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Guo Z, Xie Q, Ren Q, Liu Y, Li K, Li B, Li J. Enhancing immune regulation in vitro: the synergistic impact of 3'-sialyllactose and osteopontin in a nutrient blend following influenza virus infection. Front Immunol 2024; 15:1271926. [PMID: 38426086 PMCID: PMC10902112 DOI: 10.3389/fimmu.2024.1271926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 02/02/2024] [Indexed: 03/02/2024] Open
Abstract
Natural components of breast milk, human milk oligosaccharides (HMOs) and osteopontin (OPN) have been shown to have a variety of functional activities and are widely used in infant formulas. However, the preventive and therapeutic effects of both on influenza viruses are not known. In this study, antiviral assays using a human laryngeal carcinoma cell line (HEP-2) showed that 3'-sialyllactose (3'-SL) and OPN had the best antiviral ability with IC50 values of 33.46 μM and 1.65 μM, respectively. 3'-SL (10 μM) and OPN (4 μM) were used in combination to achieve 75% inhibition. Further studies found that the combination of 200 μg/mL of 3'-SL with 500 μg/mL of OPN exerted the best antiviral ability. The reason for this was related to reduced levels of the cytokines TNF-α, IL-6, and iNOS in relation to mRNA expression. Plaque assay and TCID50 assay found the same results and verified synergistic effects. Our research indicates that a combination of 3'-SL and OPN can effectively reduce inflammatory storms and exhibit anti-influenza virus effects through synergistic action.
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Affiliation(s)
- Zhengtao Guo
- School of Food, Northeast Agricultural University, Harbin, Heilongjiang, China
- Key Laboratory of Dairy Science, College of Food Science, Northeast Agricultural University, Harbin, Heilongjiang, China
| | - Qinggang Xie
- Feihe Reseach Institute, Heilongjiang Feihe Dairy Co., Beijing, China
| | - Qiqi Ren
- Feihe Reseach Institute, Heilongjiang Feihe Dairy Co., Beijing, China
| | - Yang Liu
- Feihe Reseach Institute, Heilongjiang Feihe Dairy Co., Beijing, China
| | - Kaifeng Li
- Feihe Reseach Institute, Heilongjiang Feihe Dairy Co., Beijing, China
| | - Bailiang Li
- School of Food, Northeast Agricultural University, Harbin, Heilongjiang, China
- Key Laboratory of Dairy Science, College of Food Science, Northeast Agricultural University, Harbin, Heilongjiang, China
| | - Jufang Li
- Feihe Reseach Institute, Heilongjiang Feihe Dairy Co., Beijing, China
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2
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Almond M, Farne HA, Jackson MM, Jha A, Katsoulis O, Pitts O, Tunstall T, Regis E, Dunning J, Byrne AJ, Mallia P, Kon OM, Saunders KA, Simpson KD, Snelgrove RJ, Openshaw PJM, Edwards MR, Barclay WS, Heaney LM, Johnston SL, Singanayagam A. Obesity dysregulates the pulmonary antiviral immune response. Nat Commun 2023; 14:6607. [PMID: 37857661 PMCID: PMC10587167 DOI: 10.1038/s41467-023-42432-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 10/11/2023] [Indexed: 10/21/2023] Open
Abstract
Obesity is a well-recognized risk factor for severe influenza infections but the mechanisms underlying susceptibility are poorly understood. Here, we identify that obese individuals have deficient pulmonary antiviral immune responses in bronchoalveolar lavage cells but not in bronchial epithelial cells or peripheral blood dendritic cells. We show that the obese human airway metabolome is perturbed with associated increases in the airway concentrations of the adipokine leptin which correlated negatively with the magnitude of ex vivo antiviral responses. Exogenous pulmonary leptin administration in mice directly impaired antiviral type I interferon responses in vivo and ex vivo in cultured airway macrophages. Obese individuals hospitalised with influenza showed dysregulated upper airway immune responses. These studies provide insight into mechanisms driving propensity to severe influenza infections in obesity and raise the potential for development of leptin manipulation or interferon administration as novel strategies for conferring protection from severe infections in obese higher risk individuals.
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Affiliation(s)
- Mark Almond
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Hugo A Farne
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Millie M Jackson
- Centre for Bacterial Resistance Biology. Section of Molecular Microbiology. Department of Infectious Disease, Imperial College London, London, UK
| | - Akhilesh Jha
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Orestis Katsoulis
- Centre for Bacterial Resistance Biology. Section of Molecular Microbiology. Department of Infectious Disease, Imperial College London, London, UK
| | - Oliver Pitts
- Centre for Bacterial Resistance Biology. Section of Molecular Microbiology. Department of Infectious Disease, Imperial College London, London, UK
| | | | - Eteri Regis
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Jake Dunning
- Pandemic Sciences Institute, University of Oxford, Oxford, UK
| | - Adam J Byrne
- National Heart and Lung Institute, Imperial College London, London, UK
- School of Medicine and Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin, 4, Ireland
| | - Patrick Mallia
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Onn Min Kon
- National Heart and Lung Institute, Imperial College London, London, UK
| | | | | | | | | | - Michael R Edwards
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Wendy S Barclay
- Section of Virology, Department of Infectious Disease, Imperial College London, London, UK
| | - Liam M Heaney
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | | | - Aran Singanayagam
- Centre for Bacterial Resistance Biology. Section of Molecular Microbiology. Department of Infectious Disease, Imperial College London, London, UK.
