomes, as agreement between personal and in-home monitors is limited. Inhaled exposure to PM 10 constituents modifies asthma exacerbation risk, suggesting efforts to limit these exposures among high-risk children may decrease their asthma burden. CLINICAL IMPLICATIONS In-home and community monitoring of environmental pollutants may underestimate personal exposures. Levels of inhaled exposure to PM 10 constituents appear to strongly influence asthma exacerbation risk. Therefore, efforts should be made to mitigate these exposures. CAPSULE SUMMARY Leveraging wearable, breathing-zone monitors, we show exposures to inhaled pollutants are poorly proxied by in-home and community monitors, among children with exacerbation-prone asthma. Inhaled exposure to multiple PM 10 constituents is associated with asthma exacerbation risk.
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7
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Alcala E, Capitman JA, Cisneros R. The Moderating Role of Housing Quality on Concentrated Poverty and Asthma-Related Emergency Department Visits Among Hispanics/Latinos. J Asthma 2023:1-8. [PMID: 36927232 DOI: 10.1080/02770903.2023.2188567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
Background. Rates of asthma-related emergency department visits have been shown to vary significantly by place (i.e., neighborhood) and race/ethnicity. The moderating factors of asthmatic events among Hispanic/Latino-specific populations are known to a much lesser degree. Objective. To assess the extent to which housing moderates the effect of poverty on Hispanic/Latino-specific asthma-related emergency department (ED) visits at an ecological level. Methods. Using data from the Office of Statewide Health Planning and Development (OSHPD) and the 2016-2017 U.S. Census, a cross-sectional ecological analysis at the census tract-level was conducted. Crosswalk files from the U.S. Department of Housing and Urban Development were used to associate zip codes to census tracts. Negative binomial regression was used to estimate rate ratios. Results. The effect of poverty on asthma-related ED visits was significantly moderated by the median year of housing structures built. The effect of mid-level poverty (RR= 1.57, 95% CI 1.27, 1.95) and high-level poverty (RR= 1.47, 95% CI 1.22, 1.78) in comparison to low-level poverty, was significantly greater among census tracts with housing built prior to 1965 in comparison to census tract with housing built between 1965-2020. Conclusion. Communities with older housing structures tend to be associated with increased Hispanic/Latino ED visits apart from affluent communities.
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Affiliation(s)
- Emanuel Alcala
- Department of Public Health, School of Social Sciences, Humanities, and Arts, University of California, Merced, CA 95343, USA.,Central Valley Health Policy Institute, College of Health and Human Services, California State University, Fresno, CA 93740, USA
| | - John A Capitman
- Central Valley Health Policy Institute, College of Health and Human Services, California State University, Fresno, CA 93740, USA
| | - Ricardo Cisneros
- Department of Public Health, School of Social Sciences, Humanities, and Arts, University of California, Merced, CA 95343, USA
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Teng J, Li J, Yang T, Cui J, Xia X, Chen G, Zheng S, Bao J, Wang T, Shen M, Zhang X, Meng C, Wang Z, Wu T, Xu Y, Wang Y, Ding G, Duan H, Li W. Long-term exposure to air pollution and lung function among children in China: Association and effect modification. Front Public Health 2022; 10:988242. [PMID: 36589956 PMCID: PMC9795025 DOI: 10.3389/fpubh.2022.988242] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 11/18/2022] [Indexed: 12/15/2022] Open
Abstract
Background Children are vulnerable to the respiratory effects of air pollution, and their lung function has been associated with long-term exposure to low air pollution level in developed countries. However, the impact of contemporary air pollution level in developing countries as a result of recent efforts to improve air quality on children's lung function is less understood. Methods We obtained a cross-sectional sample of 617 schoolchildren living in three differently polluted areas in Anhui province, China. 2-year average concentrations of air pollutants at the year of spirometry and the previous year (2017-2018) obtained from district-level air monitoring stations were used to characterize long-term exposure. Forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and forced expiratory flow between 25 and 75% of FVC (FEF25-75) were determined under strict quality control. Multivariable regression was employed to evaluate the associations between air pollution level and lung function parameters, overall and by demographic characteristics, lifestyle, and vitamin D that was determined by liquid chromatography tandem mass spectrometry. Results Mean concentration of fine particulate matter was 44.7 μg/m3, which is slightly above the interim target 1 standard of the World Health Organization. After adjusting for confounders, FVC, FEV1, and FEF25-75 showed inverse trends with increasing air pollution levels, with children in high exposure group exhibiting 87.9 [95% confidence interval (CI): 9.5, 166.4] mL decrement in FEV1 and 195.3 (95% CI: 30.5, 360.1) mL/s decrement in FEF25-75 compared with those in low exposure group. Additionally, the above negative associations were more pronounced among those who were younger, girls, not exposed to secondhand smoke, non-overweight, physically inactive, or vitamin D deficient. Conclusions Our study suggests that long-term exposure to relatively high air pollution was associated with impaired lung function in children. More stringent pollution control measures and intervention strategies accounting for effect modification are needed for vulnerable populations in China and other developing countries.
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Affiliation(s)
- Jingjing Teng
- Anhui Center for Disease Control and Prevention, Public Health Research Institute of Anhui Province, Hefei, China
| | - Jie Li
- Department of Occupational and Environmental Health, School of Public Health, Capital Medical University, Beijing, China,Beijing Key Laboratory of Environmental Toxicology, School of Public Health, Capital Medical University, Beijing, China
| | - Tongjin Yang
- Anhui Center for Disease Control and Prevention, Public Health Research Institute of Anhui Province, Hefei, China
| | - Jie Cui
- Anhui Center for Disease Control and Prevention, Public Health Research Institute of Anhui Province, Hefei, China
| | - Xin Xia
- Anhui Center for Disease Control and Prevention, Public Health Research Institute of Anhui Province, Hefei, China
| | - Guoping Chen
- Anhui Center for Disease Control and Prevention, Public Health Research Institute of Anhui Province, Hefei, China
| | - Siyu Zheng
- Anhui Center for Disease Control and Prevention, Public Health Research Institute of Anhui Province, Hefei, China
| | - Junhui Bao
- Anhui Center for Disease Control and Prevention, Public Health Research Institute of Anhui Province, Hefei, China
| | - Ting Wang
- Chinese Center for Disease Control and Prevention, National Institute for Occupational Health and Poison Control, Beijing, China
| | - Meili Shen
- Chinese Center for Disease Control and Prevention, National Institute for Occupational Health and Poison Control, Beijing, China
| | - Xiao Zhang
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Can Meng
- Anhui Center for Disease Control and Prevention, Public Health Research Institute of Anhui Province, Hefei, China
| | - Zhiqiang Wang
- Anhui Center for Disease Control and Prevention, Public Health Research Institute of Anhui Province, Hefei, China
| | - Tongjun Wu
- Anhui Center for Disease Control and Prevention, Public Health Research Institute of Anhui Province, Hefei, China
| | - Yanlong Xu
- Anhui Center for Disease Control and Prevention, Public Health Research Institute of Anhui Province, Hefei, China
| | - Yan Wang
- Anhui Center for Disease Control and Prevention, Public Health Research Institute of Anhui Province, Hefei, China
| | - Gang Ding
- Anhui Center for Disease Control and Prevention, Public Health Research Institute of Anhui Province, Hefei, China
| | - Huawei Duan
- Chinese Center for Disease Control and Prevention, National Institute for Occupational Health and Poison Control, Beijing, China
| | - Weidong Li
- Anhui Center for Disease Control and Prevention, Public Health Research Institute of Anhui Province, Hefei, China,*Correspondence: Weidong Li
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9
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Influence of the environment on the characteristics of asthma. Sci Rep 2022; 12:20522. [PMID: 36443644 PMCID: PMC9705565 DOI: 10.1038/s41598-022-25028-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 11/23/2022] [Indexed: 11/29/2022] Open
Abstract
Few studies have compared the prevalence of asthma in urban and rural settings or explored the issue of whether these two manifestations of the disease may represent different phenotypes. The aim of this study was: (a) to establish whether the prevalence of asthma differs between rural and urban settings, and b) to identify differences in the clinical presentation of asthma in these two environments. Descriptive epidemiological study involving individuals aged 18 or over from a rural (n = 516) and an urban population (n = 522). In the first phase, individuals were contacted by letter in order to organize the administration of a first validated questionnaire (Q1) designed to establish the possible prevalence of bronchial asthma. In the second phase, patients who had presented association patterns in the set of variables related to asthma in Q1 completed a second validated questionnaire (Q2), designed to identify the characteristics of asthma. According to Q1, the prevalence of asthma was 15% (n = 78) and 11% (n = 59) in rural and urban populations respectively. Sixty-five individuals with asthma from the rural population and all 59 individuals from the urban population were contacted and administered the Q2. Thirty-seven per cent of the individuals surveyed had previously been diagnosed with bronchial asthma (35% in the rural population and 40% in the urban setting). In the urban asthmatic population there was a predominance of women, a greater personal history of allergic rhinitis and a family history of allergic rhinitis and/or eczema. Asthma was diagnosed in adulthood in 74.8% of the patients, with no significant differences between the two populations. Regarding symptoms, cough (morning, daytime and night) and expectoration were more frequent in the urban population. The prevalence of asthma does not differ between urban and rural settings. The differences in exposure that characterize each environment may lead to different manifestations of the disease and may also affect its severity.
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10
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Benamar M, Harb H, Chen Q, Wang M, Chan TMF, Fong J, Phipatanakul W, Cunningham A, Ertem D, Petty CR, Mousavi AJ, Sioutas C, Crestani E, Chatila TA. A common IL-4 receptor variant promotes asthma severity via a T reg cell GRB2-IL-6-Notch4 circuit. Allergy 2022; 77:3377-3387. [PMID: 35841382 PMCID: PMC9617759 DOI: 10.1111/all.15444] [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: 03/30/2022] [Revised: 07/01/2022] [Accepted: 07/07/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND The mechanisms by which genetic and environmental factors interact to promote asthma remain unclear. Both the IL-4 receptor alpha chain R576 (IL-4RαR576) variant and Notch4 license asthmatic lung inflammation by allergens and ambient pollutant particles by subverting lung regulatory T (Treg ) cells in an IL-6-dependent manner. OBJECTIVE We examined the interaction between IL-4RαR576 and Notch4 in promoting asthmatic inflammation. METHODS Peripheral blood mononuclear cells (PBMCs) of asthmatics were analyzed for T helper type 2 cytokine production and Notch4 expression on Treg cells as a function of IL4RR576 allele. The capacity of IL-4RαR576 to upregulate Notch4 expression on Treg cells to promote severe allergic airway inflammation was further analyzed in genetic mouse models. RESULTS Asthmatics carrying the IL4RR576 allele had increased Notch4 expression on their circulating Treg cells as a function of disease severity and serum IL-6. Mice harboring the Il4raR576 allele exhibited increased Notch4-dependent allergic airway inflammation that was inhibited upon Treg cell-specific Notch4 deletion or treatment with an anti-Notch4 antibody. Signaling via IL-4RαR576 upregulated the expression in lung Treg cells of Notch4 and its downstream mediators Yap1 and beta-catenin, leading to exacerbated lung inflammation. This upregulation was dependent on growth factor receptor-bound protein 2 (GRB2) and IL-6 receptor. CONCLUSION These results identify an IL-4RαR576-regulated GRB2-IL-6-Notch4 circuit that promotes asthma severity by subverting lung Treg cell function.
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Affiliation(s)
- Mehdi Benamar
- Division of Immunology, Boston Children’s Hospital,
Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston,
MA, USA
| | - Hani Harb
- Division of Immunology, Boston Children’s Hospital,
Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston,
MA, USA
- Institute for Medical Microbiology and Virology, Technical
University Dresden, Germany
| | - Qian Chen
- Division of Immunology, Boston Children’s Hospital,
Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston,
MA, USA
| | - Muyun Wang
- Division of Immunology, Boston Children’s Hospital,
Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston,
MA, USA
| | - Tsz Man Fion Chan
- Division of Immunology, Boston Children’s Hospital,
Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston,
MA, USA
| | - Jason Fong
- Division of Immunology, Boston Children’s Hospital,
Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston,
MA, USA
| | - Wanda Phipatanakul
- Division of Immunology, Boston Children’s Hospital,
Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston,
MA, USA
| | - Amparito Cunningham
- Division of Immunology, Boston Children’s Hospital,
Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston,
MA, USA
| | - Deniz Ertem
- Division of Immunology, Boston Children’s Hospital,
Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston,
MA, USA
| | - Carter R. Petty
- Institutional Centers for Clinical and Translational
Research, Boston Children’s Hospital, Boston, Massachusetts
| | - Amirhosein J. Mousavi
- Department of Civil and Environmental Engineering,
University of Southern California, CA, USA
| | - Constantinos Sioutas
- Department of Civil and Environmental Engineering,
University of Southern California, CA, USA
| | - Elena Crestani
- Division of Immunology, Boston Children’s Hospital,
Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston,
MA, USA
| | - Talal A. Chatila
- Division of Immunology, Boston Children’s Hospital,
Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston,
MA, USA
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11
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Washington C, Dapas M, Biddanda A, Magnaye KM, Aneas I, Helling BA, Szczesny B, Boorgula MP, Taub MA, Kenny E, Mathias RA, Barnes KC, Khurana Hershey GK, Kercsmar CM, Gereige JD, Makhija M, Gruchalla RS, Gill MA, Liu AH, Rastogi D, Busse W, Gergen PJ, Visness CM, Gold DR, Hartert T, Johnson CC, Lemanske RF, Martinez FD, Miller RL, Ownby D, Seroogy CM, Wright AL, Zoratti EM, Bacharier LB, Kattan M, O'Connor GT, Wood RA, Nobrega MA, Altman MC, Jackson DJ, Gern JE, McKennan CG, Ober C. African-specific alleles modify risk for asthma at the 17q12-q21 locus in African Americans. Genome Med 2022; 14:112. [PMID: 36175932 PMCID: PMC9520885 DOI: 10.1186/s13073-022-01114-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 09/15/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Asthma is the most common chronic disease in children, occurring at higher frequencies and with more severe disease in children with African ancestry. METHODS We tested for association with haplotypes at the most replicated and significant childhood-onset asthma locus at 17q12-q21 and asthma in European American and African American children. Following this, we used whole-genome sequencing data from 1060 African American and 100 European American individuals to identify novel variants on a high-risk African American-specific haplotype. We characterized these variants in silico using gene expression and ATAC-seq data from airway epithelial cells, functional annotations from ENCODE, and promoter capture (pc)Hi-C maps in airway epithelial cells. Candidate causal variants were then assessed for correlation with asthma-associated phenotypes in African American children and adults. RESULTS Our studies revealed nine novel African-specific common variants, enriched on a high-risk asthma haplotype, which regulated the expression of GSDMA in airway epithelial cells and were associated with features of severe asthma. Using ENCODE annotations, ATAC-seq, and pcHi-C, we narrowed the associations to two candidate causal variants that are associated with features of T2 low severe asthma. CONCLUSIONS Previously unknown genetic variation at the 17q12-21 childhood-onset asthma locus contributes to asthma severity in individuals with African ancestries. We suggest that many other population-specific variants that have not been discovered in GWAS contribute to the genetic risk for asthma and other common diseases.
