Genetics of asthma: a molecular biologist perspective

The influence of asthma on neuroinflammation and neurodevelopment: From epidemiology to basic models

Asthma is a highly heterogeneous inflammatory disease that can have a significant effect on both the respiratory system and central nervous system. Population based studies and animal models have found asthma to be comorbid with a number of neurological conditions, including depression, anxiety, and neurodevelopmental disorders. In addition, maternal asthma during pregnancy has been associated with neurodevelopmental disorders in the offspring, such as autism spectrum disorders and attention deficit hyperactivity disorder. In this article, we review the most current epidemiological studies of asthma that identify links to neurological conditions, both as it relates to individuals that suffer from asthma and the impacts asthma during pregnancy may have on offspring neurodevelopment. We also discuss the relevant animal models investigating these links, address the gaps in knowledge, and explore the potential future directions in this field.

Toxocara spp. infection and risk of childhood asthma: A systematic review and meta-analysis

Asthma is one of the most common chronic respiratory disease worldwide, with a negative impact on quality of life and socio-economic status of patients. There are some evidences to suggest that Toxocara infection is a neglected risk factor for childhood asthma. We performed a systematic review and meta-analysis to further understanding of this relationship. Five databases include PubMed, Science Direct, Scopus, Web of Science (ISI), and Google scholar were searched (up to October 2017) to identify the relevant studies. We used random-effects meta-analysis model to estimate the pooled odds ratio (OR) and 95% confidence intervals (CI). Heterogeneity was assessed with the Q-test and I² statistic. A total of 17 studies including 11 studies with case-control design (1139 patients and 1023 controls) and six studies with cross-sectional design (a total of 5469 participants, 872 asthmatics, and 4597 non-asthmatics children) met the eligibility criteria. An increased risk for asthma was observed in children with Toxocara infection seropositivity (OR, 1.91; 95% CI, 1.47-2.47). In sub-group analysis, the pooled ORs were (OR, 2.13; 95% CI, 1.43-3.15) and (OR, 1.73; 95% CI, 1.23-2.44) for case-control and cross-sectional studies, respectively. Moreover, considering to specific IgE seropositivity, a pooled OR of 2.36 (95% CI, 0.93-5.98) was observed. In conclusion, this meta-analysis revealed that children infected with Toxocara spp. are more likely to have asthma compared to non-infected children. More studies (especially longitudinal studies) are needed to further investigate the impact of Toxocara spp. infection on the onset or development of asthma.

The roles of miRNAs as potential biomarkers in lung diseases

MicroRNAs (miRNAs) are small non-coding RNAs which can act as master regulators of gene expression, modulate almost all biological process and are essential for maintaining cellular homeostasis. Dysregulation of miRNA expression has been associated with aberrant gene expression and may lead to pathological conditions. Evidence suggests that miRNA expression profiles are altered between health and disease and as such may be considered as biomarkers of disease. Evidence is increasing that miRNAs are particularly important in lung homeostasis and development and have been demonstrated to be the involved in many pulmonary diseases such as asthma, COPD, sarcoidosis, lung cancer and other smoking related diseases. Better understanding of the function of miRNA and the mechanisms underlying their action in the lung, would help to improve current diagnosis and therapeutics strategies in pulmonary diseases. Recently, some miRNA-based drugs have been introduced as possible therapeutic agents. In this review we aim to summarize the recent findings regarding the role of miRNAs in the airways and lung and emphasise their potential therapeutic roles in pulmonary diseases.