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3
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Bloom CI. Covid-19 pandemic and asthma: What did we learn? Respirology 2023; 28:603-614. [PMID: 37154075 DOI: 10.1111/resp.14515] [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: 01/23/2023] [Accepted: 03/28/2023] [Indexed: 05/10/2023]
Abstract
This review addresses some of the major lessons we have learnt regarding asthma and the covid-19 pandemic, including susceptibility to SARS-CoV-2 infection and severe covid-19, potentially protective factors, comparison to other respiratory infections, changes in healthcare behaviour from the perspective of patients and clinicians, medications to treat or prevent covid-19, and post-covid syndrome.
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Affiliation(s)
- Chloe I Bloom
- Imperial College London, National Heart and Lung Institute, London, UK
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4
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Conway FM, Bloom CI, Shah PL. Susceptibility of Patients with Airway Disease to SARS-CoV-2 Infection. Am J Respir Crit Care Med 2022; 206:696-703. [PMID: 35549839 PMCID: PMC9799128 DOI: 10.1164/rccm.202111-2547pp] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- Francesca M. Conway
- Royal Brompton Hospital, London, United Kingdom;,Chelsea & Westminster Hospital, London, United Kingdom; and,National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Chloe I. Bloom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Pallav L. Shah
- Royal Brompton Hospital, London, United Kingdom;,Chelsea & Westminster Hospital, London, United Kingdom; and,National Heart and Lung Institute, Imperial College London, London, United Kingdom
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Sharma S, Tasnim N, Agadi K, Asfeen U, Kanda J. Vulnerability for Respiratory Infections in Asthma Patients: A Systematic Review. Cureus 2022; 14:e28839. [PMID: 36225449 PMCID: PMC9536399 DOI: 10.7759/cureus.28839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2022] [Indexed: 11/30/2022] Open
Abstract
Asthma is a non-communicable and long-term condition affecting children and adults. The air passages in the lungs become narrow due to inflammation and tightening of the muscles around the small airways. Symptoms of asthma are intermittent and include cough, wheeze, shortness of breath, and chest tightness. Asthma is very often underdiagnosed and under-treated in many regions, especially in developing countries. While many studies show that viral infections can precipitate asthmatic attacks, very few studies have been conducted to see if history or current asthmatic attack increases the risk of viral infections. Our study aims to determine the predisposition of asthmatics to develop various viral infections and susceptibility toward certain viruses that cause upper respiratory tract infections. We performed a literature review of both published and unpublished articles. We included case reports, case series, reviews, clinical trials, cohort, and case-control studies, written only in English. Commentaries, letters to editors, and book chapters were excluded. Our initial search yielded 948 articles, of which 826 were rejected either because they were irrelevant or because they did not meet our inclusion criteria. We finally screened 122 abstracts and identified 24 relevant articles. People with a history of asthma have an abnormal innate immune response, making them potentially slower in clearing the infection and susceptible to both infections and virus-induced cell cytotoxicity. Also, in these studies, deficiencies in the interferon alpha response of peripheral blood mononuclear cells and plasmacytoid dendritic cells have been observed in asthmatics, both adults and children. Asthmatics with a viral infection usually present with an acute exacerbation of asthma, represented by dyspnea and cough, with other prodromal symptoms including vomiting and general malaise. The review includes an update on the relevance of dysregulated immune pathways in causing viral infections in asthmatic populations. It focuses on the evidence to suggest that people with asthma are at increased risk of viral infection, and viral infections in turn are known to precipitate and worsen the asthmatic status, making this a vicious cycle. The authors also suggest that further studies be undertaken to elucidate the pathophysiology and identify the critical therapeutic steps to break this vicious cycle and improve the quality of life for people with asthma.