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Affiliation(s)
- Charles Washington
- Department of Human Genetics, The University of Chicago, 928 E. 58th St. CLSC 507C, Chicago, IL, 60637, USA
| | - Matthew Dapas
- Department of Human Genetics, The University of Chicago, 928 E. 58th St. CLSC 507C, Chicago, IL, 60637, USA
| | - Arjun Biddanda
- Department of Human Genetics, The University of Chicago, 928 E. 58th St. CLSC 507C, Chicago, IL, 60637, USA
| | - Kevin M Magnaye
- Department of Human Genetics, The University of Chicago, 928 E. 58th St. CLSC 507C, Chicago, IL, 60637, USA
| | - Ivy Aneas
- Department of Human Genetics, The University of Chicago, 928 E. 58th St. CLSC 507C, Chicago, IL, 60637, USA
| | - Britney A Helling
- Department of Human Genetics, The University of Chicago, 928 E. 58th St. CLSC 507C, Chicago, IL, 60637, USA
| | - Brooke Szczesny
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | | | - Margaret A Taub
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Eimear Kenny
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rasika A Mathias
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Kathleen C Barnes
- Department of Medicine, University of Colorado Denver, Aurora, CO, USA
| | | | - Carolyn M Kercsmar
- Division of Asthma Research, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Jessica D Gereige
- Department of Medicine, Division of Pulmonary, Allergy, Sleep, and Critical Care Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Melanie Makhija
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | | | - Michelle A Gill
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Andrew H Liu
- Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, CO, USA
| | - Deepa Rastogi
- Children's National Hospital and George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - William Busse
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | | | | | - Diane R Gold
- The Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Department of Environmental Health, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Tina Hartert
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Christine C Johnson
- Department of Public Health Sciences, Henry Ford Health Systems, Detroit, MI, USA
| | - Robert F Lemanske
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Fernando D Martinez
- Asthma and Airway Disease Research Center, University of Arizona, Tucson, AZ, USA
| | - Rachel L Miller
- Department of Medicine, Division of Clinical Immunology Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Dennis Ownby
- Department of Public Health Sciences, Henry Ford Health Systems, Detroit, MI, USA
| | - Christine M Seroogy
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Anne L Wright
- Asthma and Airway Disease Research Center, University of Arizona, Tucson, AZ, USA
| | - Edward M Zoratti
- Department of Medicine, Henry Ford Health Systems, Detroit, MI, USA
| | - Leonard B Bacharier
- Department of Pediatrics, Monroe Carell Jr Children's Hospital at Vanderbilt University Medical Center, Nashville, TN, USA
| | - Meyer Kattan
- Department of Pediatrics, Columbia University Medical Center, New York, NY, USA
| | - George T O'Connor
- Pulmonary Center, Boston University School of Medicine, Boston, MA, USA
| | - Robert A Wood
- Department of Pediatrics, Johns Hopkins University, Baltimore, MD, USA
| | - Marcelo A Nobrega
- Department of Human Genetics, The University of Chicago, 928 E. 58th St. CLSC 507C, Chicago, IL, 60637, USA
| | - Matthew C Altman
- Immunology Division, Benaroya Research Institute Systems, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Daniel J Jackson
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - James E Gern
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | | | - Carole Ober
- Department of Human Genetics, The University of Chicago, 928 E. 58th St. CLSC 507C, Chicago, IL, 60637, USA.
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12
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Sajuthi SP, Everman JL, Jackson ND, Saef B, Rios CL, Moore CM, Mak ACY, Eng C, Fairbanks-Mahnke A, Salazar S, Elhawary J, Huntsman S, Medina V, Nickerson DA, Germer S, Zody MC, Abecasis G, Kang HM, Rice KM, Kumar R, Zaitlen NA, Oh S, Rodríguez-Santana J, Burchard EG, Seibold MA. Nasal airway transcriptome-wide association study of asthma reveals genetically driven mucus pathobiology. Nat Commun 2022; 13:1632. [PMID: 35347136 PMCID: PMC8960819 DOI: 10.1038/s41467-022-28973-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 02/10/2022] [Indexed: 12/13/2022] Open
Abstract
To identify genetic determinants of airway dysfunction, we performed a transcriptome-wide association study for asthma by combining RNA-seq data from the nasal airway epithelium of 681 children, with UK Biobank genetic association data. Our airway analysis identified 95 asthma genes, 58 of which were not identified by transcriptome-wide association analyses using other asthma-relevant tissues. Among these genes were MUC5AC, an airway mucin, and FOXA3, a transcriptional driver of mucus metaplasia. Muco-ciliary epithelial cultures from genotyped donors revealed that the MUC5AC risk variant increases MUC5AC protein secretion and mucus secretory cell frequency. Airway transcriptome-wide association analyses for mucus production and chronic cough also identified MUC5AC. These cis-expression variants were associated with trans effects on expression; the MUC5AC variant was associated with upregulation of non-inflammatory mucus secretory network genes, while the FOXA3 variant was associated with upregulation of type-2 inflammation-induced mucus-metaplasia pathway genes. Our results reveal genetic mechanisms of airway mucus pathobiology.
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Affiliation(s)
- Satria P Sajuthi
- Center for Genes, Environment, and Health, National Jewish Health, Denver, CO, USA
| | - Jamie L Everman
- Center for Genes, Environment, and Health, National Jewish Health, Denver, CO, USA
| | - Nathan D Jackson
- Center for Genes, Environment, and Health, National Jewish Health, Denver, CO, USA
| | - Benjamin Saef
- Center for Genes, Environment, and Health, National Jewish Health, Denver, CO, USA
| | - Cydney L Rios
- Center for Genes, Environment, and Health, National Jewish Health, Denver, CO, USA
| | - Camille M Moore
- Center for Genes, Environment, and Health, National Jewish Health, Denver, CO, USA
- Department of Biomedical Research, National Jewish Health, Denver, CO, USA
- Department of Biostatistics and Informatics, University of Colorado, Denver, CO, USA
| | - Angel C Y Mak
- Department of Medicine, University of California-San Francisco, San Francisco, CA, USA
| | - Celeste Eng
- Department of Medicine, University of California-San Francisco, San Francisco, CA, USA
| | - Ana Fairbanks-Mahnke
- Center for Genes, Environment, and Health, National Jewish Health, Denver, CO, USA
| | - Sandra Salazar
- Department of Medicine, University of California-San Francisco, San Francisco, CA, USA
| | - Jennifer Elhawary
- Department of Medicine, University of California-San Francisco, San Francisco, CA, USA
| | - Scott Huntsman
- Department of Medicine, University of California-San Francisco, San Francisco, CA, USA
| | | | | | | | | | - Gonçalo Abecasis
- Center for Statistical Genetics, University of Michigan, Ann Arbor, MI, USA
| | - Hyun Min Kang
- Center for Statistical Genetics, University of Michigan, Ann Arbor, MI, USA
| | - Kenneth M Rice
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Rajesh Kumar
- Ann and Robert H. Lurie Children's Hospital of Chicago, Department of Pediatrics, Northwestern University, Chicago, IL, USA
| | - Noah A Zaitlen
- Department of Neurology and Computational Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Sam Oh
- Department of Medicine, University of California-San Francisco, San Francisco, CA, USA
| | | | - Esteban G Burchard
- Department of Medicine, University of California-San Francisco, San Francisco, CA, USA
- Department of Bioengineering and Therapeutic Sciences, University of California-San Francisco, San Francisco, CA, USA
| | - Max A Seibold
- Center for Genes, Environment, and Health, National Jewish Health, Denver, CO, USA.
- Department of Pediatrics, National Jewish Health, Denver, CO, USA.
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
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13
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Wang J, Xu W, Tian X, Yang Y, Wang ST, Xu KF. Lung function and air pollution exposure in adults with asthma in Beijing: a 2-year longitudinal panel study. Front Med 2022; 16:574-583. [PMID: 35079979 DOI: 10.1007/s11684-021-0882-1] [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: 03/11/2021] [Accepted: 06/25/2021] [Indexed: 11/29/2022]
Abstract
The effect of air pollution on the lung function of adults with asthma remains unclear to date. This study followed 112 patients with asthma at 3-month intervals for 2 years. The pollutant exposure of the participants was estimated using the inverse distance weight method. The participants were divided into three groups according to their lung function level at every visit. A linear mixed-effect model was applied to predict the change in lung function with each unit change in pollution concentration. Exposure to carbon monoxide (CO) and particles less than 2.5 micrometers in diameter (PM2.5) was negatively associated with large airway function in participants. In the severe group, exposure to chronic sulfur dioxide (SO2) was negatively associated with post-bronchodilator forced expiratory flow at 50%, between 25% and 75% of vital capacity % predicted (change of 95% CI per unit: -0.34 (-0.55, -0.12), -0.24 (-0.44, -0.03), respectively). In the mild group, the effect of SO2 on the small airways was similar to that in the severe group, and it was negatively associated with large airway function. Exposure to CO and PM2.5 was negatively associated with the large airway function of adults with asthma. The negative effects of SO2 were more evident and widely observed in adults with severe and mild asthma than in adults with moderate asthma. Patients with asthma react differently to air pollutants as evidenced by their lung function levels.
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Affiliation(s)
- Jun Wang
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Wenshuai Xu
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Xinlun Tian
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Yanli Yang
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Shao-Ting Wang
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Kai-Feng Xu
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China.
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14
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Karimi L, Vijverberg SJ, Engelkes M, Hernandez-Pacheco N, Farzan N, Soares P, Pino-Yanes M, Jorgensen AL, Eng C, Mukhopadhyay S, Schieck M, Kabesch M, Burchard EG, Chew FT, Sio YY, Potočnik U, Gorenjak M, Hawcutt DB, Palmer CN, Turner S, Janssens HM, Maitland-van der Zee AH, Verhamme KM. ADRB2 haplotypes and asthma exacerbations in children and young adults: An individual participant data meta-analysis. Clin Exp Allergy 2021; 51:1157-1171. [PMID: 34128573 PMCID: PMC8503671 DOI: 10.1111/cea.13965] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 05/25/2021] [Accepted: 05/28/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND The polymorphism Arg16 in β2 -adrenergic receptor (ADRB2) gene has been associated with an increased risk of exacerbations in asthmatic children treated with long-acting β2 -agonists (LABA). However, it remains unclear whether this increased risk is mainly attributed to this single variant or the combined effect of the haplotypes of polymorphisms at codons 16 and 27. OBJECTIVE We assessed whether the haplotype analysis could explain the association between the polymorphisms at codons 16 (Arg16Gly) and 27 (Gln27Glu) in ADRB2 and risk of asthma exacerbations in patients treated with inhaled corticosteroids (ICS) plus LABA. METHODS The study was undertaken using data from 10 independent studies (n = 5903) participating in the multi-ethnic Pharmacogenomics in Childhood Asthma (PiCA) consortium. Asthma exacerbations were defined as asthma-related use of oral corticosteroids or hospitalizations/emergency department visits in the past 6 or 12 months prior to the study visit/enrolment. The association between the haplotypes and the risk of asthma exacerbations was performed per study using haplo.stats package adjusted for age and sex. Results were meta-analysed using the inverse variance weighting method assuming random-effects. RESULTS In subjects treated with ICS and LABA (n = 832, age: 3-21 years), Arg16/Gln27 versus Gly16/Glu27 (OR: 1.40, 95% CI: 1.05-1.87, I2 = 0.0%) and Arg16/Gln27 versus Gly16/Gln27 (OR: 1.43, 95% CI: 1.05-1.94, I2 = 0.0%), but not Gly16/Gln27 versus Gly16/Glu27 (OR: 0.99, 95% CI: 0.71-1.39, I2 = 0.0%), were significantly associated with an increased risk of asthma exacerbations. The sensitivity analyses indicated no significant association between the ADRB2 haplotypes and asthma exacerbations in the other treatment categories, namely as-required short-acting β2 -agonists (n = 973), ICS monotherapy (n = 2623), ICS plus leukotriene receptor antagonists (LTRA; n = 338), or ICS plus LABA plus LTRA (n = 686). CONCLUSION AND CLINICAL RELEVANCE The ADRB2 Arg16 haplotype, presumably mainly driven by the Arg16, increased the risk of asthma exacerbations in patients treated with ICS plus LABA. This finding could be beneficial in ADRB2 genotype-guided treatment which might improve clinical outcomes in asthmatic patients.
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Affiliation(s)
- Leila Karimi
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Susanne J. Vijverberg
- Department of Respiratory Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
- Department of Pediatric Respiratory Medicine and Allergy, Emma Children’s Hospital, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Faculty of Science, Utrecht University, Utrecht, the Netherlands
| | - Marjolein Engelkes
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Natalia Hernandez-Pacheco
- Research Unit, Hospital Universitario N.S. de Candelaria, Universidad de La Laguna, Santa Cruz de Tenerife, Spain
- Genomics and Health Group, Department of Biochemistry, Microbiology, Cell Biology and Genetics, Universidad de La Laguna, San Cristóbal de La Laguna, Santa Cruz de Tenerife, Spain
| | - Niloufar Farzan
- Department of Respiratory Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Faculty of Science, Utrecht University, Utrecht, the Netherlands
| | - Patricia Soares
- Academic department of Pediatrics, Brighton & Sussex Medical School, Royal Alexandra Children’s Hospital, Brighton, United Kingdom
| | - Maria Pino-Yanes
- Genomics and Health Group, Department of Biochemistry, Microbiology, Cell Biology and Genetics, Universidad de La Laguna, San Cristóbal de La Laguna, Santa Cruz de Tenerife, Spain
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
- Instituto de Tecnologías Biomédicas (ITB), Universidad de La Laguna, Santa Cruz de Tenerife, Spain
| | - Andrea L. Jorgensen
- Department of Biostatistics, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Celeste Eng
- Department of Medicine, University of California, San Francisco, San Francisco, California, United States
| | - Somnath Mukhopadhyay
- Academic department of Pediatrics, Brighton & Sussex Medical School, Royal Alexandra Children’s Hospital, Brighton, United Kingdom
| | - Maximilian Schieck
- Department of Pediatric Pneumology and Allergy, University Children’s Hospital Regensburg (KUNO), Regensburg, Germany
- Department of Human Genetics, Hannover Medical School, Hannover, Germany
| | - Michael Kabesch
- Department of Pediatric Pneumology and Allergy, University Children’s Hospital Regensburg (KUNO), Regensburg, Germany
| | - Esteban G. Burchard
- Department of Medicine, University of California, San Francisco, San Francisco, California, United States
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, San Francisco, California, United States
| | - Fook Tim Chew
- Department of Biological Science, National University of Singapore, Singapore
| | - Yang Yie Sio
- Department of Biological Science, National University of Singapore, Singapore
| | - Uroš Potočnik
- Center for Human Molecular Genetics and Pharmacogenomics, Faculty of Medicine, University of Maribor, Maribor, Slovenia
- Laboratory for Biochemistry, Molecular Biology and Genomics, Faculty of Chemistry and Chemical Engineering, University of Maribor, Maribor, Slovenia
| | - Mario Gorenjak
- Center for Human Molecular Genetics and Pharmacogenomics, Faculty of Medicine, University of Maribor, Maribor, Slovenia
| | - Daniel B. Hawcutt
- University of Liverpool and Alder Hey Children’s Hospital, members of Liverpool Health Partners, Liverpool, UK
- NIHR Alder Hey Clinical Research Facility, Alder Hey Children’s Hospital, Liverpool, UK
| | - Colin N. Palmer
- Division of Cardiovascular and Diabetes Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, United Kingdom
| | - Steve Turner
- Child Health, University of Aberdeen, Aberdeen, United Kingdom
| | - Hettie M. Janssens
- Department of Pediatrics/division Respiratory Medicine and Allergology Erasmus MC/Sophia Children’s Hospital, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Anke H. Maitland-van der Zee
- Department of Respiratory Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
- Department of Pediatric Respiratory Medicine and Allergy, Emma Children’s Hospital, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Faculty of Science, Utrecht University, Utrecht, the Netherlands
| | - Katia M.C. Verhamme
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, the Netherlands
- Department of Bioanalysis, Ghent University, Ghent, Belgium
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15
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Holm SM, Balmes JR. Systematic Review of Ozone Effects on Human Lung Function, 2013 through 2020. Chest 2021; 161:190-201. [PMID: 34389296 PMCID: PMC8783034 DOI: 10.1016/j.chest.2021.07.2170] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/27/2021] [Accepted: 07/31/2021] [Indexed: 01/09/2023] Open
Abstract
Background Ozone effects on lung function are particularly important to understand in the context of the air pollution-health outcomes epidemiologic literature, given the complex relationships between ozone and other air pollutants with known lung function effects. Research Question What has been learned about the association between ozone exposures and lung function from epidemiology studies published from 2013 through 2020? Study Design and Methods On March 18, 2018, and September 8, 2020, PubMed was searched using the terms health AND ozone, filtering to articles in English and about humans, from 2013 or later. An additional focused review searching for ozone AND (lung function OR FEV1OR FVC) was performed June 26, 2021. Articles were selected for this review if they reported a specific relationship between a lung function outcome and ozone exposure. Results Of 3,271 articles screened, 53 ultimately met criteria for inclusion. A systematic review with assessment of potential for bias was conducted, but a meta-analysis was not carried out because of differences in exposure duration and outcome quantification. Consistent evidence exists of small decreases in children’s lung function, even associated with very low levels of short-term ozone exposure. The effects on adult lung function from exposure to low-level, short-term ozone are less clear, although ozone-associated decrements may occur in the elderly. Finally, long-term ozone exposure decreases both lung function and lung function growth in children, although few new studies have examined long-term ozone and lung function in adults. Interpretation Much of this literature involves concentrations below the current US Environmental Protection Agency’s National Ambient Air Quality Standard of 70 parts per billion over an 8-h averaging time, suggesting that this current standard may not protect children adequately from ozone-related decrements in lung function.
