1
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Noguchi K, Furukawa T, Tatsumi Y, Kasama S, Yoshikawa T, Hashimoto T, Azuma N, Hirota S, Kimura T, Matsui K. Involvement of YKL-40-positive macrophages commonly identified in polymyositis and dermatomyositis in the pathogenesis of myositis: a retrospective study. Immunol Med 2024; 47:37-44. [PMID: 37817562 DOI: 10.1080/25785826.2023.2264007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 09/23/2023] [Indexed: 10/12/2023] Open
Abstract
YKL-40 is implicated in inflammation and tissue repair, but no reports have investigated its involvement in myositis in polymyositis (PM) and dermatomyositis (DM). Therefore, we aimed to investigate the relationship between YKL-40 and PM/DM. We retrospectively enrolled 35 patients diagnosed with PM/DM along with 26 healthy controls (HCs). Both PM and DM were diagnosed according to Bohan and Peter's criteria. Serum YKL-40 levels were measured, age-corrected to YKL-40 percentile values, and compared to HCs. Patients with myositis without interstitial lung disease were also enrolled and compared to HCs. Immunofluorescence staining was performed to identify YKL-40-positive inflammatory cells in muscle biopsy samples from two patients each with PM and DM. Age-corrected serum YKL-40 levels were significantly higher in patients with PM/DM compared to HCs with and without lung disease; however, these levels decreased significantly after treatment. Immunohistochemical analysis showed infiltration of YKL-40-positive inflammatory cells into the intramuscular sheath and perimuscular membrane. Immunofluorescence staining showed CD68 expression in YKL-40-positive inflammatory cells, suggesting that these cells were macrophages. To the best of our knowledge, this is the first study to demonstrate that YKL-40-positive macrophages are present in PM and DM, indicating that YKL-40 may be involved in PM/DM.
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Affiliation(s)
- Kazuteru Noguchi
- Department of Diabetes Endocrinology and Clinical Immunology, School of Medicine, Hyogo Medical University, Nishinomiya, Japan
| | - Tetsuya Furukawa
- Department of Diabetes Endocrinology and Clinical Immunology, School of Medicine, Hyogo Medical University, Nishinomiya, Japan
| | - Yoshiki Tatsumi
- Department of Neurology, School of Medicine, Hyogo Medical University, Nishinomiya, Japan
| | - Shuhei Kasama
- Department of Neurology, School of Medicine, Hyogo Medical University, Nishinomiya, Japan
| | - Takahiro Yoshikawa
- Department of Diabetes Endocrinology and Clinical Immunology, School of Medicine, Hyogo Medical University, Nishinomiya, Japan
| | - Teppei Hashimoto
- Department of Diabetes Endocrinology and Clinical Immunology, School of Medicine, Hyogo Medical University, Nishinomiya, Japan
| | - Naoto Azuma
- Department of Diabetes Endocrinology and Clinical Immunology, School of Medicine, Hyogo Medical University, Nishinomiya, Japan
| | - Seiichi Hirota
- Department of Surgical Pathology, School of Medicine, Hyogo Medical University, Nishinomiya, Japan
| | - Takashi Kimura
- Department of Neurology, School of Medicine, Hyogo Medical University, Nishinomiya, Japan
| | - Kiyoshi Matsui
- Department of Diabetes Endocrinology and Clinical Immunology, School of Medicine, Hyogo Medical University, Nishinomiya, Japan
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2
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Hussain M, Liu G. Eosinophilic Asthma: Pathophysiology and Therapeutic Horizons. Cells 2024; 13:384. [PMID: 38474348 PMCID: PMC10931088 DOI: 10.3390/cells13050384] [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: 01/22/2024] [Revised: 02/16/2024] [Accepted: 02/21/2024] [Indexed: 03/14/2024] Open
Abstract
Asthma is a prevalent chronic non-communicable disease, affecting approximately 300 million people worldwide. It is characterized by significant airway inflammation, hyperresponsiveness, obstruction, and remodeling. Eosinophilic asthma, a subtype of asthma, involves the accumulation of eosinophils in the airways. These eosinophils release mediators and cytokines, contributing to severe airway inflammation and tissue damage. Emerging evidence suggests that targeting eosinophils could reduce airway remodeling and slow the progression of asthma. To achieve this, it is essential to understand the immunopathology of asthma, identify specific eosinophil-associated biomarkers, and categorize patients more accurately based on the clinical characteristics (phenotypes) and underlying pathobiological mechanisms (endotypes). This review delves into the role of eosinophils in exacerbating severe asthma, exploring various phenotypes and endotypes, as well as biomarkers. It also examines the current and emerging biological agents that target eosinophils in eosinophilic asthma. By focusing on these aspects, both researchers and clinicians can advance the development of targeted therapies to combat eosinophilic pathology in severe asthma.
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Affiliation(s)
- Musaddique Hussain
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Gang Liu
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA
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3
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Zhang L, Li L, Zhou M, Zhou QY, Tang JH, Liang M, Liu Q, Fu XF. Association of serum YKL-40 and DPP4 with T2-high asthma in Chinese adults. Medicine (Baltimore) 2024; 103:e37169. [PMID: 38335422 PMCID: PMC10860958 DOI: 10.1097/md.0000000000037169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/28/2023] [Accepted: 01/16/2024] [Indexed: 02/12/2024] Open
Abstract
This study aimed to assess the utility of serum YKL-40 and serum dipeptidyl peptidase IV (DPP4) as biomarkers for distinguishing between type 2 (T2)-high and T2-low asthma in the Chinese population. Additionally, we sought to explore the associations of serum YKL-40 and DPP4 levels with asthma characteristics and conventional markers. A real-world observational cross-sectional study was conducted, involving a total of 75 adult asthma patients. We collected general information, including demographics and medical history. Measurements included complete blood count, fractional exhaled nitric oxide (FeNO), post-bronchodilator spirometry, serum YKL-40 and serum DPP4 levels. Asthma endotypes, T2-high and T2-low, were defined through a comprehensive review of existing literature and expert group discussions. Logistic and linear regression models were employed. Our findings indicated no significant association between serum YKL-40 or serum DPP4 levels and T2-high asthma across all models. In the fully adjusted model, their odds ratios (OR) were 0.967 (95% CI: 0.920-1.017) and 0.997 (95% CI: 0.993-1.001), respectively. Notably, serum YKL-40 exhibited a positive correlation with FeNO (β = 0.382, 95% CI: 0.230-0.533) after adjusting for confounding factors. This association, however, diminished in patients under 40 years old (P = .24), males (P = .25), and those with FEV1%pred of 80% or higher (P = .25). Serum DPP4 demonstrated a negative correlation with FEV1/FVC in the fully adjusted model (β: -0.005, 95% CI: -0.009, -0.000). Among Chinese adult asthma patients, a positive correlation was observed between serum YKL-40 levels and FeNO in females aged over 40 with FEV1%pred less than 80%. Additionally, a weak negative correlation was found between serum DPP4 levels and FEV1/FVC. However, neither serum YKL-40 nor serum DPP4 levels exhibited the capability to differentiate between T2-high and T2-low asthma.
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Affiliation(s)
- Li Zhang
- Department of Respiratory and Critical Care Medicine, The People’s Hospital of Yubei District of Chongqing City, Chongqing, China
| | - Liang Li
- Department of Clinical Laboratory, The People’s Hospital of Yubei District of Chongqing City, Chongqing, China
| | - Mei Zhou
- Department of Respiratory and Critical Care Medicine, The People’s Hospital of Yubei District of Chongqing City, Chongqing, China
| | - Qian-Yun Zhou
- Department of Respiratory and Critical Care Medicine, The People’s Hospital of Yubei District of Chongqing City, Chongqing, China
| | - Ji-Hong Tang
- Department of Respiratory and Critical Care Medicine, The People’s Hospital of Yubei District of Chongqing City, Chongqing, China
| | - Mei Liang
- Department of Respiratory and Critical Care Medicine, The People’s Hospital of Yubei District of Chongqing City, Chongqing, China
| | - Qin Liu
- Department of Respiratory and Critical Care Medicine, The People’s Hospital of Yubei District of Chongqing City, Chongqing, China
| | - Xiao-Feng Fu
- Department of Respiratory and Critical Care Medicine, The People’s Hospital of Yubei District of Chongqing City, Chongqing, China
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4
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Declercq J, Hammad H, Lambrecht BN, Smole U. Chitinases and chitinase-like proteins in asthma. Semin Immunol 2023; 67:101759. [PMID: 37031560 DOI: 10.1016/j.smim.2023.101759] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 03/27/2023] [Indexed: 04/11/2023]
Abstract
Despite the lack of endogenous chitin synthesis, mammalian genomes encode two enzymatically active true chitinases (chitotriosidase and acidic mammalian chitinase) and a variable number of chitinase-like proteins (CLPs) that have no enzyme activity but bind chitin. Chitinases and CLPs are prominent components of type-2 immune response-mediated respiratory diseases. However, despite extensive research into their role in allergic airway disease, there is still no agreement on whether they are mere biomarkers of disease or actual disease drivers. Functions ascribed to chitinases and CLPs include, but are not limited to host defense against chitin-containing pathogens, directly promoting inflammation, and modulating tissue remodeling and fibrosis. Here, we discuss in detail the chitin-dependent and -independent roles of chitinases and CLPs in the context of allergic airway disease, and recent advances and emerging concepts in the field that might identify opportunities for new therapies.
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Affiliation(s)
- Jozefien Declercq
- Immunoregulation Unit, VIB Center for Inflammation Research, Ghent, Belgium; Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - Hamida Hammad
- Immunoregulation Unit, VIB Center for Inflammation Research, Ghent, Belgium; Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - Bart N Lambrecht
- Immunoregulation Unit, VIB Center for Inflammation Research, Ghent, Belgium; Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium; Department of Pulmonary Medicine, ErasmusMC, Rotterdam, the Netherlands.
| | - Ursula Smole
- Immunoregulation Unit, VIB Center for Inflammation Research, Ghent, Belgium; Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium.
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5
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Specjalski K, Romantowski J, Niedoszytko M. YKL-40 as a possible marker of neutrophilic asthma. Front Med (Lausanne) 2023; 10:1115938. [PMID: 36844232 PMCID: PMC9945318 DOI: 10.3389/fmed.2023.1115938] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 01/23/2023] [Indexed: 02/11/2023] Open
Abstract
Asthma is a heterogeneous chronic disorder of the airways, with inflammation and bronchial hyperresponsiveness as its major underlying phenomena. Asthmatics vary in terms of inflammation pattern, concomitant pathologies, and factors aggravating the course of the disease. As a result, there is a need for sensitive and specific biomarkers that could facilitate diagnosing asthma as well as phenotyping in everyday practice. Chitinases and chitinase-like proteins (CLPs) seem promising in this field. Chitinases are evolutionarily conserved hydrolases that degrade chitin. In contrast, CLPs bind chitin but do not have degrading activity. Mammalian chitinases and CLPs are produced by neutrophils, monocytes, and macrophages in response to parasitic or fungal infections. Recently, several questions have been raised about their role in chronic airway inflammation. Several studies demonstrated that overexpression of CLP YKL-40 was associated with asthma. Moreover, it correlated with exacerbation rate, therapy resistance, poor control of symptoms, and, inversely, with FEV1. YKL-40 facilitated allergen sensitization and IgE production. Its concentration was elevated in bronchoalveolar lavage fluid after an allergen challenge. It was also found to promote the proliferation of bronchial smooth muscle cells and correlate with subepithelial membrane thickness. Thus, it may be involved in bronchial remodeling. Associations between YKL-40 and particular asthma phenotypes remain unclear. Some studies showed that YKL-40 correlates with blood eosinophilia and FeNO, suggesting a role in T2-high inflammation. Quite the opposite, cluster analyses revealed the highest upregulation in severe neutrophilic asthma and obesity-associated asthma. The main limitation in the practical application of YKL-40 as a biomarker is its low specificity. High serum levels of YKL-40 were also found in COPD and several malignancies, in addition to infectious and autoimmune diseases. To conclude, the level of YKL-40 correlates with asthma and some clinical features in the whole asthmatic population. The highest levels are found in neutrophilic and obesity-related phenotypes. However, due to its low specificity, the practical application of YKL-40 remains uncertain but could be useful in phenotyping, especially when combined with other biomarkers.
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Affiliation(s)
| | - Jan Romantowski
- Department of Allergology, Medical University of Gdańsk, Gdańsk, Poland
| | - Marek Niedoszytko
- Department of Allergology, Medical University of Gdańsk, Gdańsk, Poland
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6
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Xu T, Zhang K, Zhong C, Zhu Z, Zheng X, Yang P, Che B, Lu Y, Zhang Y. Plasma Human Cartilage Glycoprotein‐39 Is Associated With the Prognosis of Acute Ischemic Stroke. J Am Heart Assoc 2022; 11:e026263. [DOI: 10.1161/jaha.122.026263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background
To evaluate the prognostic value of plasma YKL‐40 (human cartilage glycoprotein‐39) for acute ischemic stroke.
Methods and Results
We measured plasma YKL‐40 levels in 3377 participants from CATIS (China Antihypertensive Trial in Acute Ischemic Stroke). Study outcome data on death, major disability (modified Rankin Scale score ≥3), and vascular diseases were collected at 3 months after stroke onset. The primary outcome was defined as a combination of death and major disability. During the 3‐month follow‐up, 828 participants (24.5%) experienced major disability or died. After multivariate adjustment, the highest YKL‐40 quartile was associated with an increased risk of the primary outcome (odds ratio, 1.426 [95% CI, 1.105–1.839];
P
trend
=0.01) compared with the lowest quartile. Each SD increase in log‐transformed YKL‐40 level was associated with a 15.5% (95% CI, 5.6–26.3%) increased risk of the primary outcome. The multivariable‐adjusted spline regression models showed a linear dose–response relationship between YKL‐40 and clinical outcomes. Adding YKL‐40 to a model containing conventional risk factors significantly improved the reclassification power for the primary outcome (net reclassification improvement: 15.61%,
P
<0.001; integrated discrimination index: 0.37%,
P
=0.004) and marginally significantly improved the discriminatory power for the primary outcome (area under the receiver operating characteristic curve improved by 0.003,
P
=0.099).
Conclusions
A higher YKL‐40 level in the acute phase of ischemic stroke was associated with an increased risk of mortality and major disability at 3 months after stroke, indicating that YKL‐40 may play an important role as a prognostic marker of ischemic stroke.
Registration
URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT01840072.
