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Witte JA, Braunstahl GJ, Blox WJB, van ’t Westeinde SC, in ’t Veen JCCM, Kappen JH, van Rossum EFC. STOP: an open label crossover trial to study ICS withdrawal in patients with a combination of obesity and low-inflammatory asthma and evaluate its effect on asthma control and quality of life. BMC Pulm Med 2022; 22:53. [PMID: 35123457 PMCID: PMC8818143 DOI: 10.1186/s12890-022-01843-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 01/26/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Asthma patients with obesity often have a high disease burden, despite the use of high-dose inhaled corticosteroids (ICS). In contrast to asthmatics with normal weight, the efficacy of ICS in patients with obesity and asthma is often relatively low. Meanwhile, patients do suffer from side effects, such as weight gain, development of diabetes, cataract, or high blood pressure. The relatively poor response to ICS might be explained by the low prevalence of type 2 inflammatory patterns (T2-low) in patients with asthma and obesity. T2-low inflammation is characterized by low eosinophilic count, low Fractional exhaled NO (FeNO), no clinically allergy-driven asthma, and no need for maintenance oral corticosteroids (OCS). We aim to study whether ICS can be safely withdrawn in patients with T2-low asthma and obesity while maintaining an equal level of asthma control. Secondary outcomes focus on the prevalence of ‘false-negative’ T2-low phenotypes (i.e. T2-hidden) and the effect of ICS withdrawal on parameters of the metabolic syndrome. This study will lead to a better understanding of this poorly understood subgroup and might find new treatable traits.
Methods
The STOP trial is an investigator-initiated, multicenter, non-inferiority, open-label, crossover study aiming to assess whether ICS can be safely withdrawn in adults aged 17–75 years with T2-low asthma and obesity (body mass index (BMI) ≥ 30 kg/m2). Patients will be randomly divided into two arms (both n = 60). One arm will start with fixed-dose ICS (control group) and one arm will taper and subsequently stop ICS (intervention group). Patients in the intervention group will remain ICS naïve for ten weeks. After a washout of 4 weeks, patients will crossover to the other study arm. The crossover study takes 36 weeks to complete. Patients will be asked to participate in the extension study, to investigate the long-term metabolic benefits of ICS withdrawal.
Discussion
This study yields valuable data on ICS tapering in patients with T2-low asthma and obesity. It informs future guidelines and committees on corticosteroid-sparing algorithms in these patients.
Trial registration Netherlands Trial Register, NL8759, registered 2020–07-06, https://www.trialregister.nl/trial/8759.
Protocol version and date: version 2.1, 20 November 2020.
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Mincham KT, Bruno N, Singanayagam A, Snelgrove RJ. Our evolving view of neutrophils in defining the pathology of chronic lung disease. Immunology 2021; 164:701-721. [PMID: 34547115 PMCID: PMC8561104 DOI: 10.1111/imm.13419] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/07/2021] [Accepted: 09/09/2021] [Indexed: 12/13/2022] Open
Abstract
Neutrophils are critical components of the body's immune response to infection, being loaded with a potent arsenal of toxic mediators and displaying immense destructive capacity. Given the potential of neutrophils to impart extensive tissue damage, it is perhaps not surprising that when augmented these cells are also implicated in the pathology of inflammatory diseases. Prominent neutrophilic inflammation is a hallmark feature of patients with chronic lung diseases such as chronic obstructive pulmonary disease, severe asthma, bronchiectasis and cystic fibrosis, with their numbers frequently associating with worse prognosis. Accordingly, it is anticipated that neutrophils are central to the pathology of these diseases and represent an attractive therapeutic target. However, in many instances, evidence directly linking neutrophils to the pathology of disease has remained somewhat circumstantial and strategies that have looked to reduce neutrophilic inflammation in the clinic have proved largely disappointing. We have classically viewed neutrophils as somewhat crude, terminally differentiated, insular and homogeneous protagonists of pathology. However, it is now clear that this does not do the neutrophil justice, and we now recognize that these cells exhibit heterogeneity, a pronounced awareness of the localized environment and a remarkable capacity to interact with and modulate the behaviour of a multitude of cells, even exhibiting anti-inflammatory, pro-resolving and pro-repair functions. In this review, we discuss evidence for the role of neutrophils in chronic lung disease and how our evolving view of these cells may impact upon our perceived assessment of their contribution to disease pathology and efforts to target them therapeutically.
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Affiliation(s)
- Kyle T. Mincham
- National Heart and Lung InstituteImperial College LondonLondonUK
| | - Nicoletta Bruno
- National Heart and Lung InstituteImperial College LondonLondonUK
| | - Aran Singanayagam
- National Heart and Lung InstituteImperial College LondonLondonUK
- Department of Infectious DiseaseImperial College LondonLondonUK
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Total IgE Variability Is Associated with Future Asthma Exacerbations: A 1-Year Prospective Cohort Study. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:2812-2824. [PMID: 33991705 DOI: 10.1016/j.jaip.2021.04.065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 04/26/2021] [Accepted: 04/27/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Few prospective studies have investigated the relationship between IgE variability and risk for asthma exacerbations (AEs). OBJECTIVE To explore the relationship between IgE variability and AEs. METHODS Recruited patients with stable asthma underwent two serum total IgE tests within a month (at screening [baseline IgE] and at 1 month) to obtain the coefficient of variation (CV) of base 10 log-transformed IgE. Patients with IgE CV were divided into IgE CV-high and IgE CV-low cohorts based on the CV median and were observed within 12 months, during which the association between IgE variability and AEs was explored using a negative binomial regression model. RESULTS The IgE CV levels obtained from 340 patients classified patients into two groups (n = 170 for the IgE CV-high and IgE CV-low groups, respectively) based on the serum total IgE CV median of 2.12% (quartiles 1 and 3: 0.98% and 3.91%, respectively). The IgE CV-high patients exhibited worse asthma control and lung function and more marked airway inflammation, and received more intensive medication use compared with IgE CV-low patients. The IgE CV-high patients exhibited increased rates of moderate-to-severe (adjusted rate ratio = 2.88; 95% confidence interval, 1.65-5.03; P < .001) and severe (adjusted rate ratio = 2.16; 95% confidence interval, 1.08-4.32; P = .029) AEs during the follow-up year compared with IgE CV-low patients. Furthermore, sputum IL-6 partially mediated the associations between IgE CV with moderate-to-severe and severe AEs. CONCLUSIONS Variability in total serum IgE levels is an easily obtained and practical measure for predicting AEs. Future studies are needed to investigate whether IgE variability can be used to guide precision medicine in asthma.
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Crisford H, Sapey E, Rogers GB, Taylor S, Nagakumar P, Lokwani R, Simpson JL. Neutrophils in asthma: the good, the bad and the bacteria. Thorax 2021; 76:thoraxjnl-2020-215986. [PMID: 33632765 PMCID: PMC8311087 DOI: 10.1136/thoraxjnl-2020-215986] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 01/12/2021] [Accepted: 01/18/2021] [Indexed: 12/30/2022]
Abstract
Airway inflammation plays a key role in asthma pathogenesis but is heterogeneous in nature. There has been significant scientific discovery with regard to type 2-driven, eosinophil-dominated asthma, with effective therapies ranging from inhaled corticosteroids to novel biologics. However, studies suggest that approximately 1 in 5 adults with asthma have an increased proportion of neutrophils in their airways. These patients tend to be older, have potentially pathogenic airway bacteria and do not respond well to classical therapies. Currently, there are no specific therapeutic options for these patients, such as neutrophil-targeting biologics.Neutrophils comprise 70% of the total circulatory white cells and play a critical defence role during inflammatory and infective challenges. This makes them a problematic target for therapeutics. Furthermore, neutrophil functions change with age, with reduced microbial killing, increased reactive oxygen species release and reduced production of extracellular traps with advancing age. Therefore, different therapeutic strategies may be required for different age groups of patients.The pathogenesis of neutrophil-dominated airway inflammation in adults with asthma may reflect a counterproductive response to the defective neutrophil microbial killing seen with age, resulting in bystander damage to host airway cells and subsequent mucus hypersecretion and airway remodelling. However, in children with asthma, neutrophils are less associated with adverse features of disease, and it is possible that in children, neutrophils are less pathogenic.In this review, we explore the mechanisms of neutrophil recruitment, changes in cellular function across the life course and the implications this may have for asthma management now and in the future. We also describe the prevalence of neutrophilic asthma globally, with a focus on First Nations people of Australia, New Zealand and North America.
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Affiliation(s)
- Helena Crisford
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Elizabeth Sapey
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Geraint B Rogers
- SAHMRI Microbiome Research Laboratory, Flinders University College of Medicine and Public Health, Adelaide, South Australia, Australia
- Microbiome and Host Health, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Steven Taylor
- SAHMRI Microbiome Research Laboratory, Flinders University College of Medicine and Public Health, Adelaide, South Australia, Australia
- Microbiome and Host Health, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Prasad Nagakumar
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- Respiratory Medicine, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Ravi Lokwani
- Faculty of Health and Medicine, Priority Research Centre for Healthy Lungs, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Jodie L Simpson
- Faculty of Health and Medicine, Priority Research Centre for Healthy Lungs, The University of Newcastle, Callaghan, New South Wales, Australia
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Maneechotesuwan K, Kasetsinsombat K, Wongkajornsilp A, Barnes PJ. Role of autophagy in regulating interleukin-10 and the responses to corticosteroids and statins in asthma. Clin Exp Allergy 2021; 51:1553-1565. [PMID: 33423318 DOI: 10.1111/cea.13825] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 12/24/2020] [Accepted: 01/05/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Interleukin (IL)-10 is a key anti-inflammatory cytokine that may be reduced in asthma but is enhanced by corticosteroids, especially when combined with a statin, although the mechanisms of these effects are uncertain. OBJECTIVE To study the role of autophagy in macrophages in promoting inflammation in asthma through reducing IL-10 secretion and how corticosteroids and statins may reverse this process. METHODS We conducted a randomised double-blind placebo-controlled study in moderate to severe asthmatic patients (n = 44) to investigate the effect of an inhaled corticosteroid (budesonide 400 μg/day) and the combination of budesonide with an oral statin (simvastatin 10 mg/day) given for 8 weeks on autophagy protein expression in sputum cells by using immunocytochemistry and measurement of IL-10 release. In in vitro experiments, we studied cross-regulation between autophagy and IL-10 release by measuring the expression of autophagy proteins in M2-like macrophages and the effects of budesonide and simvastatin on these mechanisms. RESULTS In asthmatic patients, inhaled budesonide inhibited airway macrophage autophagy (beclin-1, LC3) as well as autophagic flux (p62), which was enhanced by simvastatin and was correlated with increased sputum IL-10 and reduced IL-4 concentrations. In macrophages in vitro, budesonide and simvastatin inhibited rapamycin-induced autophagy as well as autophagic flux, with reduced expression of beclin-1 and LC3, but enhanced the accumulation of p62 and increased expression of IL-10, which itself further inhibited autophagy in macrophages. With siRNA-mediated silencing, LC3-deficient macrophages also showed a maximal induction of IL-10 transcription. Neutralisation of IL-10 with recombinant specific blocking antibody and silencing IL-10 transcription reversed the inhibitory effects of budesonide and simvastatin on macrophage autophagy. CONCLUSION AND CLINICAL RELEVANCE Inhibition by corticosteroids and a statin of macrophage autophagy enhances IL-10 production, resulting in the control of asthmatic inflammation.