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Martín-Martín J, Martín-Cazorla F, Suárez J, Rubio L, Martín-de-Las-Heras S. Comorbidities and autopsy findings of COVID-19 deaths and their association with time to death: a systematic review and meta-analysis. Curr Med Res Opin 2022; 38:785-792. [PMID: 35254193 DOI: 10.1080/03007995.2022.2050110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Examination of postmortem findings can help establish effective therapeutic strategies to reduce mortality. The aim of this study was therefore to review complete autopsy cases and their postmortem findings and comorbidities associated with death caused by COVID-19, in order to establish a profile of the deceased and the likelihood of time to death. METHODS A systematic review was carried out following the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and meets Cochrane criteria recommendations (PROSPERO registration number CRD 42020209649). An electronic search in the databases Pubmed, Scopus, Web of Science, Wiley Online Library, and Scientific Electronic Library Online (SciELO) was performed. RESULTS The search strategy yielded a total of 25 articles where 140 cases of complete autopsies were reported. The most prevalent comorbidity was vascular diseases. Patients with vascular disease, heart disease, and diabetes died significantly in a shorter period of time. Autopsies mainly focused on the lungs. The proliferative phase of Diffuse Alveolar Damage (DAD) was the most reported in the microscopic postmortem findings, and these patients died in a shorter period of time. However, individuals aged over 80 years significantly presented fibrotic phase of DAD at the time of death. The kidney was the second most affected organ with thrombosis and tubular damage, followed by the liver with congestion and necrosis. CONCLUSION Given that accurate information of complete autopsies findings is still scarce, it is necessary to perform complete autopsies by examining organs other than the lungs in order to provide information to improve new treatment strategies in patients with a high risk of mortality.
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Affiliation(s)
- Jaime Martín-Martín
- Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain
- Department of Legal and Forensic Medicine. Facultad de Medicina, Universidad de Málaga, Málaga, Spain
| | - Fernando Martín-Cazorla
- Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain
- Instituto de Medicina Legal, Servicio de Patología Forense, Málaga, Spain
| | - Juan Suárez
- Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain
- Department of Legal and Forensic Medicine. Facultad de Medicina, Universidad de Málaga, Málaga, Spain
| | - Leticia Rubio
- Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain
- Department of Legal and Forensic Medicine. Facultad de Medicina, Universidad de Málaga, Málaga, Spain
| | - Stella Martín-de-Las-Heras
- Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain
- Department of Legal and Forensic Medicine. Facultad de Medicina, Universidad de Málaga, Málaga, Spain
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Drăgănescu AC, Miron VD, Streinu-Cercel A, Florea D, Vlaicu O, Bilaşco A, Oţelea D, Luminos ML, Piţigoi D, Streinu-Cercel A, Săndulescu O. Circulation of influenza A viruses among patients hospitalized for severe acute respiratory infection in a tertiary care hospital in Romania in the 2018/19 season: Results from an observational descriptive epidemiological study. Medicine (Baltimore) 2021; 100:e28460. [PMID: 34967388 PMCID: PMC8718231 DOI: 10.1097/md.0000000000028460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 12/09/2021] [Indexed: 01/05/2023] Open
Abstract
The seasonal circulation of influenza viruses and the impact that this infection has on the population varies from year to year. We have prospectively captured hospital-based surveillance data describing the circulation of influenza viruses and characterizing patients with influenza admitted to a tertiary hospital in Bucharest, Romania in the 2018/19 season.We have conducted an observational descriptive epidemiological study analyzing all consecutive patients hospitalized for influenza like illness or severe acute respiratory infection at the National Institute for Infectious Diseases "Prof. Dr. Matei Balş", Bucharest, Romania, from November 2018 to April 2019. For all patients we actively collected standardized clinical information and performed real-time reverse transcription polymerase chain reaction testing of respiratory samples to identify the presence of influenza viruses and to determine the subtype/lineage.A total of 1128 hospitalized patients were tested in this study, with an influenza positivity rate of 41.2% (n = 465). We identified an exclusive circulation of influenza A viruses (A/H1 - 57.2%, A/H3 - 29.3%, A not subtyped - 13.3%), with only 1 case of influenza B detected at the end of the season (week 18/2019). Children under 5 years of age accounted for the majority of cases (40%, n = 186), and all cases had a favorable evolution. Females were more likely to test positive for influenza (53.3%) compared to males (46.7%), P = .048, and presence of asthma or chronic obstructive pulmonary disease increased the risk of influenza 4.4-fold and 2-fold, respectively (P < .001 and P = .034). Thirteen influenza patients required hospitalization in intensive care and 5 deaths were recorded (1.1%). The vaccination rate for all patients included in the study was low (4.6%). The existence of chronic conditions or age over 65 years prolonged the hospitalization period with 2 days (P < .001 each).In the 2018/19 season, we identified an important circulation of influenza A viruses among patients hospitalized for influenza like illness/severe acute respiratory infection in a tertiary care hospital in Romania, with a higher likelihood of affecting females and patients with pre-existing lung conditions. Monitoring of the clinical and epidemiological characteristics of influenza virus infection is of great interest and should be done carefully each season to better inform on the necessary measures to limit the impact that this infection may have on risk groups.