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Affiliation(s)
- Tian Xu
- Department of Neurology Affiliated Hospital of Nantong University Nantong China
| | - Kaixin Zhang
- Department of Epidemiology School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University Suzhou China
| | - Chongke Zhong
- Department of Epidemiology School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University Suzhou China
| | - Zhengbao Zhu
- Department of Epidemiology School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University Suzhou China
| | - Xiaowei Zheng
- Department of Epidemiology School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University Suzhou China
| | - Pinni Yang
- Department of Epidemiology School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University Suzhou China
| | - Bizhong Che
- Department of Epidemiology School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University Suzhou China
| | - Yaling Lu
- Department of Epidemiology School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University Suzhou China
| | - Yonghong Zhang
- Department of Epidemiology School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University Suzhou China
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7
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Kimura H, Shimizu K, Tanabe N, Makita H, Taniguchi N, Kimura H, Suzuki M, Abe Y, Matsumoto-Sasaki M, Oguma A, Takimoto-Sato M, Takei N, Matsumoto M, Goudarzi H, Sato S, Ono J, Izuhara K, Hirai T, Nishimura M, Konno S. Further evidence for association of YKL-40 with severe asthma airway remodeling. Ann Allergy Asthma Immunol 2022; 128:682-688.e5. [PMID: 35342020 DOI: 10.1016/j.anai.2022.03.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 02/25/2022] [Accepted: 03/16/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND The chitinase-like protein YKL-40 is associated with airflow limitation on spirometry and airway remodeling in patients with asthma. It remains unclear whether YKL-40 is associated with morphologic changes in the airways and parenchyma or with future progression of airflow limitation in severe asthma. OBJECTIVE To evaluate the association of circulating YKL-40 levels with morphologic changes in the airways and parenchyma and with longitudinal progression of airflow limitation. METHODS The patients were participants in the Hokkaido Severe Asthma Cohort Study (n = 127), including smokers. This study consisted of 2 parts. In analysis 1, we analyzed associations between circulating YKL-40 levels and several asthma-related indices, including computed tomography-derived indices of proximal wall area percentage, the complexity of the airways (airway fractal dimension), and the parenchyma (exponent D) cross-sectionally (n = 97). In analysis 2, we evaluated the impact of circulating YKL-40 levels on forced expiratory volume in 1 second (FEV1) decline longitudinally for a 5-year follow-up (n = 103). RESULTS Circulating YKL-40 levels were significantly associated with proximal wall area percentage and airway fractal dimension (r = 0.25, P = .01; r = -0.22, P = .04, respectively), but not with exponent D. The mean annual change in FEV1 was -33.7 (± 23.3) mL/y, and the circulating YKL-40 level was a significant independent factor associated with annual FEV1 decline (β = -0.24, P = .02), even after controlling for exponent D (β = -0.26, P = .01). CONCLUSION These results provide further evidence for the association of YKL-40 with the pathogenesis of airway remodeling in severe asthma.
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Affiliation(s)
- Hirokazu Kimura
- Faculty of Medicine, Department of Respiratory Medicine, Hokkaido University, Sapporo, Japan.
| | - Kaoruko Shimizu
- Faculty of Medicine, Department of Respiratory Medicine, Hokkaido University, Sapporo, Japan
| | - Naoya Tanabe
- Graduate School of Medicine, Department of Respiratory Medicine, Kyoto University, Kyoto, Japan
| | - Hironi Makita
- Faculty of Medicine, Department of Respiratory Medicine, Hokkaido University, Sapporo, Japan
| | - Natsuko Taniguchi
- Faculty of Medicine, Department of Respiratory Medicine, Hokkaido University, Sapporo, Japan
| | - Hiroki Kimura
- Faculty of Medicine, Department of Respiratory Medicine, Hokkaido University, Sapporo, Japan
| | - Masaru Suzuki
- Faculty of Medicine, Department of Respiratory Medicine, Hokkaido University, Sapporo, Japan
| | - Yuki Abe
- Faculty of Medicine, Department of Respiratory Medicine, Hokkaido University, Sapporo, Japan
| | | | - Akira Oguma
- Faculty of Medicine, Department of Respiratory Medicine, Hokkaido University, Sapporo, Japan
| | - Michiko Takimoto-Sato
- Faculty of Medicine, Department of Respiratory Medicine, Hokkaido University, Sapporo, Japan
| | - Nozomu Takei
- Faculty of Medicine, Department of Respiratory Medicine, Hokkaido University, Sapporo, Japan
| | - Munehiro Matsumoto
- Faculty of Medicine, Department of Respiratory Medicine, Hokkaido University, Sapporo, Japan
| | - Houman Goudarzi
- Faculty of Medicine, Department of Respiratory Medicine, Hokkaido University, Sapporo, Japan
| | - Susumu Sato
- Graduate School of Medicine, Department of Respiratory Medicine, Kyoto University, Kyoto, Japan
| | - Junya Ono
- R&D Center, Shino-Test Corporation, Kanagawa, Japan
| | - Kenji Izuhara
- Division of Medical Biochemistry, Department of Biomolecular Sciences, Saga Medical School, Saga, Japan
| | - Toyohiro Hirai
- Graduate School of Medicine, Department of Respiratory Medicine, Kyoto University, Kyoto, Japan
| | - Masaharu Nishimura
- Faculty of Medicine, Department of Respiratory Medicine, Hokkaido University, Sapporo, Japan; Hokkaido Medical Research Institute for Respiratory Diseases, Sapporo, Japan
| | - Satoshi Konno
- Faculty of Medicine, Department of Respiratory Medicine, Hokkaido University, Sapporo, Japan
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8
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Baek HS, Won HY, Kim JH, Ha EK, Jee HM, Shin YH, Kim MA, Han MY. Association of phthalate exposure and airway dysfunction with mediation by serum periostin. Pediatr Allergy Immunol 2021; 32:1681-1690. [PMID: 34291496 DOI: 10.1111/pai.13602] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 06/22/2021] [Accepted: 06/24/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Phthalates can cause respiratory and immunological disorders. However, little is known about the role of serum periostin and YKL-40 levels in mediating the effects of phthalates. We investigated the mediating role of these biomarkers in the relationship between phthalates and airway dysfunction. METHODS A total of 487 children (aged 10-12 years old) were examined. Four high-molecular-weight phthalate (HMWP) [Σ4 HMWP] metabolites and 3 low-molecular-weight phthalate (LMWP) [Σ3 LMWP] metabolites in urine samples were measured. Serum periostin and YKL-40 levels were measured. Airway function was measured using impulse oscillometry. A mediation model was used to quantify the mediating effects of periostin and YKL-40 on airway dysfunction. RESULTS After adjustment for height, gender, BMI z-score, aeroallergen sensitization, secondary smoking, and vitamin D level, the level of urinary Σ3 LMWP metabolites was significantly associated with respiratory system resistance at 5 Hz (Rrs5; adjusted β: 0.020, 95% CI: 0.005-0.034; p = .010). The levels of urinary Σ4 HMWP and Σ3 LMWP metabolites were significantly associated with periostin level, but not with YKL-40 level. In addition, the periostin level was associated with Rrs5 (adjusted β: 0.048, 95% CI: 0.015-0.081; p = .005) and Rrs20-5 (adjusted β: 0.040, 95% CI: 0.011-0.069; p = .007). Serum periostin level had a significant effect in mediating the relationship between Σ3 LMWP and Rrs5 (13.9%, 95% CI: 10.7-77.0; p < .001). CONCLUSION Exposure to LMWPs was significantly associated with airway dysfunction, and this effect was partially attributable to increased serum periostin level.
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Affiliation(s)
- Hey Sung Baek
- Department of Pediatrics, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Ha Young Won
- Clinical Research Institute, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Ju Hee Kim
- Departments of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Eun Kyo Ha
- Department of Pediatrics, Kangnam Sacred Heart Hospital, Hallym University Medical Center, Seoul, Korea
| | - Hye Mi Jee
- Departments of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Youn Ho Shin
- Department of Pediatrics, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea
| | - Mi-Ae Kim
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Man Yong Han
- Departments of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
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9
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Pan R, Li Q, Zhu X, Zhou Y, Ding L, Cui Y. Diagnostic value of YKL-40 for patients with asthma: A meta-analysis. Allergy Asthma Proc 2021; 42:e167-e173. [PMID: 34871165 DOI: 10.2500/aap.2021.42.210078] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objective: YKL-40 is a highly conserved and chitin-bound human glycoprotein in mammals that is associated with airway inflammation and has no enzyme activity. We aimed to conduct a meta-analysis to assess the use of YKL-40 levels as a diagnosis of asthma. Methods: A meta-analysis was conducted based on the data from medical literature data base searches with time restrictions of January 2007 to January 2021. We searched and extracted relevant information from a total of 15 studies that reported YKL-40 levels in patients with asthma and in healthy controls, and obtained a sample of 1647 patients with asthma and 1259 healthy controls. Standardized mean differences (SMD) with 95% confidence intervals (CI) were calculated for this study by using statistical software packages. Results: Serum YKL-40 levels were higher in the patients with asthma than in the healthy controls (SMD 1.36 ng/ml [95% CI, 0.82-1.89 ng/ml]). YKL-40 levels are elevated in pediatric patients with asthma (SMD 2.26 ng/ml [95% CI, 1.33-3.18 ng/ml]) and in adult patients with asthma (SMD 0.96 ng/ml [95% CI, 0.26-1.66 ng/ml]). In addition, a subgroup analysis of asthma disease status showed that YKL-40 levels were significantly increased in the patients with stable asthma (SMD 1.69 ng/ml [95% CI, 0.81-2.56 ng/ml]) and in those with acute exacerbation asthma (SMD 3.31 ng/ml [95% CI, 2.04-4.58 ng/ml]), and serum YKL-40 levels were significantly higher in patients with acute exacerbation asthma than in patients with stable asthma (SMD 1.49 ng/ml [95% CI, 0.50-2.48 ng/ml]). Conclusion: Results of this meta-analysis suggested that increased serum levels of YKL-40 in patients with asthma could be used as an emerging indicator for distinguishing individuals with asthma from healthy individuals.
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10
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Jin Y, Song J, Xu F, Zhang D, He J, Zheng J, Zhang Y, Li J, Guo Y, Xu M, Yu X, Liu Y, Liu Q, Yan J. Association between YKL-40 and asthma: a systematic meta-analysis. Sleep Breath 2021; 26:1011-1022. [PMID: 34657273 DOI: 10.1007/s11325-021-02495-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 09/09/2021] [Accepted: 09/17/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Many studies have shown that chitinase-3-like protein 1 (CHI3L1), also known as YKL-40, is associated with asthma. The purpose of this meta-analysis was to evaluate the role of serum YKL-40 in the diagnosis and differential diagnosis of asthma, severity grading, and determination of disease state. METHODS The PubMed, Ovid, and Cochrane databases were searched. A total of 17 articles involving 5696 subjects were included in this meta-analysis. RESULTS The results showed that the level of YKL-40 was significantly higher in asthmatic patients than in the normal group regardless of age and residential location, and increased with severity and acute exacerbation (p < 0.05). YKL-40 levels were significantly different between chronic obstructive pulmonary disease (COPD) and asthma, and also between asthma-COPD overlap syndrome (ACO) and asthma (p < 0.05). CONCLUSION YKL-40 may act as a potential serological marker for the diagnosis of asthma, assessment of severity, indicator of the disease state, and differential diagnosis of COPD, ACO, and asthma.
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Affiliation(s)
- Yihan Jin
- Department of Respiratory Medicine, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Jie Song
- Department of Respiratory Medicine, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Fang Xu
- Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Di Zhang
- Department of Respiratory Medicine, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Jinfang He
- Department of Respiratory Medicine, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Jiakun Zheng
- Department of Respiratory Medicine, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Yanan Zhang
- Department of Respiratory Medicine, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Jintong Li
- Department of Respiratory Medicine, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Yikun Guo
- Department of Respiratory Medicine, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Mengjiao Xu
- Department of Respiratory Medicine, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Xiangfeng Yu
- Department of Respiratory Medicine, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Yanbin Liu
- Department of Respiratory Medicine, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Qinghua Liu
- Department of Respiratory Medicine, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Jun Yan
- Department of Respiratory Medicine, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, 100700, China.
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11
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Yang Y, Jia M, Ou Y, Adcock IM, Yao X. Mechanisms and biomarkers of airway epithelial cell damage in asthma: A review. CLINICAL RESPIRATORY JOURNAL 2021; 15:1027-1045. [PMID: 34097803 DOI: 10.1111/crj.13407] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 05/17/2021] [Accepted: 06/03/2021] [Indexed: 12/15/2022]
Abstract
Bronchial asthma is a heterogeneous disease with complex pathological mechanisms representing different phenotypes, including severe asthma. The airway epithelium is a major site of complex pathological changes in severe asthma due, in part, to activation of inflammatory and immune mechanisms in response to noxious agents. Current imaging procedures are unable to accurately measure epithelial and airway remodeling. Damage of airway epithelial cells occurs is linked to specific phenotypes and endotypes which provides an opportunity for the identification of biomarkers reflecting epithelial, and airway, remodeling. Identification of patients with more severe epithelial disruption using biomarkers may also provide personalised therapeutic opportunities and/or markers of successful therapeutic intervention. Here, we review the evidence for ongoing epithelial cell dysregulation in the pathogenesis of asthma, the sentinel role of the airway epithelium and how understanding these molecular mechanisms provides the basis for the identification of candidate biomarkers for asthma prediction, prevention, diagnosis, treatment and monitoring.
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Affiliation(s)
- Yuemei Yang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Man Jia
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yingwei Ou
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.,Department of Emergency Medical, Zhejiang Province People's Hospital, Zhejiang, China
| | - Ian M Adcock
- Airway Disease Section, National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
| | - Xin Yao
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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12
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Abstract
BACKGROUND This study was aimed to investigate the associations among Chitinase 3-like 1 (CHI3L1) polymorphisms, asthma and plasma YKL-40 levels in Chinese population. MATERIAL AND METHODS Four CHI3L1 single nucleotide polymorphisms (SNPs) were genotyped. The YKL-40 level in plasma and eosinophil percentage in peripheral blood were quantified. RESULTS A SNP (rs4950928) in the CHI3L1 promoter was associated with elevated plasma YKL-40 levels (p = .02), asthma (p = .042) and lung function (p = .029 to .002) in this Chinese population. Plasma YKL-40 levels were significantly elevated in patients with asthma compared to those in control subjects (p < .05). Plasma YKL-40 levels were significantly correlated with forced expiratory volume per cent (FEV1%) measurements (p < .05). Although plasma YKL-40 levels were decreased after treatment, the correlation with FEV1% still existed. CONCLUSIONS CHI3L1 locus is a risk factor for asthma in Chinese population.