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Affiliation(s)
- Kittipong Maneechotesuwan
- Division of Respiratory Disease and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kanda Kasetsinsombat
- Department of Pharmacology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Adisak Wongkajornsilp
- Department of Pharmacology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Peter J Barnes
- National Heart and Lung Institute, Imperial College, London, UK
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Shrestha Palikhe N, Wu Y, Konrad E, Gandhi VD, Rowe BH, Vliagoftis H, Cameron L. Th2 cell markers in peripheral blood increase during an acute asthma exacerbation. Allergy 2021; 76:281-290. [PMID: 32750154 DOI: 10.1111/all.14543] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 06/22/2020] [Accepted: 06/24/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Allergic asthma is characterized by type 2 inflammation. We have shown the presence of increased type 2 inflammation in patients with severe asthma and those with frequent exacerbations. However, it is not known whether increased type 2 inflammation drives asthma exacerbations. This study aims to determine Th2 immune parameters in patients presenting to the emergency department (ED) with an acute asthma exacerbation and correlate these parameters with clinical and physiological measures of asthma. METHODS Sixteen adults presenting to the ED with acute asthma exacerbations were recruited after giving informed consent. Ten patients returned 2 weeks later for follow-up. Physiological parameters, asthma control (ACQ6), asthma quality of life (AQLQ) questionnaires, and venous blood were collected during both visits. An immune cell profiling was performed by whole blood flow cytometry: CD4+ T cells, Th2 cells (CD4+ CRTh2+ T cells and % of CD4+ T cells expressing CRTh2), eosinophils and innate lymphoid cells (ILC2). RESULTS During exacerbation, peripheral blood Th2 cell numbers correlated with ACQ6 and AQLQ scores, while ILC2 and eosinophil numbers did not. Subjects had higher % of CD4+ T cells expressing CRTh2 and worse FEV1 during exacerbation compared with the follow-up. The decrease in the % of CD4+ T cells expressing CRTh2 seen during the follow-up visit correlated with the improvement in lung function. CONCLUSIONS These data suggest that Th2 cells in peripheral blood may be a sensitive measure of increasing symptoms in patients with asthma exacerbations and may serve as a biomarker of an asthma exacerbation.
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Affiliation(s)
- Nami Shrestha Palikhe
- Division of Pulmonary Medicine Department of Medicine Faculty of Medicine and Dentistry University of Alberta Edmonton AB Canada
- Alberta Respiratory Centre University of Alberta Edmonton AB Canada
| | - Yingqi Wu
- Division of Pulmonary Medicine Department of Medicine Faculty of Medicine and Dentistry University of Alberta Edmonton AB Canada
- Alberta Respiratory Centre University of Alberta Edmonton AB Canada
| | - Emily Konrad
- Division of Pulmonary Medicine Department of Medicine Faculty of Medicine and Dentistry University of Alberta Edmonton AB Canada
- Alberta Respiratory Centre University of Alberta Edmonton AB Canada
| | - Vivek Dipak Gandhi
- Division of Pulmonary Medicine Department of Medicine Faculty of Medicine and Dentistry University of Alberta Edmonton AB Canada
- Alberta Respiratory Centre University of Alberta Edmonton AB Canada
| | - Brian H. Rowe
- Division of Pulmonary Medicine Department of Medicine Faculty of Medicine and Dentistry University of Alberta Edmonton AB Canada
- Alberta Respiratory Centre University of Alberta Edmonton AB Canada
- Department of Emergency Medicine Faculty of Medicine and Dentistry University of Alberta Edmonton AB Canada
- School of Public Health University of Alberta Edmonton AB Canada
| | - Harissios Vliagoftis
- Division of Pulmonary Medicine Department of Medicine Faculty of Medicine and Dentistry University of Alberta Edmonton AB Canada
- Alberta Respiratory Centre University of Alberta Edmonton AB Canada
| | - Lisa Cameron
- Division of Pulmonary Medicine Department of Medicine Faculty of Medicine and Dentistry University of Alberta Edmonton AB Canada
- Department of Pathology Schulich School of Medicine and Dentistry Western University London ON Canada
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Kim JH, Lee S, Shin YH, Ha EK, Lee SW, Kim MA, Yoon JW, Baek HS, Choi SH, Han MY. Airway mechanics after withdrawal of a leukotriene receptor antagonist in children with mild persistent asthma: Double-blind, randomized, cross-over study. Pediatr Pulmonol 2020; 55:3279-3286. [PMID: 32965787 DOI: 10.1002/ppul.25085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/15/2020] [Accepted: 09/17/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND To determine the response of airway mechanics and the changes in asthma symptoms to stepping down of leukotriene receptor antagonist (LTRA) therapy. METHODS Thirty children (mean age: 7.1 years) with mild, well-controlled, and persistent asthma who took LTRA as maintenance treatment were randomized into a double-blind, placebo-controlled, cross-over study. Each group received an LTRA (montelukast) or placebo daily for 2 weeks, followed by a 1-week washout period, and then the alternate treatment for 2 weeks. Spirometry and impulse oscillation system (IOS) measurements before and after four puffs of salbutamol inhalation, fractional exhaled nitric oxide (FeNO), and the childhood asthma control test (C-ACT) were evaluated at baseline, the end of placebo treatment, and the end of LTRA treatment. RESULTS Changes of FEV1 /FVC (p = .113) and FEV1 (p = .109) from baseline to posttreatment did not differ significantly between the placebo and montelukast groups. In the placebo group, prebronchodilator (pre-) FEV1 /FVC was decreased (83% vs. 86%) and bronchodilator response (BDR) in FEV1 was diminished (10.7% vs. 6.4%) at posttreatment compared with baseline. However, the montelukast group had no significant changes in pre-FEV1 /FVC (p = .865) and BDR in FEV1 (p = .461). In addition, compared with the montelukast group, the placebo group showed no significant changes in Rrs5 (total airway resistance), Rrs5-20 (peripheral airway resistance), FeNO, and symptoms by the C-ACT. CONCLUSION In children with well-controlled mild persistent asthma, changes in spirometry, IOS, FeNO, and C-ACT results did not differ between the placebo and montelukast groups within 2 weeks.
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Affiliation(s)
- Ju Hee Kim
- Departments of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Shinhae Lee
- Departments of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Youn Ho Shin
- Department of Pediatrics, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Republic of Korea
| | - Eun Kyo Ha
- Department of Pediatrics, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Seung Won Lee
- Department of Data Science, Sejong University College of Software Convergence, Seoul, Republic of Korea
| | - Mi-Ae Kim
- Departments of Internal Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Jung Won Yoon
- Department of Pediatrics, Myongji Hospital, Seonam University College of Medicine, Goyang, Republic of Korea
| | - Hey Sung Baek
- Department of Pediatrics, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Sun-Hee Choi
- Department of Pediatrics, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - Man Yong Han
- Departments of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
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De Volder J, Vereecke L, Joos G, Maes T. Targeting neutrophils in asthma: A therapeutic opportunity? Biochem Pharmacol 2020; 182:114292. [PMID: 33080186 DOI: 10.1016/j.bcp.2020.114292] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/14/2020] [Accepted: 10/15/2020] [Indexed: 02/06/2023]
Abstract
Suppression of airway inflammation with inhaled corticosteroids has been the key therapeutic approach for asthma for many years. Identification of inflammatory phenotypes in asthma has moreover led to important breakthroughs, e.g. with specific targeting of the IL-5 pathway as add-on treatment in difficult-to-treat eosinophilic asthma. However, the impact of interfering with the neutrophilic component in asthma is less documented and understood. This review provides an overview of established and recent insights with regard to the role of neutrophils in asthma, focusing on research in humans. We will describe the main drivers of neutrophilic responses in asthma, the heterogeneity in neutrophils and how they could contribute to asthma pathogenesis. Moreover we will describe findings from clinical trials, in which neutrophilic inflammation was targeted. It is clear that neutrophils are important actors in asthma development and play a role in exacerbations. However, more research is required to fully understand how modulation of neutrophil activity could lead to a significant benefit in asthma patients with airway neutrophilia.
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Affiliation(s)
- Joyceline De Volder
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Lars Vereecke
- VIB Inflammation Research Center, Ghent, Belgium; Ghent Gut Inflammation Group (GGIG), Ghent University, Belgium; Department of Rheumatology, Ghent University Hospital, Belgium
| | - Guy Joos
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Tania Maes
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium.
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Tavares LP, Peh HY, Tan WSD, Pahima H, Maffia P, Tiligada E, Levi-Schaffer F. Granulocyte-targeted therapies for airway diseases. Pharmacol Res 2020; 157:104881. [PMID: 32380052 PMCID: PMC7198161 DOI: 10.1016/j.phrs.2020.104881] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 04/27/2020] [Indexed: 12/24/2022]
Abstract
The average respiration rate for an adult is 12-20 breaths per minute, which constantly exposes the lungs to allergens and harmful particles. As a result, respiratory diseases, which includes asthma, chronic obstructive pulmonary disease (COPD) and acute lower respiratory tract infections (LTRI), are a major cause of death worldwide. Although asthma, COPD and LTRI are distinctly different diseases with separate mechanisms of disease progression, they do share a common feature - airway inflammation with intense recruitment and activation of granulocytes and mast cells. Neutrophils, eosinophils, basophils, and mast cells are crucial players in host defense against pathogens and maintenance of lung homeostasis. Upon contact with harmful particles, part of the pulmonary defense mechanism is to recruit these cells into the airways. Despite their protective nature, overactivation or accumulation of granulocytes and mast cells in the lungs results in unwanted chronic airway inflammation and damage. As such, understanding the bright and the dark side of these leukocytes in lung physiology paves the way for the development of therapies targeting this important mechanism of disease. Here we discuss the role of granulocytes in respiratory diseases and summarize therapeutic strategies focused on granulocyte recruitment and activation in the lungs.