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Affiliation(s)
- Stephanie M Holm
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA; Western States Pediatric Environmental Health Specialty Unit, University of California, San Francisco, CA; Division of Occupational and Environmental Medicine, University of California, San Francisco, San Francisco, CA.
| | - John R Balmes
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, CA; Western States Pediatric Environmental Health Specialty Unit, University of California, San Francisco, CA; Division of Occupational and Environmental Medicine, University of California, San Francisco, San Francisco, CA
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16
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Air pollution and lung function in children. J Allergy Clin Immunol 2021; 148:1-14. [PMID: 34238501 DOI: 10.1016/j.jaci.2021.05.006] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/30/2021] [Accepted: 05/06/2021] [Indexed: 11/21/2022]
Abstract
In this narrative review, we summarize the literature and provide updates on recent studies of air pollution exposures and child lung function and lung function growth. We include exposures to outdoor air pollutants that are monitored and regulated through air quality standards, and air pollutants that are not routinely monitored or directly regulated, including wildfires, indoor biomass and coal burning, gas and wood stove use, and volatile organic compounds. Included is a more systematic review of the recent literature on long-term air pollution and child lung function because this is an indicator of future adult respiratory health and exposure assessment tools have improved dramatically in recent years. We present "summary observations" and "knowledge gaps." We end by discussing what is known about what can be done at the individual/household, local/regional, and national levels to overcome structural impediments, reduce air pollution exposures, and improve child lung function. We found a large literature on adverse air pollution effects on children's lung function level and growth; however, many questions remain. Important areas needing further research include whether early-life effects are fixed or reversible; and what are windows of increased susceptibility, long-term effects of repeated wildfire events, and effects of air quality interventions.
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17
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Mersha TB, Qin K, Beck AF, Ding L, Huang B, Kahn RS. Genetic ancestry differences in pediatric asthma readmission are mediated by socioenvironmental factors. J Allergy Clin Immunol 2021; 148:1210-1218.e4. [PMID: 34217757 DOI: 10.1016/j.jaci.2021.05.046] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 05/17/2021] [Accepted: 05/28/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Social and financial hardships, combined with disease managment and environmental factors explain approximately 80% of the observed disparity in asthma-related readmissions between Black and White children. OBJECTIVE We sought to determine whether asthma-related readmissions differed by degree of African ancestry and the extent to which such an association would also be explained by socioenvironmental risk factors. METHODS This study used data from a prospective cohort study of 695 Black and White children aged 1 to 16 years with an asthma-related admission. The primary outcome was a similar readmission within 12 months. Each subject's African ancestry was determined by single nucleotide polymorphisms on a continuous scale ranging from 0 to 1 (0 = no African ancestry; 1 = 100% African ancestry). We also assessed 37 social, environmental, and clinical variables that we clustered into 6 domains (for example, hardship, disease management). Survival and mediation analyses were conducted. RESULTS A total of 134 children (19.3%) were readmitted within 12 months. Higher African ancestry was associated with asthma readmission (odds ratio 1.11, 95% confidence interval 1.05-1.18 for every 10% increase in African ancestry) with adjustment for age and gender. The association between African ancestry and readmission was mediated by hardship (sβ = 3.42, P < .001) and disease management (sβ = 0.046, P = .001), accounting for >50% of African ancestry's effect on readmission. African ancestry was no longer significantly associated with readmission (sβ = 0.035, P = .388) after accounting for these mediators. CONCLUSIONS African ancestry was strongly associated with readmission, and the association was mediated by family hardship and disease management. These results are consistent with the notion that asthma-related racial disparities are driven by factors like structural racism and social adversity.
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Affiliation(s)
- Tesfaye B Mersha
- Division of Asthma Research, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio; Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, College of Medicine, Cincinnati, Ohio.
| | - Ke Qin
- Division of Asthma Research, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio; Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, College of Medicine, Cincinnati, Ohio
| | - Andrew F Beck
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio; Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio; Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, College of Medicine, Cincinnati, Ohio
| | - Lili Ding
- Division of Biostatistics and Epidemiology, Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio; Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, College of Medicine, Cincinnati, Ohio
| | - Bin Huang
- Division of Biostatistics and Epidemiology, Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio; Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, College of Medicine, Cincinnati, Ohio
| | - Robert S Kahn
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio; Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, College of Medicine, Cincinnati, Ohio
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18
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Ruran HB, Adamkiewicz G, Cunningham A, Petty CR, Greco KF, Gunnlaugsson S, Stamatiadis N, Sierra G, Vallarino J, Alvarez M, Hayden LP, Sheils CA, Weller E, Phipatanakul W, Gaffin JM. Air quality, Environment and Respiratory Outcomes in Bronchopulmonary Dysplasia, the AERO-BPD cohort study: design and adaptation during the SARS-CoV-2 pandemic. BMJ Open Respir Res 2021; 8:e000915. [PMID: 34193433 PMCID: PMC8249170 DOI: 10.1136/bmjresp-2021-000915] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 06/07/2021] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Almost half of all school-age children with bronchopulmonary dysplasia (BPD) have asthma-like symptoms and more suffer from lung function deficits. While air pollution and indoor respiratory irritants are known to affect high-risk populations of children, few studies have objectively evaluated environmental contributions to long-term respiratory morbidity in this population. This study aimed to examine the role of indoor environmental exposures on respiratory morbidity in children with BPD. METHODS AND ANALYSIS The Air quality, Environment and Respiratory Ouctomes in BPD (AERO-BPD) study is a prospective, single-centre observational study that will enrol a unique cohort of 240 children with BPD and carefully characterise participants and their indoor home environmental exposures. Measures of indoor air quality constituents will assess the relationship of nitrogen dioxide (NO2), particulate matter (PM2.5), nitric oxide (NO), temperature and humidity, as well as dust concentrations of allergens, with concurrently measured respiratory symptoms and lung function.Adaptations to the research protocol due to the SARS-CoV-2 pandemic included remote home environment and participant assessments. ETHICS AND DISSEMINATION Study protocol was approved by the Boston Children's Hospital Committee on Clinical Investigation. Dissemination will be in the form of peer-reviewed publications and participant information products. TRIAL REGISTRATION NUMBER NCT04107701.
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Affiliation(s)
- Hana B Ruran
- Boston Children's Hospital Division of Pulmonary and Respiratory Diseases, Boston, Massachusetts, USA
| | - Gary Adamkiewicz
- Department of Environmental Health, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Amparito Cunningham
- Boston Children's Hospital Division of Immunology, Boston, Massachusetts, USA
| | - Carter R Petty
- Boston Children's Hospital, Biostatistics and Research Design Center, Institutional Centers for Clinical and Translational Research, Boston, Massachusetts, USA
| | - Kimberly F Greco
- Boston Children's Hospital, Biostatistics and Research Design Center, Institutional Centers for Clinical and Translational Research, Boston, Massachusetts, USA
| | - Sigfus Gunnlaugsson
- Boston Children's Hospital Division of Pulmonary and Respiratory Diseases, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Natalie Stamatiadis
- Boston Children's Hospital Division of Pulmonary and Respiratory Diseases, Boston, Massachusetts, USA
| | - Gabriella Sierra
- Boston Children's Hospital Division of Pulmonary and Respiratory Diseases, Boston, Massachusetts, USA
| | - Jose Vallarino
- Department of Environmental Health, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Marty Alvarez
- Department of Environmental Health, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Lystra P Hayden
- Boston Children's Hospital Division of Pulmonary and Respiratory Diseases, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Catherine A Sheils
- Boston Children's Hospital Division of Pulmonary and Respiratory Diseases, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Edie Weller
- Boston Children's Hospital, Biostatistics and Research Design Center, Institutional Centers for Clinical and Translational Research, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Wanda Phipatanakul
- Boston Children's Hospital Division of Immunology, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Jonathan M Gaffin
- Boston Children's Hospital Division of Pulmonary and Respiratory Diseases, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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19
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Altman MC, Flynn K, Rosasco MG, Dapas M, Kattan M, Lovinsky-Desir S, O'Connor GT, Gill MA, Gruchalla RS, Liu AH, Pongracic JA, Khurana Hershey GK, Zoratti EM, Teach SJ, Rastrogi D, Wood RA, Bacharier LB, LeBeau P, Gergen PJ, Togias A, Busse WW, Presnell S, Gern JE, Ober C, Jackson DJ. Inducible expression quantitative trait locus analysis of the MUC5AC gene in asthma in urban populations of children. J Allergy Clin Immunol 2021; 148:1505-1514. [PMID: 34019912 PMCID: PMC8599524 DOI: 10.1016/j.jaci.2021.04.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 04/13/2021] [Accepted: 04/16/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Mucus plugging can worsen asthma control, lead to reduced lung function and fatal exacerbations. MUC5AC is the secretory mucin implicated in mucus plugging, and MUC5AC gene expression has been associated with development of airway obstruction and asthma exacerbations in urban children with asthma. However, the genetic determinants of MUC5AC expression are not established. OBJECTIVES This study sought to assess single-nucleotide polymorphisms (SNPs) that influence MUC5AC expression and relate to pulmonary functions in childhood asthma. METHODS This study used RNA-sequencing data from upper airway samples and performed cis-expression quantitative trait loci (eQTL) and allele-specific expression analyses in 2 cohorts of predominantly Black and Hispanic urban children, a high asthma-risk birth cohort, and an exacerbation-prone asthma cohort. Inducible MUC5AC eQTLs were further investigated during incipient asthma exacerbations. Significant eQTLs SNPs were tested for associations with lung function measurements and their functional consequences were investigated in DNA regulatory databases. RESULTS Two independent groups of SNPs in the MUC5AC gene that were significantly associated with MUC5AC expression were identified. Moreover, these SNPs showed stronger eQTL associations with MUC5AC expression during asthma exacerbations, which is consistent with inducible expression. SNPs in 1 group also showed significant association with decreased pulmonary functions. These SNPs included multiple EGR1 transcription factor binding sites, suggesting a mechanism of effect. CONCLUSIONS These findings demonstrate the applicability of organ-specific RNA-sequencing data to determine genetic factors contributing to a key disease pathway. Specifically, they suggest important genetic variations that may underlie propensity to mucus plugging in asthma and could be important in targeted asthma phenotyping and disease management strategies.
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Affiliation(s)
- Matthew C Altman
- Department of Medicine, University of Washington, Seattle, Wash; Benaroya Research Institute, Seattle, Wash.
| | | | | | - Matthew Dapas
- Department of Human Genetics, University of Chicago, Chicago, Ill
| | | | | | | | - Michelle A Gill
- University of Texas Southwestern Medical Center, Dallas, Tex
| | | | - Andrew H Liu
- Children's Hospital Colorado University of Colorado School of Medicine, Aurora, Colo
| | | | | | | | | | | | - Robert A Wood
- Department of Pediatrics, Johns Hopkins University Medical Center, Baltimore, Md
| | | | | | - Peter J Gergen
- National Institutes of Health/National Institute of Allergy and Infectious Diseases, Bethesda, Md
| | - Alkis Togias
- National Institutes of Health/National Institute of Allergy and Infectious Diseases, Bethesda, Md
| | - William W Busse
- University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | | | - James E Gern
- University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Carole Ober
- Department of Human Genetics, University of Chicago, Chicago, Ill
| | - Daniel J Jackson
- University of Wisconsin School of Medicine and Public Health, Madison, Wis
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20
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Single-Cell and Population Transcriptomics Reveal Pan-epithelial Remodeling in Type 2-High Asthma. Cell Rep 2021; 32:107872. [PMID: 32640237 PMCID: PMC8046336 DOI: 10.1016/j.celrep.2020.107872] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 05/14/2020] [Accepted: 06/15/2020] [Indexed: 12/15/2022] Open
Abstract
The type 2 cytokine-high asthma endotype (T2H) is characterized by IL-13-driven mucus obstruction of the airways. To further investigate this incompletely understood pathobiology, we characterize IL-13 effects on human airway epithelial cell cultures using single-cell RNA sequencing, finding that IL-13 generates a distinctive transcriptional state for each cell type. Specifically, we discover a mucus secretory program induced by IL-13 in all cell types which converts both mucus and defense secretory cells into a metaplastic state with emergent mucin production and secretion, while leading to ER stress and cell death in ciliated cells. The IL-13-remodeled epithelium secretes a pathologic, mucin-imbalanced, and innate immunity-depleted proteome that arrests mucociliary motion. Signatures of IL-13-induced cellular remodeling are mirrored by transcriptional signatures characteristic of the nasal airway epithelium within T2H versus T2-low asthmatic children. Our results reveal the epithelium-wide scope of T2H asthma and present candidate therapeutic targets for restoring normal epithelial function. Using airway epithelial cell cultures, Jackson et al. show that IL-13, a driver of type 2-high asthma, induces emergent mucus secretory expression states for each cell type. This program universally diminishes innate airway defense, produces a pathologic mucus secretome that arrests mucociliary movement, and is recapitulated in type 2 inflamed children.