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Affiliation(s)
- Jinlian Shao
- Department of ICU, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
- Department of Respiratory Diseases, Nanfang Hospital, Guangzhou, China
| | - Xuexi Yang
- Department of Immunology, Southern Medical University, Guangzhou, China
| | - Dunqiang Ren
- The Affiliated Hospital of Medical College, Qingdao University, Qingdao, China
| | - Yaling Luo
- Department of Respiratory Diseases, Nanfang Hospital, Guangzhou, China
| | - Wenyan Lai
- Laborwatory of Cardiovascular Diseases, Nanfang Hospital, Guangzhou, China
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13
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The Predictive Role of Biomarkers and Genetics in Childhood Asthma Exacerbations. Int J Mol Sci 2021; 22:ijms22094651. [PMID: 33925009 PMCID: PMC8124320 DOI: 10.3390/ijms22094651] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 04/22/2021] [Accepted: 04/23/2021] [Indexed: 12/24/2022] Open
Abstract
Asthma exacerbations are associated with significant childhood morbidity and mortality. Recurrent asthma attacks contribute to progressive loss of lung function and can sometimes be fatal or near-fatal, even in mild asthma. Exacerbation prevention becomes a primary target in the management of all asthmatic patients. Our work reviews current advances on exacerbation predictive factors, focusing on the role of non-invasive biomarkers and genetics in order to identify subjects at higher risk of asthma attacks. Easy-to-perform tests are necessary in children; therefore, interest has increased on samples like exhaled breath condensate, urine and saliva. The variability of biomarker levels suggests the use of seriate measurements and composite markers. Genetic predisposition to childhood asthma onset has been largely investigated. Recent studies highlighted the influence of single nucleotide polymorphisms even on exacerbation susceptibility, through involvement of both intrinsic mechanisms and gene-environment interaction. The role of molecular and genetic aspects in exacerbation prediction supports an individual-shaped approach, in which follow-up planning and therapy optimization take into account not only the severity degree, but also the risk of recurrent exacerbations. Further efforts should be made to improve and validate the application of biomarkers and genomics in clinical settings.
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14
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Peng J, Yu Q, Fan S, Chen X, Tang R, Wang D, Qi D. High Blood Eosinophil and YKL-40 Levels, as Well as Low CXCL9 Levels, are Associated with Increased Readmission in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease. Int J Chron Obstruct Pulmon Dis 2021; 16:795-806. [PMID: 33814903 PMCID: PMC8009765 DOI: 10.2147/copd.s294968] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 03/04/2021] [Indexed: 12/14/2022] Open
Abstract
Background Readmission after hospital discharge is common among patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Predictive biomarkers of readmission would facilitate stratification strategies and individualized prognosis. Therefore, this study aimed to investigate the utility of type 2 biomarkers (eosinophils, periostin, and YKL-40) and a type 1 biomarker (CXCL9) in predicting readmission events in patients with AECOPD. Methods This is a prospective observational study design. Blood levels of eosinophils, periostin, YKL-40, and CXCL9 were measured at admission. The clinical outcomes were 12-month COPD-related readmission, time to COPD-related readmission, and number of 12-month COPD-related readmissions. These outcomes were analyzed using logistic and Cox regression models and Spearman's rank test. Results A total of 123 patients were included, of whom 51 had experienced at least one readmission for AECOPD. High levels of eosinophils (≥200 cells/μL or 2% of the total white blood cell count, adjusted odds ratio [aOR] =3.138, P=0.009) and YKL-40 (≥14.5 ng/mL, aOR =2.840, P=0.015), as well as low CXCL9 levels (≤30.1 ng/mL, aOR =2.551, P=0.028), were associated with an increased COPD-related readmission. The highest relative readmission rate was observed in patients with both high eosinophil and YKL-40 levels. Moreover, high eosinophil and YKL-40 levels were associated with a shorter time to first COPD-related readmission and an increased number of 12-month COPD-related readmissions. Conclusion High blood eosinophil and YKL-40 levels, as well as low CXCL9 levels, have predictive utility for the 12-month COPD-related readmission rate. Using eosinophils and YKL-40 together allows more precise identification of patients at high risk of COPD-related readmission.
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Affiliation(s)
- Junnan Peng
- Department of Respiratory Medicine, Second Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Qian Yu
- Department of Respiratory Medicine, Second Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Shulei Fan
- Department of Respiratory Medicine, Second Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Xingru Chen
- Department of Respiratory Medicine, Second Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Rui Tang
- Department of Respiratory Medicine, Second Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Daoxin Wang
- Department of Respiratory Medicine, Second Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Di Qi
- Department of Respiratory Medicine, Second Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
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15
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A Novel Association between YKL-40, a Marker of Structural Lung Disease, and Short Telomere Length in 10-Year-Old Children with Bronchopulmonary Dysplasia. CHILDREN-BASEL 2021; 8:children8020080. [PMID: 33498968 PMCID: PMC7912154 DOI: 10.3390/children8020080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 01/20/2021] [Accepted: 01/21/2021] [Indexed: 02/06/2023]
Abstract
Extremely preterm infants are born with immature lungs and are exposed to an inflammatory environment as a result of oxidative stress. This may lead to airway remodeling, cellular aging and the development of bronchopulmonary dysplasia (BPD). Reliable markers that predict the long-term consequences of BPD in infancy are still lacking. We analyzed two biomarkers of cellular aging and lung function, telomere length and YKL-40, respectively, at 10 years of age in children born preterm with a history of BPD (n = 29). For comparison, these markers were also evaluated in sex-and-age-matched children born at term with childhood asthma (n = 28). Relative telomere length (RTL) was measured in whole blood with qPCR and serum YKL-40 with ELISA, and both were studied in relation to gas exchange and the regional ventilation/perfusion ratio using three-dimensional V/Q-scintigraphy (single photon emission computer tomography, SPECT) in children with BPD. Higher levels of YKL-40 were associated with shorter leukocyte RTL (Pearson's correlation: -0.55, p = 0.002), but were not associated with a lower degree of matching between ventilation and perfusion within the lung. Serum YKL-40 levels were significantly higher in children with BPD compared to children with asthma (17.7 vs. 13.2 ng/mL, p < 0.01). High levels of YKL-40 and short RTLs were associated to the need for ventilatory support more than 1 month in the neonatal period (p < 0.01). The link between enhanced telomere shortening in childhood and structural remodeling of the lung, as observed in children with former BPD but not in children with asthma at the age of 10 years, suggests altered lung development related to prematurity and early life inflammatory exposure. In conclusion, relative telomere length and YKL-40 may serve as biomarkers of altered lung development as a result of early-life inflammation in children with a history of prematurity.
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Satitsri S, Muanprasat C. Chitin and Chitosan Derivatives as Biomaterial Resources for Biological and Biomedical Applications. Molecules 2020; 25:molecules25245961. [PMID: 33339290 PMCID: PMC7766609 DOI: 10.3390/molecules25245961] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 12/09/2020] [Accepted: 12/10/2020] [Indexed: 01/30/2023] Open
Abstract
Chitin is a long-chain polymer of N-acetyl-glucosamine, which is regularly found in the exoskeleton of arthropods including insects, shellfish and the cell wall of fungi. It has been known that chitin can be used for biological and biomedical applications, especially as a biomaterial for tissue repairing, encapsulating drug for drug delivery. However, chitin has been postulated as an inducer of proinflammatory cytokines and certain diseases including asthma. Likewise, chitosan, a long-chain polymer of N-acetyl-glucosamine and d-glucosamine derived from chitin deacetylation, and chitosan oligosaccharide, a short chain polymer, have been known for their potential therapeutic effects, including anti-inflammatory, antioxidant, antidiarrheal, and anti-Alzheimer effects. This review summarizes potential utilization and limitation of chitin, chitosan and chitosan oligosaccharide in a variety of diseases. Furthermore, future direction of research and development of chitin, chitosan, and chitosan oligosaccharide for biomedical applications is discussed.
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Chitinase-3 like-protein-1 function and its role in diseases. Signal Transduct Target Ther 2020; 5:201. [PMID: 32929074 PMCID: PMC7490424 DOI: 10.1038/s41392-020-00303-7] [Citation(s) in RCA: 209] [Impact Index Per Article: 52.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/28/2020] [Accepted: 08/20/2020] [Indexed: 12/12/2022] Open
Abstract
Non-enzymatic chitinase-3 like-protein-1 (CHI3L1) belongs to glycoside hydrolase family 18. It binds to chitin, heparin, and hyaluronic acid, and is regulated by extracellular matrix changes, cytokines, growth factors, drugs, and stress. CHI3L1 is synthesized and secreted by a multitude of cells including macrophages, neutrophils, synoviocytes, chondrocytes, fibroblast-like cells, smooth muscle cells, and tumor cells. It plays a major role in tissue injury, inflammation, tissue repair, and remodeling responses. CHI3L1 has been strongly associated with diseases including asthma, arthritis, sepsis, diabetes, liver fibrosis, and coronary artery disease. Moreover, following its initial identification in the culture supernatant of the MG63 osteosarcoma cell line, CHI3L1 has been shown to be overexpressed in a wealth of both human cancers and animal tumor models. To date, interleukin-13 receptor subunit alpha-2, transmembrane protein 219, galectin-3, chemo-attractant receptor-homologous 2, and CD44 have been identified as CHI3L1 receptors. CHI3L1 signaling plays a critical role in cancer cell growth, proliferation, invasion, metastasis, angiogenesis, activation of tumor-associated macrophages, and Th2 polarization of CD4+ T cells. Interestingly, CHI3L1-based targeted therapy has been increasingly applied to the treatment of tumors including glioma and colon cancer as well as rheumatoid arthritis. This review summarizes the potential roles and mechanisms of CHI3L1 in oncogenesis and disease pathogenesis, then posits investigational strategies for targeted therapies.
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Rani R, Singh V. Overexpression of YKL-40 (CHI3L1 gene) in patient fluids may be a potential predictive marker for early detection of comorbidity in non-communicable disease. Med Hypotheses 2020; 143:110076. [PMID: 32721792 DOI: 10.1016/j.mehy.2020.110076] [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: 06/04/2020] [Revised: 07/01/2020] [Accepted: 07/02/2020] [Indexed: 10/23/2022]
Abstract
Predictive biomarkers which can diagnose the onset of non-communicable diseases and the associated comorbid conditions are lacking for clinical utility. Highly sensitive and specific biomarkers for early disease detection and risk stratification may provide timely intervention to patients and prevent secondary complications. However, till the time patients are diagnosed, cellular events and biomolecules get active effecting multiple organs at the same time. This series of events lead to disruption in normal functioning of the organs and their coordinative crosstalk, hence, increase in mortality rate of patients. The primary functional molecules of inflammatory pathways are active in NCDs. YKL-40, an anti-apoptotic molecule in inflammatory pathways, is overexpressed in patient fluids in different organs under diseased conditions. We performed a preliminary network analysis to study YKL-40 co-expression with diagnostic markers: TNNT2/I3 (Cardiac Troponin T/I) for cardiovascular diseases, LCN2 (NGAL) and CKM (Creatinine kinase M-type) in acute kidney injury and HbA1c in type-2-diabetes. It is observed that YKL-40 is actively co-expressed and linked with standard diagnostic markers and may be influencing the pathways active in organ crosstalk. The pathways may be regulating the signaling events in patients with non-communicable diseases leading to comorbidities. We, hence, postulate that if YKL-40 and disease specific pathways influenced are clinically utilized, this will provide the foundation of establishing tailored and specific approach in diagnosis and monitoring non-communicable diseases and predict the onset of comorbid conditions due to phenomenon influencing organ cross talks.
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Affiliation(s)
- Raj Rani
- Centre for Life Sciences, Chitkara School of Health Sciences, Chitkara University, Punjab, India
| | - Varsha Singh
- Centre for Life Sciences, Chitkara School of Health Sciences, Chitkara University, Punjab, India.
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Evaluation serum levels of YKL-40, Periostin, and some inflammatory cytokines together with IL-37, a new anti-inflammatory cytokine, in patients with stable and exacerbated asthma. Heart Lung 2020; 50:177-183. [PMID: 32475627 DOI: 10.1016/j.hrtlng.2020.04.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 04/21/2020] [Accepted: 04/27/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION As asthma has a wide range of inflammatory pathways, the researchers were focused on the markers that may be associated with exacerbation and stability in asthma. OBJECTIVE Our aim is to investigate the serum levels of some inflammatory markers and cytokines in stable and exacerbated asthmatic patients. METHODS The study included in 59 non-smoker asthma patient (Exacerbated=25, Stable=34) and 30 healthy volunteers. The serum level of periostin, YKL-40, IL-4, IL-5, IL-37, and TNF-α were detected by enzyme-linked immunosorbent assay. RESULTS Except for IL-37, the periostin, YKL-40, IL-4, IL-5, and TNF-α level in asthmatic patients were significantly higher than those of healthy control. In the exacerbated group, the periostin, YKL-40, IL-5, and TNF-α level were significantly higher than stable asthma and healthy control groups. The serum levels of IL-4 in exacerbated and stable asthma groups were significantly higher than healthy control group. There was a significant difference between IL4 levels, in stable asthma and healthy control groups. In exacerbated asthma group, IL-37 level was significantly lower than stable and healthy control groups. The highest area under the ROC curve (AUC) was found for IL-4. While there was a significant negative correlation between these parameters and FEV1, there was a positive correlation between IL-37 and FEV1, but not significant. CONCLUSIONS This study showed that increased serum periostin, YKL-40, IL-5, IL-4, and TNF-α and decreased serum IL-37 were associated with exacerbation showing uncontrolled asthma.
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Chimponda TN, Mduluza T. Inflammation during Schistosoma haematobium infection and anti-allergy in pre-school-aged children living in a rural endemic area in Zimbabwe. Trop Med Int Health 2020; 25:618-623. [PMID: 31990094 DOI: 10.1111/tmi.13376] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Allergies and autoimmune disorders are less prevalent in areas where parasitic infections are abundant. The relationship between schistosomiasis, Chitinase 3-Like 1 protein (YKL-40), an inflammatory marker, and antinuclear antibodies (ANA), an allergy marker, was investigated in pre-school-aged children (1-5 years old) living in an area endemic to Schistosoma haematobium infection. METHODS Cross-sectional study including 145 participants, 66 females and 79 males. S. haematobium infection was diagnosed using the urine filtration technique. Levels of YKL-40 and antinuclear antibodies concentrations were determined using enzyme-linked immunosorbent assay. RESULTS The prevalence of S. haematobium infection was 21.4 % (n = 31) with 114 not infected, 18 with light and 13 with moderate infections. YKL-40 levels were higher in the S. haematobium-infected group than in the uninfected group (P = 0.038). However, S. haematobium infection intensity did not correlate with YKL-40 levels. ANA levels were significantly higher in uninfected children than in infected children (P = 0.028). There was a significant inverse relationship between ANA levels and schistosome infection intensity (r = -0.225, P = 0.016). The correlation between ANA levels and YKL-40 levels was not significant. CONCLUSION Inflammatory marker in pre-school-aged children living in an area endemic for schistosomiasis indicate YKL-40 as a possible biomarker of S. haematobium infection in pre-school-aged children, warranting further investigations in a longitudinal study. The study gives an insight into allergy as ANA levels were higher in schistosome-uninfected than infected participants, further studies on allergies are needed.