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Affiliation(s)
- Luciana P Tavares
- ImmuPhar - Immunopharmacology Section Committee of International Union of Basic and Clinical Pharmacology (IUPHAR); Pulmonary and Critical Care Medicine Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Hong Yong Peh
- ImmuPhar - Immunopharmacology Section Committee of International Union of Basic and Clinical Pharmacology (IUPHAR); Pulmonary and Critical Care Medicine Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA; Department of Pharmacology, Yong Loo Lin School of Medicine, National University Health System, 16 Medical Drive, 117600, Singapore
| | - Wan Shun Daniel Tan
- ImmuPhar - Immunopharmacology Section Committee of International Union of Basic and Clinical Pharmacology (IUPHAR); Department of Pharmacology, Yong Loo Lin School of Medicine, National University Health System, 16 Medical Drive, 117600, Singapore
| | - Hadas Pahima
- ImmuPhar - Immunopharmacology Section Committee of International Union of Basic and Clinical Pharmacology (IUPHAR); Pharmacology and Experimental Therapeutics Unit, School of Pharmacy, Institute for Drug Research, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Pasquale Maffia
- ImmuPhar - Immunopharmacology Section Committee of International Union of Basic and Clinical Pharmacology (IUPHAR); Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom; Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom; Department of Pharmacy, University of Naples Federico II, Naples, Italy
| | - Ekaterini Tiligada
- ImmuPhar - Immunopharmacology Section Committee of International Union of Basic and Clinical Pharmacology (IUPHAR); Department of Pharmacology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Francesca Levi-Schaffer
- ImmuPhar - Immunopharmacology Section Committee of International Union of Basic and Clinical Pharmacology (IUPHAR); Pharmacology and Experimental Therapeutics Unit, School of Pharmacy, Institute for Drug Research, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
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de Groot LES, van de Pol MA, Fens N, Dierdorp BS, Dekker T, Kulik W, Majoor CJ, Hamann J, Sterk PJ, Lutter R. Corticosteroid Withdrawal-Induced Loss of Control in Mild to Moderate Asthma Is Independent of Classic Granulocyte Activation. Chest 2019; 157:16-25. [PMID: 31622588 DOI: 10.1016/j.chest.2019.09.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 09/03/2019] [Accepted: 09/23/2019] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Loss of asthma control and asthma exacerbations are associated with increased sputum eosinophil counts. However, whether eosinophils, or the also present neutrophils, actively contribute to the accompanying inflammation has not been extensively investigated. METHODS Twenty-three patients with mild to moderate asthma were included in a standardized prospective inhaled corticosteroid (ICS) withdrawal study; 22 of the patients experienced loss of asthma control. The study assessed various immune, inflammatory, and oxidative stress parameters, as well as markers of eosinophil and neutrophil activity, in exhaled breath condensate, plasma, and sputum collected at three phases (baseline, during loss of control, and following recovery). RESULTS Loss of asthma control was characterized by increased sputum eosinophils, whereas no differences were detected between the three phases for most inflammatory and oxidative stress responses. There were also no differences detected for markers of activated eosinophils (eosinophil cationic protein and bromotyrosine) and neutrophils (myeloperoxidase and chlorotyrosine). However, free eosinophilic granules and citrullinated histone H3, suggestive of eosinophil cytolysis and potentially eosinophil extracellular trap formation, were enhanced. Baseline blood eosinophils and changes in asymmetric dimethylarginine (an inhibitor of nitric oxide synthase) in plasma were found to correlate with the decrease in FEV1 percent predicted upon ICS withdrawal (both, rs = 0.46; P = .03). CONCLUSIONS The clinical effect in mild to moderate asthma upon interruption of ICS therapy is not related to the classic inflammatory activation of eosinophils and neutrophils. It may, however, reflect another pathway underlying the onset of loss of disease control and asthma exacerbations. TRIAL REGISTRY The Netherlands Trial Register; No.: NTR3316; URL: trialregister.nl/trial/3172.
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Affiliation(s)
- Linsey E S de Groot
- Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; Department of Experimental Immunology (Amsterdam Infection & Immunity Institute), Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - Marianne A van de Pol
- Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Niki Fens
- Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Barbara S Dierdorp
- Department of Experimental Immunology (Amsterdam Infection & Immunity Institute), Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Tamara Dekker
- Department of Experimental Immunology (Amsterdam Infection & Immunity Institute), Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Wim Kulik
- Laboratory Genetic Metabolic Diseases, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Christof J Majoor
- Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jörg Hamann
- Department of Experimental Immunology (Amsterdam Infection & Immunity Institute), Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Peter J Sterk
- Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - René Lutter
- Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; Department of Experimental Immunology (Amsterdam Infection & Immunity Institute), Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Zamora-Mendoza BN, Espinosa-Tanguma R, Ramírez-Elías MG, Cabrera-Alonso R, Montero-Moran G, Portales-Pérez D, Rosales-Romo JA, Gonzalez JF, Gonzalez C. Surface-enhanced raman spectroscopy: A non invasive alternative procedure for early detection in childhood asthma biomarkers in saliva. Photodiagnosis Photodyn Ther 2019; 27:85-91. [PMID: 31082526 DOI: 10.1016/j.pdpdt.2019.05.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 03/28/2019] [Accepted: 05/09/2019] [Indexed: 12/18/2022]
Abstract
The early detection of bronchial inflammation in asthma, through a non-invasive, simple method and under a subclinical state, could lead to a more effective control of this condition. The aim of this study was to identify biomarkers of bronchial inflammation in the saliva of children with asthma through immunoassay and Surface Enhanced Raman Spectroscopy (SERS). We conducted an analytical cross-sectional study in 44 children ages 6-12; the diagnosis of asthma was made according to Global Initiative for Asthma (GINA) standards. The children's saliva was analyzed by immunoassay for the quantification of 37 cytokines, as well as SERS analysis in a confocal Raman microscope at 785 nm. We found a significant association between bronchial obstruction and IL-8 (p = 0.004), IL-10 (p = 0.008) and sCD163 (p = 0.003). The Raman spectra showed significant amplification in the region of 760 to 1750 cm-1. The Principal Component Analysis and Linear Discriminant Analysis (PCA-LDA) method has a sensitivity of 85%, specificity of 82% and an accuracy of 84% for the diagnosis of asthma. These results demonstrate the presence of a subclinical inflammatory state, suggestive of bronchial remodeling in the population studied. The SERS method is a potential tool for identifying bronchial inflammation and its endotype, allowing for a highly sensitive and specific diagnosis.
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Affiliation(s)
- B N Zamora-Mendoza
- Universidad Autonoma de San Luis Potosi, Facultad de Ciencias Quimicas, Av. Dr. Manuel Nava #6, San Luis Potosí, 78210, Mexico
| | - R Espinosa-Tanguma
- Universidad Autonoma de San Luis Potosi, Facultad de Medicina, Av. Venustiano Carranza #2405, San Luis Potosí, 78210, Mexico
| | - M G Ramírez-Elías
- Universidad Autonoma de San Luis Potosi, Facultad de Ciencias, Av. Chapultepec #1570Privadas del Pedregal, San Luis Potosí, 78290, Mexico
| | - R Cabrera-Alonso
- Universidad Autonoma de San Luis Potosi, Coordinación para la Innovacion y Aplicacion de la Ciencia y la Tecnologia (CIACyT), Av. Sierra Leona #550, San Luis Potosi, 78210, Mexico
| | - G Montero-Moran
- Universidad Autonoma de San Luis Potosi, Facultad de Ciencias Quimicas, Av. Dr. Manuel Nava #6, San Luis Potosí, 78210, Mexico
| | - D Portales-Pérez
- Universidad Autonoma de San Luis Potosi, Facultad de Ciencias Quimicas, Av. Dr. Manuel Nava #6, San Luis Potosí, 78210, Mexico
| | - J A Rosales-Romo
- Servicios de Salud de San Luis Potosi, Hospital General de Soledad de Graciano Sánchez, Prolongación Valentín Amador #1112, Colonia Genovevo Rivas Guillen, Soledad de Graciano Sánchez, San Luis Potosí, 78432, Mexico
| | - J F Gonzalez
- Universidad Autonoma de San Luis Potosi, Coordinación para la Innovacion y Aplicacion de la Ciencia y la Tecnologia (CIACyT), Av. Sierra Leona #550, San Luis Potosi, 78210, Mexico
| | - C Gonzalez
- Universidad Autonoma de San Luis Potosi, Facultad de Ciencias Quimicas, Av. Dr. Manuel Nava #6, San Luis Potosí, 78210, Mexico.
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12
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Khindri S, Cahn A, Begg M, Montembault M, Leemereise C, Cui Y, Hogg A, Wajdner H, Yang S, Robertson J, Hamblin JN, Ludwig-Sengpiel A, Kornmann O, Hessel EM. A Multicentre, Randomized, Double-Blind, Placebo-Controlled, Crossover Study To Investigate the Efficacy, Safety, Tolerability, and Pharmacokinetics of Repeat Doses of Inhaled Nemiralisib in Adults with Persistent, Uncontrolled Asthma. J Pharmacol Exp Ther 2018; 367:405-413. [PMID: 30217958 DOI: 10.1124/jpet.118.249516] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 09/11/2018] [Indexed: 12/29/2022] Open
Abstract
Phosphoinositide 3-kinase δ (PI3Kδ) is a lipid kinase involved in leukocyte recruitment and activation. Activation of PI3Kδ has been linked to airway inflammation and asthma pathogenesis. This randomized, double-blind, placebo-controlled, crossover study investigated the efficacy, safety, tolerability, and pharmacokinetics of a PI3Kδ inhibitor, nemiralisib (GSK2269557), in patients with persistent, uncontrolled asthma. Patients (n = 50) received once-daily inhaled nemiralisib (1000 µg) or placebo for 28 days, with a crossover to the alternative treatment following a 4-week washout period. Spirometry demonstrated no discernible difference in trough forced expiratory volume in 1 second (FEV1) from baseline (adjusted posterior median 7 ml; 95% credible interval -83, 102 ml) between nemiralisib and placebo treatment at day 28 (primary endpoint). These results were supported by most secondary endpoints, including weighted mean FEV1 (0-4 hours) and change in trough forced vital capacity at day 28. Nemiralisib was generally well-tolerated, with few side effects except for post-inhalation cough (nemiralisib: 35%; placebo: 9%). At day 14, sputum interleukin (IL)-5, IL-13, IL-6, and IL-8 levels were reduced by a median of 17%, 7%, 15%, and 8%, respectively, when comparing nemiralisib with placebo [n = 15 (IL-5, IL-8) or 16 (IL-6, IL-13); posterior probability of a true ratio >0%: 78%, 64%, 76%, and 63%, respectively]. These results suggest that nemiralisib inhibited PI3Kδ locally; however, this did not translate into meaningful clinical improvement. Further studies will investigate the potential efficacy of nemiralisib in patients with asthma with other specific more severe phenotypes, including those who are colonized with bacteria and frequently exacerbate.