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21
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Montgomery MT, Sajuthi SP, Cho SH, Everman JL, Rios CL, Goldfarbmuren KC, Jackson ND, Saef B, Cromie M, Eng C, Medina V, Elhawary JR, Oh SS, Rodriguez-Santana J, Vladar EK, Burchard EG, Seibold MA. Genome-Wide Analysis Reveals Mucociliary Remodeling of the Nasal Airway Epithelium Induced by Urban PM 2.5. Am J Respir Cell Mol Biol 2020; 63:172-184. [PMID: 32275839 DOI: 10.1165/rcmb.2019-0454oc] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Air pollution particulate matter <2.5 μm (PM2.5) exposure is associated with poor respiratory outcomes. Mechanisms underlying PM2.5-induced lung pathobiology are poorly understood but likely involve cellular and molecular changes to the airway epithelium. We extracted and chemically characterized the organic and water-soluble components of air pollution PM2.5 samples, then determined the whole transcriptome response of human nasal mucociliary airway epithelial cultures to a dose series of PM2.5 extracts. We found that PM2.5 organic extract (OE), but not water-soluble extract, elicited a potent, dose-dependent transcriptomic response from the mucociliary epithelium. Exposure to a moderate OE dose modified the expression of 424 genes, including activation of aryl hydrocarbon receptor signaling and an IL-1 inflammatory program. We generated an OE-response gene network defined by eight functional enrichment groups, which exhibited high connectivity through CYP1A1, IL1A, and IL1B. This OE exposure also robustly activated a mucus secretory expression program (>100 genes), which included transcriptional drivers of mucus metaplasia (SPDEF and FOXA3). Exposure to a higher OE dose modified the expression of 1,240 genes and further exacerbated expression responses observed at the moderate dose, including the mucus secretory program. Moreover, the higher OE dose significantly increased the MUC5AC/MUC5B gel-forming mucin expression ratio and strongly downregulated ciliated cell expression programs, including key ciliating cell transcription factors (e.g., FOXJ1 and MCIDAS). Chronic OE stimulation induced mucus metaplasia-like remodeling characterized by increases in MUC5AC+ secretory cells and MUC5AC mucus secretions. This epithelial remodeling may underlie poor respiratory outcomes associated with high PM2.5 exposure.
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Affiliation(s)
| | | | - Seung-Hyun Cho
- RTI International, Research Triangle Park, North Carolina
| | | | | | | | | | | | | | | | - Vivian Medina
- Centro de Neumología Pediátrica, San Juan, Puerto Rico; and
| | | | | | | | - Eszter K Vladar
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine and.,Department of Cell and Developmental Biology, University of Colorado School of Medicine, Aurora, Colorado
| | - Esteban G Burchard
- Department of Medicine and.,Department of Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, California
| | - Max A Seibold
- Center for Genes, Environment, and Health, and.,Department of Pediatrics, National Jewish Health, Denver, Colorado.,Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine and
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22
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Sajuthi SP, DeFord P, Li Y, Jackson ND, Montgomery MT, Everman JL, Rios CL, Pruesse E, Nolin JD, Plender EG, Wechsler ME, Mak ACY, Eng C, Salazar S, Medina V, Wohlford EM, Huntsman S, Nickerson DA, Germer S, Zody MC, Abecasis G, Kang HM, Rice KM, Kumar R, Oh S, Rodriguez-Santana J, Burchard EG, Seibold MA. Type 2 and interferon inflammation regulate SARS-CoV-2 entry factor expression in the airway epithelium. Nat Commun 2020; 11:5139. [PMID: 33046696 PMCID: PMC7550582 DOI: 10.1038/s41467-020-18781-2] [Citation(s) in RCA: 103] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 09/08/2020] [Indexed: 11/08/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is caused by SARS-CoV-2, an emerging virus that utilizes host proteins ACE2 and TMPRSS2 as entry factors. Understanding the factors affecting the pattern and levels of expression of these genes is important for deeper understanding of SARS-CoV-2 tropism and pathogenesis. Here we explore the role of genetics and co-expression networks in regulating these genes in the airway, through the analysis of nasal airway transcriptome data from 695 children. We identify expression quantitative trait loci for both ACE2 and TMPRSS2, that vary in frequency across world populations. We find TMPRSS2 is part of a mucus secretory network, highly upregulated by type 2 (T2) inflammation through the action of interleukin-13, and that the interferon response to respiratory viruses highly upregulates ACE2 expression. IL-13 and virus infection mediated effects on ACE2 expression were also observed at the protein level in the airway epithelium. Finally, we define airway responses to common coronavirus infections in children, finding that these infections generate host responses similar to other viral species, including upregulation of IL6 and ACE2. Our results reveal possible mechanisms influencing SARS-CoV-2 infectivity and COVID-19 clinical outcomes.
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Grants
- R01 ES015794 NIEHS NIH HHS
- R01 HL120393 NHLBI NIH HHS
- HL128439 U.S. Department of Health & Human Services | NIH | National Heart, Lung, and Blood Institute (NHLBI)
- R01 HL141992 NHLBI NIH HHS
- UM1 HG008901 NHGRI NIH HHS
- R01 HL141845 NHLBI NIH HHS
- HL107202 U.S. Department of Health & Human Services | NIH | National Heart, Lung, and Blood Institute (NHLBI)
- HHSN268201800001C NHLBI NIH HHS
- U01 HG009080 NHGRI NIH HHS
- HL138626 U.S. Department of Health & Human Services | NIH | National Heart, Lung, and Blood Institute (NHLBI)
- R01 HL117626 NHLBI NIH HHS
- HL135156 U.S. Department of Health & Human Services | NIH | National Heart, Lung, and Blood Institute (NHLBI)
- HL132821 U.S. Department of Health & Human Services | NIH | National Heart, Lung, and Blood Institute (NHLBI)
- P01 HL107202 NHLBI NIH HHS
- K01 HL140218 NHLBI NIH HHS
- U01 HL120393 NHLBI NIH HHS
- HL117004 U.S. Department of Health & Human Services | NIH | National Heart, Lung, and Blood Institute (NHLBI)
- R01 HL135156 NHLBI NIH HHS
- T32 GM007546 NIGMS NIH HHS
- MD010443 U.S. Department of Health & Human Services | NIH | National Institute on Minority Health and Health Disparities (NIMHD)
- R01 HL128439 NHLBI NIH HHS
- R01 HL117004 NHLBI NIH HHS
- P60 MD006902 NIMHD NIH HHS
- HHSN268201600032C NHLBI NIH HHS
- U24 HG008956 NHGRI NIH HHS
- P01 HL132821 NHLBI NIH HHS
- R01 MD010443 NIMHD NIH HHS
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Affiliation(s)
- Satria P Sajuthi
- Center for Genes, Environment, and Health, National Jewish Health, Denver, CO, USA
| | - Peter DeFord
- Center for Genes, Environment, and Health, National Jewish Health, Denver, CO, USA
| | - Yingchun Li
- Center for Genes, Environment, and Health, National Jewish Health, Denver, CO, USA
| | - Nathan D Jackson
- Center for Genes, Environment, and Health, National Jewish Health, Denver, CO, USA
| | - Michael T Montgomery
- Center for Genes, Environment, and Health, National Jewish Health, Denver, CO, USA
| | - Jamie L Everman
- Center for Genes, Environment, and Health, National Jewish Health, Denver, CO, USA
| | - Cydney L Rios
- Center for Genes, Environment, and Health, National Jewish Health, Denver, CO, USA
| | - Elmar Pruesse
- Center for Genes, Environment, and Health, National Jewish Health, Denver, CO, USA
| | - James D Nolin
- Center for Genes, Environment, and Health, National Jewish Health, Denver, CO, USA
| | - Elizabeth G Plender
- Center for Genes, Environment, and Health, National Jewish Health, Denver, CO, USA
| | | | - Angel C Y Mak
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Celeste Eng
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Sandra Salazar
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Vivian Medina
- Centro de Neumología Pediátrica, San Juan, Puerto Rico
| | - Eric M Wohlford
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- Division of Pediatric Allergy and Immunology, University of California San Francisco, San Francisco, CA, USA
| | - Scott Huntsman
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Deborah A Nickerson
- Department of Genome Sciences, University of Washington, Seattle, WA, USA
- Northwest Genomics Center, Seattle, WA, USA
- Brotman Baty Institute, Seattle, WA, USA
| | | | | | - Gonçalo Abecasis
- Center for Statistical Genetics, University of Michigan, Ann Arbor, MI, USA
| | - Hyun Min Kang
- Center for Statistical Genetics, University of Michigan, Ann Arbor, MI, USA
| | - Kenneth M Rice
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Rajesh Kumar
- Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, IL, USA
| | - Sam Oh
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | | | - Esteban G Burchard
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- Department of Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Max A Seibold
- Center for Genes, Environment, and Health, National Jewish Health, Denver, CO, USA.
- Department of Pediatrics, National Jewish Health, Denver, CO, USA.
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado-AMC, Aurora, CO, USA.
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Lee EY, Mak ACY, Hu D, Sajuthi S, White MJ, Keys KL, Eckalbar W, Bonser L, Huntsman S, Urbanek C, Eng C, Jain D, Abecasis G, Kang HM, Germer S, Zody MC, Nickerson DA, Erle D, Ziv E, Rodriguez-Santana J, Seibold MA, Burchard EG. Whole-Genome Sequencing Identifies Novel Functional Loci Associated with Lung Function in Puerto Rican Youth. Am J Respir Crit Care Med 2020; 202:962-972. [PMID: 32459537 PMCID: PMC7528787 DOI: 10.1164/rccm.202002-0351oc] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 05/27/2020] [Indexed: 12/22/2022] Open
Abstract
Rationale: Puerto Ricans have the highest childhood asthma prevalence in the United States (23.6%); however, the etiology is uncertain.Objectives: In this study, we sought to uncover the genetic architecture of lung function in Puerto Rican youth with and without asthma who were recruited from the island (n = 836).Methods: We used admixture-mapping and whole-genome sequencing data to discover genomic regions associated with lung function. Functional roles of the prioritized candidate SNPs were examined with chromatin immunoprecipitation sequencing, RNA sequencing, and expression quantitative trait loci data.Measurements and Main Results: We discovered a genomic region at 1q32 that was significantly associated with a 0.12-L decrease in the lung volume of exhaled air (95% confidence interval, -0.17 to -0.07; P = 6.62 × 10-8) with each allele of African ancestry. Within this region, two SNPs were expression quantitative trait loci of TMEM9 in nasal airway epithelial cells and MROH3P in esophagus mucosa. The minor alleles of these SNPs were associated with significantly decreased lung function and decreased TMEM9 gene expression. Another admixture-mapping peak was observed on chromosome 5q35.1, indicating that each Native American ancestry allele was associated with a 0.15-L increase in lung function (95% confidence interval, 0.08-0.21; P = 5.03 × 10-6). The region-based association tests identified four suggestive windows that harbored candidate rare variants associated with lung function.Conclusions: We identified common and rare genetic variants that may play a critical role in lung function among Puerto Rican youth. We independently validated an inflammatory pathway that could potentially be used to develop more targeted treatments and interventions for patients with asthma.
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Affiliation(s)
- Eunice Y. Lee
- Department of Bioengineering and Therapeutic Sciences and
- Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Angel C. Y. Mak
- Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Donglei Hu
- Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Satria Sajuthi
- Department of Pediatrics, Center for Genes, Environment, and Health, and
| | - Marquitta J. White
- Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Kevin L. Keys
- Department of Medicine, University of California, San Francisco, San Francisco, California
| | | | - Luke Bonser
- Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Scott Huntsman
- Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Cydney Urbanek
- Department of Pediatrics, Center for Genes, Environment, and Health, and
| | - Celeste Eng
- Department of Medicine, University of California, San Francisco, San Francisco, California
| | | | - Gonçalo Abecasis
- Center for Statistical Genetics, University of Michigan, Ann Arbor, Michigan
- Regeneron Pharmaceuticals, Tarrytown, New York
| | - Hyun M. Kang
- Center for Statistical Genetics, University of Michigan, Ann Arbor, Michigan
| | | | | | - Deborah A. Nickerson
- Department of Genome Sciences, University of Washington, Seattle, Washington
- Northwest Genomics Center, Seattle, Washington
- Brotman Baty Institute, Seattle, Washington
| | - David Erle
- Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Elad Ziv
- Department of Medicine, University of California, San Francisco, San Francisco, California
| | | | - Max A. Seibold
- Department of Pediatrics, Center for Genes, Environment, and Health, and
- Department of Pediatrics, National Jewish Health, Denver, Colorado
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado–Anschutz Medical Campus, Aurora, Colorado
| | - Esteban G. Burchard
- Department of Bioengineering and Therapeutic Sciences and
- Department of Medicine, University of California, San Francisco, San Francisco, California
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24
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Expression quantitative trait locus fine mapping of the 17q12-21 asthma locus in African American children: a genetic association and gene expression study. THE LANCET RESPIRATORY MEDICINE 2020; 8:482-492. [PMID: 32380068 DOI: 10.1016/s2213-2600(20)30011-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 01/08/2020] [Accepted: 01/13/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND African ancestry is associated with a higher prevalence and greater severity of asthma than European ancestries, yet genetic studies of the most common locus associated with childhood-onset asthma, 17q12-21, in African Americans have been inconclusive. The aim of this study was to leverage both the phenotyping of the Children's Respiratory and Environmental Workgroup (CREW) birth cohort consortium, and the reduced linkage disequilibrium in African Americans, to fine map the 17q12-21 locus. METHODS We first did a genetic association study and meta-analysis using 17q12-21 tag single-nucleotide polymorphisms (SNPs) for childhood-onset asthma in 1613 European American and 870 African American children from the CREW consortium. Nine tag SNPs were selected based on linkage disequilibrium patterns at 17q12-21 and their association with asthma, considering the effect allele under an additive model (0, 1, or 2 effect alleles). Results were meta-analysed with publicly available summary data from the EVE consortium (on 4303 European American and 3034 African American individuals) for seven of the nine SNPs of interest. Subsequently, we tested for expression quantitative trait loci (eQTLs) among the SNPs associated with childhood-onset asthma and the expression of 17q12-21 genes in resting peripheral blood mononuclear cells (PBMCs) from 85 African American CREW children and in upper airway epithelial cells from 246 African American CREW children; and in lower airway epithelial cells from 44 European American and 72 African American adults from a case-control study of asthma genetic risk in Chicago (IL, USA). FINDINGS 17q12-21 SNPs were broadly associated with asthma in European Americans. Only two SNPs (rs2305480 in gasdermin-B [GSDMB] and rs8076131 in ORMDL sphingolipid biosynthesis regulator 3 [ORMDL3]) were associated with asthma in African Americans, at a Bonferroni-corrected threshold of p<0·0055 (for rs2305480_G, odds ratio [OR] 1·36 [95% CI 1·12-1·65], p=0·0014; and for rs8076131_A, OR 1·37 [1·13-1·67], p=0·0010). In upper airway epithelial cells from African American children, genotype at rs2305480 was the most significant eQTL for GSDMB (eQTL effect size [β] 1·35 [95% CI 1·25-1·46], p<0·0001), and to a lesser extent showed an eQTL effect for post-GPI attachment to proteins phospholipase 3 (β 1·15 [1·08-1·22], p<0·0001). No SNPs were eQTLs for ORMDL3. By contrast, in PBMCs, the five core SNPs were associated only with expression of GSDMB and ORMDL3. Genotype at rs12936231 (in zona pellucida binding protein 2) showed the strongest associations across both genes (for GSDMB, eQTLβ 1·24 [1·15-1·32], p<0·0001; and for ORMDL3 (β 1·19 [1·12-1·24], p<0·0001). The eQTL effects of rs2305480 on GSDMB expression were replicated in lower airway cells from African American adults (β 1·29 [1·15-1·44], p<0·0001). INTERPRETATION Our study suggests that SNPs regulating GSDMB expression in airway epithelial cells have a major role in childhood-onset asthma, whereas SNPs regulating the expression levels of 17q12-21 genes in resting blood cells are not central to asthma risk. Our genetic and gene expression data in African Americans and European Americans indicated GSDMB to be the leading candidate gene at this important asthma locus. FUNDING National Institutes of Health, Office of the Director.