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Affiliation(s)
| | | | - Anca Streinu-Cercel
- National Institute for Infectious Diseases “Prof. Dr. Matei Balş”, Bucharest, Romania
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Dragoş Florea
- National Institute for Infectious Diseases “Prof. Dr. Matei Balş”, Bucharest, Romania
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Ovidiu Vlaicu
- National Institute for Infectious Diseases “Prof. Dr. Matei Balş”, Bucharest, Romania
| | - Anuţa Bilaşco
- National Institute for Infectious Diseases “Prof. Dr. Matei Balş”, Bucharest, Romania
| | - Dan Oţelea
- National Institute for Infectious Diseases “Prof. Dr. Matei Balş”, Bucharest, Romania
| | - Monica Luminiţa Luminos
- National Institute for Infectious Diseases “Prof. Dr. Matei Balş”, Bucharest, Romania
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Daniela Piţigoi
- National Institute for Infectious Diseases “Prof. Dr. Matei Balş”, Bucharest, Romania
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Adrian Streinu-Cercel
- National Institute for Infectious Diseases “Prof. Dr. Matei Balş”, Bucharest, Romania
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Oana Săndulescu
- National Institute for Infectious Diseases “Prof. Dr. Matei Balş”, Bucharest, Romania
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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8
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Lee ZY, Tam JKC, Tran T. Corticosteroid use in respiratory viral infections — friend or foe? CURRENT OPINION IN PHYSIOLOGY 2021. [DOI: 10.1016/j.cophys.2021.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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9
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Wark PA, Pathinayake PS, Eapen MS, Sohal SS. Asthma, COPD and SARS-CoV-2 infection (COVID-19): potential mechanistic insights. Eur Respir J 2021; 58:13993003.00920-2021. [PMID: 34244320 PMCID: PMC8287734 DOI: 10.1183/13993003.00920-2021] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/24/2021] [Indexed: 12/23/2022]
Abstract
We read with interest the manuscripts [1, 2] and the accompanying editorial [3] describing the risk of severe disease and infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and asthma, but are struck by the difference seen with risk of complications from asthma and coronavirus disease 2019 (COVID-19) compared to the experience during the 2009 influenza pandemic, where people with asthma were clearly at heightened risk, at least of hospitalisation [4]. In contrast, those who smoke or have COPD, appear at greater risk. Observational studies will never be able to provide evidence of cause and effect and a greater understanding of the mechanisms of susceptibility to infection with SARS-CoV-2 is also required. Hence, we would like to take this further and enhance discussion on potential mechanisms (figure 1). Patients with asthma are somewhat protected from COVID-19 complications compared to COPD. This may be due to variability in viral attachment protein, ICS use, smoking/vaping status, a skewed inflammatory pattern, and dysregulated endocytic machinery.https://bit.ly/3qOcyNb
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Affiliation(s)
- Peter Ab Wark
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia.,Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, NSW, Australia
| | - Prabuddha S Pathinayake
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Mathew Suji Eapen
- Respiratory Translational Research Group, Department of Laboratory Medicine, School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, TAS, Australia
| | - Sukhwinder Singh Sohal
- Respiratory Translational Research Group, Department of Laboratory Medicine, School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, TAS, Australia
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10
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Bloom CI, Drake TM, Docherty AB, Lipworth BJ, Johnston SL, Nguyen-Van-Tam JS, Carson G, Dunning J, Harrison EM, Baillie JK, Semple MG, Cullinan P, Openshaw PJM. Risk of adverse outcomes in patients with underlying respiratory conditions admitted to hospital with COVID-19: a national, multicentre prospective cohort study using the ISARIC WHO Clinical Characterisation Protocol UK. THE LANCET. RESPIRATORY MEDICINE 2021; 9:699-711. [PMID: 33676593 PMCID: PMC8241313 DOI: 10.1016/s2213-2600(21)00013-8] [Citation(s) in RCA: 104] [Impact Index Per Article: 34.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/29/2020] [Accepted: 01/05/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND Studies of patients admitted to hospital with COVID-19 have found varying mortality outcomes associated with underlying respiratory conditions and inhaled corticosteroid use. Using data from a national, multicentre, prospective cohort, we aimed to characterise people with COVID-19 admitted to hospital with underlying respiratory disease, assess the level of care received, measure in-hospital mortality, and examine the effect of inhaled corticosteroid use. METHODS We analysed data from the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) WHO Clinical Characterisation Protocol UK (CCP-UK) study. All patients admitted to hospital with COVID-19 across England, Scotland, and Wales between Jan 17 and Aug 3, 2020, were eligible for inclusion in this analysis. Patients with asthma, chronic pulmonary disease, or both, were identified and stratified by age (<16 years, 16-49 years, and ≥50 years). In-hospital mortality was measured by use of multilevel Cox proportional hazards, adjusting for demographics, comorbidities, and medications (inhaled corticosteroids, short-acting β-agonists [SABAs], and long-acting β-agonists [LABAs]). Patients with asthma who were taking an inhaled corticosteroid plus LABA plus another maintenance asthma medication were considered to have severe asthma. FINDINGS 75 463 patients from 258 participating health-care facilities were included in this analysis: 860 patients younger than 16 years (74 [8·6%] with asthma), 8950 patients aged 16-49 years (1867 [20·9%] with asthma), and 65 653 patients aged 50 years and older (5918 [9·0%] with asthma, 10 266 [15·6%] with chronic pulmonary disease, and 2071 [3·2%] with both asthma and chronic pulmonary disease). Patients with asthma were significantly more likely than those without asthma to receive critical care (patients aged 16-49 years: adjusted odds ratio [OR] 1·20 [95% CI 1·05-1·37]; p=0·0080; patients aged ≥50 years: adjusted OR 1·17 [1·08-1·27]; p<0·0001), and patients aged 50 years and older with chronic pulmonary disease (with or without asthma) were significantly less likely than those without a respiratory condition to receive critical care (adjusted OR 0·66 [0·60-0·72] for those without asthma and 0·74 [0·62-0·87] for those with asthma; p<0·0001 for both). In patients aged 16-49 years, only those with severe asthma had a significant increase in mortality compared to those with no asthma (adjusted hazard ratio [HR] 1·17 [95% CI 0·73-1·86] for those on no asthma therapy, 0·99 [0·61-1·58] for those on SABAs only, 0·94 [0·62-1·43] for those on inhaled corticosteroids only, 1·02 [0·67-1·54] for those on inhaled corticosteroids plus LABAs, and 1·96 [1·25-3·08] for those with severe asthma). Among patients aged 50 years and older, those with chronic pulmonary disease had a significantly increased mortality risk, regardless of inhaled corticosteroid use, compared to patients without an underlying respiratory condition (adjusted HR 1·16 [95% CI 1·12-1·22] for those not on inhaled corticosteroids, and 1·10 [1·04-1·16] for those on inhaled corticosteroids; p<0·0001). Patients aged 50 years and older with severe asthma also had an increased mortality risk compared to those not on asthma therapy (adjusted HR 1·24 [95% CI 1·04-1·49]). In patients aged 50 years and older, inhaled corticosteroid use within 2 weeks of hospital admission was associated with decreased mortality in those with asthma, compared to those without an underlying respiratory condition (adjusted HR 0·86 [95% CI 0·80-0·92]). INTERPRETATION Underlying respiratory conditions are common in patients admitted to hospital with COVID-19. Regardless of the severity of symptoms at admission and comorbidities, patients with asthma were more likely, and those with chronic pulmonary disease less likely, to receive critical care than patients without an underlying respiratory condition. In patients aged 16 years and older, severe asthma was associated with increased mortality compared to non-severe asthma. In patients aged 50 years and older, inhaled corticosteroid use in those with asthma was associated with lower mortality than in patients without an underlying respiratory condition; patients with chronic pulmonary disease had significantly increased mortality compared to those with no underlying respiratory condition, regardless of inhaled corticosteroid use. Our results suggest that the use of inhaled corticosteroids, within 2 weeks of admission, improves survival for patients aged 50 years and older with asthma, but not for those with chronic pulmonary disease. FUNDING National Institute for Health Research, Medical Research Council, NIHR Health Protection Research Units in Emerging and Zoonotic Infections at the University of Liverpool and in Respiratory Infections at Imperial College London in partnership with Public Health England.
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Affiliation(s)
- Chloe I Bloom
- National Heart and Lung Institute, Imperial College London, London, UK.
| | - Thomas M Drake
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Annemarie B Docherty
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Brian J Lipworth
- Scottish Centre for Respiratory Research, Ninewells Hospital, University of Dundee, Dundee, UK
| | | | - Jonathan S Nguyen-Van-Tam
- Division of Epidemiology and Public Health, University of Nottingham School of Medicine, Nottingham, UK
| | - Gail Carson
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Jake Dunning
- National Heart and Lung Institute, Imperial College London, London, UK; National Infection Service, Public Health England, London, UK
| | - Ewen M Harrison
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | | | - Malcolm G Semple
- Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection Veterinary and Ecological Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK; Department of Respiratory Medicine, Alder Hey Children's Hospital, Liverpool, UK
| | - Paul Cullinan
- National Heart and Lung Institute, Imperial College London, London, UK
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11
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Farne H, Singanayagam A. Why asthma might surprisingly protect against poor outcomes in COVID-19. Eur Respir J 2020; 56:13993003.03045-2020. [PMID: 33154034 PMCID: PMC7651838 DOI: 10.1183/13993003.03045-2020] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 10/23/2020] [Indexed: 11/28/2022]
Abstract