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Affiliation(s)
- Sanjeev Khindri
- Respiratory Therapy Area Unit (S.K.), Clinical Pharmacology Science and Study Operations (M.M.), Global Clinical Safety and Pharmacovigilance (Y.C.), and Clinical Pharmacology Modelling and Simulation, Quantitative Sciences, RD Projects Clinical Platforms and Sciences (S.Y.), GSK, Stockley Park, Uxbridge, Middlesex, United Kingdom; Discovery Medicine (A.C.), Refractory Respiratory Inflammation Discovery Performance Unit (M.B., H.W., J.N.H., E.M.H.), Clinical Pharmacology Science and Study Operations (A.H.), and Clinical Statistics (J.R.), GSK, Stevenage, Hertfordshire, United Kingdom; Clinical Operations Department, GSK, Zeist, The Netherlands (C.L.); KLB Gesundheitsforschung Lübeck, Lübeck, Germany (A.L.-S.); and IKF Pneumologie Frankfurt, Clinical Research Centre Respiratory Diseases, Frankfurt, Germany (O.K.)
| | - Anthony Cahn
- Respiratory Therapy Area Unit (S.K.), Clinical Pharmacology Science and Study Operations (M.M.), Global Clinical Safety and Pharmacovigilance (Y.C.), and Clinical Pharmacology Modelling and Simulation, Quantitative Sciences, RD Projects Clinical Platforms and Sciences (S.Y.), GSK, Stockley Park, Uxbridge, Middlesex, United Kingdom; Discovery Medicine (A.C.), Refractory Respiratory Inflammation Discovery Performance Unit (M.B., H.W., J.N.H., E.M.H.), Clinical Pharmacology Science and Study Operations (A.H.), and Clinical Statistics (J.R.), GSK, Stevenage, Hertfordshire, United Kingdom; Clinical Operations Department, GSK, Zeist, The Netherlands (C.L.); KLB Gesundheitsforschung Lübeck, Lübeck, Germany (A.L.-S.); and IKF Pneumologie Frankfurt, Clinical Research Centre Respiratory Diseases, Frankfurt, Germany (O.K.)
| | - Malcolm Begg
- Respiratory Therapy Area Unit (S.K.), Clinical Pharmacology Science and Study Operations (M.M.), Global Clinical Safety and Pharmacovigilance (Y.C.), and Clinical Pharmacology Modelling and Simulation, Quantitative Sciences, RD Projects Clinical Platforms and Sciences (S.Y.), GSK, Stockley Park, Uxbridge, Middlesex, United Kingdom; Discovery Medicine (A.C.), Refractory Respiratory Inflammation Discovery Performance Unit (M.B., H.W., J.N.H., E.M.H.), Clinical Pharmacology Science and Study Operations (A.H.), and Clinical Statistics (J.R.), GSK, Stevenage, Hertfordshire, United Kingdom; Clinical Operations Department, GSK, Zeist, The Netherlands (C.L.); KLB Gesundheitsforschung Lübeck, Lübeck, Germany (A.L.-S.); and IKF Pneumologie Frankfurt, Clinical Research Centre Respiratory Diseases, Frankfurt, Germany (O.K.)
| | - Mickael Montembault
- Respiratory Therapy Area Unit (S.K.), Clinical Pharmacology Science and Study Operations (M.M.), Global Clinical Safety and Pharmacovigilance (Y.C.), and Clinical Pharmacology Modelling and Simulation, Quantitative Sciences, RD Projects Clinical Platforms and Sciences (S.Y.), GSK, Stockley Park, Uxbridge, Middlesex, United Kingdom; Discovery Medicine (A.C.), Refractory Respiratory Inflammation Discovery Performance Unit (M.B., H.W., J.N.H., E.M.H.), Clinical Pharmacology Science and Study Operations (A.H.), and Clinical Statistics (J.R.), GSK, Stevenage, Hertfordshire, United Kingdom; Clinical Operations Department, GSK, Zeist, The Netherlands (C.L.); KLB Gesundheitsforschung Lübeck, Lübeck, Germany (A.L.-S.); and IKF Pneumologie Frankfurt, Clinical Research Centre Respiratory Diseases, Frankfurt, Germany (O.K.)
| | - Claudia Leemereise
- Respiratory Therapy Area Unit (S.K.), Clinical Pharmacology Science and Study Operations (M.M.), Global Clinical Safety and Pharmacovigilance (Y.C.), and Clinical Pharmacology Modelling and Simulation, Quantitative Sciences, RD Projects Clinical Platforms and Sciences (S.Y.), GSK, Stockley Park, Uxbridge, Middlesex, United Kingdom; Discovery Medicine (A.C.), Refractory Respiratory Inflammation Discovery Performance Unit (M.B., H.W., J.N.H., E.M.H.), Clinical Pharmacology Science and Study Operations (A.H.), and Clinical Statistics (J.R.), GSK, Stevenage, Hertfordshire, United Kingdom; Clinical Operations Department, GSK, Zeist, The Netherlands (C.L.); KLB Gesundheitsforschung Lübeck, Lübeck, Germany (A.L.-S.); and IKF Pneumologie Frankfurt, Clinical Research Centre Respiratory Diseases, Frankfurt, Germany (O.K.)
| | - Yi Cui
- Respiratory Therapy Area Unit (S.K.), Clinical Pharmacology Science and Study Operations (M.M.), Global Clinical Safety and Pharmacovigilance (Y.C.), and Clinical Pharmacology Modelling and Simulation, Quantitative Sciences, RD Projects Clinical Platforms and Sciences (S.Y.), GSK, Stockley Park, Uxbridge, Middlesex, United Kingdom; Discovery Medicine (A.C.), Refractory Respiratory Inflammation Discovery Performance Unit (M.B., H.W., J.N.H., E.M.H.), Clinical Pharmacology Science and Study Operations (A.H.), and Clinical Statistics (J.R.), GSK, Stevenage, Hertfordshire, United Kingdom; Clinical Operations Department, GSK, Zeist, The Netherlands (C.L.); KLB Gesundheitsforschung Lübeck, Lübeck, Germany (A.L.-S.); and IKF Pneumologie Frankfurt, Clinical Research Centre Respiratory Diseases, Frankfurt, Germany (O.K.)
| | - Annabel Hogg
- Respiratory Therapy Area Unit (S.K.), Clinical Pharmacology Science and Study Operations (M.M.), Global Clinical Safety and Pharmacovigilance (Y.C.), and Clinical Pharmacology Modelling and Simulation, Quantitative Sciences, RD Projects Clinical Platforms and Sciences (S.Y.), GSK, Stockley Park, Uxbridge, Middlesex, United Kingdom; Discovery Medicine (A.C.), Refractory Respiratory Inflammation Discovery Performance Unit (M.B., H.W., J.N.H., E.M.H.), Clinical Pharmacology Science and Study Operations (A.H.), and Clinical Statistics (J.R.), GSK, Stevenage, Hertfordshire, United Kingdom; Clinical Operations Department, GSK, Zeist, The Netherlands (C.L.); KLB Gesundheitsforschung Lübeck, Lübeck, Germany (A.L.-S.); and IKF Pneumologie Frankfurt, Clinical Research Centre Respiratory Diseases, Frankfurt, Germany (O.K.)
| | - Hannah Wajdner
- Respiratory Therapy Area Unit (S.K.), Clinical Pharmacology Science and Study Operations (M.M.), Global Clinical Safety and Pharmacovigilance (Y.C.), and Clinical Pharmacology Modelling and Simulation, Quantitative Sciences, RD Projects Clinical Platforms and Sciences (S.Y.), GSK, Stockley Park, Uxbridge, Middlesex, United Kingdom; Discovery Medicine (A.C.), Refractory Respiratory Inflammation Discovery Performance Unit (M.B., H.W., J.N.H., E.M.H.), Clinical Pharmacology Science and Study Operations (A.H.), and Clinical Statistics (J.R.), GSK, Stevenage, Hertfordshire, United Kingdom; Clinical Operations Department, GSK, Zeist, The Netherlands (C.L.); KLB Gesundheitsforschung Lübeck, Lübeck, Germany (A.L.-S.); and IKF Pneumologie Frankfurt, Clinical Research Centre Respiratory Diseases, Frankfurt, Germany (O.K.)
| | - Shuying Yang
- Respiratory Therapy Area Unit (S.K.), Clinical Pharmacology Science and Study Operations (M.M.), Global Clinical Safety and Pharmacovigilance (Y.C.), and Clinical Pharmacology Modelling and Simulation, Quantitative Sciences, RD Projects Clinical Platforms and Sciences (S.Y.), GSK, Stockley Park, Uxbridge, Middlesex, United Kingdom; Discovery Medicine (A.C.), Refractory Respiratory Inflammation Discovery Performance Unit (M.B., H.W., J.N.H., E.M.H.), Clinical Pharmacology Science and Study Operations (A.H.), and Clinical Statistics (J.R.), GSK, Stevenage, Hertfordshire, United Kingdom; Clinical Operations Department, GSK, Zeist, The Netherlands (C.L.); KLB Gesundheitsforschung Lübeck, Lübeck, Germany (A.L.-S.); and IKF Pneumologie Frankfurt, Clinical Research Centre Respiratory Diseases, Frankfurt, Germany (O.K.)
| | - Jon Robertson
- Respiratory Therapy Area Unit (S.K.), Clinical Pharmacology Science and Study Operations (M.M.), Global Clinical Safety and Pharmacovigilance (Y.C.), and Clinical Pharmacology Modelling and Simulation, Quantitative Sciences, RD Projects Clinical Platforms and Sciences (S.Y.), GSK, Stockley Park, Uxbridge, Middlesex, United Kingdom; Discovery Medicine (A.C.), Refractory Respiratory Inflammation Discovery Performance Unit (M.B., H.W., J.N.H., E.M.H.), Clinical Pharmacology Science and Study Operations (A.H.), and Clinical Statistics (J.R.), GSK, Stevenage, Hertfordshire, United Kingdom; Clinical Operations Department, GSK, Zeist, The Netherlands (C.L.); KLB Gesundheitsforschung Lübeck, Lübeck, Germany (A.L.-S.); and IKF Pneumologie Frankfurt, Clinical Research Centre Respiratory Diseases, Frankfurt, Germany (O.K.)
| | - J Nicole Hamblin
- Respiratory Therapy Area Unit (S.K.), Clinical Pharmacology Science and Study Operations (M.M.), Global Clinical Safety and Pharmacovigilance (Y.C.), and Clinical Pharmacology Modelling and Simulation, Quantitative Sciences, RD Projects Clinical Platforms and Sciences (S.Y.), GSK, Stockley Park, Uxbridge, Middlesex, United Kingdom; Discovery Medicine (A.C.), Refractory Respiratory Inflammation Discovery Performance Unit (M.B., H.W., J.N.H., E.M.H.), Clinical Pharmacology Science and Study Operations (A.H.), and Clinical Statistics (J.R.), GSK, Stevenage, Hertfordshire, United Kingdom; Clinical Operations Department, GSK, Zeist, The Netherlands (C.L.); KLB Gesundheitsforschung Lübeck, Lübeck, Germany (A.L.-S.); and IKF Pneumologie Frankfurt, Clinical Research Centre Respiratory Diseases, Frankfurt, Germany (O.K.)
| | - Andrea Ludwig-Sengpiel
- Respiratory Therapy Area Unit (S.K.), Clinical Pharmacology Science and Study Operations (M.M.), Global Clinical Safety and Pharmacovigilance (Y.C.), and Clinical Pharmacology Modelling and Simulation, Quantitative Sciences, RD Projects Clinical Platforms and Sciences (S.Y.), GSK, Stockley Park, Uxbridge, Middlesex, United Kingdom; Discovery Medicine (A.C.), Refractory Respiratory Inflammation Discovery Performance Unit (M.B., H.W., J.N.H., E.M.H.), Clinical Pharmacology Science and Study Operations (A.H.), and Clinical Statistics (J.R.), GSK, Stevenage, Hertfordshire, United Kingdom; Clinical Operations Department, GSK, Zeist, The Netherlands (C.L.); KLB Gesundheitsforschung Lübeck, Lübeck, Germany (A.L.-S.); and IKF Pneumologie Frankfurt, Clinical Research Centre Respiratory Diseases, Frankfurt, Germany (O.K.)