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Affiliation(s)
| | - Takafira Mduluza
- Biochemistry Department, University of Zimbabwe, Harare, Zimbabwe
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21
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Guida G, Riccio AM. Immune induction of airway remodeling. Semin Immunol 2019; 46:101346. [PMID: 31734128 DOI: 10.1016/j.smim.2019.101346] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 10/17/2019] [Accepted: 11/06/2019] [Indexed: 12/17/2022]
Abstract
Airway remodeling is accepted to be a determining component within the natural history of asthma. It is a phenomenon characterized by changes in the airways structures that marches in parallel with and can be influenced by airway inflammation, floating at the interface between both natural and adaptive immunity and physical and mechanical cells behavior. In this review we aimed to highlight the comprehensive, yet not exhaustive, evidences of how immune cells induce, regulate and adapt to the recognized markers of airway remodeling. Mucous cell hyperplasia, epithelial dysfunction and mesenchymal transition, extracellular matrix protein synthesis and restructuration, fibroblast to myofibroblast transition, airway smooth muscle proliferation, bioactive and contractile properties, and vascular remodeling encompass complex physiopathological mechanisms that can be induced, suppressed or regulated by different cellular and molecular pathways. Growth factors, cytokines, chemokines and adhesion molecules expressed or derived either from the immune network of cells infiltrating the asthmatic airways and involving T helper lymphocytes, immune lymphoid cells, dendritic cells, eosinophils, neutrophils, mast cells or by the structural components such as epithelial cells, fibroblasts, myocytes, airway smooth muscle cells concur with protein cellular matrix component and metalloproteases in modifying the airway structure in a detrimental way. The consequences in lung function decline, fixed airway obstruction and clinical severity of the disease suggest the possibility of identify among the immune molecular pathway of remodeling some biological parameters or signal pathway to be either a good tracer for monitoring the disease evolution or a target for hypothetical phenotypes and endotypes. In the era of personalized medicine, a biomarker of remodeling might predict a response to small-molecule inhibitors or biologicals potentially targeting a fundamental aspect of asthma pathogenesis that impacts on the low responsiveness to airway inflammation directed treatments.
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Affiliation(s)
- Giuseppe Guida
- Allergology and Lung Pathology, Santa Croce and Carle Hospital, Cuneo - Antonio Carle Hospital, Via Antonio Carle 5, 12100, Confreria (CN), Italy.
| | - Anna Maria Riccio
- Allergy and Respiratory Diseases - Department of Internal Medicine, University of Genoa, Italy.
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Narendra D, Blixt J, Hanania NA. Immunological biomarkers in severe asthma. Semin Immunol 2019; 46:101332. [PMID: 31735516 DOI: 10.1016/j.smim.2019.101332] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 10/21/2019] [Indexed: 12/13/2022]
Abstract
Severe asthma is heterogeneous in its clinical presentation, underlying pathophysiology, course and response to therapy. Clinical and physiological assessment of severe asthma is often inadequate in predicting underlying disease mechanisms and or response to medications. With the emergence of novel targeted therapies in severe asthma, the need for reproducible, easily measured biomarkers became obvious but only few are currently available for clinical use. These biomarkers along with the clinical presentation of the patient play an important role in identifying phenotypes and endotypes, predicting the clinical course and prognosis and improving the precision therapeutic approach to asthma.
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Affiliation(s)
- Dharani Narendra
- Section of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, Texas, United States
| | - John Blixt
- Section of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, Texas, United States
| | - Nicola A Hanania
- Section of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, Texas, United States.
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Zhou PM, Fu LX, Chen T, Wang L, Lu YH. Elevated YKL-40 serum levels in patients with chronic spontaneous urticaria. Ann Allergy Asthma Immunol 2019; 123:404-405. [PMID: 31330242 DOI: 10.1016/j.anai.2019.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 06/22/2019] [Accepted: 07/14/2019] [Indexed: 02/05/2023]
Affiliation(s)
- Pei-Mei Zhou
- Department of Dermatovenereology, West China Hospital of Sichuan University, Chengdu, Sichuan, China; Department of Dermatovenereology, Chengdu Second People's Hospital, Chengdu, Sichuan, China
| | - Li-Xin Fu
- Department of Dermatovenereology, Chengdu Second People's Hospital, Chengdu, Sichuan, China
| | - Tao Chen
- Department of Dermatovenereology, Chengdu Second People's Hospital, Chengdu, Sichuan, China
| | - Lin Wang
- Department of Dermatovenereology, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
| | - Yong-Hong Lu
- Department of Dermatovenereology, Chengdu Second People's Hospital, Chengdu, Sichuan, China
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Elshaer NS, Foda NM, Kassem HS, Ayaad MW, Meleis DS. Bronchial asthma among workers in Alexandria and its association with occupation, eosinophil count, total serum immunoglobulin E antibodies, and glutathione S-transferase genes polymorphism. ALEXANDRIA JOURNAL OF MEDICINE 2019. [DOI: 10.1016/j.ajme.2011.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Noha S. Elshaer
- Community Medicine Department, Faculty of Medicine, Alexandria University, Egypt
| | - Nermine M.T. Foda
- Community Medicine Department, Faculty of Medicine, Alexandria University, Egypt
| | - Heba S. Kassem
- Pathology Department, Clinical Genomics Center, Faculty of Medicine, Alexandria University, Egypt
| | - Mona W. Ayaad
- Clinical Pathology Department, Faculty of Medicine, Alexandria University, Egypt
| | - Dorreya S. Meleis
- Community Medicine Department, Faculty of Medicine, Alexandria University, Egypt
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Abstract
Asthma is a heterogenous disease characterized by multiple phenotypes driven by different mechanisms. The implementation of precision medicine in the management of asthma requires the identification of phenotype-specific markers measurable in biological fluids. To become useful, these biomarkers need to be quantifiable by reliable systems, reproducible in the clinical setting, easy to obtain and cost-effective. Using biomarkers to predict asthma outcomes and therapeutic response to targeted therapies has a great clinical significance, particularly in severe asthma. In the last years, significant research has been realized in the identification of valid biomarkers for asthma. This review focuses on the existent and emerging biomarkers with clinical higher applicability in the management of asthma.
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Affiliation(s)
- Angelica Tiotiu
- Pulmonology Department, University Hospital, 9, Rue du Morvan, 54511 Nancy, Vandœuvre-lès-Nancy France
- EA 3450 DevAH, Development, Adaptation, Cardio-Respiratory Regulations and Motor Control, University of Lorraine, Nancy, France
- National Heart and Lung Institute, Airway Disease Section, Imperial College London, London, UK
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Furukawa T, Matsui K, Kitano M, Yokoyama Y, Sekiguchi M, Azuma N, Imai Y, Hirota S, Yamanishi K, Sano H. Relationship between YKL-40 and pulmonary arterial hypertension in systemic sclerosis. Mod Rheumatol 2018; 29:476-483. [DOI: 10.1080/14397595.2018.1480256] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- Tetsuya Furukawa
- Division of Rheumatology, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Kiyoshi Matsui
- Division of Rheumatology, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Masayasu Kitano
- Division of Rheumatology, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Yuichi Yokoyama
- Division of Rheumatology, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Masahiro Sekiguchi
- Division of Rheumatology, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Naoto Azuma
- Division of Rheumatology, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Yasutomo Imai
- Department of Dermatology, Hyogo College of Medicine, Hyogo, Japan
| | - Seiichi Hirota
- Department of Surgical Pathology, Hyogo College of Medicine, Hyogo, Japan
| | | | - Hajime Sano
- Division of Rheumatology, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
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El Basha NR, Osman HM, Abdelaal AA, Saed SM, Shaaban HH. Increased expression of serum periostin and YKL40 in children with severe asthma and asthma exacerbation. J Investig Med 2018; 66:1102-1108. [PMID: 29970479 DOI: 10.1136/jim-2017-000680] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2018] [Indexed: 12/12/2022]
Abstract
Children with severe asthma or acute asthma exacerbation may encounter difficulties in performing pulmonary function tests. In this situation, serum biomarkers can play a great role in evaluation of such patients. The aim of this study was to estimate the serum levels of human chitinase-3-like protein 1 (YKL40) and periostin in a group of Egyptian children with asthma during acute asthma exacerbation and in stable asthmatics compared with healthy control, and to correlate these findings with the severity of asthma. This cross-sectional study enrolled 120 childrenwith asthma with different degrees of asthma severity, according to the Global Initiative for Asthma guidelines, along with 60 age-matched and sex-matched healthy control. A complete blood count and an estimation of serum periostin and YKL40 levels were performed for all cases and control. Individual and mean values of periostin and YKL40 were significantly higher during acute asthma exacerbations, p<0.001. A highly significant relation between serum levels of periostin and YKL40 and asthma severity, p value for each was <0.001. Absolute eosinophil count was significantly correlated with the serum periostin levels in stable asthmatic group (p=0.01) only. There was significantly positive correlation (P<0.001) between both markers in stable asthmatic group. Spearman's correlation coefficient shows a statistically significant positive correlation between both markers and patient's age and duration of asthma, p value for each was 0.001. These findings highlight the importance of periostin and YKL40 as serum biomarkers for assessment of asthma severity and acute asthma exacerbations in children with asthma.
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Affiliation(s)
- Noussa Ragab El Basha
- Pediatric Department, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt
| | - Hanan Mohsen Osman
- Pediatric Department, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt
| | - Amaal Abdo Abdelaal
- Clinical and Chemical Pathology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Salma Mohamed Saed
- Clinical and Chemical Pathology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hala Hamdy Shaaban
- Pediatric Department, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt
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Sinus Computed Tomographic Findings in Adult Smokers and Nonsmokers with Asthma. Analysis of Clinical Indices and Biomarkers. Ann Am Thorac Soc 2018; 14:332-341. [PMID: 28029801 DOI: 10.1513/annalsats.201606-463oc] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
RATIONALE When they occur together, sinusitis and asthma are often thought to represent anatomically separate components of the same chronic inflammatory airway disease. Information about the effect of smoking on the interaction between sinusitis and asthma in patients who have both disorders is limited. OBJECTIVES To evaluate the effect of cigarette smoking on the relationship between the presence and severity of sinusitis and selected asthma-related indices in adults who have asthma. METHODS This study included 127 patients with severe asthma and 79 patients with mild to moderate asthma. Clinical data were obtained from all subjects during a 2-day stay at Hokkaido University Hospital (Sapporo, Japan). The Lund-Mackay scoring system was used to assess the anatomic extent and severity of sinusitis as revealed by sinus computed tomographic (CT) images obtained during hospitalization. We examined associations between Lund-Mackay scores and a variety of asthma-related indices and levels of biomarkers in blood and sputum. To clarify the effect of smoking on these associations, we conducted separate analyses for nonsmoking (<10 pack-years; n = 130) and smoking subjects (≥10 pack-years; n = 76). MEASUREMENTS AND MAIN RESULTS In our cohort of adults with asthma, we found significant positive relationships between the presence and severity of sinusitis as assessed by Lund-Mackay score and the severity of asthma as measured by percent predicted FEV1 or FEV1/FVC for nonsmoking subjects (<10 pack-years) but not for cigarette smokers (>10 pack-years). Lund-Mackay scores correlated with blood and sputum eosinophil counts, serum IgE levels, and fractional exhaled nitric oxide, regardless of smoking status. Lund-Mackay scores also showed significant positive associations with serum periostin and chemokine C-C motif ligand 18 levels, regardless of smoking status, whereas a positive association with plasma osteopontin level was seen only for nonsmoking subjects. CONCLUSIONS We found an association between the severity of sinusitis on CT imaging and the severity of concomitant asthma on spirometry for nonsmoking adults but not for smokers. In adults with asthma, CT imaging evidence of severe sinusitis indicates intense Th2-related inflammation, regardless of smoking status.
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Pavord ID, Afzalnia S, Menzies-Gow A, Heaney LG. The current and future role of biomarkers in type 2 cytokine-mediated asthma management. Clin Exp Allergy 2017; 47:148-160. [PMID: 28134501 DOI: 10.1111/cea.12881] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Assessment and management of asthma is complicated by the heterogeneous pathophysiological mechanisms that underlie its clinical presentation, which are not necessarily reflected in standardized management paradigms and which necessitate an individualized approach to treatment. This is particularly important with the emerging availability of a variety of targeted forms of therapy that may only be appropriate for use in particular patient subgroups. The identification of biomarkers can potentially aid diagnosis and inform prognosis, help guide treatment decisions and allow clinicians to predict and monitor response to treatment. Biomarkers for asthma have been identified from a variety of sources, including airway, exhaled breath and blood. Biomarkers from exhaled breath include fractional exhaled nitric oxide, measurement of which can help identify patients most likely to benefit from inhaled corticosteroids and targeted anti-immunoglobulin E therapy. Biomarkers measured in blood are relatively non-invasive and technically more straightforward than those measured from exhaled breath or directly from the airway. The most well established of these are the blood eosinophil count and serum periostin, both of which have demonstrated utility in identifying patients most likely to benefit from targeted anti-interleukin and anti-immunoglobulin E therapies, and in monitoring subsequent treatment response. For example, serum periostin appears to be a biomarker for responsiveness to inhaled corticosteroid therapy and may help identify patients as suitable candidates for anti-IL-13 treatment. The use of biomarkers can therefore potentially help avoid unnecessary morbidity from high-dose corticosteroid therapy and allow the most appropriate and cost-effective use of targeted therapies. Ongoing clinical trials are helping to further elucidate the role of established biomarkers in routine clinical practice, and a range of other circulating novel potential biomarkers are currently being investigated in the research setting.
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Affiliation(s)
- I D Pavord
- Respiratory Medicine Unit, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - S Afzalnia
- Roche Products Ltd, Welwyn Garden City, Hertfordshire, UK
| | | | - L G Heaney
- Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
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Pathological Roles of Neutrophil-Mediated Inflammation in Asthma and Its Potential for Therapy as a Target. J Immunol Res 2017; 2017:3743048. [PMID: 29359169 PMCID: PMC5735647 DOI: 10.1155/2017/3743048] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 09/10/2017] [Accepted: 09/27/2017] [Indexed: 12/22/2022] Open
Abstract
Asthma is a chronic inflammatory disease that undermines the airways. It is caused by dysfunction of various types of cells, as well as cellular components, and is characterized by recruitment of inflammatory cells, bronchial hyperreactivity, mucus production, and airway remodelling and narrowing. It has commonly been considered that airway inflammation is caused by the Th2 immune response, or eosinophilia, which is a hallmark of bronchial asthma pathogenesis. Some patients display a neutrophil-dominant presentation and are characterized with low (or even absent) Th2 cytokines. In recent years, increasing evidence has also suggested that neutrophils play a key role in the development of certain subtypes of asthma. This review discusses neutrophils in asthma and potentially related targeted therapies.