Genetic risk factors for the development of allergic disease identified by genome-wide association

An increasing proportion of the worldwide population is affected by allergic diseases such as allergic rhinitis (AR), atopic dermatitis (AD) and allergic asthma and improved treatment options are needed particularly for severe, refractory disease. Allergic diseases are complex and development involves both environmental and genetic factors. Although the existence of a genetic component for allergy was first described almost 100 years ago, progress in gene identification has been hindered by lack of high throughput technologies to investigate genetic variation in large numbers of subjects. The development of Genome-Wide Association Studies (GWAS), a hypothesis-free method of interrogating large numbers of common variants spanning the entire genome in disease and non-disease subjects has revolutionised our understanding of the genetics of allergic disease. Susceptibility genes for asthma, AR and AD have now been identified with confidence, suggesting there are common and distinct genetic loci associated with these diseases, providing novel insights into potential disease pathways and mechanisms. Genes involved in both adaptive and innate immune mechanisms have been identified, notably including multiple genes involved in epithelial function/secretion, suggesting that the airway epithelium may be particularly important in asthma. Interestingly, concordance/discordance between the genetic factors driving allergic traits such as IgE levels and disease states such as asthma have further supported the accumulating evidence for heterogeneity in these diseases. While GWAS have been useful and continue to identify novel genes for allergic diseases through increased sample sizes and phenotype refinement, future approaches will integrate analyses of rare variants, epigenetic mechanisms and eQTL approaches, leading to greater insight into the genetic basis of these diseases. Gene identification will improve our understanding of disease mechanisms and generate potential therapeutic opportunities.

Genetic association of key Th1/Th2 pathway candidate genes, IRF2, IL6, IFNGR2, STAT4 and IL4RA, with atopic asthma in the Indian population

Asthma is a complex, multifactorial disease resulting due to dysregulated immune responses. Genetic factors contribute significantly to asthma pathogenesis, and identification of these factors is one of the major goals in understanding the disease. Th1/Th2 helper differentiation has a critical role in modulating the phenotypes associated with atopic asthma. This study was aimed at identifying genetic modifiers of asthma in selected genes involved in T helper differentiation. A total of 354 single-nucleotide polymorphisms (SNPs) in 33 candidate genes were genotyped in a case-control cohort (cases=147, controls=199) and families (n=247) using Illumina's Golden Gate Assay. Five SNPs, rs3733475A/C (IRF2), rs2069832A/G (IL6), rs2012075G/A (IFNGR2) and rs1400656G/A (STAT4) and rs1805011C/A (IL4RA) were found to be associated with asthma in family based as well as in case-control analyses (P=0.002, P=0.001, P=0.004, P=0.003 and P=0.001, respectively). Interestingly, the minor alleles at these loci showed a protective effect. A five loci haplotype, TAACG, in IRF2 gene, was significantly associated with asthma in families (P=1.1 × 10(-6)) and in case-control cohort (P=0.01). In conclusion, our studies led to identification of some key candidate genes, namely IRF2, IL6, IFNGR2, STAT4 and IL4RA that modulate genetic susceptibility to asthma in the Indian population. Also, this is the first report of independent association of IL6 gene polymorphism with atopic asthma.

Analysis of the SMAD4 gene in asthma

Considering the importance of the TGF-β signaling pathway for normal lung function and especially its roles in inflammation and tissue remodeling, key features of asthma pathology, it can be assumed that these molecules may harbor mutations in asthmatics. The aim of this study was to analyze the SMAD4 gene in patients with asthma. Analysis has encompassed exons 10, 11, 12 and 13 encoding the carboxy-terminal (MH2) domain of the SMAD4 protein, where mutations most frequently occur. The study included 50 patients (20 men and 30 women) with asthma aged between 17 and 73 years (average age 45.2±15.6 years). Polymerase chain reaction (PCR) was used to amplify exons 10, 11, 12 and 13 of the SMAD4 gene and the obtained PCR products were subjected to direct DNA sequencing. No nucleotide changes were found in any of the analyzed exons in either of the subjects. Based on the results of this study, it seems that mutations in the carboxy-terminal (MH2) domain of the SMAD4 are not present in asthmatic patients. Future research should be directed at the analysis of the complete gene, including regulatory elements, in order to resolve the exact role of SMAD4 in asthma.