| | - Oliver Kornmann
- Respiratory Therapy Area Unit (S.K.), Clinical Pharmacology Science and Study Operations (M.M.), Global Clinical Safety and Pharmacovigilance (Y.C.), and Clinical Pharmacology Modelling and Simulation, Quantitative Sciences, RD Projects Clinical Platforms and Sciences (S.Y.), GSK, Stockley Park, Uxbridge, Middlesex, United Kingdom; Discovery Medicine (A.C.), Refractory Respiratory Inflammation Discovery Performance Unit (M.B., H.W., J.N.H., E.M.H.), Clinical Pharmacology Science and Study Operations (A.H.), and Clinical Statistics (J.R.), GSK, Stevenage, Hertfordshire, United Kingdom; Clinical Operations Department, GSK, Zeist, The Netherlands (C.L.); KLB Gesundheitsforschung Lübeck, Lübeck, Germany (A.L.-S.); and IKF Pneumologie Frankfurt, Clinical Research Centre Respiratory Diseases, Frankfurt, Germany (O.K.)
| | - Edith M Hessel
- Respiratory Therapy Area Unit (S.K.), Clinical Pharmacology Science and Study Operations (M.M.), Global Clinical Safety and Pharmacovigilance (Y.C.), and Clinical Pharmacology Modelling and Simulation, Quantitative Sciences, RD Projects Clinical Platforms and Sciences (S.Y.), GSK, Stockley Park, Uxbridge, Middlesex, United Kingdom; Discovery Medicine (A.C.), Refractory Respiratory Inflammation Discovery Performance Unit (M.B., H.W., J.N.H., E.M.H.), Clinical Pharmacology Science and Study Operations (A.H.), and Clinical Statistics (J.R.), GSK, Stevenage, Hertfordshire, United Kingdom; Clinical Operations Department, GSK, Zeist, The Netherlands (C.L.); KLB Gesundheitsforschung Lübeck, Lübeck, Germany (A.L.-S.); and IKF Pneumologie Frankfurt, Clinical Research Centre Respiratory Diseases, Frankfurt, Germany (O.K.)
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13
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Hastie AT, Steele C, Dunaway CW, Moore WC, Rector BM, Ampleford E, Li H, Denlinger LC, Jarjour N, Meyers DA, Bleecker ER. Complex association patterns for inflammatory mediators in induced sputum from subjects with asthma. Clin Exp Allergy 2018. [PMID: 29520864 DOI: 10.1111/cea.13129] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND The release of various inflammatory mediators into the bronchial lumen is thought to reflect both the type and degree of airway inflammation, eosinophilic Th2, and Th9, or neutrophilic Th1, and Th17, in patients with asthma. AIMS We investigated whether cytokines and chemokines differed in sputum from subjects with more severe compared with milder asthma and whether unbiased factor analysis of cytokine and chemokine groupings indicates specific inflammatory pathways. METHODS Cell-free supernatants from induced sputum were obtained from subjects with a broad range of asthma severity (n = 158) and assessed using Milliplex® Cytokines/Chemokine kits I, II and III, measuring 75 individual proteins. Each cytokine, chemokine or growth factor concentration was examined for differences between asthma severity groups, for association with leucocyte counts, and by factor analysis. RESULTS Severe asthma subjects had 9 increased and 4 decreased proteins compared to mild asthma subjects and fewer differences compared to moderate asthma. Twenty-six mediators were significantly associated with an increasing single leucocyte type: 16 with neutrophils (3 interleukins [IL], 3 CC chemokines, 4 CXC chemokines, 4 growth factors, TNF-α and CX3CL1/Fractalkine); 5 with lymphocytes (IL-7, IL-16, IL-23, IFN-α2 and CCL4/MIP1β); IL-15 and CCL15/MIP1δ with macrophages; IL-5 with eosinophils; and IL-4 and TNFSF10/TRAIL with airway epithelial cells. Factor analysis grouped 43 cytokines, chemokines and growth factors which had no missing data onto the first 10 factors, containing mixes of Th1, Th2, Th9 and Th17 inflammatory and anti-inflammatory proteins. CONCLUSIONS Sputum cytokines, chemokines and growth factors were increased in severe asthma, primarily with increased neutrophils. Factor analysis identified complex inflammatory protein interactions, suggesting airway inflammation in asthma is characterized by overlapping immune pathways. Thus, focus on a single specific inflammatory mediator or pathway may limit understanding the complexity of inflammation underlying airway changes in asthma and selection of appropriate therapy.
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Affiliation(s)
- A T Hastie
- Department of Internal Medicine, Section on Pulmonary, Critical Care, Allergy and Immunology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - C Steele
- Lung Immunology of Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - C W Dunaway
- Lung Immunology of Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - W C Moore
- Department of Internal Medicine, Section on Pulmonary, Critical Care, Allergy and Immunology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - B M Rector
- Department of Internal Medicine, Section on Pulmonary, Critical Care, Allergy and Immunology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - E Ampleford
- Department of Internal Medicine, Section on Pulmonary, Critical Care, Allergy and Immunology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - H Li
- University of Arizona College of Medicine, Tucson, AZ, USA
| | - L C Denlinger
- Department of Medicine, University of Wisconsin, Madison, WI, USA
| | - N Jarjour
- Department of Medicine, University of Wisconsin, Madison, WI, USA
| | - D A Meyers
- University of Arizona College of Medicine, Tucson, AZ, USA
| | - E R Bleecker
- University of Arizona College of Medicine, Tucson, AZ, USA
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14
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Bullone M, Lavoie JP. The Contribution of Oxidative Stress and Inflamm-Aging in Human and Equine Asthma. Int J Mol Sci 2017; 18:ijms18122612. [PMID: 29206130 PMCID: PMC5751215 DOI: 10.3390/ijms18122612] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 11/27/2017] [Accepted: 11/29/2017] [Indexed: 02/07/2023] Open
Abstract
Aging is associated with a dysregulation of the immune system, leading to a general pro-inflammatory state of the organism, a process that has been named inflamm-aging. Oxidative stress has an important role in aging and in the regulation of immune responses, probably playing a role in the development of age-related diseases. The respiratory system function physiologically declines with the advancement of age. In elderly asthmatic patients, this may contribute to disease expression. In this review, we will focus on age-related changes affecting the immune system and in respiratory structure and function that could contribute to asthma occurrence, and/or clinical presentation in the elderly. Also, naturally occurring equine asthma will be discussed as a possible model for studying the importance of oxidative stress and immun-aging/inflamm-aging in humans.
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Affiliation(s)
- Michela Bullone
- Department of Clinical and Biological Sciences, University of Turin, AUO San Luigi Gonzaga, Regione Gonzole 10, 10043 Orbassano, Italy.
| | - Jean-Pierre Lavoie
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Université de Montréal, 3200 Rue Sicotte, St-Hyacinthe, QC J2S 2M2, Canada.
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15
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Brooks CR, Van Dalen CJ, Harding E, Hermans IF, Douwes J. Effects of treatment changes on asthma phenotype prevalence and airway neutrophil function. BMC Pulm Med 2017; 17:169. [PMID: 29202821 PMCID: PMC5715501 DOI: 10.1186/s12890-017-0511-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 11/22/2017] [Indexed: 11/10/2022] Open
Abstract
Background Asthma inflammatory phenotypes are often defined by relative cell counts of airway eosinophils/neutrophils. However, the importance of neutrophilia remains unclear, as does the effect of ICS treatment on asthma phenotypes and airway neutrophil function. The purpose of this study was to assess asthma phenotype prevalence/characteristics in a community setting, and, in a nested preliminary study, determine how treatment changes affect phenotype stability and inflammation, with particular focus on airway neutrophils. Methods Fifty adult asthmatics and 39 non-asthmatics were assessed using questionnaires, skin prick tests, spirometry, exhaled nitric oxide (FENO) measurement, and sputum induction. Twenty-one asthmatics underwent further assessment following treatment optimisation (n = 11) or sub-optimisation (n = 10). Results Forty percent (20/50) had eosinophilic asthma (EA) and 8% had neutrophilic asthma. EA was associated with increased FENO, bronchodilator reversibility (BDR) and reduced lung function (p < 0.05). Following optimisation/sub-optimisation, the EA/NEA (non-eosinophilic asthma) phenotype changed in 11/21 (52%) asthmatics. In particular, fewer subjects had EA post treatment optimisation, but this was not statistically significant. However, a significant (p < 0.05) reduction in FENO, ACQ7 score, and BDR was observed after treatment optimisation, as well as an increase in FEV1-% predicted (p < 0.05). It was also associated with reduced eosinophils (p < 0.05) and enhanced neutrophil phagocytosis (p < 0.05) in EA only, and enhanced neutrophil oxidative burst in both EA and NEA (p < 0.05). Conclusions In this community based population, non-eosinophilic asthma was common, less severe than EA, and at baseline most asthmatics showed no evidence of inflammation. In the nested change in treatment study, treatment optimisation was associated with reduced sputum eosinophils, improved symptoms and lung function, and enhanced neutrophil function, but a significant reduction in EA could not be demonstrated. Trial registration The nested change in treatment component of this study is registered at the Australia and New Zealand Clinical Trial Registry (www.ANZCTR.org.au) ACTRN12617001356358. Registration date 27/09/2017. Retrospectively registered. Electronic supplementary material The online version of this article (10.1186/s12890-017-0511-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Collin R Brooks
- Centre for Public Health Research, Massey University Wellington Campus, Private Box 756, Wellington, 6140, New Zealand.
| | - Christine J Van Dalen
- Centre for Public Health Research, Massey University Wellington Campus, Private Box 756, Wellington, 6140, New Zealand
| | - Elizabeth Harding
- Centre for Public Health Research, Massey University Wellington Campus, Private Box 756, Wellington, 6140, New Zealand
| | - Ian F Hermans
- Malaghan Institute of Medical Research, Wellington, New Zealand
| | - Jeroen Douwes
- Centre for Public Health Research, Massey University Wellington Campus, Private Box 756, Wellington, 6140, New Zealand
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16
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Brinkman P, van de Pol MA, Gerritsen MG, Bos LD, Dekker T, Smids BS, Sinha A, Majoor CJ, Sneeboer MM, Knobel HH, Vink TJ, de Jongh FH, Lutter R, Sterk PJ, Fens N. Exhaled breath profiles in the monitoring of loss of control and clinical recovery in asthma. Clin Exp Allergy 2017. [PMID: 28626990 DOI: 10.1111/cea.12965] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Asthma is a chronic inflammatory airway disease, associated with episodes of exacerbations. Therapy with inhaled corticosteroids (ICS) targets airway inflammation, which aims to maintain and restore asthma control. Clinical features are only modestly associated with airways inflammation. Therefore, we hypothesized that exhaled volatile metabolites identify longitudinal changes between clinically stable episodes and loss of asthma control. OBJECTIVES To determine whether exhaled volatile organic compounds (VOCs) as measured by gas-chromatography/mass-spectrometry (GC/MS) and electronic nose (eNose) technology discriminate between clinically stable and unstable episodes of asthma. METHODS Twenty-three patients with (partly) controlled mild to moderate persistent asthma using ICS were included in this prospective steroid withdrawal study. Exhaled metabolites were measured at baseline, during loss of control and after recovery. Standardized sampling of exhaled air was performed, after which samples were analysed by GC/MS and eNose. Univariate analysis of covariance (ANCOVA), followed by multivariate principal component analysis (PCA) was used to reduce data dimensionality. Next paired t tests were utilized to analyse within-subject breath profile differences at the different time-points. Finally, associations between exhaled metabolites and sputum inflammation markers were examined. RESULTS Breath profiles by eNose showed 95% (21/22) correct classification for baseline vs loss of control and 86% (19/22) for loss of control vs recovery. Breath profiles using GC/MS showed accuracies of 68% (14/22) and 77% (17/22) for baseline vs loss of control and loss of control vs recovery, respectively. Significant associations between exhaled metabolites captured by GC/MS and sputum eosinophils were found (Pearson r≥.46, P<.01). CONCLUSIONS & CLINICAL RELEVANCE Loss of asthma control can be discriminated from clinically stable episodes by longitudinal monitoring of exhaled metabolites measured by GC/MS and particularly eNose. Part of the uncovered biomarkers was associated with sputum eosinophils. These findings provide proof of principle for monitoring and identification of loss of asthma control by breathomics.