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Pranzatelli MR, Tate ED, McGee NR. Microglial/macrophage markers CHI3L1, sCD14, and sCD163 in CSF and serum of pediatric inflammatory and non-inflammatory neurological disorders: A case-control study and reference ranges. J Neurol Sci 2017; 381:285-290. [PMID: 28991699 DOI: 10.1016/j.jns.2017.09.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 08/31/2017] [Accepted: 09/05/2017] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To assess the role of microglia and macrophages in neuroinflammatory disorders in children via biomarkers, and establish control reference ranges. METHODS In an IRB-approved case-control study of 98 children, the concentrations of CSF/serum CHI3L1, sCD14, and sCD163 were measured by ELISA. Groups were controls (non-inflammatory neurological disorders, NIND, n=37), opsoclonus-myoclonus syndrome (OMS, n=37), and other inflammatory neurological disorders (OIND, n=24). RESULTS In control CSF, median concentrations (ng/ml) were 25 (IQR 16,41) for CHI3L1 and 42 (26,160) for sCD14; in serum, 16 (12,22) for CHI3L1, and 431 (270,957) for sCD163. The median CSF concentration of CHI3L1 in OIND was significantly higher than controls (2.9-fold, P<0.0001) and OMS (1.6-fold higher than controls, NS). The CSF sCD14 concentration was 1.9-fold higher in OIND (P=0.008) and 1.4-fold higher in OMS than controls. sCD163, below detection limits in CSF, was not significantly increased in OIND or OMS sera. CONCLUSIONS CSF CHI3L1 and sCD14 elevations hold promise as immunomarkers in pediatric OIND, especially in high-expression individuals. These results provide evidence of innate immune system involvement in several pediatric neuroinflammatory disorders. Pediatric control data on CSF microglia/macrophage activation markers are hereby available for other investigators.
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Affiliation(s)
- Michael R Pranzatelli
- National Pediatric Myoclonus Center, National Pediatric Neuroinflammation Organization, Inc., Orlando, FL, USA.
| | - Elizabeth D Tate
- National Pediatric Myoclonus Center, National Pediatric Neuroinflammation Organization, Inc., Orlando, FL, USA.
| | - Nathan R McGee
- National Pediatric Myoclonus Center, National Pediatric Neuroinflammation Organization, Inc., Orlando, FL, USA.
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George L, Mitra A, Thimraj TA, Irmler M, Vishweswaraiah S, Lunding L, Hühn D, Madurga A, Beckers J, Fehrenbach H, Upadhyay S, Schulz H, Leikauf GD, Ganguly K. Transcriptomic analysis comparing mouse strains with extreme total lung capacities identifies novel candidate genes for pulmonary function. Respir Res 2017; 18:152. [PMID: 28793908 PMCID: PMC5551015 DOI: 10.1186/s12931-017-0629-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 07/25/2017] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Failure to attain peak lung function by early adulthood is a risk factor for chronic lung diseases. Previously, we reported that C3H/HeJ mice have about twice total lung capacity (TLC) compared to JF1/MsJ mice. We identified seven lung function quantitative trait loci (QTL: Lfnq1-Lfnq7) in backcross/intercross mice derived from these inbred strains. We further demonstrated, superoxide dismutase 3, extracellular (Sod3), Kit oncogene (Kit) and secreted phosphoprotein 1 (Spp1) located on these Lfnqs as lung function determinants. Emanating from the concept of early origin of lung disease, we sought to identify novel candidate genes for pulmonary function by investigating lung transcriptome in C3H/HeJ and JF1/MsJ mice at the completion of embryonic development, bulk alveolar formation and maturity. METHODS Design-based stereological analysis was performed to study lung structure in C3H/HeJ and JF1/MsJ mice. Microarray was used for lung transcriptomic analysis [embryonic day 18, postnatal days 28, 70]. Quantitative real time polymerase chain reaction (qRT-PCR), western blot and immunohistochemical analysis were used to confirm selected differences. RESULTS Stereological analysis revealed decreased alveolar number density, elastin to collagen ratio and increased mean alveolar volume in C3H/HeJ mice compared to JF1/MsJ. Gene ontology term "extracellular region" was enriched among the decreased JF1/MsJ transcripts. Candidate genes identified using the expression-QTL strategy include: ATP-binding cassette, sub-family G (WHITE), member 1 (Abcg1), formyl peptide receptor 1 (Fpr1), gamma-aminobutyric acid (GABA) B receptor, 1 (Gabbr1); histocompatibility 2 genes: class II antigen E beta (H2-Eb1), D region locus 1 (H2-D1), and Q region locus 4 (H2-Q4); leucine rich repeat containing 6 (testis) (Lrrc6), radial spoke head 1 homolog (Rsph1), and surfactant associated 2 (Sfta2). Noteworthy genes selected as candidates for their consistent expression include: Wnt inhibitor factor 1 (Wif1), follistatin (Fst), chitinase-like 1 (Chil1), and Chil3. CONCLUSIONS Comparison of late embryonic, adolescent and adult lung transcript profiles between mouse strains with extreme TLCs lead to the identification of candidate genes for pulmonary function that has not been reported earlier. Further mechanistic investigations are warranted to elucidate their mode of action in determining lung function.
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Affiliation(s)
- Leema George
- SRM Research Institute, SRM University, Chennai, 603203 India
| | - Ankita Mitra
- SRM Research Institute, SRM University, Chennai, 603203 India
| | | | - Martin Irmler
- Institute of Experimental Genetics, Helmholtz Zentrum Muenchen, German Research Center for Environmental Health, 85764 Neuherberg, Munich Germany
| | | | - Lars Lunding
- Priority Area Asthma & Allergy, Division of Asthma Exacerbation & Regulation, Research Center Borstel, Airway Research Center North (ARCN), 23845 Borstel, Germany
| | - Dorothea Hühn
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Centre Giessen and Marburg, Philipps-University Marburg, Marburg, Germany
- Present address: Lahn-Dill-Kliniken, Klinikum Wetzlar, Medizinische Klinik II, Forsthausstraße 1, D-35578 Wetzlar, Germany
| | - Alicia Madurga
- Department of Internal Medicine (Pulmonology), University of Giessen and Marburg Lung Center (UGMLC), 35392, Giessen, Germany
| | - Johannes Beckers
- Institute of Experimental Genetics, Helmholtz Zentrum Muenchen, German Research Center for Environmental Health, 85764 Neuherberg, Munich Germany
- German Center for Diabetes Research (DZD), 85764 Neuherberg, Germany
- Experimental Genetics, Technische Universität München, 85354 Freising, Germany
| | - Heinz Fehrenbach
- Priority Area Asthma & Allergy, Division of Experimental Pneumology, Research Center Borstel, Airway Research Center North (ARCN), 23845 Borstel, Germany
| | - Swapna Upadhyay
- Lung and Airway Research, Institute of Environmental Medicine, Karolinska Institutet, Box 287, SE-171 77 Stockholm, Sweden
- Institute of Lung Biology and Disease, Helmholtz Zentrum Muenchen, German Research Center for Environmental Health, 85764 Neuherberg, Munich Germany
| | - Holger Schulz
- Institute of Epidemiology I, Helmholtz Zentrum Muenchen, German Research Center for Environmental Health, 85764 Neuherberg, Munich Germany
- Comprehensive Pneumology Center Munich (CPC-M), Munich, Germany
| | - George D. Leikauf
- Department of Environmental and Occupational Health, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15219 USA
| | - Koustav Ganguly
- SRM Research Institute, SRM University, Chennai, 603203 India
- Lung and Airway Research, Institute of Environmental Medicine, Karolinska Institutet, Box 287, SE-171 77 Stockholm, Sweden
- Institute of Lung Biology and Disease, Helmholtz Zentrum Muenchen, German Research Center for Environmental Health, 85764 Neuherberg, Munich Germany
- Work Environment Toxicology; Institute of Environmental Medicine, Karolinska Institutet, Box 287, SE-171 77 Stockholm, Sweden
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YKL-40 is a novel biomarker for predicting hypertension incidence among prehypertensive subjects: A population-based nested case-control study in China. Clin Chim Acta 2017; 472:146-150. [PMID: 28797750 DOI: 10.1016/j.cca.2017.08.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 08/04/2017] [Accepted: 08/07/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND AIMS The previous study suggested that Human cartilage glycoprotein-39 (YKL-40) was positively associated with hypertension incidence in certain high-risk groups of hypertension. We aimed to investigate that whether YKL-40 is an effective biomarker for predicting hypertension incidence among prehypertensive subjects. METHODS In a 1:1 matched case-control study of 700 pairs with available YKL-40 levels nested in a prospective cohort of initially healthy Chinese subjects, 294 pairs additionally have matched baseline BP status (prehypertensive or normotensive). Multivariable conditional logistic regression analyses were used to calculate the odds ratios (95% confidential intervals) of hypertension associated with higher levels of YKL-40 in both prehypertensive and normotensive subgroups, respectively. RESULTS In the prehypertensive subgroup, the subjects in the highest quartile of plasma YKL-40 levels had a significantly higher risk of hypertension incidence, compared with those in the lowest quartile. The odds ratio (95% confidential intervals) is 2.01 (1.05-3.85). A positive association between YKL-40 levels and hypertension incidence was found (P for trend<0.05). However, this significant association was not observed in the normotensive subgroup. CONCLUSIONS Higher YKL-40 levels at baseline were positively associated with hypertension incidence among prehypertensive subjects. YKL-40 may represent a novel biomarker for predicting hypertension risk in prehypertension population.
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Genetic and epigenetic regulation of YKL-40 in childhood. J Allergy Clin Immunol 2017; 141:1105-1114. [PMID: 28739286 DOI: 10.1016/j.jaci.2017.06.030] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 05/30/2017] [Accepted: 06/14/2017] [Indexed: 01/26/2023]
Abstract
BACKGROUND Circulating levels of the chitinase-like protein YKL-40 are influenced by genetic variation in its encoding gene (chitinase 3-like 1 [CHI3L1]) and are increased in patients with several diseases, including asthma. Epigenetic regulation of circulating YKL-40 early in life is unknown. OBJECTIVE We sought to determine (1) whether methylation levels at CHI3L1 CpG sites mediate the association of CHI3L1 single nucleotide polymorphisms (SNPs) with YKL-40 levels in the blood and (2) whether these biomarkers (CHI3L1 SNPs, methylation profiles, and YKL-40 levels) are associated with asthma in early childhood. METHODS We used data from up to 2405 participants from the Spanish Infancia y Medio Ambiente; the Swedish Barn/Children, Allergy, Milieu, Stockholm, Epidemiological survey; and the Dutch Prevention and Incidence of Asthma and Mite Allergy birth cohorts. Associations between 68 CHI3L1 SNPs, methylation levels at 14 CHI3L1 CpG sites in whole-blood DNA, and circulating YKL-40 levels at 4 years of age were tested by using correlation analysis, multivariable regression, and mediation analysis. Each of these biomarkers was also tested for association with asthma at 4 years of age by using multivariable logistic regression. RESULTS YKL-40 levels were significantly associated with 7 SNPs and with methylation at 5 CpG sites. Consistent associations between these 7 SNPs (particularly rs10399931 and rs4950928) and 5 CpG sites were observed. Alleles linked to lower YKL-40 levels were associated with higher methylation levels. Participants with high YKL-40 levels (defined as the highest YKL-40 tertile) had increased odds for asthma compared with subjects with low YKL-40 levels (meta-analyzed adjusted odds ratio, 1.90 [95% CI, 1.08-3.36]). In contrast, neither SNPs nor methylation levels at CpG sites in CHI3L1 were associated with asthma. CONCLUSIONS The effects of CHI3L1 genetic variation on circulating YKL-40 levels are partly mediated by methylation profiles. In our study YKL-40 levels, but not CHI3L1 SNPs or methylation levels, were associated with childhood asthma.
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Agache I, Rogozea L. Asthma Biomarkers: Do They Bring Precision Medicine Closer to the Clinic? ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2017; 9:466-476. [PMID: 28913985 PMCID: PMC5603474 DOI: 10.4168/aair.2017.9.6.466] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 03/03/2017] [Accepted: 03/13/2017] [Indexed: 12/11/2022]
Abstract
Measurement of biomarkers has been incorporated within clinical research of asthma to characterize the population and to associate the disease with environmental and therapeutic effects. Regrettably, at present, there are no specific biomarkers, none is validated or qualified, and endotype-driven choices overlap. Biomarkers have not yet reached clinical practice and are not included in current asthma guidelines. Last but not least, the choice of the outcome upholding the value of the biomarkers is extremely difficult, since it has to reflect the mechanistic intervention while being relevant to both the disease and the particular person. On the verge of a new age of asthma healthcare standard, we must embrace and adapt to the key drivers of change. Disease endotypes, biomarkers, and precision medicine represent an emerging model of patient care building on large-scale biologic databases, omics and diverse cellular assays, health information technology, and computational tools for analyzing sizable sets of data. A profound transformation of clinical and research pattern from population to individual risk and from investigator-imposed subjective disease clustering (hypothesis driven) to unbiased, data-driven models is facilitated by the endotype/biomarker-driven approach.
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Affiliation(s)
- Ioana Agache
- Faculty of Medicine, Department of Allergy and Clinical Immunology, Transylvania University of Brasov, Brasov, Romania.
| | - Liliana Rogozea
- Faculty of Medicine, Department of Allergy and Clinical Immunology, Transylvania University of Brasov, Brasov, Romania
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Lotfy AM, Khalil F, Zidan H, Hadad M, Elsayed MA, Al-Sayyad MM, Mohamed NAE, Abouelyazed E. Assessment of severity of bronchial asthma by studying new markers: transforming growth factor-β1 and chitinase-3-like-1. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2016. [DOI: 10.4103/1110-7782.203295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Long X, He X, Ohshimo S, Griese M, Sarria R, Guzman J, Costabel U, Bonella F. Serum YKL-40 as predictor of outcome in hypersensitivity pneumonitis. Eur Respir J 2016; 49:13993003.01924-2015. [DOI: 10.1183/13993003.01924-2015] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 09/29/2016] [Indexed: 01/13/2023]
Abstract
YKL-40, a chitinase-like protein mainly secreted by macrophages, neutrophils and epithelial cells, is increased in patients with idiopathic interstitial pneumonia and sarcoidosis. We aimed to investigate the role of YKL-40 as a biomarker in hypersensitivity pneumonitis (HP).72 HP patients, 100 interstitial lung disease (ILD) controls and 60 healthy controls were studied. YKL-40 was measured by ELISA in serum and bronchoalveolar lavage fluid (BALF) at baseline and follow-up. The relationship between YKL-40 levels, clinical variables and disease outcome was evaluated.Baseline serum YKL-40 levels were significantly higher in HP patients than in healthy controls (p<0.001), but lower than in patients with other ILDs. Baseline BALF YKL-40 levels in HP patients were the highest among ILD patients. In HP patients, serum YKL-40 correlated with the diffusing capacity of the lung for carbon monoxide at baseline (p<0.01) and over time (p<0.001). HP patients whose disease progressed or who died had higher baseline YKL-40 levels than those who remained stable and survived (p<0.001). At a cut-off of 119 ng·mL−1, the baseline serum YKL-40 level predicted disease progression (hazard ratio 6.567; p<0.001), and at a cut-off of 150 ng·mL−1 was associated with mortality (hazard ratio 9.989; p<0.001).Serum YKL-40 may be a useful prognostic biomarker in HP patients.