An understanding of the genetic basis of asthma

Asthma is the most common chronic childhood disease in developed nations and its prevalence has increased in the world over the last 25 years. It is a complex disease with both genetic and environmental risk factors. Asthma is caused by multiple interacting genes, some having a protective effect and others contributing to the disease pathogenesis, with each gene having its own tendency to be influenced by the environment. This article reviews the current state of the genetics of asthma in six categories, viz. epidemiology, management, aetiology, family and twin studies, segregation and linkage studies, and candidate genes and single nucleotide polymorphisms (SNPs).

The impact of common tumor necrosis factor haplotypes on the development of asthma in children: an Egyptian model

Conflicting results have arisen among different ethnic populations with regard to the ability of tumor necrosis factor (TNF) to control the development of bronchial asthma. We examined common TNF polymorphisms (TNFA -1031C>T, TNFA -308G>A, and TNFB +252A>G) to develop a model of the associations between these genetic markers and the development of the disease in Egypt. Amplified DNA from buccal mucosa was genotyped for 240 children using polymerase chain reaction-restriction fragment length polymorphism. Skin prick test, total serum immunoglobulin E levels, and assessment of pulmonary functions were investigated. The onset age for one-third of the asthma patients in our study was between 7 and 10 years. The TNFA -1031C>T and TNFA -308G>A polymorphisms were strongly associated with the risk of asthma (p = 0.007, and p = 0.000, respectively), but the TNFB +252A>G polymorphism was not (p = 0.6). We detected a significant linkage between the +252A>G and -1031C>T, and another between the +252A>G and the -308G>A (p < 0.0001 for both). The -1031C>T and -308G>A polymorphisms were not linked (p = 0.14). The -308A/A genotype was absent, and the -308A allele was expressed only in patients with -308G/A heterozygosity (13%). All but the +252G/A genotype were also strongly associated with the severity of disease. Environmental factors, as genetic variations, clearly influence susceptibility, the onset, progression, and severity of bronchial asthma. More information is needed to develop genetic models of susceptibility for different ethnic populations.

Epidemiology of stress and asthma: from constricting communities and fragile families to epigenetics

Several epidemiologic frameworks, exemplified through extant research examples, provide insight into the role of stress in the expression of asthma and other allergic disorders. Biologic, psychological, and social processes interact throughout the life course to influence disease expression. Studies exploiting a child development framework focus on critical periods of exposure, including the in utero environment, to examine the influence of stress on disease onset. Early stress effects that alter the normal course of morphogenesis and maturation that affect both structure and function of key organ systems (eg, immune, respiratory) may persist into adult life underscoring the importance of a life course perspective. Other evidence suggests that maternal stress influences programming of integrated physiologic systems in their offspring (eg, neuroendocrine, autonomic, immune function) starting in pregnancy; consequently stress effects may be transgenerational. A multilevel approach that includes an ecological perspective may help to explain heterogeneities in asthma expression across socioeconomic and geographic boundaries that to date remain largely unexplained. Evolving studies incorporating psychological, behavioral, and physiologic correlates of stress more specifically inform underlying mechanisms operating in these critical periods of development. The role of genetics, gene by environment interactions, and epigenetic mechanisms of gene expression have been sparsely examined in epidemiologic studies on stress and asthma although overlapping evidence provides proof of concept for such studies in the future.

Association between β+252 tumour necrosis factor polymorphism and asthma in western Saudi children