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25
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Magaña J, Contreras MG, Keys KL, Risse-Adams O, Goddard PC, Zeiger AM, Mak ACY, Elhawary JR, Samedy-Bates LA, Lee E, Thakur N, Hu D, Eng C, Salazar S, Huntsman S, Hu T, Burchard EG, White MJ. An epistatic interaction between pre-natal smoke exposure and socioeconomic status has a significant impact on bronchodilator drug response in African American youth with asthma. BioData Min 2020; 13:7. [PMID: 32636926 PMCID: PMC7333373 DOI: 10.1186/s13040-020-00218-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 06/23/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Asthma is one of the leading chronic illnesses among children in the United States. Asthma prevalence is higher among African Americans (11.2%) compared to European Americans (7.7%). Bronchodilator medications are part of the first-line therapy, and the rescue medication, for acute asthma symptoms. Bronchodilator drug response (BDR) varies substantially among different racial/ethnic groups. Asthma prevalence in African Americans is only 3.5% higher than that of European Americans, however, asthma mortality among African Americans is four times that of European Americans; variation in BDR may play an important role in explaining this health disparity. To improve our understanding of disparate health outcomes in complex phenotypes such as BDR, it is important to consider interactions between environmental and biological variables. RESULTS We evaluated the impact of pairwise and three-variable interactions between environmental, social, and biological variables on BDR in 233 African American youth with asthma using Visualization of Statistical Epistasis Networks (ViSEN). ViSEN is a non-parametric entropy-based approach able to quantify interaction effects using an information-theory metric known as Information Gain (IG). We performed analyses in the full dataset and in sex-stratified subsets. Our analyses identified several interaction models significantly, and suggestively, associated with BDR. The strongest interaction significantly associated with BDR was a pairwise interaction between pre-natal smoke exposure and socioeconomic status (full dataset IG: 2.78%, p = 0.001; female IG: 7.27%, p = 0.004)). Sex-stratified analyses yielded divergent results for females and males, indicating the presence of sex-specific effects. CONCLUSIONS Our study identified novel interaction effects significantly, and suggestively, associated with BDR in African American children with asthma. Notably, we found that all of the interactions identified by ViSEN were "pure" interaction effects, in that they were not the result of strong main effects on BDR, highlighting the complexity of the network of biological and environmental factors impacting this phenotype. Several associations uncovered by ViSEN would not have been detected using regression-based methods, thus emphasizing the importance of employing statistical methods optimized to detect both additive and non-additive interaction effects when studying complex phenotypes such as BDR. The information gained in this study increases our understanding and appreciation of the complex nature of the interactions between environmental and health-related factors that influence BDR and will be invaluable to biomedical researchers designing future studies.
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Affiliation(s)
- J. Magaña
- Department of Medicine, University of California, 1550 4th Street, UCSF Rock Hall, Box 2911, San Francisco, CA 94158 USA
| | - M. G. Contreras
- Department of Medicine, University of California, 1550 4th Street, UCSF Rock Hall, Box 2911, San Francisco, CA 94158 USA
- Department of Biology, San Francisco State University, San Francisco, CA USA
| | - K. L. Keys
- Department of Medicine, University of California, 1550 4th Street, UCSF Rock Hall, Box 2911, San Francisco, CA 94158 USA
- Berkeley Institute for Data Science, University of California, Berkeley, CA USA
| | - O. Risse-Adams
- Department of Medicine, University of California, 1550 4th Street, UCSF Rock Hall, Box 2911, San Francisco, CA 94158 USA
- Lowell Science Research Program, Lowell High School, San Francisco, CA USA
- Department of Biology, University of California, Santa Cruz, CA USA
| | - P. C. Goddard
- Department of Medicine, University of California, 1550 4th Street, UCSF Rock Hall, Box 2911, San Francisco, CA 94158 USA
- Department of Genetics, Stanford University, Stanford, CA USA
| | - A. M. Zeiger
- Department of Medicine, University of California, 1550 4th Street, UCSF Rock Hall, Box 2911, San Francisco, CA 94158 USA
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA USA
| | - A. C. Y. Mak
- Department of Medicine, University of California, 1550 4th Street, UCSF Rock Hall, Box 2911, San Francisco, CA 94158 USA
| | - J. R. Elhawary
- Department of Medicine, University of California, 1550 4th Street, UCSF Rock Hall, Box 2911, San Francisco, CA 94158 USA
| | - L. A. Samedy-Bates
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, CA USA
| | - E. Lee
- Department of Medicine, University of California, 1550 4th Street, UCSF Rock Hall, Box 2911, San Francisco, CA 94158 USA
| | - N. Thakur
- Department of Medicine, University of California, 1550 4th Street, UCSF Rock Hall, Box 2911, San Francisco, CA 94158 USA
| | - D. Hu
- Department of Medicine, University of California, 1550 4th Street, UCSF Rock Hall, Box 2911, San Francisco, CA 94158 USA
| | - C. Eng
- Department of Medicine, University of California, 1550 4th Street, UCSF Rock Hall, Box 2911, San Francisco, CA 94158 USA
| | - S. Salazar
- Department of Medicine, University of California, 1550 4th Street, UCSF Rock Hall, Box 2911, San Francisco, CA 94158 USA
| | - S. Huntsman
- Department of Medicine, University of California, 1550 4th Street, UCSF Rock Hall, Box 2911, San Francisco, CA 94158 USA
| | - T. Hu
- School of Computing, Queen’s University, Kingston, ON Canada
| | - E. G. Burchard
- Department of Medicine, University of California, 1550 4th Street, UCSF Rock Hall, Box 2911, San Francisco, CA 94158 USA
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, CA USA
| | - M. J. White
- Department of Medicine, University of California, 1550 4th Street, UCSF Rock Hall, Box 2911, San Francisco, CA 94158 USA
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Olaniyan T, Jeebhay M, Röösli M, Naidoo RN, Künzli N, de Hoogh K, Saucy A, Badpa M, Baatjies R, Parker B, Leaner J, Dalvie MA. The association between ambient NO 2 and PM 2.5 with the respiratory health of school children residing in informal settlements: A prospective cohort study. ENVIRONMENTAL RESEARCH 2020; 186:109606. [PMID: 32371276 DOI: 10.1016/j.envres.2020.109606] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 04/25/2020] [Accepted: 04/25/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND No previous epidemiological study has investigated the combined association of long-term ambient nitrogen dioxide (NO2) and particulate matter of diameter size-2.5 (PM2.5) exposure with asthma outcomes among schoolchildren in Africa. OBJECTIVES This study investigated the independent and co-pollutant association of long-term exposures to ambient air pollutants on asthma-associated outcomes in a cohort of schoolchildren in the Western Cape Province of South Africa. METHODS A total of 590 grade-4 schoolchildren residing in four informal settlements were studied. Spirometry and fractional exhaled nitric-oxide (FeNO) measurements were conducted, including a standardized questionnaire administered to caregivers at baseline and 12-months follow-up. Annual NO2 and PM2.5 levels were estimated for each child's home using land-use regression modelling. Single- and two-pollutant models were constructed to assess the independent and co-pollutant association of both air pollutants (NO2 and PM2.5) on new cases of asthma-associated outcomes adjusting-for host characteristics, indoor exposures and study area. RESULTS The annual average concentration of PM2.5 and NO2 were 10.01μg/m3 and 16.62μg/m3 respectively, across the four study areas, and were below the local Standards of 20μg/m3 and 40μg/m3, for both pollutants, respectively. In the two-pollutant-adjusted models, an interquartile range (IQR) increase of 14.2μg/m3 in NO2 was associated with an increased risk of new onset of ocular-nasal symptoms (adjusted odds ratio-aOR: 1.63, 95% CI: 1.01-2.60), wheezing (aOR: 3.57, 95% CI: 1.18-10.92), more than two or more asthma symptom score (aOR: 1.71, 95% CI: 1.02-2.86), and airway inflammation defined as FeNO > 35 ppb (aOR: 3.10, 95% CI: 1.10-8.71), independent of PM2.5 exposures. CONCLUSION This study provided evidence that ambient NO2 levels below local standards and international guidelines, independent of PM2.5 exposure, increases new cases of asthma-associated outcomes after 12-months.
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Affiliation(s)
- Toyib Olaniyan
- Centre for Environmental and Occupational Health Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
| | - Mohamed Jeebhay
- Centre for Environmental and Occupational Health Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa; Division of Occupational Medicine, University of Cape Town, Cape Town, South Africa.
| | - Martin Röösli
- Swiss Tropical and Public Health Institute, Socinstrasse 57, P.O. Box, 4002, Basel, Switzerland; University of Basel, Petersplatz 1, 4003, Basel, Switzerland.
| | | | - Nino Künzli
- Swiss Tropical and Public Health Institute, Socinstrasse 57, P.O. Box, 4002, Basel, Switzerland; University of Basel, Petersplatz 1, 4003, Basel, Switzerland.
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Socinstrasse 57, P.O. Box, 4002, Basel, Switzerland; University of Basel, Petersplatz 1, 4003, Basel, Switzerland.
| | - Apolline Saucy
- Swiss Tropical and Public Health Institute, Socinstrasse 57, P.O. Box, 4002, Basel, Switzerland; University of Basel, Petersplatz 1, 4003, Basel, Switzerland.
| | - Mahnaz Badpa
- Swiss Tropical and Public Health Institute, Socinstrasse 57, P.O. Box, 4002, Basel, Switzerland; University of Basel, Petersplatz 1, 4003, Basel, Switzerland.
| | - Roslynn Baatjies
- Centre for Environmental and Occupational Health Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa; Department of Environmental and Occupational Studies, Faculty of Applied Sciences, Cape Peninsula University of Technology, Cape Town, 7700, South Africa.
| | - Bhawoodien Parker
- Department of Environmental Affairs and Developmental Planning, Western Cape Government, Cape Town, South Africa.
| | - Joy Leaner
- Department of Environmental Affairs and Developmental Planning, Western Cape Government, Cape Town, South Africa.
| | - Mohamed Aqiel Dalvie
- Centre for Environmental and Occupational Health Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
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Mak ACY, Sajuthi S, Joo J, Xiao S, Sleiman PM, White MJ, Lee EY, Saef B, Hu D, Gui H, Keys KL, Lurmann F, Jain D, Abecasis G, Kang HM, Nickerson DA, Germer S, Zody MC, Winterkorn L, Reeves C, Huntsman S, Eng C, Salazar S, Oh SS, Gilliland FD, Chen Z, Kumar R, Martínez FD, Wu AC, Ziv E, Hakonarson H, Himes BE, Williams LK, Seibold MA, Burchard EG. Lung Function in African American Children with Asthma Is Associated with Novel Regulatory Variants of the KIT Ligand KITLG/SCF and Gene-By-Air-Pollution Interaction. Genetics 2020; 215:869-886. [PMID: 32327564 PMCID: PMC7337089 DOI: 10.1534/genetics.120.303231] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 04/22/2020] [Indexed: 01/12/2023] Open
Abstract
Baseline lung function, quantified as forced expiratory volume in the first second of exhalation (FEV1), is a standard diagnostic criterion used by clinicians to identify and classify lung diseases. Using whole-genome sequencing data from the National Heart, Lung, and Blood Institute Trans-Omics for Precision Medicine project, we identified a novel genetic association with FEV1 on chromosome 12 in 867 African American children with asthma (P = 1.26 × 10-8, β = 0.302). Conditional analysis within 1 Mb of the tag signal (rs73429450) yielded one major and two other weaker independent signals within this peak. We explored statistical and functional evidence for all variants in linkage disequilibrium with the three independent signals and yielded nine variants as the most likely candidates responsible for the association with FEV1 Hi-C data and expression QTL analysis demonstrated that these variants physically interacted with KITLG (KIT ligand, also known as SCF), and their minor alleles were associated with increased expression of the KITLG gene in nasal epithelial cells. Gene-by-air-pollution interaction analysis found that the candidate variant rs58475486 interacted with past-year ambient sulfur dioxide exposure (P = 0.003, β = 0.32). This study identified a novel protective genetic association with FEV1, possibly mediated through KITLG, in African American children with asthma. This is the first study that has identified a genetic association between lung function and KITLG, which has established a role in orchestrating allergic inflammation in asthma.