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Xu T, Zhong C, Wang A, Guo Z, Bu X, Zhou Y, Tian Y, HuangFu X, Zhu Z, Zhang Y. YKL-40 Level and Hypertension Incidence: A Population-Based Nested Case-Control Study in China. J Am Heart Assoc 2016; 5:JAHA.116.004534. [PMID: 27815265 PMCID: PMC5210351 DOI: 10.1161/jaha.116.004534] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background Human cartilage glycoprotein‐39 (YKL‐40) has been suggested to be a new marker of inflammation, atherosclerosis, and endothelial dysfunction. However, whether a higher level of YKL‐40 is an independent risk factor for hypertension incidence is still unknown. Methods and Results In a nested case‐control study within a prospective cohort of 12 423 initially healthy Chinese adults, we measured baseline plasma concentrations of YKL‐40 among 700 new‐onset hypertension cases and 700 age‐ and sex‐matched controls. Multiple conditional logistic regression analyses were used to calculate the odds ratios (95% CIs) of hypertension associated with higher levels of YKL‐40 both in the total population and in the age‐ (>55 and ≤55 years) and sex‐matched subgroups. Among the total population, YKL‐40 levels were not associated with hypertension risk. In the subgroup older than 55 years, odds ratios (95% CIs) of hypertension for those in the two higher tertiles of YKL‐40 were 1.23 (0.77–1.97) and 1.59 (0.99–2.55) (P for linear trend=0.05). In the male subgroup, odds ratios (95% CIs) of hypertension for those in the two higher tertiles of YKL‐40 were 1.55 (0.88–2.72) and 2.09 (1.14–3.82) (P for linear trend=0.02). An interaction effect was observed between YKL‐40 and sex (P for interaction <0.01) but not between YKL‐40 and age (P for interaction=0.21). High YKL‐40 level significantly increased hypertension risk in men but decreased hypertension risk with a trend although not significant in women. Conclusions This study suggests that YKL‐40 is associated with hypertension incidence only among men. The study findings need to be further verified by prospective cohort studies or clinical trials.
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Affiliation(s)
- Tian Xu
- Department of Neurology, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Chongke Zhong
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, Jiangsu, China
| | - Aili Wang
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, Jiangsu, China
| | - Zhirong Guo
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, Jiangsu, China
| | - Xiaoqing Bu
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, Jiangsu, China
| | - Yipeng Zhou
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, Jiangsu, China
| | - Yunfan Tian
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, Jiangsu, China
| | - Xinfeng HuangFu
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, Jiangsu, China
| | - Zhengbao Zhu
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, Jiangsu, China
| | - Yonghong Zhang
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, Jiangsu, China
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König K, Guy KJ, Nold-Petry CA, Barfield CP, Walsh G, Drew SM, Veldman A, Nold MF, Casalaz DM. BNP, troponin I, and YKL-40 as screening markers in extremely preterm infants at risk for pulmonary hypertension associated with bronchopulmonary dysplasia. Am J Physiol Lung Cell Mol Physiol 2016; 311:L1076-L1081. [PMID: 27760764 DOI: 10.1152/ajplung.00344.2016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 10/13/2016] [Indexed: 11/22/2022] Open
Abstract
Bronchopulmonary dysplasia (BPD) is often complicated by pulmonary hypertension (PH). We investigated three biomarkers potentially suitable as screening markers for extremely preterm infants at risk of BPD-associated PH. In this prospective observational cohort study conducted in a tertiary neonatal intensive care unit, 83 preterm infants with BPD born <28-wk gestation and still inpatients at 36-wk corrected age received an echocardiogram and blood tests of B-type natriuretic peptide (BNP), troponin I, and YKL-40. Infants were analyzed according to echocardiographic evidence of tricuspid regurgitation (TR). Thirty infants had evidence of TR on echocardiogram at 36-wk corrected age. Infants with or without TR had similar baseline demographics: mean ± SD gestational age 261 ± 12 vs. 261 ± 11 wk and birth weight 830 ± 206 vs. 815 ± 187 g, respectively. There was no difference in duration of respiratory support. The right ventricular systolic pressure of infants with evidence of TR was 40 ± 16 mmHg. BNP was the only biomarker that proved to be significantly higher in infants with evidence of TR: median (interquartile range) serum level 54.5 (35-105) vs. 41.5 (30-59) pg/ml, P = 0.043. Subgroup analysis of infants with severe BPD requiring discharge on home oxygen or BPD-related mortality revealed similar results. There was no difference between groups for troponin I and YKL-40. In conclusion, increased serum levels of BNP were associated with evidence of TR at 36-wk corrected gestational age in extremely preterm infants, suggesting a potential role as a screening biomarker for BPD-associated PH.
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Affiliation(s)
- Kai König
- Mercy Hospital for Women, Department of Paediatrics, Melbourne, Victoria, Australia;
| | - Katelyn J Guy
- Mercy Hospital for Women, Department of Paediatrics, Melbourne, Victoria, Australia
| | - Claudia A Nold-Petry
- Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia; and.,Department of Paediatrics, Monash University, Clayton, Victoria, Australia
| | - Charles P Barfield
- Mercy Hospital for Women, Department of Paediatrics, Melbourne, Victoria, Australia
| | - Geraldine Walsh
- Mercy Hospital for Women, Department of Paediatrics, Melbourne, Victoria, Australia
| | - Sandra M Drew
- Mercy Hospital for Women, Department of Paediatrics, Melbourne, Victoria, Australia
| | - Alex Veldman
- Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia; and.,Department of Paediatrics, Monash University, Clayton, Victoria, Australia
| | - Marcel F Nold
- Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia; and.,Department of Paediatrics, Monash University, Clayton, Victoria, Australia
| | - Dan M Casalaz
- Mercy Hospital for Women, Department of Paediatrics, Melbourne, Victoria, Australia
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40
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Gao J, Iwamoto H, Koskela J, Alenius H, Hattori N, Kohno N, Laitinen T, Mazur W, Pulkkinen V. Characterization of sputum biomarkers for asthma-COPD overlap syndrome. Int J Chron Obstruct Pulmon Dis 2016; 11:2457-2465. [PMID: 27757028 PMCID: PMC5053388 DOI: 10.2147/copd.s113484] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Asthma–COPD overlap syndrome (ACOS) is a commonly encountered chronic airway disease. However, ACOS is still a consensus-based clinical phenotype and the underlying inflammatory mechanisms are inadequately characterized. To clarify the inflammatory mediatypical for ACOS, five biomarkers, namely interleukin (IL)-13, myeloperoxidase (MPO), neutrophil gelatinase-associated lipocalin (NGAL), chitinase-like protein (YKL-40), and IL-6, were selected. This study hypothesized that sputum biomarkers relevant for airway inflammation in asthma (IL-13), COPD (MPO, NGAL), or in both asthma and COPD (YKL-40, IL-6) could be used to differentiate ACOS from COPD and asthma. The aim of this study was to characterize the inflammatory profile and improve the recognition of ACOS. Induced sputum levels of IL-13, MPO, NGAL, YKL-40, and IL-6 were measured by enzyme-linked immunosorbent assay/Luminex assay in a Finnish discovery cohort (n=90) of nonsmokers, smokers, and patients with asthma, COPD, and ACOS and validated in a Japanese cohort (n=135). The classification accuracy of potential biomarkers was compared with area under the receiver operating characteristic curves. Only sputum NGAL levels could differentiate ACOS from asthma (P<0.001 and P<0.001) and COPD (P<0.05 and P=0.002) in the discovery and replication cohorts, respectively. Sputum NGAL levels were independently correlated with the percentage of pre-bronchodilator forced expiratory volume in 1 second predicted in multivariate analysis in the discovery and replication cohorts (P=0.001 and P=0.002, respectively). In conclusion, sputum biomarkers reflecting both airway inflammation and remodeling of the tissue show potential in differentiation between asthma, COPD, and ACOS.
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Affiliation(s)
- Jing Gao
- Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Hiroshi Iwamoto
- Department of Molecular and Internal Medicine, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Jukka Koskela
- Clinical Research Unit of Pulmonary Diseases and Division of Pulmonology, Heart and Lung Center, University of Helsinki and Helsinki University Hospital
| | - Harri Alenius
- Unit of Systems Toxicology, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Noboru Hattori
- Department of Molecular and Internal Medicine, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | | | - Tarja Laitinen
- Department of Pulmonary Diseases and Clinical Allergology, Turku University Hospital, University of Turku, Turku, Finland
| | - Witold Mazur
- Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ville Pulkkinen
- Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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41
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Naglot S, Aggarwal P, Dey S, Dalal K. Estimation of Serum YKL-40 by Real-Time Surface Plasmon Resonance Technology in North-Indian Asthma Patients. J Clin Lab Anal 2016; 31. [PMID: 27616735 DOI: 10.1002/jcla.22028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 06/16/2016] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Many studies reported for estimating serum YKL-40 using ELISA or RIA methods. This study introduces the plausible utilization of real-time surface plasmon resonance (SPR) technology in investigating the expression of serum YKL-40 protein levels and ELISA method for serum IgE in bronchial asthma. METHODS A commercially available BIAcore 2000 instrument, based on SPR technology, was utilized for assessing serum YKL-40 levels in a control sample size of 45 and active sample size of 97. Antibody immobilization was optimized to obtain the best sensor performance and a sensitive analytic detection. A commercially available ELISA kit was utilized for detecting serum IgE to estimate allergic condition-associated asthma. RESULTS The results of SPR technology could distinctly classify with highly statistical significance, the asthma severities by estimating the elevated levels of YKL-40 in blood sera of minute quantities (up to 0.33 ng/ml), and thus differentiates superior utility in comparison with ELISA method. No statistically significant correlation of YKL-40 and IgE was observed. CONCLUSIONS Serum YKL-40 may be used as a protein marker in classifying asthma severity by applying SPR technology as a reliable, label-free, highly sensitive, and cost-effective tool.
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Affiliation(s)
- Sarla Naglot
- Department of Biophysics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Praveen Aggarwal
- Department of Emergency Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Sharmistha Dey
- Department of Biophysics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Krishna Dalal
- Department of Biophysics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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42
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James AJ, Reinius LE, Verhoek M, Gomes A, Kupczyk M, Hammar U, Ono J, Ohta S, Izuhara K, Bel E, Kere J, Söderhäll C, Dahlén B, Boot RG, Dahlén SE. Increased YKL-40 and Chitotriosidase in Asthma and Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2016; 193:131-42. [PMID: 26372680 DOI: 10.1164/rccm.201504-0760oc] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Serum chitinases may be novel biomarkers of airway inflammation and remodeling, but less is known about factors regulating their levels. OBJECTIVES To examine serum chitotriosidase activity and YKL-40 levels in patients with asthma and chronic obstructive pulmonary disease (COPD) and evaluate clinically relevant factors that may affect chitinase levels, including genetic variability, corticosteroid treatment, disease exacerbations, and allergen exposure. METHODS Serum chitotriosidase (CHIT1) activity and YKL-40 (CHI3L1) levels, as well as the CHIT1 rs3831317 and CHI3L1 rs4950928 genotypes, were examined in subsets of patients with mild to moderate asthma (n = 76), severe asthma (n = 93), and COPD (n = 64) taking part in the European multicenter BIOAIR (Longitudinal Assessment of Clinical Course and Biomarkers in Severe Chronic Airway Disease) study. Blood was obtained at baseline, before and after a 2-week oral steroid intervention, up to six times during a 1-year period, and during exacerbations. Baseline chitinase levels were also measured in 72 healthy control subjects. The effect of allergen inhalation on blood and sputum YKL-40 levels was measured in two separate groups of patients with mild atopic asthma; one group underwent repeated low-dose allergen challenge (n = 15), and the other underwent high-dose allergen challenge (n = 16). MEASUREMENTS AND MAIN RESULTS Serum chitotriosidase and YKL-40 were significantly elevated in patients with asthma and those with COPD compared with healthy control subjects. Genotype and age strongly affected both YKL-40 and chitotriosidase activity, but associations with disease remained following adjustment for these factors. Correlations were observed with lung function but not with other biomarkers, including exhaled nitric oxide, blood eosinophils, periostin, and IgE. Generally, acute exacerbations, allergen-induced airway obstruction, and corticosteroid treatment did not affect circulating chitinase levels. CONCLUSIONS YKL-40 and chitotriosidase are increased in asthma and more so in COPD. The data in the present study support these substances as being relatively steroid-insensitive, non-T-helper cell type 2-type biomarkers distinctly related to chronic inflammatory disease processes.
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Affiliation(s)
- Anna J James
- 1 Institute of Environmental Medicine.,2 Center for Allergy Research
| | - Lovisa E Reinius
- 2 Center for Allergy Research.,3 Center for Innovative Medicine, and.,4 Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden
| | - Marri Verhoek
- 5 Department of Biochemistry, Leiden Institute of Chemistry, Leiden University, Leiden, the Netherlands
| | - Anna Gomes
- 1 Institute of Environmental Medicine.,2 Center for Allergy Research
| | - Maciej Kupczyk
- 1 Institute of Environmental Medicine.,2 Center for Allergy Research
| | | | - Junya Ono
- 6 Shino-Test Corporation, Sagamihara, Japan
| | | | - Kenji Izuhara
- 8 Division of Medical Biochemistry, Department of Biomolecular Sciences, Saga Medical School, Saga University, Saga, Japan
| | - Elisabeth Bel
- 9 Department of Pulmonology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; and
| | - Juha Kere
- 2 Center for Allergy Research.,3 Center for Innovative Medicine, and.,4 Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden
| | - Cilla Söderhäll
- 2 Center for Allergy Research.,3 Center for Innovative Medicine, and.,4 Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden
| | - Barbro Dahlén
- 2 Center for Allergy Research.,10 Department of Medicine, Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - Rolf G Boot
- 5 Department of Biochemistry, Leiden Institute of Chemistry, Leiden University, Leiden, the Netherlands
| | - Sven-Erik Dahlén
- 1 Institute of Environmental Medicine.,2 Center for Allergy Research
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43
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Usemann J, Frey U, Mack I, Schmidt A, Gorlanova O, Röösli M, Hartl D, Latzin P. CHI3L1 polymorphisms, cord blood YKL-40 levels and later asthma development. BMC Pulm Med 2016; 16:81. [PMID: 27193312 PMCID: PMC4870763 DOI: 10.1186/s12890-016-0239-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 05/01/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Single nucleotide polymorphisms (SNPs) in chitinase 3-like 1 (CHI3L1), the gene encoding YKL-40, and increased serum YKL-40 levels are associated with severe forms of asthma. It has never been addressed whether SNPs in CHI3L1 and cord blood YKL-40 levels could already serve as potential biomarkers for milder forms of asthma. We assessed in an unselected population whether SNPs in CHI3L1 and cord blood YKL-40 levels at birth are associated with respiratory symptoms, lung function changes, asthma, and atopy. METHODS In a prospective birth cohort of healthy term-born neonates (n = 260), we studied CHI3L1 polymorphisms, and measured cord blood YKL-40 levels by ELISA in (n = 170) infants. Lung function was performed at 5 weeks and 6 years. Respiratory health during the first year of life was assessed weekly by telephone interviews. Diagnosis of asthma and allergic sensitisation was assessed at 6 years (n = 142). RESULTS The SNP rs10399805 was significantly associated with asthma at 6 years. The odds ratio for asthma was 4.5 (95 % CI 1.59-12.94) per T-allele. This finding was unchanged when adjusting for cord blood YKL-40 levels. There was no significant association for cord blood YKL-40 levels and asthma. SNPs in CHI3L1 and cord blood YKL-40 were not associated with lung function measurements at 5 weeks and 6 years, respiratory symptoms in the first year, and allergic sensitisation at 6 years. CONCLUSION Genetic variation in CHI3L1 might be related to the development of milder forms of asthma. Larger studies are warranted to establish the role of YKL-40 in that pathway.