We read with interest the study by Beurnieret al. [1] describing a lower prevalence of asthma (4.8%) in a cohort of 768 patients hospitalised with coronavirus disease 2019 (COVID-19) compared to the general population, none of whom presented with an asthma exacerbation and only one who was treated for bronchospasm. This subgroup also had significantly reduced mortality compared to a control group without asthma. These findings must be considered preliminary given that they arise from a relatively small, single-centre cohort. In particular, the control group differed significantly in age (older) and gender balance (greater male/female ratio); both characteristics are associated worse outcomes and this raises the possibility that the results represent a statistical artefact. Asthma may protect against poor outcomes in COVID-19 due to several possible mechanisms, including altered viral entry receptor expression, inhaled corticosteroid use, chronic inflammation, reduced exposure due to shielding and/or mucus hypersecretionhttps://bit.ly/3eiXOPP
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Affiliation(s)
- Hugo Farne
- National Heart and Lung Institute, Imperial College, London, UK
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12
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Habibi MS, Thwaites RS, Chang M, Jozwik A, Paras A, Kirsebom F, Varese A, Owen A, Cuthbertson L, James P, Tunstall T, Nickle D, Hansel TT, Moffatt MF, Johansson C, Chiu C, Openshaw PJM. Neutrophilic inflammation in the respiratory mucosa predisposes to RSV infection. Science 2020; 370:eaba9301. [PMID: 33033192 PMCID: PMC7613218 DOI: 10.1126/science.aba9301] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 06/30/2020] [Accepted: 08/19/2020] [Indexed: 12/12/2022]
Abstract
The variable outcome of viral exposure is only partially explained by known factors. We administered respiratory syncytial virus (RSV) to 58 volunteers, of whom 57% became infected. Mucosal neutrophil activation before exposure was highly predictive of symptomatic RSV disease. This was associated with a rapid, presymptomatic decline in mucosal interleukin-17A (IL-17A) and other mediators. Conversely, those who resisted infection showed presymptomatic activation of IL-17- and tumor necrosis factor-related pathways. Vulnerability to infection was not associated with baseline microbiome but was reproduced in mice by preinfection chemokine-driven airway recruitment of neutrophils, which caused enhanced disease mediated by pulmonary CD8+ T cell infiltration. Thus, mucosal neutrophilic inflammation at the time of RSV exposure enhances susceptibility, revealing dynamic, time-dependent local immune responses before symptom onset and explaining the as-yet unpredictable outcomes of pathogen exposure.
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Affiliation(s)
| | - Ryan S Thwaites
- National Heart and Lung Institute, Imperial College London, London, UK
| | | | - Agnieszka Jozwik
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Allan Paras
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Freja Kirsebom
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Augusto Varese
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Amber Owen
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Leah Cuthbertson
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Phillip James
- National Heart and Lung Institute, Imperial College London, London, UK
| | | | - David Nickle
- Genetics & Pharmacogenomics, Department of Translational Medicine, Merck & Co., Inc., Boston, MA, USA
| | - Trevor T Hansel
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Miriam F Moffatt
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Cecilia Johansson
- National Heart and Lung Institute, Imperial College London, London, UK.
| | - Christopher Chiu
- Department of Infectious Disease, Imperial College London, London, UK.
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13
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Rich HE, Antos D, Melton NR, Alcorn JF, Manni ML. Insights Into Type I and III Interferons in Asthma and Exacerbations. Front Immunol 2020; 11:574027. [PMID: 33101299 PMCID: PMC7546400 DOI: 10.3389/fimmu.2020.574027] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 08/25/2020] [Indexed: 01/16/2023] Open
Abstract
Asthma is a highly prevalent, chronic respiratory disease that impacts millions of people worldwide and causes thousands of deaths every year. Asthmatics display different phenotypes with distinct genetic components, environmental causes, and immunopathologic signatures, and are broadly characterized into type 2-high or type 2-low (non-type 2) endotypes by linking clinical characteristics, steroid responsiveness, and molecular pathways. Regardless of asthma severity and adequate disease management, patients may experience acute exacerbations of symptoms and a loss of disease control, often triggered by respiratory infections. The interferon (IFN) family represents a group of cytokines that play a central role in the protection against and exacerbation of various infections and pathologies, including asthma. Type I and III IFNs in particular play an indispensable role in the host immune system to fight off pathogens, which seems to be altered in both pediatric and adult asthmatics. Impaired IFN production leaves asthmatics susceptible to infection and with uncontrolled type 2 immunity, promotes airway hyperresponsiveness (AHR), and inflammation which can lead to asthma exacerbations. However, IFN deficiency is not observed in all asthmatics, and alterations in IFN expression may be independent of type 2 immunity. In this review, we discuss the link between type I and III IFNs and asthma both in general and in specific contexts, including during viral infection, co-infection, and bacterial/fungal infection. We also highlight several studies which examine the potential role for type I and III IFNs as asthma-related therapies.