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Affiliation(s)
- P Brinkman
- Department of Respiratory Medicine, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands
| | - M A van de Pol
- Department of Experimental Immunology, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands
| | - M G Gerritsen
- Department of Respiratory Medicine, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands
| | - L D Bos
- Department of Intensive Care, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands
| | - T Dekker
- Department of Experimental Immunology, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands
| | - B S Smids
- Department of Experimental Immunology, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands
| | - A Sinha
- Department of Respiratory Medicine, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands
| | - C J Majoor
- Department of Respiratory Medicine, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands
| | - M M Sneeboer
- Department of Respiratory Medicine, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands
| | - H H Knobel
- Philips Research, Eindhoven, The Netherlands
| | - T J Vink
- Philips Research, Eindhoven, The Netherlands
| | - F H de Jongh
- Department of Pulmonary Function, Medisch Spectrum Twente, Enschede, The Netherlands
| | - R Lutter
- Department of Experimental Immunology, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands
| | - P J Sterk
- Department of Respiratory Medicine, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands
| | - N Fens
- Department of Respiratory Medicine, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands
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Advanced Role of Neutrophils in Common Respiratory Diseases. J Immunol Res 2017; 2017:6710278. [PMID: 28589151 PMCID: PMC5447318 DOI: 10.1155/2017/6710278] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 03/22/2017] [Accepted: 04/16/2017] [Indexed: 12/18/2022] Open
Abstract
Respiratory diseases, always being a threat towards the health of people all over the world, are most tightly associated with immune system. Neutrophils serve as an important component of immune defense barrier linking innate and adaptive immunity. They participate in the clearance of exogenous pathogens and endogenous cell debris and play an essential role in the pathogenesis of many respiratory diseases. However, the pathological mechanism of neutrophils remains complex and obscure. The traditional roles of neutrophils in severe asthma, chronic obstructive pulmonary diseases (COPD), pneumonia, lung cancer, pulmonary fibrosis, bronchitis, and bronchiolitis had already been reviewed. With the development of scientific research, the involvement of neutrophils in respiratory diseases is being brought to light with emerging data on neutrophil subsets, trafficking, and cell death mechanism (e.g., NETosis, apoptosis) in diseases. We reviewed all these recent studies here to provide you with the latest advances about the role of neutrophils in respiratory diseases.
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Nakamoto K, Watanabe M, Sada M, Inui T, Nakamura M, Honda K, Wada H, Mikami Y, Matsuzaki H, Horie M, Noguchi S, Yamauchi Y, Koyama H, Kogane T, Kohyama T, Takizawa H. Serum Reactive Oxygen Metabolite Levels Predict Severe Exacerbations of Asthma. PLoS One 2016; 11:e0164948. [PMID: 27776186 PMCID: PMC5077110 DOI: 10.1371/journal.pone.0164948] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 10/04/2016] [Indexed: 01/05/2023] Open
Abstract
Background and Purpose Bronchial asthma (BA) is a chronic airway disease characterized by airway hyperresponsiveness and remodeling, which are intimately linked to chronic airway inflammation. Reactive oxygen species (ROS) such as hydrogen peroxide are generated by inflammatory cells that are involved in the pathogenesis of BA. However, the role of ROS in the management of BA patients is not yet clear. We attempted to determine the role of ROS as a biomarker in the clinical setting of BA. Subjects and Methods We enrolled patients with BA from 2013 through 2015 and studied the degrees of asthma control, anti-asthma treatment, pulmonary function test results, fractional exhaled nitric oxide (FeNO), serum reactive oxygen metabolite (ROM) levels, and serum levels of interleukin (IL)-6 and IL-8. Results We recruited 110 patients with BA. Serum ROM levels correlated with white blood cell (WBC) count (rs = 0.273, p = 0.004), neutrophil count (rs = 0.235, p = 0.014), CRP (rs = 0.403, p < 0.001), and IL-6 (rs = 0.339, p < 0.001). Serum ROM levels and IL-8 and CRP levels negatively correlated with %FEV1 (rs = -0.240, p = 0.012, rs = -0.362, p < 0.001, rs = -0.197, p = 0.039, respectively). Serum ROM levels were significantly higher in patients who experienced severe exacerbation within 3 months than in patients who did not (339 [302–381] vs. 376 [352–414] CARR U, p < 0.025). Receiver-operating characteristics analysis showed that ROM levels correlated significantly with the occurrence of severe exacerbation (area under the curve: 0.699, 95% CI: 0.597–0.801, p = 0.025). Conclusions Serum levels of ROM were significantly associated with the degrees of airway obstruction, WBC counts, neutrophil counts, IL-6, and severe exacerbations. This biomarker may be useful in predicting severe exacerbations of BA.
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Affiliation(s)
- Keitaro Nakamoto
- Department of Respiratory Medicine, Kyorin University School of Medicine, Tokyo, Japan
| | - Masato Watanabe
- Department of Respiratory Medicine, Kyorin University School of Medicine, Tokyo, Japan
| | - Mitsuru Sada
- Department of Respiratory Medicine, Kyorin University School of Medicine, Tokyo, Japan
| | - Toshiya Inui
- Department of Respiratory Medicine, Kyorin University School of Medicine, Tokyo, Japan
| | - Masuo Nakamura
- Department of Respiratory Medicine, Kyorin University School of Medicine, Tokyo, Japan
| | - Kojiro Honda
- Department of Respiratory Medicine, Kyorin University School of Medicine, Tokyo, Japan
| | - Hiroo Wada
- Department of Respiratory Medicine, Kyorin University School of Medicine, Tokyo, Japan
| | - Yu Mikami
- Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hirotaka Matsuzaki
- Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masafumi Horie
- Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Satoshi Noguchi
- Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yasuhiro Yamauchi
- Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hikari Koyama
- Department of Internal medicine, Teikyo University Mizonokuchi Hospital, Kanagawa, Japan
| | - Toshiyuki Kogane
- Department of Internal medicine, Teikyo University Mizonokuchi Hospital, Kanagawa, Japan
| | - Tadashi Kohyama
- Department of Internal medicine, Teikyo University Mizonokuchi Hospital, Kanagawa, Japan
| | - Hajime Takizawa
- Department of Respiratory Medicine, Kyorin University School of Medicine, Tokyo, Japan
- * E-mail:
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Du W, Su J, Ye D, Wang Y, Huang Q, Gong X. Pinellia ternata Attenuates Mucus Secretion and Airway Inflammation after Inhaled Corticosteroid Withdrawal in COPD Rats. THE AMERICAN JOURNAL OF CHINESE MEDICINE 2016; 44:1027-41. [PMID: 27430907 DOI: 10.1142/s0192415x16500579] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Inhaled corticosteroids (ICS) are widely used to manage chronic obstructive pulmonary disease (COPD). However, withdrawal of ICS generally causes various adverse effects, warranting careful management of the ICS withdrawal. Pinellia ternata, a traditional Chinese herbal medicine, has been used to treat respiratory diseases in China for centuries. Here, we investigated its role in antagonizing ICS withdrawal-induced side effects, and explored the underlying mechanisms. The rat COPD model was established using a combination of passive cigarette smoking and intratracheal instillation of lipopolysaccharide (LPS). COPD rats were treated with saline or budesonide inhalation, or with budesonide inhalation followed by saline inhalation or Pinellia ternata gavage. The number of goblet cells and the level of mucin 5AC (MUC5AC) were enhanced by budesonide withdrawal. Pinellia ternata treatment significantly blocked these effects. Further, Pinellia ternata treatment reversed budesonide withdrawal-induced increase of interleukin 1[Formula: see text] (IL-1[Formula: see text] and tumor necrosis factor [Formula: see text] (TNF-[Formula: see text]) levels in bronchoalveolar lavage fluid (BALF). Extracellular signal-regulated kinase (ERK), but neither p38 nor c-Jun N-terminal kinase (JNK), was activated by budesonide withdrawal, and the activation was blocked by Pinellia ternata treatment. The MUC5AC expression was positively correlated with goblet cell number, IL-1[Formula: see text] and TNF-[Formula: see text] levels, and ERK activity. Pinellia ternata treatment protected the airway from ICS withdrawal-induced mucus hypersecretion and airway inflammation by inhibiting ERK activation. Pinellia ternata treatment may represent a novel therapeutic strategy to prevent ICS withdrawal-induced side effects in COPD patients.
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Affiliation(s)
- Wei Du
- * Department of Pathophysiology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.,‡ Respiratory Diseases Group, the 6th Unit, Department of Internal Medicine, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou 510010, China
| | - Jinyu Su
- * Department of Pathophysiology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Dan Ye
- § Hexian Memorial Hospital, Panyu, Guangzhou 511400, China
| | - Yuegang Wang
- † Department of Cardiovascular Diseases, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Qiaobing Huang
- * Department of Pathophysiology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Xiaowei Gong
- * Department of Pathophysiology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.,¶ Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge 14183, Sweden
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Abstract
Noneosinophilic airway inflammation occurs in approximately 50% of patients with asthma. It is subdivided into neutrophilic or paucigranulocytic inflammation, although the proportion of each subtype is uncertain because of variable cut-off points used to define neutrophilia. This article reviews the evidence for noneosinophilic inflammation being a target for therapy in asthma and assesses clinical trials of licensed drugs, novel small molecules and biologics agents in noneosinophilic inflammation. Current symptoms, rate of exacerbations and decline in lung function are generally less in noneosinophilic asthma than eosinophilic asthma. Noneosinophilic inflammation is associated with corticosteroid insensitivity. Neutrophil activation in the airways and systemic inflammation is reported in neutrophilic asthma. Neutrophilia in asthma may be due to corticosteroids, associated chronic pulmonary infection, altered airway microbiome or delayed neutrophil apoptosis. The cause of poorly controlled noneosinophilic asthma may differ between patients and involve several mechanism including neutrophilic inflammation, T helper 2 (Th2)-low or other subtypes of airway inflammation or corticosteroid insensitivity as well as noninflammatory pathways such as airway hyperreactivity and remodelling. Smoking cessation in asthmatic smokers and removal from exposure to some occupational agents reduces neutrophilic inflammation. Preliminary studies of 'off-label' use of licensed drugs suggest that macrolides show efficacy in nonsmokers with noneosinophilic severe asthma and statins, low-dose theophylline and peroxisome proliferator-activated receptor gamma (PPARγ) agonists may benefit asthmatic smokers with noneosinophilic inflammation. Novel small molecules targeting neutrophilic inflammation, such as chemokine (CXC) receptor 2 (CXCR2) antagonists reduce neutrophils, but do not improve clinical outcomes in studies to date. Inhaled phosphodiesterase (PDE)4 inhibitors, dual PDE3 and PDE4 inhibitors, p38MAPK (mitogen-activated protein kinase) inhibitors, tyrosine kinase inhibitors and PI (phosphoinositide) 3kinase inhibitors are under development and these compounds may be of benefit in noneosinophilic inflammation. The results of clinical trials of biological agents targeting mediators associated with noneosinophilic inflammation, such as interleukin (IL)-17 and tumor necrosis factor (TNF)-α are disappointing. Greater understanding of the mechanisms of noneosinophilic inflammation in asthma should lead to improved therapies.