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Affiliation(s)
- Jakob Usemann
- University of Basel Children's Hospital, University of Basel, Basel, 4056, Switzerland.,Division of Respiratory Medicine, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, 3010, Switzerland
| | - Urs Frey
- University of Basel Children's Hospital, University of Basel, Basel, 4056, Switzerland.
| | - Ines Mack
- University of Basel Children's Hospital, University of Basel, Basel, 4056, Switzerland
| | - Anne Schmidt
- University of Basel Children's Hospital, University of Basel, Basel, 4056, Switzerland.,Division of Respiratory Medicine, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, 3010, Switzerland
| | - Olga Gorlanova
- University of Basel Children's Hospital, University of Basel, Basel, 4056, Switzerland
| | - Martin Röösli
- Swiss Tropical and Public Health Institute Basel, Basel, 4051, Switzerland.,University of Basel, Basel, 4003, Switzerland
| | - Dominik Hartl
- Children's Hospital, University of Tuebingen, Tuebingen, 72076, Germany
| | - Philipp Latzin
- University of Basel Children's Hospital, University of Basel, Basel, 4056, Switzerland.,Division of Respiratory Medicine, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, 3010, Switzerland
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44
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Han SS, Lee WH, Hong Y, Kim WJ, Yang J, Lim MN, Lee SJ, Kwon JW. Comparison of serum biomarkers between patients with asthma and with chronic obstructive pulmonary disease. J Asthma 2016; 53:583-8. [PMID: 27104648 DOI: 10.3109/02770903.2015.1056347] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Asthma and chronic obstructive pulmonary disease (COPD) have distinct pathophysiological mechanisms but sometimes share similar clinical manifestations. Distinguishing between these diseases is important. This study compared the profiles of serum biomarkers between patients with asthma and those with COPD. METHODS Serum levels of the chitinase like protein YKL-40, periostin, interleukin (IL)-18, and chemokine (C--C motif) ligand 18 (CCL18) were measured in asthma patients (n = 20), COPD patients (n = 16), and normal controls (n = 20). RESULTS Serum levels of YKL-40 were higher in COPD patients [median (range), 55 (17-565) versus 208 (74-922) ng/mL, p < 0.0001], but no differences were observed between asthma and COPD patients after adjusting for age and forced expiratory volume in 1 s (FEV1). No differences in serum levels of periostin, IL-18, or CCL18 were observed between the patient groups. Total IgE and airway hypersensitivity were negatively correlated (r = -0.485, p = 0.007). CCL18 levels were related to patients' age in asthmatic patients (r = -0.562, p = 0.010). Serum levels of CCL18 and IL-18 were positively correlated in patients with COPD (r = 0.696, p = 0.003). CONCLUSIONS No differences in the serum profiles of periostin, IL-18, or CCL18 were observed between patients with asthma and those with COPD. Serum levels of YKL-40 were not different between asthma and COPD patients after adjusting for age and FEV1. There were negative correlation between CCL18 and age in patients with asthma and positive correlation between IL-18 and CCL18 in patients with COPD.
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Affiliation(s)
- Seon-Sook Han
- a Department of Internal Medicine , Kangwon National University College of Medicine , Chuncheon , Korea.,b Environmental Health Center , Kangwon National University Hospital , Chuncheon , Korea
| | - Won Ho Lee
- a Department of Internal Medicine , Kangwon National University College of Medicine , Chuncheon , Korea
| | - Yoonki Hong
- a Department of Internal Medicine , Kangwon National University College of Medicine , Chuncheon , Korea.,b Environmental Health Center , Kangwon National University Hospital , Chuncheon , Korea
| | - Woo Jin Kim
- a Department of Internal Medicine , Kangwon National University College of Medicine , Chuncheon , Korea.,b Environmental Health Center , Kangwon National University Hospital , Chuncheon , Korea
| | - JeongHee Yang
- c Department of Family Medicine , Kangwon National University School of Medicine , Chuncheon , Korea
| | - Myoung Nam Lim
- d Regional Center for Respiratory Diseases , Kangwon National University Hospital , Chuncheon , Korea
| | - Seung-Joon Lee
- a Department of Internal Medicine , Kangwon National University College of Medicine , Chuncheon , Korea.,b Environmental Health Center , Kangwon National University Hospital , Chuncheon , Korea
| | - Jae-Woo Kwon
- a Department of Internal Medicine , Kangwon National University College of Medicine , Chuncheon , Korea.,b Environmental Health Center , Kangwon National University Hospital , Chuncheon , Korea.,e Department of Allergy and Clinical Immunology , Kangwon National University Hospital , Chuncheon , Korea
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45
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YKL-40 expression in chronic obstructive pulmonary disease: relation to acute exacerbations and airway remodeling. Respir Res 2016; 17:31. [PMID: 27013031 PMCID: PMC4806429 DOI: 10.1186/s12931-016-0338-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 02/17/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recent studies suggest that YKL-40, also called chitinase-3-like-1 protein, has been implicated in the pathogenesis of various inflammatory diseases. It is currently unknown, however, whether YKL-40 plays a role in acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and airway remodeling. METHODS We evaluated serum YKL-40 levels in patients with AECOPD (n = 37) and stable COPD (n = 44), as well as in controls (n = 47). The association between YKL-40 expression and airway remodeling was analyzed. The effects of YKL-40 on collagen synthesis of primary human lung fibroblasts were also evaluated. RESULTS Serum YKL-40 levels were elevated at AECOPD onset as compared to stable disease (median [interquartile range], 78.6 [52.3-122.2] ng/ml versus 46.7 [31.2-75.5] ng/ml; p = 0.0005). The ideal cutoff point for distinguishing patients with AECOPD from those with stable COPD was 64.7 ng/ml (AUC: 0.71; 95%CI: 0.596 to 0.823). YKL-40 expression correlated with airflow obstruction, C-reactive protein, and collagen deposition. Stimulation with YKL-40 promoted collagen production in lung fibroblasts through ERK- and p38-dependent mechanisms. CONCLUSIONS YKL-40 expression is up-regulated in patients with COPD and correlates with exacerbation attacks and may contribute to airway remodeling by acting on lung fibroblasts. The current data may provide insight into the underlying pathogenesis of COPD, in which YKL-40 has an important pathogenic role. TRIAL REGISTRATION ChiCTR-OCC-13003567.
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46
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Mohammed IA, Diab SM, Soliman DR, Shalaby WA. Study of serum YKL-40 in children with bronchial asthma. EGYPTIAN PEDIATRIC ASSOCIATION GAZETTE 2016. [DOI: 10.1016/j.epag.2015.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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47
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Liu CL, Wemmelund H, Wang Y, Liao M, Lindholt JS, Johnsen SP, Vestergaard H, Fernandes C, Sukhova GK, Cheng X, Zhang JY, Yang C, Huang X, Daugherty A, Levy BD, Libby P, Shi GP. Asthma Associates With Human Abdominal Aortic Aneurysm and Rupture. Arterioscler Thromb Vasc Biol 2016; 36:570-8. [PMID: 26868210 DOI: 10.1161/atvbaha.115.306497] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 12/21/2015] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Both asthma and abdominal aortic aneurysms (AAA) involve inflammation. It remains unknown whether these diseases interact. APPROACH AND RESULTS Databases analyzed included Danish National Registry of Patients, a population-based nationwide case-control study included all patients with ruptured AAA and age- and sex-matched AAA controls without rupture in Denmark from 1996 to 2012; Viborg vascular trial, subgroup study of participants from the population-based randomized Viborg vascular screening trial. Patients with asthma were categorized by hospital diagnosis, bronchodilator use, and the recorded use of other anti-asthma prescription medications. Logistic regression models were fitted to determine whether asthma associated with the risk of ruptured AAA in Danish National Registry of Patients and an independent risk of having an AAA at screening in the Viborg vascular trial. From the Danish National Registry of Patients study, asthma diagnosed <1 year or 6 months before the index date increased the risk of AAA rupture before (odds ratio [OR]=1.60-2.12) and after (OR=1.51-2.06) adjusting for AAA comorbidities. Use of bronchodilators elevated the risk of AAA rupture from ever use to within 90 days from the index date, before (OR=1.10-1.37) and after (OR=1.10-1.31) adjustment. Patients prescribed anti-asthma drugs also showed an increased risk of rupture before (OR=1.12-1.79) and after (OR=1.09-1.48) the same adjustment. In Viborg vascular trial, anti-asthmatic medication use associated with increased risk of AAA before (OR=1.45) or after adjustment for smoking (OR=1.45) or other risk factors (OR=1.46). CONCLUSIONS Recent active asthma increased risk of AAA and ruptured AAA. These findings document and furnish novel links between airway disease and AAA, 2 common diseases that share inflammatory aspects.
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Affiliation(s)
- Cong-Lin Liu
- From the Department of Cardiology, Institute of Clinical Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China (C.L.L., J.Y.Z., G.P.S.); Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (C.L.L., Y.W., M.L., C.F., G.K.S., C.Y., B.D.L., P.L., G.P.S.); Department of Vascular Surgery, Viborg Regional Hospital, Viborg, Denmark (H.W.); Department of Cardiology, Shanghai First People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China (Y.W.); Department of Cardiology, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China (M.L., X.C.); Department of Cardiothoracic and Vascular Surgery, Elitary Research Centre of Individualized Medicine of Arterial Disease, Odense University Hospital, Odense, Denmark (J.S.L.); Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark (H.W., S.P.J.); Section for Metabolic Genetics, The Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, University of Copenhagen, Copenhagen, Denmark (H.V.); Department of Medicine, University of California, San Francisco (X.H.); and Departments of Physiology and Medicine, Saha Cardiovascular Research Center, University of Kentucky, Lexington (A.D.)
| | - Holger Wemmelund
- From the Department of Cardiology, Institute of Clinical Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China (C.L.L., J.Y.Z., G.P.S.); Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (C.L.L., Y.W., M.L., C.F., G.K.S., C.Y., B.D.L., P.L., G.P.S.); Department of Vascular Surgery, Viborg Regional Hospital, Viborg, Denmark (H.W.); Department of Cardiology, Shanghai First People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China (Y.W.); Department of Cardiology, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China (M.L., X.C.); Department of Cardiothoracic and Vascular Surgery, Elitary Research Centre of Individualized Medicine of Arterial Disease, Odense University Hospital, Odense, Denmark (J.S.L.); Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark (H.W., S.P.J.); Section for Metabolic Genetics, The Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, University of Copenhagen, Copenhagen, Denmark (H.V.); Department of Medicine, University of California, San Francisco (X.H.); and Departments of Physiology and Medicine, Saha Cardiovascular Research Center, University of Kentucky, Lexington (A.D.)
| | - Yi Wang
- From the Department of Cardiology, Institute of Clinical Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China (C.L.L., J.Y.Z., G.P.S.); Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (C.L.L., Y.W., M.L., C.F., G.K.S., C.Y., B.D.L., P.L., G.P.S.); Department of Vascular Surgery, Viborg Regional Hospital, Viborg, Denmark (H.W.); Department of Cardiology, Shanghai First People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China (Y.W.); Department of Cardiology, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China (M.L., X.C.); Department of Cardiothoracic and Vascular Surgery, Elitary Research Centre of Individualized Medicine of Arterial Disease, Odense University Hospital, Odense, Denmark (J.S.L.); Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark (H.W., S.P.J.); Section for Metabolic Genetics, The Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, University of Copenhagen, Copenhagen, Denmark (H.V.); Department of Medicine, University of California, San Francisco (X.H.); and Departments of Physiology and Medicine, Saha Cardiovascular Research Center, University of Kentucky, Lexington (A.D.)
| | - Mengyang Liao
- From the Department of Cardiology, Institute of Clinical Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China (C.L.L., J.Y.Z., G.P.S.); Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (C.L.L., Y.W., M.L., C.F., G.K.S., C.Y., B.D.L., P.L., G.P.S.); Department of Vascular Surgery, Viborg Regional Hospital, Viborg, Denmark (H.W.); Department of Cardiology, Shanghai First People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China (Y.W.); Department of Cardiology, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China (M.L., X.C.); Department of Cardiothoracic and Vascular Surgery, Elitary Research Centre of Individualized Medicine of Arterial Disease, Odense University Hospital, Odense, Denmark (J.S.L.); Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark (H.W., S.P.J.); Section for Metabolic Genetics, The Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, University of Copenhagen, Copenhagen, Denmark (H.V.); Department of Medicine, University of California, San Francisco (X.H.); and Departments of Physiology and Medicine, Saha Cardiovascular Research Center, University of Kentucky, Lexington (A.D.)
| | - Jes S Lindholt
- From the Department of Cardiology, Institute of Clinical Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China (C.L.L., J.Y.Z., G.P.S.); Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (C.L.L., Y.W., M.L., C.F., G.K.S., C.Y., B.D.L., P.L., G.P.S.); Department of Vascular Surgery, Viborg Regional Hospital, Viborg, Denmark (H.W.); Department of Cardiology, Shanghai First People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China (Y.W.); Department of Cardiology, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China (M.L., X.C.); Department of Cardiothoracic and Vascular Surgery, Elitary Research Centre of Individualized Medicine of Arterial Disease, Odense University Hospital, Odense, Denmark (J.S.L.); Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark (H.W., S.P.J.); Section for Metabolic Genetics, The Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, University of Copenhagen, Copenhagen, Denmark (H.V.); Department of Medicine, University of California, San Francisco (X.H.); and Departments of Physiology and Medicine, Saha Cardiovascular Research Center, University of Kentucky, Lexington (A.D.)