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Affiliation(s)
- Helen E Rich
- Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States
| | - Danielle Antos
- Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States
| | - Natalie R Melton
- Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States
| | - John F Alcorn
- Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States
| | - Michelle L Manni
- Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States
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14
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García-Pachón E, Zamora-Molina L, Soler-Sempere MJ, Baeza-Martínez C, Grau-Delgado J, Padilla-Navas I, Gutiérrez F. Asthma and COPD in Hospitalized COVID-19 Patients. Arch Bronconeumol 2020; 56:604-606. [PMID: 32586704 PMCID: PMC7261473 DOI: 10.1016/j.arbres.2020.05.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 05/12/2020] [Accepted: 05/14/2020] [Indexed: 01/11/2023]
Affiliation(s)
- Eduardo García-Pachón
- Sección de Neumología, Hospital General Universitario de Elche, Elche, Alicante, España; Departamento de Medicina Clínica, Universidad Miguel Hernández, Elche, Alicante, España.
| | - Lucía Zamora-Molina
- Sección de Neumología, Hospital General Universitario de Elche, Elche, Alicante, España
| | - María J Soler-Sempere
- Sección de Neumología, Hospital General Universitario de Elche, Elche, Alicante, España
| | - Carlos Baeza-Martínez
- Sección de Neumología, Hospital General Universitario de Elche, Elche, Alicante, España
| | - Justo Grau-Delgado
- Sección de Neumología, Hospital General Universitario de Elche, Elche, Alicante, España
| | - Isabel Padilla-Navas
- Sección de Neumología, Hospital General Universitario de Elche, Elche, Alicante, España
| | - Félix Gutiérrez
- Departamento de Medicina Clínica, Universidad Miguel Hernández, Elche, Alicante, España; Servicio de Medicina Interna, Hospital General Universitario de Elche, Elche, Alicante, España
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15
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García-Pachón E, Zamora-Molina L, Soler-Sempere MJ, Baeza-Martínez C, Grau-Delgado J, Padilla-Navas I, Gutiérrez F. Asthma and COPD in hospitalized COVID-19 patients. Arch Bronconeumol 2020. [PMID: 34025003 PMCID: PMC7386266 DOI: 10.1016/j.arbr.2020.05.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Eduardo García-Pachón
- Sección de Neumología, Hospital General Universitario de Elche, Elche, Alicante, Spain.,Departamento de Medicina Clínica, Universidad Miguel Hernández, Elche, Alicante, Spain
| | - Lucía Zamora-Molina
- Sección de Neumología, Hospital General Universitario de Elche, Elche, Alicante, Spain
| | - María J Soler-Sempere
- Sección de Neumología, Hospital General Universitario de Elche, Elche, Alicante, Spain
| | - Carlos Baeza-Martínez
- Sección de Neumología, Hospital General Universitario de Elche, Elche, Alicante, Spain
| | - Justo Grau-Delgado
- Sección de Neumología, Hospital General Universitario de Elche, Elche, Alicante, Spain
| | - Isabel Padilla-Navas
- Sección de Neumología, Hospital General Universitario de Elche, Elche, Alicante, Spain
| | - Félix Gutiérrez
- Departamento de Medicina Clínica, Universidad Miguel Hernández, Elche, Alicante, Spain.,Servicio de Medicina Interna, Hospital General Universitario de Elche, Elche, Alicante, Spain
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16
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Jha A, Thwaites RS, Tunstall T, Kon OM, Shattock RJ, Hansel TT, Openshaw PJM. Increased nasal mucosal interferon and CCL13 response to a TLR7/8 agonist in asthma and allergic rhinitis. J Allergy Clin Immunol 2020; 147:694-703.e12. [PMID: 32717253 DOI: 10.1016/j.jaci.2020.07.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 05/19/2020] [Accepted: 07/01/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Acute respiratory viral infections are a major cause of respiratory morbidity and mortality, especially in patients with preexisting lung diseases such as asthma. Toll-like receptors are critical in the early detection of viruses and in activating innate immunity in the respiratory mucosa, but there is no reliable and convenient method by which respiratory mucosal innate immune responses can be measured. OBJECTIVE We sought to assess in vivo immune responses to an innate stimulus and compare responsiveness between healthy volunteers and volunteers with allergy. METHODS We administered the Toll-like receptor 7/8 agonist resiquimod (R848; a synthetic analogue of single-stranded RNA) or saline by nasal spray to healthy participants without allergy (n = 12), those with allergic rhinitis (n = 12), or those with allergic rhinitis with asthma (n = 11). Immune mediators in blood and nasal fluid and mucosal gene expression were monitored over time. RESULTS R848 was well tolerated and significantly induced IFN-α2a, IFN-γ, proinflammatory cytokines (TNF-α, IL-2, IL-12p70), and chemokines (CXCL10, C-C motif chemokine ligand [CCL]2, CCL3, CCL4, and CCL13) in nasal mucosal fluid, without causing systemic immune activation. Participants with allergic rhinitis or allergic rhinitis with asthma had increased IFN-α2a, CCL3, and CCL13 responses relative to healthy participants; those with asthma had increased induction of IFN-stimulated genes DExD/H-box helicase 58, MX dynamin-like GTPase 1, and IFN-induced protein with tetratricopeptide repeats 3. CONCLUSIONS Responses to nasal delivery of R848 enables simple assessment of mucosal innate responsiveness, revealing that patients with allergic disorders have an increased nasal mucosal IFN and chemokine response to the viral RNA analogue R848. This highlights that dysregulated innate immune responses of the nasal mucosa in allergic individuals may be important in determining the outcome of viral exposure.