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Affiliation(s)
- Neil C Thomson
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow G12 0YN, UK
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Matsuzaki H, Mikami Y, Makita K, Takeshima H, Horie M, Noguchi S, Jo T, Narumoto O, Kohyama T, Takizawa H, Nagase T, Yamauchi Y. Interleukin-17A and Toll-Like Receptor 3 Ligand Poly(I:C) Synergistically Induced Neutrophil Chemoattractant Production by Bronchial Epithelial Cells. PLoS One 2015; 10:e0141746. [PMID: 26505478 PMCID: PMC4624416 DOI: 10.1371/journal.pone.0141746] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 10/11/2015] [Indexed: 12/13/2022] Open
Abstract
Chronic inflammatory airway diseases, such as bronchial asthma and chronic obstructive pulmonary disease, are common respiratory disorders worldwide. Exacerbations of these diseases are frequent and worsen patients’ respiratory condition and overall health. However, the mechanisms of exacerbation have not been fully elucidated. Recently, it was reported that interleukin (IL)-17A might play an important role in neutrophilic inflammation, which is characteristic of such exacerbations, through increased production of neutrophil chemoattractants. Therefore, we hypothesized that IL-17A was involved in the pathogenesis of acute exacerbation, due to viral infection in chronic inflammatory airway diseases. In this study, we assessed chemokine production by bronchial epithelial cells and investigated the underlying mechanisms. Comprehensive chemokine analysis showed that, compared with poly(I:C) alone, co-stimulation of BEAS-2B cells with IL-17A and poly(I:C) strongly induced production of such neutrophil chemoattractants as CXC chemokine ligand (CXCL)8, growth-related oncogene (GRO), and CXCL1. Co-stimulation synergistically induced CXCL8 and CXCL1 mRNA and protein production by BEAS-2B cells and normal human bronchial epithelial cells. Poly(I:C) induced chemokine expression by BEAS-2B cells mainly via Toll-like receptor 3/TIR-domain-containing adapter-inducing interferon-β–mediated signals. The co-stimulation with IL-17A and poly(I:C) markedly activated the p38 and extracellular-signal-regulated kinase 1/2 pathway, compared with poly(I:C), although there was little change in nuclear factor-κB translocation into the nucleus or the transcriptional activities of nuclear factor-κB and activator protein 1. IL-17A promoted stabilization of CXCL8 mRNA in BEAS-2B cells treated with poly(I:C). In conclusion, IL-17A appears to be involved in the pathogenesis of chronic inflammatory airway disease exacerbation, due to viral infection by promoting release of neutrophil chemoattractants from bronchial epithelial cells.
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Affiliation(s)
- Hirotaka Matsuzaki
- Department of Respiratory Medicine, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Yu Mikami
- Department of Respiratory Medicine, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
- Department of Clinical Laboratory, the University of Tokyo Hospital, Tokyo, Japan
| | - Kousuke Makita
- Department of Respiratory Medicine, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Hideyuki Takeshima
- Department of Respiratory Medicine, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Masafumi Horie
- Department of Respiratory Medicine, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
- Division of Health Service Promotion, the University of Tokyo, Tokyo, Japan
| | - Satoshi Noguchi
- Department of Respiratory Medicine, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Taisuke Jo
- Department of Respiratory Medicine, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
- Division of Health Service Promotion, the University of Tokyo, Tokyo, Japan
| | - Osamu Narumoto
- Department of Respiratory Medicine, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Tadashi Kohyama
- Fourth Department of Internal Medicine, Teikyo University School of Medicine, Mizonokuchi Hospital, Kanagawa, Japan
| | - Hajime Takizawa
- Department of Respiratory Medicine, Kyorin University School of Medicine, Tokyo, Japan
| | - Takahide Nagase
- Department of Respiratory Medicine, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Yasuhiro Yamauchi
- Department of Respiratory Medicine, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
- * E-mail:
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Virchow JC, Backer V, de Blay F, Kuna P, Ljørring C, Prieto JL, Villesen HH. Defining moderate asthma exacerbations in clinical trials based on ATS/ERS joint statement. Respir Med 2015; 109:547-56. [PMID: 25676887 DOI: 10.1016/j.rmed.2015.01.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 01/23/2015] [Accepted: 01/23/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND Exacerbations are a key outcome in clinical research, providing patient-relevant information about symptomatic control, health state and disease progression. Generally considered as an episode of (sub)acute deterioration of respiratory symptoms, a precise, clinically useful definition is needed for use in clinical trials. AIM AND METHODS Focussing on moderate exacerbations, this opinion piece reviews landmark trials and current guidelines to provide a practical definition of a moderate exacerbation. Specifically, we adapt the ATS/ERS consensus statement of terminology Reddel et al. (2009) [1] which provides a conceptual (or 'theoretical') definition for moderate exacerbations, to an operational (or 'practical') criterion suitable for use in clinical research. RESULTS The proposed definition for a moderate exacerbation requires ≥1 of the following criteria combined with a change in treatment: a) nocturnal awakening(s) due to asthma requiring SABA for 2 consecutive nights or an increase of ≥0.75 from baseline in daily symptom scores on 2 consecutive days; b) increase from baseline in occasions of SABA use on 2 consecutive days (minimum increase: 4 puffs/day); c) ≥20% decrease in PEF from baseline on at least 2 consecutive mornings/evenings or ≥20% decrease in FEV1 from baseline and/or d) visit to the emergency room/trial site for asthma treatment not requiring systemic corticosteroids. CONCLUSION A clinically and patient-relevant, operational definition of moderate exacerbations is needed. The proposed definition has been endorsed by the EMA Scientific Advice Working Party in 2011and needs to be trialled in forthcoming clinical studies.
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Affiliation(s)
- J Christian Virchow
- Department of Pneumology/Intensive Care Medicine, Zentrum für Innere Medizin, Klinik I, Universitätsklinikum Rostock, Germany.
| | - Vibeke Backer
- Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen University, Denmark
| | - Frédéric de Blay
- Chest Diseases Department, University Hospital of Strasbourg, Federation of Translational Medicine of Strasbourg, Strasbourg University, Strasbourg, France
| | - Piotr Kuna
- Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Lodz, Poland
| | - Christian Ljørring
- Global Clinical Development, ALK, Bøge Allé 1, DK 2970 Hørsholm, Denmark
| | - Jesus L Prieto
- Department of Medicine, University of Valencia, Valencia, Spain
| | - Hanne H Villesen
- Global Clinical Development, ALK, Bøge Allé 1, DK 2970 Hørsholm, Denmark
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Artemisinins: Pharmacological actions beyond anti-malarial. Pharmacol Ther 2014; 142:126-39. [DOI: 10.1016/j.pharmthera.2013.12.001] [Citation(s) in RCA: 309] [Impact Index Per Article: 30.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 11/26/2013] [Indexed: 12/23/2022]
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Morton R, Eid N. From Childhood Asthma to Chronic Obstructive Pulmonary Disease: Evidence Supporting a Disease Continuum. PEDIATRIC ALLERGY, IMMUNOLOGY, AND PULMONOLOGY 2013; 26:168-174. [PMID: 35923041 DOI: 10.1089/ped.2013.0305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
In this review, we analyze the available evidence showing a link between asthma and chronic obstructive pulmonary disease (COPD). Many features (epidemiologic, physiologic, and histologic) overlap between these two conditions. Both environmental cigarette smoke exposure and early lung development are risk factors for the development of asthma and COPD. However, recent studies suggest that up to 25% of COPD cases were nonsmokers. Asthma during early childhood, independent of smoking history, may be an independent risk factor for the later development of COPD. One explanation for this phenomenon suggests that early small airway dysfunction (including chronic airway inflammation and airway remodeling) can lead to permanent impairment in lung physiology. Several reasons why control of airway inflammation is difficult in some patients are explored. Finally, we examine the available evidence suggesting overlapping histologic features in both asthma and COPD.
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Affiliation(s)
- Ronald Morton
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky
| | - Nemr Eid
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky
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26
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Biomarker surrogates do not accurately predict sputum eosinophil and neutrophil percentages in asthmatic subjects. J Allergy Clin Immunol 2013; 132:72-80. [PMID: 23706399 DOI: 10.1016/j.jaci.2013.03.044] [Citation(s) in RCA: 187] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Revised: 03/05/2013] [Accepted: 03/13/2013] [Indexed: 01/21/2023]
Abstract
BACKGROUND Sputum eosinophil percentages are a strong predictor of airway inflammation and exacerbations and aid asthma management, whereas sputum neutrophil percentages indicate a different severe asthma phenotype that is potentially less responsive to TH2-targeted therapy. Variables, such as blood eosinophil counts, total IgE levels, fraction of exhaled nitric oxide (Feno) levels, or FEV1 percent predicted, might predict airway eosinophil percentages, whereas age, FEV1 percent predicted, or blood neutrophil counts might predict sputum neutrophil percentages. Availability and ease of measurement are useful characteristics, but accuracy in predicting airway eosinophil and neutrophil percentages either individually or combined is not established. OBJECTIVES We sought to determine whether blood eosinophil counts, Feno levels, and IgE levels accurately predict sputum eosinophil percentages and whether age, FEV1 percent predicted, and blood neutrophil counts accurately predict sputum neutrophil percentages. METHODS Subjects in the Wake Forest Severe Asthma Research Program (n = 328) were characterized by blood and sputum cell counts, health care use, lung function, Feno levels, and IgE levels. Multiple analytic techniques were used. RESULTS Despite significant association with sputum eosinophil percentages, blood eosinophil counts, Feno levels, and total IgE levels did not accurately predict sputum eosinophil percentages, and combinations of these variables did not improve prediction. Age, FEV1 percent predicted, and blood neutrophil counts were similarly unsatisfactory for the prediction of sputum neutrophil percentages. Factor analysis and stepwise selection found Feno levels, IgE levels, and FEV1 percent predicted, but not blood eosinophil counts, correctly predicted 69% of sputum eosinophil percentages of less than 2% or 2% and greater. Likewise, age, asthma duration, and blood neutrophil counts correctly predicted 64% of sputum neutrophil percentages of less than 40% or 40% and greater. A model to predict both sputum eosinophil and neutrophil percentages accurately assigned only 41% of samples. CONCLUSION Despite statistically significant associations, Feno levels, IgE levels, blood eosinophil and neutrophil counts, FEV1 percent predicted, and age are poor surrogates, both separately and combined, for accurately predicting sputum eosinophil and neutrophil percentages.