| | - Søren P Johnsen
- From the Department of Cardiology, Institute of Clinical Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China (C.L.L., J.Y.Z., G.P.S.); Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (C.L.L., Y.W., M.L., C.F., G.K.S., C.Y., B.D.L., P.L., G.P.S.); Department of Vascular Surgery, Viborg Regional Hospital, Viborg, Denmark (H.W.); Department of Cardiology, Shanghai First People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China (Y.W.); Department of Cardiology, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China (M.L., X.C.); Department of Cardiothoracic and Vascular Surgery, Elitary Research Centre of Individualized Medicine of Arterial Disease, Odense University Hospital, Odense, Denmark (J.S.L.); Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark (H.W., S.P.J.); Section for Metabolic Genetics, The Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, University of Copenhagen, Copenhagen, Denmark (H.V.); Department of Medicine, University of California, San Francisco (X.H.); and Departments of Physiology and Medicine, Saha Cardiovascular Research Center, University of Kentucky, Lexington (A.D.)
| | - Henrik Vestergaard
- From the Department of Cardiology, Institute of Clinical Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China (C.L.L., J.Y.Z., G.P.S.); Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (C.L.L., Y.W., M.L., C.F., G.K.S., C.Y., B.D.L., P.L., G.P.S.); Department of Vascular Surgery, Viborg Regional Hospital, Viborg, Denmark (H.W.); Department of Cardiology, Shanghai First People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China (Y.W.); Department of Cardiology, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China (M.L., X.C.); Department of Cardiothoracic and Vascular Surgery, Elitary Research Centre of Individualized Medicine of Arterial Disease, Odense University Hospital, Odense, Denmark (J.S.L.); Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark (H.W., S.P.J.); Section for Metabolic Genetics, The Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, University of Copenhagen, Copenhagen, Denmark (H.V.); Department of Medicine, University of California, San Francisco (X.H.); and Departments of Physiology and Medicine, Saha Cardiovascular Research Center, University of Kentucky, Lexington (A.D.)
| | - Cleverson Fernandes
- From the Department of Cardiology, Institute of Clinical Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China (C.L.L., J.Y.Z., G.P.S.); Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (C.L.L., Y.W., M.L., C.F., G.K.S., C.Y., B.D.L., P.L., G.P.S.); Department of Vascular Surgery, Viborg Regional Hospital, Viborg, Denmark (H.W.); Department of Cardiology, Shanghai First People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China (Y.W.); Department of Cardiology, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China (M.L., X.C.); Department of Cardiothoracic and Vascular Surgery, Elitary Research Centre of Individualized Medicine of Arterial Disease, Odense University Hospital, Odense, Denmark (J.S.L.); Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark (H.W., S.P.J.); Section for Metabolic Genetics, The Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, University of Copenhagen, Copenhagen, Denmark (H.V.); Department of Medicine, University of California, San Francisco (X.H.); and Departments of Physiology and Medicine, Saha Cardiovascular Research Center, University of Kentucky, Lexington (A.D.)
| | - Galina K Sukhova
- From the Department of Cardiology, Institute of Clinical Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China (C.L.L., J.Y.Z., G.P.S.); Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (C.L.L., Y.W., M.L., C.F., G.K.S., C.Y., B.D.L., P.L., G.P.S.); Department of Vascular Surgery, Viborg Regional Hospital, Viborg, Denmark (H.W.); Department of Cardiology, Shanghai First People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China (Y.W.); Department of Cardiology, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China (M.L., X.C.); Department of Cardiothoracic and Vascular Surgery, Elitary Research Centre of Individualized Medicine of Arterial Disease, Odense University Hospital, Odense, Denmark (J.S.L.); Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark (H.W., S.P.J.); Section for Metabolic Genetics, The Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, University of Copenhagen, Copenhagen, Denmark (H.V.); Department of Medicine, University of California, San Francisco (X.H.); and Departments of Physiology and Medicine, Saha Cardiovascular Research Center, University of Kentucky, Lexington (A.D.)
| | - Xiang Cheng
- From the Department of Cardiology, Institute of Clinical Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China (C.L.L., J.Y.Z., G.P.S.); Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (C.L.L., Y.W., M.L., C.F., G.K.S., C.Y., B.D.L., P.L., G.P.S.); Department of Vascular Surgery, Viborg Regional Hospital, Viborg, Denmark (H.W.); Department of Cardiology, Shanghai First People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China (Y.W.); Department of Cardiology, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China (M.L., X.C.); Department of Cardiothoracic and Vascular Surgery, Elitary Research Centre of Individualized Medicine of Arterial Disease, Odense University Hospital, Odense, Denmark (J.S.L.); Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark (H.W., S.P.J.); Section for Metabolic Genetics, The Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, University of Copenhagen, Copenhagen, Denmark (H.V.); Department of Medicine, University of California, San Francisco (X.H.); and Departments of Physiology and Medicine, Saha Cardiovascular Research Center, University of Kentucky, Lexington (A.D.)
| | - Jin-Ying Zhang
- From the Department of Cardiology, Institute of Clinical Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China (C.L.L., J.Y.Z., G.P.S.); Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (C.L.L., Y.W., M.L., C.F., G.K.S., C.Y., B.D.L., P.L., G.P.S.); Department of Vascular Surgery, Viborg Regional Hospital, Viborg, Denmark (H.W.); Department of Cardiology, Shanghai First People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China (Y.W.); Department of Cardiology, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China (M.L., X.C.); Department of Cardiothoracic and Vascular Surgery, Elitary Research Centre of Individualized Medicine of Arterial Disease, Odense University Hospital, Odense, Denmark (J.S.L.); Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark (H.W., S.P.J.); Section for Metabolic Genetics, The Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, University of Copenhagen, Copenhagen, Denmark (H.V.); Department of Medicine, University of California, San Francisco (X.H.); and Departments of Physiology and Medicine, Saha Cardiovascular Research Center, University of Kentucky, Lexington (A.D.)
| | - Chongzhe Yang
- From the Department of Cardiology, Institute of Clinical Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China (C.L.L., J.Y.Z., G.P.S.); Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (C.L.L., Y.W., M.L., C.F., G.K.S., C.Y., B.D.L., P.L., G.P.S.); Department of Vascular Surgery, Viborg Regional Hospital, Viborg, Denmark (H.W.); Department of Cardiology, Shanghai First People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China (Y.W.); Department of Cardiology, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China (M.L., X.C.); Department of Cardiothoracic and Vascular Surgery, Elitary Research Centre of Individualized Medicine of Arterial Disease, Odense University Hospital, Odense, Denmark (J.S.L.); Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark (H.W., S.P.J.); Section for Metabolic Genetics, The Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, University of Copenhagen, Copenhagen, Denmark (H.V.); Department of Medicine, University of California, San Francisco (X.H.); and Departments of Physiology and Medicine, Saha Cardiovascular Research Center, University of Kentucky, Lexington (A.D.)
| | - Xiaozhu Huang
- From the Department of Cardiology, Institute of Clinical Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China (C.L.L., J.Y.Z., G.P.S.); Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (C.L.L., Y.W., M.L., C.F., G.K.S., C.Y., B.D.L., P.L., G.P.S.); Department of Vascular Surgery, Viborg Regional Hospital, Viborg, Denmark (H.W.); Department of Cardiology, Shanghai First People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China (Y.W.); Department of Cardiology, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China (M.L., X.C.); Department of Cardiothoracic and Vascular Surgery, Elitary Research Centre of Individualized Medicine of Arterial Disease, Odense University Hospital, Odense, Denmark (J.S.L.); Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark (H.W., S.P.J.); Section for Metabolic Genetics, The Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, University of Copenhagen, Copenhagen, Denmark (H.V.); Department of Medicine, University of California, San Francisco (X.H.); and Departments of Physiology and Medicine, Saha Cardiovascular Research Center, University of Kentucky, Lexington (A.D.)
| | - Alan Daugherty
- From the Department of Cardiology, Institute of Clinical Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China (C.L.L., J.Y.Z., G.P.S.); Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (C.L.L., Y.W., M.L., C.F., G.K.S., C.Y., B.D.L., P.L., G.P.S.); Department of Vascular Surgery, Viborg Regional Hospital, Viborg, Denmark (H.W.); Department of Cardiology, Shanghai First People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China (Y.W.); Department of Cardiology, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China (M.L., X.C.); Department of Cardiothoracic and Vascular Surgery, Elitary Research Centre of Individualized Medicine of Arterial Disease, Odense University Hospital, Odense, Denmark (J.S.L.); Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark (H.W., S.P.J.); Section for Metabolic Genetics, The Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, University of Copenhagen, Copenhagen, Denmark (H.V.); Department of Medicine, University of California, San Francisco (X.H.); and Departments of Physiology and Medicine, Saha Cardiovascular Research Center, University of Kentucky, Lexington (A.D.)
| | - Bruce D Levy
- From the Department of Cardiology, Institute of Clinical Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China (C.L.L., J.Y.Z., G.P.S.); Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (C.L.L., Y.W., M.L., C.F., G.K.S., C.Y., B.D.L., P.L., G.P.S.); Department of Vascular Surgery, Viborg Regional Hospital, Viborg, Denmark (H.W.); Department of Cardiology, Shanghai First People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China (Y.W.); Department of Cardiology, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China (M.L., X.C.); Department of Cardiothoracic and Vascular Surgery, Elitary Research Centre of Individualized Medicine of Arterial Disease, Odense University Hospital, Odense, Denmark (J.S.L.); Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark (H.W., S.P.J.); Section for Metabolic Genetics, The Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, University of Copenhagen, Copenhagen, Denmark (H.V.); Department of Medicine, University of California, San Francisco (X.H.); and Departments of Physiology and Medicine, Saha Cardiovascular Research Center, University of Kentucky, Lexington (A.D.)
| | - Peter Libby
- From the Department of Cardiology, Institute of Clinical Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China (C.L.L., J.Y.Z., G.P.S.); Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (C.L.L., Y.W., M.L., C.F., G.K.S., C.Y., B.D.L., P.L., G.P.S.); Department of Vascular Surgery, Viborg Regional Hospital, Viborg, Denmark (H.W.); Department of Cardiology, Shanghai First People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China (Y.W.); Department of Cardiology, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China (M.L., X.C.); Department of Cardiothoracic and Vascular Surgery, Elitary Research Centre of Individualized Medicine of Arterial Disease, Odense University Hospital, Odense, Denmark (J.S.L.); Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark (H.W., S.P.J.); Section for Metabolic Genetics, The Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, University of Copenhagen, Copenhagen, Denmark (H.V.); Department of Medicine, University of California, San Francisco (X.H.); and Departments of Physiology and Medicine, Saha Cardiovascular Research Center, University of Kentucky, Lexington (A.D.)
| | - Guo-Ping Shi
- From the Department of Cardiology, Institute of Clinical Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China (C.L.L., J.Y.Z., G.P.S.); Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (C.L.L., Y.W., M.L., C.F., G.K.S., C.Y., B.D.L., P.L., G.P.S.); Department of Vascular Surgery, Viborg Regional Hospital, Viborg, Denmark (H.W.); Department of Cardiology, Shanghai First People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China (Y.W.); Department of Cardiology, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China (M.L., X.C.); Department of Cardiothoracic and Vascular Surgery, Elitary Research Centre of Individualized Medicine of Arterial Disease, Odense University Hospital, Odense, Denmark (J.S.L.); Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark (H.W., S.P.J.); Section for Metabolic Genetics, The Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, University of Copenhagen, Copenhagen, Denmark (H.V.); Department of Medicine, University of California, San Francisco (X.H.); and Departments of Physiology and Medicine, Saha Cardiovascular Research Center, University of Kentucky, Lexington (A.D.).
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Fitzpatrick AM. Biomarkers of asthma and allergic airway diseases. Ann Allergy Asthma Immunol 2016; 115:335-40. [PMID: 26505931 DOI: 10.1016/j.anai.2015.09.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 09/04/2015] [Accepted: 09/04/2015] [Indexed: 01/29/2023]
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Naglot S, Dalal K, Aggarwal P, Dada R. Association of CG Genotype at rs4950928 Promoter in CHI3L1 Gene with YKL-40 Levels and Asthma Susceptibility in North Indian Asthma Patients. Indian J Clin Biochem 2015. [DOI: 10.1007/s12291-015-0478-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Hansen JW, Thomsen SF, Porsbjerg C, Rasmussen LM, Harmsen L, Johansen JS, Backer V. YKL-40 and genetic status of CHI3L1 in a large group of asthmatics. Eur Clin Respir J 2015; 2:25117. [PMID: 26672955 PMCID: PMC4653313 DOI: 10.3402/ecrj.v2.25117] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 07/13/2015] [Accepted: 07/23/2015] [Indexed: 12/15/2022] Open
Abstract
Background Studies have shown a relationship between asthma, serum YKL-40, and the single nucleotide polymorphism (SNP) (−131 C/G, rs4950928) in the CHI3L1 gene that codes for YKL-40. However, the findings differ. We studied the relationship between clinical asthma phenotypes, serum YKL-40, and SNP (−131 C/G, rs4950928). Methods In this study, 1,137 patients with asthma, 415 with rhinitis only, and 275 non-asthmatic controls were included. Assessment included a clinical interview concerning the diagnosis of asthma, severity of asthma, and asthma treatment as well as clinical tests to assess asthma and rhinitis. Serum YKL-40 was measured, and genotyping for the SNP (−131 C/G) was conducted. Results No significant difference in the serum concentration of YKL-40 was found between patients with asthma, patients with rhinitis, and non-asthmatic controls; however, YKL-40 was increased in patients with severe asthma. No association was found between the SNP (−131 C/G rs4950982) and the risk of having asthma (odds ratio = 0.90, p=0.4). Higher levels of serum YKL-40 were found in all subjects when comparing CC genotype to CG and GG genotypes (45 µg/L vs. 32 µg/L and 19 µg/L, p<0.0001). Conclusion There was no association between polymorphisms of SNP (−131 C/G) and asthma. The highest serum YKL-40 concentrations were seen in severe asthmatics. Individuals with less severe asthma showed a smaller difference against controls, limiting its clinical usefulness. More research is needed to clarify the relationship between different asthma phenotypes, YKL-40, and CHI3L1.
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Affiliation(s)
- Jakob W Hansen
- Department of Respiratory Medicine, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark;
| | - Simon F Thomsen
- Department of Respiratory Medicine, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Celeste Porsbjerg
- Department of Respiratory Medicine, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Linda M Rasmussen
- Department of Respiratory Medicine, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Lotte Harmsen
- Department of Respiratory Medicine, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Julia S Johansen
- Department of Medicine, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Vibeke Backer
- Department of Respiratory Medicine, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
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