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Affiliation(s)
- Angel C Y Mak
- Department of Medicine, University of California, San Francisco, California 94143
| | - Satria Sajuthi
- Center for Genes, Environment, and Health, National Jewish Health, Denver, Colorado 80206
| | - Jaehyun Joo
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania 19104
| | - Shujie Xiao
- Center for Individualized and Genomic Medicine Research, Department of Internal Medicine, Henry Ford Health System, Detroit, Michigan 48202
| | - Patrick M Sleiman
- Center for Applied Genomics, Children's Hospital of Philadelphia, Pennsylvania, 19104
- Division of Human Genetics, Department of Pediatrics, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104
| | - Marquitta J White
- Department of Medicine, University of California, San Francisco, California 94143
| | - Eunice Y Lee
- Department of Medicine, University of California, San Francisco, California 94143
| | - Benjamin Saef
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania 19104
| | - Donglei Hu
- Department of Medicine, University of California, San Francisco, California 94143
| | - Hongsheng Gui
- Center for Individualized and Genomic Medicine Research, Department of Internal Medicine, Henry Ford Health System, Detroit, Michigan 48202
| | - Kevin L Keys
- Department of Medicine, University of California, San Francisco, California 94143
- Berkeley Institute for Data Science, University of California, Berkeley, California 94720
| | | | - Deepti Jain
- Department of Biostatistics, University of Washington, Seattle, Washington 98195
| | - Gonçalo Abecasis
- Center for Statistical Genetics, University of Michigan, Ann Arbor, Michigan 48109
| | - Hyun Min Kang
- Center for Statistical Genetics, University of Michigan, Ann Arbor, Michigan 48109
| | - Deborah A Nickerson
- Department of Genome Sciences, University of Washington, Seattle, Washington 98195
- Northwest Genomics Center, Seattle, Washington, 98195
- Brotman Baty Institute for Precision Medicine, Seattle, Washington, 98195
| | | | | | | | | | - Scott Huntsman
- Department of Medicine, University of California, San Francisco, California 94143
| | - Celeste Eng
- Department of Medicine, University of California, San Francisco, California 94143
| | - Sandra Salazar
- Department of Medicine, University of California, San Francisco, California 94143
| | - Sam S Oh
- Department of Medicine, University of California, San Francisco, California 94143
| | - Frank D Gilliland
- Department of Preventive Medicine, Division of Environmental Health, Keck School of Medicine, University of Southern California, Los Angeles, California 90033
| | - Zhanghua Chen
- Department of Preventive Medicine, Division of Environmental Health, Keck School of Medicine, University of Southern California, Los Angeles, California 90033
| | - Rajesh Kumar
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois 60611
| | - Fernando D Martínez
- Asthma and Airway Disease Research Center, University of Arizona, Tucson, Arizona 85721
| | - Ann Chen Wu
- Precision Medicine Translational Research (PRoMoTeR) Center, Department of Population Medicine, Harvard Medical School and Pilgrim Health Care Institute, Boston, Massachusetts 02215
| | - Elad Ziv
- Department of Medicine, University of California, San Francisco, California 94143
| | - Hakon Hakonarson
- Center for Applied Genomics, Children's Hospital of Philadelphia, Pennsylvania, 19104
- Division of Human Genetics, Department of Pediatrics, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104
| | - Blanca E Himes
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania 19104
| | - L Keoki Williams
- Center for Individualized and Genomic Medicine Research, Department of Internal Medicine, Henry Ford Health System, Detroit, Michigan 48202
| | - Max A Seibold
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania 19104
| | - Esteban G Burchard
- Department of Medicine, University of California, San Francisco, California 94143
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, California 94143
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Differential asthma odds following respiratory infection in children from three minority populations. PLoS One 2020; 15:e0231782. [PMID: 32369487 PMCID: PMC7199930 DOI: 10.1371/journal.pone.0231782] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 03/31/2020] [Indexed: 01/01/2023] Open
Abstract
RATIONALE Severe early-life respiratory illnesses, particularly those caused by respiratory syncytial virus (RSV) and human rhinovirus (HRV), are strongly associated with the development of asthma in children. Puerto Rican children in particular have a strikingly high asthma burden. However, prior studies of the potential associations between early-life respiratory illnesses and asthma in Puerto Rican and other minority populations have been limited. OBJECTIVES We sought to determine whether early-life respiratory illness was associated with asthma in Puerto Rican, Mexican American, and African American children. METHODS Using a logistic regression analysis, we examined the association between early-life respiratory illnesses (report of upper respiratory infection (URI), pneumonia, bronchitis, and bronchiolitis/RSV) within the first two years of life and physician-diagnosed asthma after the age of two in a large cohort of Puerto Rican, Mexican American, and African American children. MEASUREMENTS AND MAIN RESULTS While early-life respiratory illnesses were associated with greater asthma odds in Puerto Ricans, Mexican Americans, and African Americans, these associations were stronger among Puerto Rican children. Specifically, in Puerto Ricans, the odds was 6.15 (95% CI: 4.21-9.05) if the child reported at least one of the following respiratory illness: URI, pneumonia, bronchitis or bronchiolitis. The odds were also higher in Puerto Ricans when considering these conditions separately. CONCLUSIONS We observed population-specific associations between early-life respiratory illnesses and asthma, which were especially significant and stronger in Puerto Ricans. Taken together with the known high burden of RSV in Puerto Rico, our results may help explain the high burden of asthma in Puerto Ricans.
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Sajuthi SP, DeFord P, Jackson ND, Montgomery MT, Everman JL, Rios CL, Pruesse E, Nolin JD, Plender EG, Wechsler ME, Mak ACY, Eng C, Salazar S, Medina V, Wohlford EM, Huntsman S, Nickerson DA, Germer S, Zody MC, Abecasis G, Kang HM, Rice KM, Kumar R, Oh S, Rodriguez-Santana J, Burchard EG, Seibold MA. Type 2 and interferon inflammation strongly regulate SARS-CoV-2 related gene expression in the airway epithelium. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2020:2020.04.09.034454. [PMID: 32511326 PMCID: PMC7239056 DOI: 10.1101/2020.04.09.034454] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Coronavirus disease 2019 (COVID-19) outcomes vary from asymptomatic infection to death. This disparity may reflect different airway levels of the SARS-CoV-2 receptor, ACE2, and the spike protein activator, TMPRSS2. Here we explore the role of genetics and co-expression networks in regulating these genes in the airway, through the analysis of nasal airway transcriptome data from 695 children. We identify expression quantitative trait loci (eQTL) for both ACE2 and TMPRSS2, that vary in frequency across world populations. Importantly, we find TMPRSS2 is part of a mucus secretory network, highly upregulated by T2 inflammation through the action of interleukin-13, and that interferon response to respiratory viruses highly upregulates ACE2 expression. Finally, we define airway responses to coronavirus infections in children, finding that these infections upregulate IL6 while also stimulating a more pronounced cytotoxic immune response relative to other respiratory viruses. Our results reveal mechanisms likely influencing SARS-CoV-2 infectivity and COVID-19 clinical outcomes.
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Affiliation(s)
- Satria P. Sajuthi
- Center for Genes, Environment, and Health, National Jewish Health, Denver, CO, 80206 USA
| | - Peter DeFord
- Center for Genes, Environment, and Health, National Jewish Health, Denver, CO, 80206 USA
| | - Nathan D. Jackson
- Center for Genes, Environment, and Health, National Jewish Health, Denver, CO, 80206 USA
| | - Michael T. Montgomery
- Center for Genes, Environment, and Health, National Jewish Health, Denver, CO, 80206 USA
| | - Jamie L. Everman
- Center for Genes, Environment, and Health, National Jewish Health, Denver, CO, 80206 USA
| | - Cydney L. Rios
- Center for Genes, Environment, and Health, National Jewish Health, Denver, CO, 80206 USA
| | - Elmar Pruesse
- Center for Genes, Environment, and Health, National Jewish Health, Denver, CO, 80206 USA
| | - James D. Nolin
- Center for Genes, Environment, and Health, National Jewish Health, Denver, CO, 80206 USA
| | - Elizabeth G. Plender
- Center for Genes, Environment, and Health, National Jewish Health, Denver, CO, 80206 USA
| | | | - Angel CY Mak
- Department of Medicine, Therapeutic Sciences University of California San Francisco, San Francisco, CA
| | - Celeste Eng
- Department of Medicine, Therapeutic Sciences University of California San Francisco, San Francisco, CA
| | - Sandra Salazar
- Department of Medicine, Therapeutic Sciences University of California San Francisco, San Francisco, CA
| | - Vivian Medina
- Centro de Neumología Pediátrica, San Juan, Puerto Rico
| | - Eric M. Wohlford
- Department of Medicine, Therapeutic Sciences University of California San Francisco, San Francisco, CA
- Division of Pediatric Allergy and Immunology, Therapeutic Sciences University of California San Francisco, San Francisco, CA
| | - Scott Huntsman
- Department of Medicine, Therapeutic Sciences University of California San Francisco, San Francisco, CA
| | - Deborah A. Nickerson
- Department of Genome Sciences, University of Washington, Seattle, WA, USA
- Northwest Genomics Center, Seattle, WA, USA
- Brotman Baty Institute, Seattle, WA, USA
| | | | | | - Gonçalo Abecasis
- Center for Statistical Genetics, University of Michigan, Ann Arbor, MI, USA
| | - Hyun Min Kang
- Center for Statistical Genetics, University of Michigan, Ann Arbor, MI, USA
| | - Kenneth M. Rice
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Rajesh Kumar
- Ann and Robert H. Lurie Children’s Hospital of Chicago, Department of Pediatrics, Northwestern University, Chicago, III
| | - Sam Oh
- Department of Medicine, Therapeutic Sciences University of California San Francisco, San Francisco, CA
| | | | - Esteban G. Burchard
- Department of Medicine, Therapeutic Sciences University of California San Francisco, San Francisco, CA
- Department of Bioengineering and Therapeutic Sciences University of California San Francisco, San Francisco, CA
| | - Max A. Seibold
- Center for Genes, Environment, and Health, National Jewish Health, Denver, CO, 80206 USA
- Department of Pediatrics, National Jewish Health, Denver, CO, 80206 USA
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado-AMC, Aurora, CO, 80045 USA
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Lack S, Kinser PA. The modification of three vulnerability theories to assist nursing practice for school-age children with severe asthma. J SPEC PEDIATR NURS 2020; 25:e12280. [PMID: 31749322 DOI: 10.1111/jspn.12280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 11/01/2019] [Accepted: 11/06/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE Severe asthma is an inflammatory illness associated with adverse health outcomes and behaviors in children, such as decreased quality of life, impaired sleep, and increased medical costs and morbidity. CONCLUSIONS Children with severe asthma frequently exhibit a cycle of health and behaviors which contribute to these adverse health outcomes, consisting of decreased physical activity, increased stress, and increased airway inflammation and asthma exacerbations. School-age children, in particular, are a vulnerable population because they not only rely on others for their care but also suffer from a chronic illness and are at risk for unequal healthcare access and health outcomes. PRACTICE IMPLICATIONS Currently, there is no one nursing theory that adequately addresses the vulnerability, cycle of health and behaviors, and adverse health outcomes of children with severe asthma. By integrating key concepts from three vulnerability theories and presenting a modified conceptual framework, this paper aims to demonstrate how the use of this new conceptual framework may assist nurses in evaluating the unique needs of school-age children with severe asthma to provide best practices and develop appropriate interventions.
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Affiliation(s)
- Sharon Lack
- School of Nursing, Virginia Commonwealth University, Richmond, Virginia
| | - Patricia A Kinser
- School of Nursing, Virginia Commonwealth University, Richmond, Virginia
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Rosser F, Forno E, Kurland KS, Han YY, Mair C, Acosta-Pérez E, Canino G, Celedón JC. Annual SO 2 exposure, asthma, atopy, and lung function in Puerto Rican children. Pediatr Pulmonol 2020; 55:330-337. [PMID: 31805225 PMCID: PMC7122992 DOI: 10.1002/ppul.24595] [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: 08/27/2019] [Accepted: 11/20/2019] [Indexed: 11/05/2022]
Abstract
BACKGROUND Long-term effects of sulfur dioxide (SO2 ) exposure on children, a vulnerable population, are largely unknown. Further, how long-term SO2 affects Puerto Rican children living in the island of Puerto Rico, a group with high asthma prevalence, is unclear. We evaluated the effects of annual average 1-hour daily maximum SO2 average on asthma, atopy, total immunoglobulin E (IgE), and lung function in Puerto Rican children. METHODS A cohort of 678 children (351 with asthma, 327 without asthma) was recruited in Puerto Rico from 2009 to 2010. Annual average 1-hour daily maximum SO2 exposure was interpolated utilizing publicly available monitoring data. Multivariable logistic and linear regression was used for the analysis of asthma, atopy (defined as an IgE ≥0.35 IU/mL to at least one of five common aero-allergens), total IgE, and lung function measures (forced vital capacity [FVC], forced expiratory volume in 1 second [FEV1], and FEV1/FVC ratio). RESULTS Annual SO2 exposure (per 1 ppb) was significantly associated with asthma (odds ratio [OR] = 1.42; 95% confidence interval [CI] = 1.05-1.91) and atopy (OR = 1.35; 95% CI = 1.02-1.78). Such exposure was also significantly associated with lower FEV1/FVC in all children (β = -1.42; 95% CI = -2.78 to -0.08) and in children with asthma (β = -2.39; 95% CI= -4.31 to -0.46). Annual SO2 exposure was not significantly associated with total IgE, FEV1, or FVC. CONCLUSIONS Among Puerto Rican children in Puerto Rico, long-term SO2 exposure is linked to asthma and atopy. In these children, long-term SO2 exposure is also associated with reduced FEV1/FVC, particularly in those with asthma.
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Affiliation(s)
- Franziska Rosser
- Division of Pediatric Pulmonary Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Erick Forno
- Division of Pediatric Pulmonary Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kristen S Kurland
- H John Heinz III College and School of Architecture, Carnegie Mellon University, Pittsburgh, Pennsylvania
| | - Yueh-Ying Han
- Division of Pediatric Pulmonary Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Christina Mair
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Edna Acosta-Pérez
- Behavioral Sciences Research Institute of Puerto Rico, University of Puerto Rico, San Juan, Puerto Rico
| | - Glorisa Canino
- Behavioral Sciences Research Institute of Puerto Rico, University of Puerto Rico, San Juan, Puerto Rico
| | - Juan C Celedón
- Division of Pediatric Pulmonary Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania
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Lee EY, Oh SS, White MJ, Eng CS, Elhawary JR, Borrell LN, Nuckton TJ, Zeiger AM, Keys KL, Mak ACY, Hu D, Huntsman S, Contreras MG, Samedy LA, Goddard PC, Salazar SL, Brigino-Buenaventura EN, Davis A, Meade KE, LeNoir MA, Lurmann FW, Burchard EG, Eisen EA, Balmes JR. Ambient air pollution, asthma drug response, and telomere length in African American youth. J Allergy Clin Immunol 2019; 144:839-845.e10. [PMID: 31247265 PMCID: PMC6938647 DOI: 10.1016/j.jaci.2019.06.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 06/07/2019] [Accepted: 06/14/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Telomere length (TL) can serve as a potential biomarker for conditions associated with chronic oxidative stress and inflammation, such as asthma. Air pollution can induce oxidative stress. Understanding the relationship between TL, asthma, and air pollution is important for identifying risk factors contributing to unhealthy aging in children. OBJECTIVES We sought to investigate associations between exposures to ambient air pollutants and TL in African American children and adolescents and to examine whether African ancestry, asthma status, and steroid medication use alter the association. METHODS Linear regression was used to examine associations between absolute telomere length (aTL) and estimated annual average residential ozone (O3) and fine particulate matter with a diameter of 2.5 μm or less (PM2.5) exposures in a cross-sectional analysis of 1072 children in an existing asthma case-control study. African ancestry, asthma status, and use of steroid medications were examined as effect modifiers. RESULTS Participants' aTLs were measured by using quantitative PCR. A 1-ppb and 1 μg/m3 increase in annual average exposure to O3 and PM2.5 were associated with a decrease in aTL of 37.1 kilo-base pair (kb; 95% CI, -66.7 to -7.4 kb) and 57.1 kb (95% CI, -118.1 to 3.9 kb), respectively. African ancestry and asthma were not effect modifiers; however, exposure to steroid medications modified the relationships between TL and pollutants. Past-year exposure to O3 and PM2.5 was associated with shorter TLs in patients without steroid use. CONCLUSION Exposure to air pollution was associated with shorter TLs in nonasthmatic children and adolescents. This was not the case for asthmatic children as a group, but those receiving steroid medication had less shortening than those not using steroids. Reduced exposure to air pollution in childhood might help to preserve TL.