There is strong evidence that supports the role of tumour necrosis factors (TNF-alpha/beta) as common genetic factors, located on 6p21.1-6p21.3 loci, in the pathogenesis of asthma disease. In this study, we extended our research work on TNFA to include the genotyping of Saudi asthmatic children as regards to TNFB gene (namely as lymphotoxin-α, LTA). We examined 60 asthmatic Saudi children compared to 56 healthy non-asthmatics using the PCR-RFLP analyses to identify the polymorphism +252A>G in intron 1 in lymphotoxin-α gene. We identified 55% of the allele A of the LTA∗NcoI polymorphism in subjects with asthma disease, and 45% of the allele G. In this study, the frequency of the LTA∗NcoI-A/A genotype was 40% preferably to the LTA∗NcoI-G/A and LTA∗NcoI-G/G genotypes. In addition, the severe persistent asthmatic cases were associated with the LTA∗NcoI-AA genotype at a frequency of 80%, while the genotype LTA∗NcoI-GG are associated with the mildest form of the disease. Consequently, one could predict the severity of asthma and hence the polymorphism of the LTA∗NcoI. Herein, we stated that more than 93% of Saudi children under investigation lived in the randomized areas of western regions of Saudi Arabia. In conclusion, genotype frequencies for the LTA+252 polymorphisms were significantly different from the controls. These findings may have implications for future early intervention studies by helping to identify infants at increased risk for wheezing and childhood asthma.

Association between β+252 tumour necrosis factor polymorphism and asthma in western Saudi children

There is strong evidence that supports the role of tumour necrosis factors (TNF-alpha/beta) as common genetic factors, located on 6p21.1-6p21.3 loci, in the pathogenesis of asthma disease. In this study, we extended our research work on TNFA to include the genotyping of Saudi asthmatic children as regards to TNFB gene (namely as lymphotoxin-α, LTA). We examined 60 asthmatic Saudi children compared to 56 healthy non-asthmatics using the PCR-RFLP analyses to identify the polymorphism +252A>G in intron 1 in lymphotoxin-α gene. We identified 55% of the allele A of the LTA∗NcoI polymorphism in subjects with asthma disease, and 45% of the allele G. In this study, the frequency of the LTA∗NcoI-A/A genotype was 40% preferably to the LTA∗NcoI-G/A and LTA∗NcoI-G/G genotypes. In addition, the severe persistent asthmatic cases were associated with the LTA∗NcoI-AA genotype at a frequency of 80%, while the genotype LTA∗NcoI-GG are associated with the mildest form of the disease. Consequently, one could predict the severity of asthma and hence the polymorphism of the LTA∗NcoI. Herein, we stated that more than 93% of Saudi children under investigation lived in the randomized areas of western regions of Saudi Arabia. In conclusion, genotype frequencies for the LTA+252 polymorphisms were significantly different from the controls. These findings may have implications for future early intervention studies by helping to identify infants at increased risk for wheezing and childhood asthma.

Ciclesonide and the treatment of asthma

IMPORTANCE OF THE FIELD

Asthma is a chronic disease characterized by airway inflammation and hyper-responsiveness. Inhaled corticosteroids (ICSs) constitute the guideline-recommended first-line therapy for persistent asthma. However, concerns regarding ICS-related adverse events may contribute to their underutilization by physicians and patients.

AREAS COVERED IN THIS REVIEW

The currently available published data on the pharmacokinetic and pharmacodynamic properties, safety and efficacy of the ICS, ciclesonide, is described. Peer-reviewed publications (1996 - 2009) on the pharmacodynamic and pharmacokinetic profile, safety and efficacy of ciclesonide were reviewed.

WHAT THE READER WILL GAIN

Ciclesonide is delivered as an inactive prodrug, which is cleaved to the active molecule by intracellular esterases located in the lungs. This and other pharmacodynamic and pharmacokinetic properties may limit the amount of active molecule outside the lung and may reduce the incidence of side effects. Randomized placebo-controlled studies found that ciclesonide can initiate and maintain disease control in subjects with persistent asthma of all disease severities. Moreover, studies have found that ciclesonide is as effective as other ICSs in establishing and controlling disease symptoms. Controlled clinical trials also showed that ciclesonide is associated with minimal systemic and local treatment-related adverse events.

TAKE HOME MESSAGE

Published findings indicate that ciclesonide is effective at initiating and maintaining asthma control and is well tolerated, with a positive safety profile.