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Affiliation(s)
- Akhilesh Jha
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Ryan S Thwaites
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Tanushree Tunstall
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Onn Min Kon
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Robin J Shattock
- Department of Infectious Diseases, Imperial College London, London, United Kingdom
| | - Trevor T Hansel
- National Heart and Lung Institute, Imperial College London, London, United Kingdom.
| | - Peter J M Openshaw
- National Heart and Lung Institute, Imperial College London, London, United Kingdom.
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17
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Garcia-Pachon E, Zamora-Molina L, Soler-Sempere MJ, Baeza-Martinez C, Grau-Delgado J, Canto-Reig V, Ramon-Sanchez A, Padilla-Navas I, Ruiz-Garcia M, Gonzalo-Jimenez N. Asthma prevalence in patients with SARS-CoV-2 infection detected by RT-PCR not requiring hospitalization. Respir Med 2020; 171:106084. [PMID: 32658837 PMCID: PMC7334641 DOI: 10.1016/j.rmed.2020.106084] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 07/03/2020] [Indexed: 01/16/2023]
Abstract
INTRODUCTION The prevalence of asthma in patients hospitalized with SARS-CoV-2 has been studied and varies widely in the different series. However, the prevalence in SARS-infected patients not requiring hospitalization is not known. The objective of this study was to analyze the presence of asthma in a consecutive series of patients who tested positive in the RT-PCR assay for SARS-CoV-2 and did not require hospital admission. METHODS AND RESULTS A total of 218 patients (58% of those who tested positive) did not require hospitalization; they had a median age of 45 years (IQR 34-57) and 57% were female. Six patients (2.8%) had a previous diagnosis of asthma. Only one patient developed a mild aggravation of asthma symptoms associated with SARS-CoV-2 infection. CONCLUSIONS Few patients with asthma were infected by SARS-CoV-2, and this infection was not a significant cause of asthma exacerbation.
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Affiliation(s)
- Eduardo Garcia-Pachon
- Section of Respiratory Medicine, Hospital General Universitario de Elche, Alicante, Spain; Department of Clinical Medicine, Universidad Miguel Hernandez de Elche, Alicante, Spain.
| | - Lucia Zamora-Molina
- Section of Respiratory Medicine, Hospital General Universitario de Elche, Alicante, Spain
| | - Maria J Soler-Sempere
- Section of Respiratory Medicine, Hospital General Universitario de Elche, Alicante, Spain
| | - Carlos Baeza-Martinez
- Section of Respiratory Medicine, Hospital General Universitario de Elche, Alicante, Spain
| | - Justo Grau-Delgado
- Section of Respiratory Medicine, Hospital General Universitario de Elche, Alicante, Spain
| | | | | | - Isabel Padilla-Navas
- Section of Respiratory Medicine, Hospital General Universitario de Elche, Alicante, Spain
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18
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Dunning J, Thwaites RS, Openshaw PJM. Seasonal and pandemic influenza: 100 years of progress, still much to learn. Mucosal Immunol 2020; 13:566-573. [PMID: 32317736 PMCID: PMC7223327 DOI: 10.1038/s41385-020-0287-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 02/26/2020] [Accepted: 03/06/2020] [Indexed: 02/04/2023]
Abstract
Influenza viruses are highly transmissible, both within and between host species. The severity of the disease they cause is highly variable, from the mild and inapparent through to the devastating and fatal. The unpredictability of epidemic and pandemic outbreaks is accompanied but the predictability of seasonal disease in wide areas of the Globe, providing an inexorable toll on human health and survival. Although there have been great improvements in understanding influenza viruses and the disease that they cause, our knowledge of the effects they have on the host and the ways that the host immune system responds continues to develop. This review highlights the importance of the mucosa in defence against infection and in understanding the pathogenesis of disease. Although vaccines have been available for many decades, they remain suboptimal in needing constant redesign and in only providing short-term protection. There are real prospects for improvement in treatment and prevention of influenza soon, based on deeper knowledge of how the virus transmits, replicates and triggers immune defences at the mucosal surface.
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Affiliation(s)
| | - Ryan S Thwaites
- National Heart and Lung Institute, Imperial College London, London, UK
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19
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Wark PAB. Why are people with asthma more susceptible to influenza? Eur Respir J 2019; 54:54/4/1901748. [PMID: 31649149 DOI: 10.1183/13993003.01748-2019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 09/05/2019] [Indexed: 11/05/2022]
Affiliation(s)
- Peter A B Wark
- Centre for Healthy Lungs, Hunter Medical Research Institute, University of Newcastle, New Lambton, Australia
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