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Affiliation(s)
- Eunice Y Lee
- Department of Bioengineering & Therapeutic Sciences, University of California, San Francisco, Calif; Department of Medicine, University of California, San Francisco, Calif.
| | - Sam S Oh
- Department of Medicine, University of California, San Francisco, Calif
| | - Marquitta J White
- Department of Medicine, University of California, San Francisco, Calif
| | - Celeste S Eng
- Department of Medicine, University of California, San Francisco, Calif
| | | | - Luisa N Borrell
- Graduate School of Public Health & Health Policy, City University of New York, New York, NY
| | - Thomas J Nuckton
- Department of Medicine, University of California, San Francisco, Calif
| | - Andrew M Zeiger
- Department of Medicine, University of California, San Francisco, Calif
| | - Kevin L Keys
- Department of Medicine, University of California, San Francisco, Calif
| | - Angel C Y Mak
- Department of Medicine, University of California, San Francisco, Calif
| | - Donglei Hu
- Department of Medicine, University of California, San Francisco, Calif
| | - Scott Huntsman
- Department of Medicine, University of California, San Francisco, Calif
| | - Maria G Contreras
- Department of Medicine, University of California, San Francisco, Calif; San Francisco State University, San Francisco, Calif
| | - Lesly-Anne Samedy
- Department of Bioengineering & Therapeutic Sciences, University of California, San Francisco, Calif
| | - Pagé C Goddard
- Department of Medicine, University of California, San Francisco, Calif
| | - Sandra L Salazar
- Department of Medicine, University of California, San Francisco, Calif
| | | | - Adam Davis
- Children's Hospital and Research Center, Oakland, Calif
| | | | | | | | - Esteban G Burchard
- Department of Bioengineering & Therapeutic Sciences, University of California, San Francisco, Calif; Department of Medicine, University of California, San Francisco, Calif.
| | - Ellen A Eisen
- Environmental Health Sciences Division, School of Public Health, University of California, Berkeley, Calif.
| | - John R Balmes
- Department of Medicine, University of California, San Francisco, Calif; Environmental Health Sciences Division, School of Public Health, University of California, Berkeley, Calif.
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Cumulative Impact of Environmental Pollution and Population Vulnerability on Pediatric Asthma Hospitalizations: A Multilevel Analysis of CalEnviroScreen. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16152683. [PMID: 31357578 PMCID: PMC6696276 DOI: 10.3390/ijerph16152683] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 07/19/2019] [Accepted: 07/25/2019] [Indexed: 12/14/2022]
Abstract
The CalEnviroScreen created by the Office of Environmental Health Hazard Assessment, Sacramento, USA, is a place-based dataset developed to measure environmental and social indicators that are theorized to have cumulative health impacts on populations. The objective of this study was to examine the extent to which the composite scores of the CalEnviroScreen tool are associated with pediatric asthma hospitalization. This was a retrospective analysis of California hospital discharge data from 2010 to 2012. Children who were hospitalized for asthma-related conditions, were aged 0–14 years, and resided in California were included in analysis. Rates of hospitalization for asthma-related conditions among children residing in California were calculated. Poisson multilevel modeling was used to account for individual- and neighborhood-level risk factors. Every unit increase in the CalEnviroScreen Score was associated with an increase of 1.6% above the mean rate of pediatric asthma hospitalizations (rate ratio (RR) = 1.016, 95% confidence interval (CI) = 1.014–1.018). Every unit increase in racial/ethnic segregation and diesel particulate matter was associated with an increase of 1.1% and 0.2% above the mean rate of pediatric asthma, respectively (RR = 1.011, 95% CI = 1.010–1.013; RR = 1.002, 95% CI = 1.001–1.004). The CalEnviroScreen is a unique tool that combines socioecological factors and environmental indicators to identify vulnerable communities with major health disparities, including pediatric asthma hospital use. Future research should identify mediating factors that contribute to community-level health disparities.
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Greenblatt RE, Himes BE. Facilitating Inclusion of Geocoded Pollution Data into Health Studies. AMIA JOINT SUMMITS ON TRANSLATIONAL SCIENCE PROCEEDINGS. AMIA JOINT SUMMITS ON TRANSLATIONAL SCIENCE 2019; 2019:553-561. [PMID: 31259010 PMCID: PMC6568125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Exposure to pollutants impacts health and has been associated with a range of diseases, including respiratory and heart diseases, as well as all-cause mortality. Because taking exposure measures for individual studies is costly and impractical, most rely on data from sources such as the Environmental Protection Agency (EPA), which provides a wealth of publicly available pollution measures taken at over two thousand monitoring sites across the United States. While EPA data is readily available, estimating pollution exposure at a given latitude-longitude location remains computationally intensive. We developed Pollution-Associated Risk Geospatial Analysis SITE (PARGASITE), an online web-application and R package, that can be used to estimate levels of pollutants in the U.S. for 2005 through 2017 at user-defined geographic locations and time ranges. We demonstrate how PARGASITE can facilitate the study of associations between exposures and health outcomes using as an example an analysis of asthma risk factors among adults.
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Affiliation(s)
- Rebecca E Greenblatt
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Blanca E Himes
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Assessing the impact of air pollution on childhood asthma morbidity: how, when, and what to do. Curr Opin Allergy Clin Immunol 2019; 18:124-131. [PMID: 29493555 DOI: 10.1097/aci.0000000000000422] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Exposure to air pollutants is linked with poor asthma control in children and represents a potentially modifiable risk factor for impaired lung function, rescue medication use, and increased asthma-related healthcare utilization. Identification of the most relevant pollutants to asthma as well as susceptibility factors and strategies to reduce exposure are needed to improve child health. RECENT FINDINGS The current available literature supports the association between pollutants and negative asthma outcomes. Ethnicity, socioeconomic status, and presence of certain gene polymorphisms may impact susceptibility to the negative health effects of air pollution. Improved air quality standards were associated with better asthma outcomes. SUMMARY The link between air pollution and pediatric asthma morbidity is supported by the recent relevant literature. Continued efforts are needed to identify the most vulnerable populations and develop strategies to reduce exposures and improve air quality.
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Everman JL, Sajuthi S, Saef B, Rios C, Stoner AM, Numata M, Hu D, Eng C, Oh S, Rodriguez-Santana J, Vladar EK, Voelker DR, Burchard EG, Seibold MA. Functional genomics of CDHR3 confirms its role in HRV-C infection and childhood asthma exacerbations. J Allergy Clin Immunol 2019; 144:962-971. [PMID: 30930175 DOI: 10.1016/j.jaci.2019.01.052] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 12/30/2018] [Accepted: 01/30/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Research in transformed immortalized cell lines indicates the cadherin-related family member 3 (CDHR3) protein serves as a receptor for human rhinovirus (HRV)-C. Similar experiments indicate that the CDHR3 coding variant rs6967330 increases CDHR3 protein surface expression. OBJECTIVE We sought to determine whether CDHR3 is necessary for HRV-C infection of primary airway epithelial cells (AECs) and to identify molecular mechanisms by which CDHR3 variants confer risk for asthma exacerbations. METHODS CDHR3 function and influence on HRV-C infection were investigated by using single-cell transcriptomics, CRISPR-Cas9 gene knockout, and genotype-specific donor experiments performed in primary AECs. Nasal airway epithelium cis-expression quantitative trait locus (eQTL) analysis of CDHR3 was performed, followed by association testing for asthma hospitalization in minority children. RESULTS CDHR3 lung expression is exclusive to ciliated AECs and associated with basal bodies during and after motile ciliogenesis. Knockout of CDHR3 in human AECs did not prevent ciliated cell differentiation but was associated with a decrease in transepithelial resistance and an 80% decrease in HRV-C infection of the mucociliary epithelium. AECs from subjects homozygous for the risk-associated rs6967330 single nucleotide polymorphism (SNP) exhibited greater HRV-C infection compared with cells homozygous for the nonrisk allele. AEC cis-eQTL analysis indicated that rs6967330 and other SNPs are eQTLs for CDHR3. Only the eQTL block containing the rs6967330 SNP showed a significant association with childhood asthma hospitalization. CONCLUSIONS Genetic deletion and genotype-specific studies in primary AECs indicate CDHR3 is critical to HRV-C infection of ciliated cells. The rs6967330 SNP confers risk of severe childhood asthma exacerbations, likely through increasing HRV-C infection levels and protein surface localization.
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Affiliation(s)
- Jamie L Everman
- Center for Genes, Environment, and Health, National Jewish Health, Denver, Colo
| | - Satria Sajuthi
- Center for Genes, Environment, and Health, National Jewish Health, Denver, Colo
| | - Benjamin Saef
- Center for Genes, Environment, and Health, National Jewish Health, Denver, Colo
| | - Cydney Rios
- Center for Genes, Environment, and Health, National Jewish Health, Denver, Colo
| | - Ari M Stoner
- Center for Genes, Environment, and Health, National Jewish Health, Denver, Colo
| | - Mari Numata
- Department of Medicine, National Jewish Health, Denver, Colo
| | - Donglei Hu
- Department of Medicine, University of California-San Francisco, San Francisco, Calif
| | - Celeste Eng
- Department of Medicine, University of California-San Francisco, San Francisco, Calif
| | - Sam Oh
- Department of Medicine, University of California-San Francisco, San Francisco, Calif
| | | | - Eszter K Vladar
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado School of Medicine, Aurora, Colo; Department of Medicine, University of Colorado School of Medicine, Aurora, Colo; Department of Cell and Developmental Biology, University of Colorado School of Medicine, Aurora, Colo
| | | | - Esteban G Burchard
- Department of Medicine, University of California-San Francisco, San Francisco, Calif; Department of Bioengineering and Therapeutic Sciences, University of California-San Francisco, San Francisco, Calif
| | - Max A Seibold
- Center for Genes, Environment, and Health, National Jewish Health, Denver, Colo; Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado School of Medicine, Aurora, Colo; Department of Pediatrics, National Jewish Health, Denver, Colo.
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Gaffin JM, Hauptman M, Petty CR, Sheehan WJ, Lai PS, Wolfson JM, Gold DR, Coull BA, Koutrakis P, Phipatanakul W. Nitrogen dioxide exposure in school classrooms of inner-city children with asthma. J Allergy Clin Immunol 2018; 141:2249-2255.e2. [PMID: 28988796 PMCID: PMC5886827 DOI: 10.1016/j.jaci.2017.08.028] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 06/27/2017] [Accepted: 08/24/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND Ambient and home exposure to nitrogen dioxide (NO2) causes asthma symptoms and decreased lung function in children with asthma. Little is known about the health effects of school classroom pollution exposure. OBJECTIVE We aimed to determine the effect of indoor classroom NO2 on lung function and symptoms in inner-city school children with asthma. METHODS Children enrolled in the School Inner-City Asthma Study were followed for 1 academic year. Subjects performed spirometry and had fraction of exhaled nitric oxide values measured twice during the school year at school. Classroom NO2 was collected by means of passive sampling for 1-week periods twice per year, coinciding with lung function testing. Generalized estimating equation models assessed lung function and symptom relationships with the temporally nearest classroom NO2 level. RESULTS The mean NO2 value was 11.1 ppb (range, 4.3-29.7 ppb). In total, exposure data were available for 296 subjects, 188 of whom had complete spirometric data. At greater than a threshold of 8 ppb of NO2 and after adjusting for race and season (spirometry standardized by age, height, and sex), NO2 levels were associated highly with airflow obstruction, such that each 10-ppb increase in NO2 level was associated with a 5% decrease in FEV1/forced vital capacity ratio (β = -0.05; 95% CI, -0.08 to -0.02; P = .01). Percent predicted forced expiratory flow between the 25th and 75th percentile of forced vital capacity was also inversely associated with higher NO2 exposure (β = -22.8; 95% CI, -36.0 to -9.7; P = .01). There was no significant association of NO2 levels with percent predicted FEV1, fraction of exhaled nitric oxide, or asthma symptoms. Additionally, there was no effect modification of atopy on lung function or symptom outcomes. CONCLUSION In children with asthma, indoor classroom NO2 levels can be associated with increased airflow obstruction.
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Affiliation(s)
- Jonathan M Gaffin
- Division of Respiratory Diseases, Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass
| | - Marissa Hauptman
- Harvard Medical School, Boston, Mass; Division of General Pediatrics, Boston Children's Hospital, Boston, Mass
| | - Carter R Petty
- Clinical Research Center, Boston Children's Hospital, Boston, Mass
| | - William J Sheehan
- Harvard Medical School, Boston, Mass; Division of Allergy and Immunology, Boston Children's Hospital, Boston, Mass
| | - Peggy S Lai
- Harvard Medical School, Boston, Mass; Massachusetts General Hospital, Boston, Mass; Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, Mass
| | - Jack M Wolfson
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, Mass
| | - Diane R Gold
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, Mass; Channing Institute of Network Medicine, Brigham and Women's Hospital, Boston, Mass
| | - Brent A Coull
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, Mass
| | - Petros Koutrakis
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, Mass
| | - Wanda Phipatanakul
- Harvard Medical School, Boston, Mass; Division of Allergy and Immunology, Boston Children's Hospital, Boston, Mass.
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Introduction to the 60th Annual Thomas L. Petty Aspen Lung Conference. Environment and Global Lung Health: Exposure, Susceptibility, and Intervention. Ann Am Thorac Soc 2018; 15:S61-S63. [PMID: 29676645 DOI: 10.1513/annalsats.201707-576mg] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Nardone A, Neophytou AM, Balmes J, Thakur N. Ambient Air Pollution and Asthma-Related Outcomes in Children of Color of the USA: a Scoping Review of Literature Published Between 2013 and 2017. Curr Allergy Asthma Rep 2018; 18:29. [PMID: 29663154 PMCID: PMC6198325 DOI: 10.1007/s11882-018-0782-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW Given racial disparities in ambient air pollution (AAP) exposure and asthma risk, this review offers an overview of the literature investigating the ambient air pollution-asthma relationship in children of color between 2013 and 2017. RECENT FINDINGS AAP is likely a key contributor to the excess burden of asthma in children of color due to pervasive exposure before birth, at home, and in school. Recent findings suggest that psychosocial stressors may modify the relationship between AAP and asthma. The effect of AAP on asthma in children of color is likely modulated by multiple unique psychosocial stressors and gene-environment interactions. Although children of color are being included in asthma studies, more research is still needed on impacts of specific criteria pollutants throughout the life course. Additionally, future studies should consider historical factors when analyzing current exposure profiles.
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Affiliation(s)
- Anthony Nardone
- University of California, San Francisco-University of California Berkeley Joint Medical Program, Berkeley, USA
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, USA
| | - Andreas M Neophytou
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, USA
| | - John Balmes
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, USA
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, San Francisco, USA
| | - Neeta Thakur
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, San Francisco, USA
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Patel MR, Song PXK, Bruzzese JM, Hao W, Evans D, Thomas LJ, Pinkett-Heller M, Meyerson K, Brown RW. Does cross-cultural communication training for physicians improve pediatric asthma outcomes? A randomized trial. J Asthma 2018; 56:273-284. [PMID: 29641357 DOI: 10.1080/02770903.2018.1455856] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Adverse cross-cultural interactions are a persistent problem within medicine impacting minority patients' use of services and health outcomes. To test whether 1) enhancing the evidence-based Physician Asthma Care Education (PACE), a continuing medical education program, with cross cultural communication training (PACE Plus) would improve the asthma outcomes of African American and Latino/Hispanic children; and 2) whether PACE is effective in diverse groups of children. METHODS A three-arm randomized control trial was used to compare PACE Plus, PACE, and usual care. Participants were primary care physicians (n = 112) and their African American or Latino/Hispanic pediatric patients with persistent asthma (n = 867). The primary outcome of interest included changes in emergency department visits for asthma overtime, measured at baseline, and 9 and 21 months following the intervention. Other outcomes included hospitalizations, asthma symptom experience, caregiver asthma-related quality of life, and patient-provider communication measures. RESULTS Over the long term, PACE Plus physicians reported significant improvements in confidence and use of patient-centered communication and counseling techniques (p < 0.01) compared to PACE physicians. No other significant benefit in primary and secondary outcomes was observed in this trial. CONCLUSION PACE Plus did not show significant benefit in asthma-specific clinical outcomes. More trials and multi-component strategies continue to be needed to address complex risk factors and reduce disparities in asthma care. TRIAL REGISTRATION ClinicalTrials.gov: NCT01251523 December 1, 2010.
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Affiliation(s)
- Minal R Patel
- a Department of Health Behavior and Health Education , University of Michigan School of Public Health Ann Arbor , MI , USA
| | - Peter X K Song
- b Department of Biostatistics , University of Michigan School of Public Health , Ann Arbor , MI , USA
| | | | - Wei Hao
- b Department of Biostatistics , University of Michigan School of Public Health , Ann Arbor , MI , USA
| | - David Evans
- d Pediatric Pulmonary Division , Columbia University , New York , NY , USA
| | - Lara J Thomas
- a Department of Health Behavior and Health Education , University of Michigan School of Public Health Ann Arbor , MI , USA
| | | | - Karen Meyerson
- f Priority Health , East Beltline Ave. NE, Grand Rapids , MI , USA
| | - Randall W Brown
- a Department of Health Behavior and Health Education , University of Michigan School of Public Health Ann Arbor , MI , USA
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Busi LE, Sly PD. Validation of the GLI-2012 spirometry reference equations in Argentinian children. Pediatr Pulmonol 2018; 53:204-208. [PMID: 29265696 DOI: 10.1002/ppul.23923] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 11/15/2017] [Indexed: 11/06/2022]
Abstract
AIM The Global Lung Function Initiative (GLI) has produced spirometry reference equations for use in different ethnic groups. Previous reports have shown that the GLI equations do not adequately describe lung function in all populations and that adopting the new equations into clinical practice can increase the number of patients considered to have abnormal lung function. Therefore, before adopting these equations into local practice it is necessary to establish how well the equations represent the local population. The present study was conducted to determine how well the GLI spirometry reference equations represented the young children in Argentina, a population not included in the GLI dataset. METHODS Spirometry was measured in 2072 healthy children (50.9% males) aged 3.0-12.4 years (mean 6.64 ± SD 1.39), with a height range of 93.0-158.5 cm and weight range from 13.1 to 54.7 kg. We used the GLI "Caucasian" and "other/mixed" race equations to create Z-scores. RESULTS The Z-scores predicted by the Caucasian GLI equations did not differ from zero and fitted the data well. Z-scores calculated using "other/mixed race" fit less well. Using the GLI definition of low lung function (Z-score <1.65) 6.8% of our healthy population had abnormal FVC, 4.9% had abnormal FEV1, 5.9 % had abnormal FEV0.75, and 3.9% had abnormal FEF25-75 when using the "Caucasian" GLI equation. This compares well with the expected 5% below the lower limit of normal. CONCLUSION We recommend the use of the GLI-2012 Caucasian equations for spirometry undertaken in Argentinian children.
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Affiliation(s)
| | - Peter D Sly
- Children's Health and Environment Program, Child Health Research Centre, The University of Queensland, Brisbane, Australia
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Beghé B, Fabbri LM, Contoli M, Papi A. Update in Asthma 2016. Am J Respir Crit Care Med 2017; 196:548-557. [PMID: 28530112 DOI: 10.1164/rccm.201702-0318up] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Bianca Beghé
- 1 Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, Modena, Italy
| | - Leonardo M Fabbri
- 2 Research Centre on Asthma and Chronic Obstructive Pulmonary Disease, Department of Medical Sciences, University of Ferrara, Ferrara, Italy; and.,3 Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Marco Contoli
- 2 Research Centre on Asthma and Chronic Obstructive Pulmonary Disease, Department of Medical Sciences, University of Ferrara, Ferrara, Italy; and
| | - Alberto Papi
- 2 Research Centre on Asthma and Chronic Obstructive Pulmonary Disease, Department of Medical Sciences, University of Ferrara, Ferrara, Italy; and
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Sack CS, Goss CH. Nature versus Nurture: Does Genetic Ancestry Alter the Effect of Air Pollution in Children with Asthma? Am J Respir Crit Care Med 2017; 193:1196-8. [PMID: 27248587 DOI: 10.1164/rccm.201601-0138ed] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Cora S Sack
- 1 Department of Medicine University of Washington Seattle, Washington and
| | - Christopher H Goss
- 1 Department of Medicine University of Washington Seattle, Washington and.,2 Department of Pediatrics University of Washington Seattle, Washington
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Effects of Long-Term Exposure to Traffic-Related Air Pollution on Lung Function in Children. Curr Allergy Asthma Rep 2017; 17:41. [PMID: 28551888 PMCID: PMC5446841 DOI: 10.1007/s11882-017-0709-y] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Lung function in early life has been shown to be an important predictor for peak lung function in adults and later decline. Reduced lung function per se is associated with increased morbidity and mortality. With this review, we aim to summarize the current epidemiological evidence on the effect of traffic-related air pollution on lung function in children and adolescents. We focus in particular on time windows of exposure, small airway involvement, and vulnerable sub-groups in the population. Findings from studies published to date support the notion that exposure over the entire childhood age range seems to be of importance for lung function development. We could not find any conclusive data to support evidence of sup-group effects considering gender, sensitization status, and asthma status, although a possibly stronger effect may be present for children with asthma. The long-term effects into adulthood of exposure to air pollution during childhood remains unknown, but current studies suggest that these deficits may be propagated into later life. In addition, further research on the effect of exposure on small airway function is warranted.
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Black C, Gerriets JE, Fontaine JH, Harper RW, Kenyon NJ, Tablin F, Schelegle ES, Miller LA. Early Life Wildfire Smoke Exposure Is Associated with Immune Dysregulation and Lung Function Decrements in Adolescence. Am J Respir Cell Mol Biol 2017; 56:657-666. [PMID: 28208028 DOI: 10.1165/rcmb.2016-0380oc] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The long-term health effects of wildfire smoke exposure in pediatric populations are not known. The objectives of this study were to determine if early life exposure to wildfire smoke can affect parameters of immunity and airway physiology that are detectable with maturity. We studied a mixed-sex cohort of rhesus macaque monkeys that were exposed as infants to ambient wood smoke from a series of Northern California wildfires in the summer of 2008. Peripheral blood mononuclear cells (PBMCs) and pulmonary function measures were obtained when animals were approximately 3 years of age. PBMCs were cultured with either LPS or flagellin, followed by measurement of secreted IL-8 and IL-6 protein. PBMCs from a subset of female animals were also evaluated by Toll-like receptor (TLR) pathway mRNA analysis. Induction of IL-8 protein synthesis with either LPS or flagellin was significantly reduced in PBMC cultures from wildfire smoke-exposed female monkeys. In contrast, LPS- or flagellin-induced IL-6 protein synthesis was significantly reduced in PBMC cultures from wildfire smoke-exposed male monkeys. Baseline and TLR ligand-induced expression of the transcription factor, RelB, was globally modulated in PBMCs from wildfire smoke-exposed monkeys, with additional TLR pathway genes affected in a ligand-dependent manner. Wildfire smoke-exposed monkeys displayed significantly reduced inspiratory capacity, residual volume, vital capacity, functional residual capacity, and total lung capacity per unit of body weight relative to control animals. Our findings suggest that ambient wildfire smoke exposure during infancy results in sex-dependent attenuation of systemic TLR responses and reduced lung volume in adolescence.
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Affiliation(s)
| | | | | | - Richart W Harper
- 2 Division of Pulmonary and Critical Care Medicine, School of Medicine, and
| | - Nicholas J Kenyon
- 2 Division of Pulmonary and Critical Care Medicine, School of Medicine, and
| | - Fern Tablin
- 3 Department of Anatomy, Physiology, and Cell Biology, School of Veterinary Medicine, University of California Davis, Davis, California
| | - Edward S Schelegle
- 3 Department of Anatomy, Physiology, and Cell Biology, School of Veterinary Medicine, University of California Davis, Davis, California
| | - Lisa A Miller
- 1 California National Primate Research Center.,3 Department of Anatomy, Physiology, and Cell Biology, School of Veterinary Medicine, University of California Davis, Davis, California
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Keet CA, Matsui EC, McCormack MC, Peng RD. Urban residence, neighborhood poverty, race/ethnicity, and asthma morbidity among children on Medicaid. J Allergy Clin Immunol 2017; 140:822-827. [PMID: 28283418 DOI: 10.1016/j.jaci.2017.01.036] [Citation(s) in RCA: 121] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 01/24/2017] [Accepted: 01/30/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Although poor-urban (inner-city) areas are thought to have high asthma prevalence and morbidity, we recently found that inner cities do not have higher prevalent pediatric asthma. Whether asthma morbidity is higher in inner-city areas across the United States is not known. OBJECTIVE This study sought to examine relationships between residence in poor and urban areas, race/ethnicity, and asthma morbidity among children with asthma who are enrolled in Medicaid. METHODS Children aged 5 to 19 enrolled in Medicaid in 2009 to 2010 were included. Asthma was defined by at least 1 outpatient or emergency department (ED) visit with a primary diagnosis code of asthma over the 2-year period. Urbanization status was defined at the county level and neighborhood poverty at the zip-code level. Among children with asthma, logistic models were created to examine the effects of urbanization, neighborhood poverty, and race/ethnicity on rates of asthma outpatient visits, ED visits, and hospitalizations. RESULTS This study included 16,860,716 children (1,534,820 with asthma). Among children enrolled in Medicaid, residence in inner-city areas did not confer increased risk of prevalent asthma in either crude or adjusted analyses, but it was associated with significantly more asthma-related ED visits and hospitalizations among those with asthma in crude analyses (risk ratio, 1.48; 95% CI, 1.24-1.36; and 1.97; 95% CI, 1.50-1.72, respectively) and when adjusted for race/ethnicity, age, and sex (adjusted risk ratio, 1.23; 95% CI, 1.08-1.15; and 1.62; 95% CI, 1.26-1.43). Residence in urban or poor areas and non-Hispanic black race/ethnicity were all independently associated with increased risk of asthma-related ED visits and hospitalizations. CONCLUSIONS Residence in poor and urban areas is an important risk factor for asthma morbidity, but not for prevalence, among low-income US children.
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Affiliation(s)
- Corinne A Keet
- Division of Pediatric Allergy and Immunology, Johns Hopkins University School of Medicine, Baltimore, Md.
| | - Elizabeth C Matsui
- Division of Pediatric Allergy and Immunology, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Meredith C McCormack
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Roger D Peng
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md
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Zhang Q, Lamichhane R, Diggs LA. Disparities in emergency department visits in American children with asthma: 2006-2010. J Asthma 2016; 54:679-686. [PMID: 27880053 DOI: 10.1080/02770903.2016.1263315] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This article was to examine the trends in emergency department (ED) visits for asthma among American children in 2006-2010 across sociodemographic factors, parental smoking status, and children's body weight status. METHODS We analyzed 5,535 children aged 2-17 years with current asthma in the Asthma Call-Back Survey in 2006-2010. Multivariate log binomial regression was used to examine the disparities of ED visits by demographics, socioeconomic status, parental smoking status, children's body weight status, and the level of asthma control. We controlled for average state-level air pollutants. Prevalence ratios (PRs) and 95% confidence intervals (CIs) were reported. RESULTS Minority children with current asthma had higher risks of ED visits compared with white children in 2009 and 2010, e.g., the PR (95% CI) for black children in 2009 was 3.64 (1.79, 7.41). Children who had current asthma and more highly educated parents experienced a higher risk of ED visits in 2007 (PRs [95% CI] = 2.15 [1.02, 4.53] and 2.97 [1.29, 6.83] for children with some college or college-graduated parents), but not significant in other years. Children with uncontrolled asthma were significantly more likely to visit the ED in 2008 (PRs [95% CI] = 2.79 [1.44, 5.41] and 6.96 [3.55, 13.64] for not-well-controlled and very poorly controlled children with asthma). CONCLUSIONS Minority children with current asthma or children with uncontrolled asthma were more likely to visit EDs for asthma treatment. However, the disparities in ED visits across sociodemographics, health status, or asthma control vary in scale and significance across time. More research is needed to explain these differences.
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Affiliation(s)
- Qi Zhang
- a School of Community and Environmental Health, Old Dominion University , Norfolk , VA , USA
| | - Rajan Lamichhane
- b Department of Mathematics , Texas A&M University-Kingsville , Kingsville , TX , USA
| | - Leigh Ann Diggs
- a School of Community and Environmental Health, Old Dominion University , Norfolk , VA , USA
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Ji H, Biagini Myers JM, Brandt EB, Brokamp C, Ryan PH, Khurana Hershey GK. Air pollution, epigenetics, and asthma. Allergy Asthma Clin Immunol 2016; 12:51. [PMID: 27777592 PMCID: PMC5069789 DOI: 10.1186/s13223-016-0159-4] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 10/04/2016] [Indexed: 12/13/2022] Open
Abstract
Exposure to traffic-related air pollution (TRAP) has been implicated in asthma development, persistence, and exacerbation. This exposure is highly significant as large segments of the global population resides in zones that are most impacted by TRAP and schools are often located in high TRAP exposure areas. Recent findings shed new light on the epigenetic mechanisms by which exposure to traffic pollution may contribute to the development and persistence of asthma. In order to delineate TRAP induced effects on the epigenome, utilization of newly available innovative methods to assess and quantify traffic pollution will be needed to accurately quantify exposure. This review will summarize the most recent findings in each of these areas. Although there is considerable evidence that TRAP plays a role in asthma, heterogeneity in both the definitions of TRAP exposure and asthma outcomes has led to confusion in the field. Novel information regarding molecular characterization of asthma phenotypes, TRAP exposure assessment methods, and epigenetics are revolutionizing the field. Application of these new findings will accelerate the field and the development of new strategies for interventions to combat TRAP-induced asthma.
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Affiliation(s)
- Hong Ji
- Division of Asthma Research, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave. MLC 7037, Cincinnati, OH 45229 USA ; Pyrosequencing lab for Genomic and Epigenomic research, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229 USA
| | - Jocelyn M Biagini Myers
- Division of Asthma Research, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave. MLC 7037, Cincinnati, OH 45229 USA
| | - Eric B Brandt
- Division of Asthma Research, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave. MLC 7037, Cincinnati, OH 45229 USA
| | - Cole Brokamp
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229 USA
| | - Patrick H Ryan
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229 USA
| | - Gurjit K Khurana Hershey
- Division of Asthma Research, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave. MLC 7037, Cincinnati, OH 45229 USA
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Cnattingius S, Haller D, Snyder PJ, Nevitt M. Clinical News. Br J Hosp Med (Lond) 2016. [DOI: 10.12968/hmed.2016.77.3.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Sven Cnattingius
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Dirk Haller
- Chair of Nutrition and Immunology, ZIEL Institute for Food & Health, Technical University of Munich, Munich, Germany
| | - Peter J Snyder
- Medical Director, Penn Pituitary Center, Perelman Center for Advanced Medicine, Philadelphia, Pennsylvania, USA
| | - Michael Nevitt
- Professor in the Department of Epidemiology and Biostatistics, University of California, San Francisco
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