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Schuttelaar MLA, Coenraads PJ, Huizinga J, De Monchy JG, Vermeulen KM. Increase in vesicular hand eczema after house dust mite inhalation provocation: a double-blind, placebo-controlled, cross-over study. Contact Dermatitis 2012; 68:76-85. [DOI: 10.1111/j.1600-0536.2012.02172.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ho WE, Cheng C, Peh HY, Xu F, Tannenbaum SR, Ong CN, Wong WSF. Anti-malarial drug artesunate ameliorates oxidative lung damage in experimental allergic asthma. Free Radic Biol Med 2012; 53:498-507. [PMID: 22634146 DOI: 10.1016/j.freeradbiomed.2012.05.021] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2011] [Revised: 04/24/2012] [Accepted: 05/16/2012] [Indexed: 11/25/2022]
Abstract
Oxidative stress is a critical pathophysiological factor in the development of allergic airway inflammation, resulting in oxidative damage to lipids, proteins, and DNA. Our recent report revealed potent anti-inflammatory effects of the antimalarial drug artesunate in experimental allergic asthma. The present study investigated potential antioxidative effects of artesunate in a murine model of allergic asthma in comparison with dexamethasone, a potent corticosteroid. Mice were sensitized and challenged with ovalbumin and developed airway inflammation and oxidative lung damage. Artesunate markedly suppressed ovalbumin-induced increases in total cell, eosinophil, and neutrophil counts. In contrast, dexamethasone failed to inhibit neutrophil recruitment. Levels of the oxidative damage markers 8-isoprostane, 8-hydroxy-2-deoxyguanosine, and 3-nitrotyrosine were potently repressed by artesunate. However, dexamethasone showed weaker inhibitory effects on 3-nitrotyrosine production. Ovalbumin-induced increases in the expression of the pro-oxidants iNOS and NADPH oxidase (NOX1, 2, 3, and 4) were significantly abated by artesunate. Gene expression of regulatory subunits of NOX, p22phox and p67phox, was also reduced by artesunate. The expression and activities of the antioxidants superoxide dismutase and catalase were substantially reversed with artesunate in ovalbumin-challenged mice. Artesunate significantly enhanced nuclear levels of nuclear factor erythroid-2-related factor 2 (Nrf2) in lung tissues from ovalbumin-challenged mice and in TNF-α-stimulated human bronchial epithelial cells. Our findings implicate a potential therapeutic value for artesunate in the treatment of asthma via the amelioration of oxidative damage in allergic airways, and it may act by suppressing pro-oxidants and restoring the activities and expression of antioxidants via activation of Nrf2. Artesunate may be a potential novel anti-asthma drug capable of controlling both inflammation and oxidative damage in chronic severe asthma.
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Affiliation(s)
- Wanxing Eugene Ho
- Saw Swee Hock School of Public Health, National University Health System, Singapore
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Wen W, Liu W, Zhang L, Bai J, Fan Y, Xia W, Luo Q, Zheng J, Wang H, Li Z, Xia J, Jiang H, Liu Z, Shi J, Li H, Xu G. Increased neutrophilia in nasal polyps reduces the response to oral corticosteroid therapy. J Allergy Clin Immunol 2012; 129:1522-8.e5. [PMID: 22460066 DOI: 10.1016/j.jaci.2012.01.079] [Citation(s) in RCA: 203] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Revised: 01/17/2012] [Accepted: 01/23/2012] [Indexed: 02/05/2023]
Abstract
BACKGROUND Nasal polyps (NPs) are characterized by eosinophilic inflammation, which is generally considered sensitive to corticosteroid treatment. OBJECTIVES We evaluated levels of neutrophilia in NPs and investigated whether increased neutrophilia in polyp tissue affected the response to corticosteroid treatment. METHODS We studied 3 independent cross-sectional groups of patients with NPs. Levels of infiltration by different types of inflammatory cells were determined by using immunohistochemical analyses and compared with those seen in control nasal tissues from subjects without NPs. Levels of inflammatory mediators were measured by using real-time PCR, ELISA, and FlowCytomix analyses. Patients with NPs received oral corticosteroid therapy (30 mg of prednisone once daily for 7 days); clinical parameters of efficacy were associated with NP phenotypes. RESULTS Among patients with NPs, 76.5% had an eosinophilic phenotype, 46.0% had a neutrophilic phenotype, and 35.8% had a mixed phenotype (indicated by double staining). Overall, patients' symptoms improved after corticosteroid treatment; numbers of eosinophils and levels of their mediators (IL-4 and IL-5), but not numbers of neutrophils or levels of their mediators (IL-8 and interferon-inducible protein 10), were reduced (P< .05). After corticosteroid treatment, patients with the nonneutrophilic phenotype (neutrophil negative) had significantly greater reductions in bilateral polyp size scores, nasal congestion scores, total nasal symptom scores, and nasal resistance than patients with the neutrophilic phenotype (neutrophil positive, P< .05). CONCLUSIONS There are different phenotypes of NPs based on the type of immune cell infiltrate and cytokines produced (eosinophilic or neutrophilic). Patients with the neutrophilic phenotype have less response to treatment with corticosteroids based on symptom scores.
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Affiliation(s)
- Weiping Wen
- Allergy and Cancer Center, Otorhinolarygology Hospital, First Affiliated Hospital of Sun Yat-sen University, and the Otorhinolaryngology Institute of Sun Yat-sen University, Guangzhou, China
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Kobayashi M, Ashino S, Shiohama Y, Wakita D, Kitamura H, Nishimura T. IFN-γ elevates airway hyper-responsiveness via up-regulation of neurokinin A/neurokinin-2 receptor signaling in a severe asthma model. Eur J Immunol 2011; 42:393-402. [PMID: 22105467 DOI: 10.1002/eji.201141845] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Revised: 10/08/2011] [Accepted: 11/16/2011] [Indexed: 12/21/2022]
Abstract
The adoptive transfer of OVA-specific Th1 cells into WT mice followed by OVA inhalation induces a significant elevation of airway hyper-responsiveness (AHR) with neutrophilia but not mucus hypersecretion. Here, we demonstrate that the airway inflammation model, pathogenically characterized as severe asthma, was partly mimicked by i.n. administration of IFN-γ. The administration of IFN-γ instead of Th1 cells caused AHR elevation but not neutrophilia, and remarkably induced neurokinin-2 receptor (NK2R) expression along with neurokinin A (NKA) production in the lung. To evaluate whether NKA/NK2R was involved in airway inflammation, we first investigated the role of NKA/NK2R-signaling in airway smooth muscle cells (ASMCs) in vitro. NK2R mRNA expression was significantly augmented in tracheal tube-derived ASMCs of WT mice but not STAT-1(-/-) mice after stimulation with IFN-γ. In addition, methacholine-mediated Ca(2+) influx into the ASMCs was significantly reduced in the presence of NK2R antagonist. Moreover, the NK2R antagonist strongly inhibited IFN-γ-dependent AHR elevation in vivo. Thus, these results demonstrated that IFN-γ directly acts on ASMCs to elevate AHR via the NKA/NK2R-signaling cascade. Our present findings suggested that NK2R-mediated neuro-immuno crosstalk would be a promising target for developing novel drugs in Th1-cell-mediated airway inflammation, including severe asthma.
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Affiliation(s)
- Minoru Kobayashi
- Division of Immunoregulation, Section of Disease Control, Institute for Genetic Medicine, Hokkaido University, Sapporo, Japan
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Essilfie-Quaye S, Ito K, Ito M, Kharitonov SA, Barnes PJ. Comparison of Symbicort® versus Pulmicort® on steroid pharmacodynamic markers in asthma patients. Respir Med 2011; 105:1784-9. [PMID: 21903370 DOI: 10.1016/j.rmed.2011.08.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2011] [Revised: 08/12/2011] [Accepted: 08/19/2011] [Indexed: 12/15/2022]
Abstract
BACKGROUND Combination therapy with inhaled corticosteroids (ICS) and long-acting β(2)-adrenergic agonists (LABA) is reported to have superior effects on controlling asthma symptoms to ICS alone; however, there is no molecular-based evidence to explain the clinical effects. Here, the effect of the ICS/LABA combination was compared with ICS on glucocorticoid receptor (GR) activation in sputum macrophages. METHODS In a randomised, double-blind cross-over placebo-controlled 6-visit study, 10 patients with mild asthma were given placebo, formoterol (Oxis(®) 12 μg), budesonide (Pulmicort(®) 200 μg :BUD200, or 800 μg :BUD800), or budesonide/formoterol combination (Symbicort(®)) as a single 100/6 μg (SYM100) or double 200/12 μg (SYM200) dose. Sputum macrophages were separated by plate adhesion from induced sputum. GR binding to the glucocorticoid-response elements on oligonucleotides (GR-GRE binding) was evaluated by ELISA. mRNA expression of MAP-kinase phosphatase (MKP)-1 and IL-8 were measured by quantitative RT-PCR. RESULTS GR-GRE binding was significantly increased after treatment with SYM100 (3.5 OD/10 μg protein, median, p < 0.05) versus placebo (1.3) and BUD200 (1.6), and the induction was higher than that of BUD800 (2.4). MKP-1 mRNA was increased and IL-8 mRNA was significantly inhibited by BUD800, SYM100 and SYM200 versus placebo. CONCLUSIONS The effects of SYM100 and SYM200 on GR activation were not different from that of BUD800 and superior to BUD200. Thus, it has been confirmed at a molecular level that inhaled combination therapy with a lower dose of budesonide has an equivalent effect to a high dose of budesonide alone. In addition, GR-GRE binding is found to be a valuable pharmacodynamic marker for steroid efficacy in clinical studies.
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Affiliation(s)
- Sarah Essilfie-Quaye
- Airway Disease, National Heart and Lung Institute, Imperial College, Dovehouse street, London SW3 6LY, UK
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Dunford PJ, Holgate ST. The role of histamine in asthma. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2011; 709:53-66. [PMID: 21618887 DOI: 10.1007/978-1-4419-8056-4_6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Histamine is a ubiquitous inflammatory mediator intimately associated with the pathology of allergy. Traditional antihistamines, targeting the histamine H1 receptor, have failed to demonstrate a significant role for histamine in asthma. Novel immunomodulatory roles for histamine and the discovery of a novel histamine receptor, the histamine H4 receptor, have resulted in a reassessment of its importance in asthma.
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Affiliation(s)
- Paul J Dunford
- Department of Immunology, Johnson & Johnson Pharmaceutical Research & Development, LLC, San Diego, California 92121, USA.
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Statins enhance the anti-inflammatory effects of inhaled corticosteroids in asthmatic patients through increased induction of indoleamine 2, 3-dioxygenase. J Allergy Clin Immunol 2010; 126:754-762.e1. [PMID: 20920765 DOI: 10.1016/j.jaci.2010.08.005] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2010] [Revised: 07/30/2010] [Accepted: 08/03/2010] [Indexed: 02/07/2023]
Abstract
BACKGROUND We have previously shown that inhaled corticosteroids activate indoleamine 2, 3-dioxygenase (IDO) activity through increased IL-10 secretion. Statins might enhance the anti-inflammatory effects of corticosteroids. OBJECTIVE In a double-blind study we added simvastatin to patients with mild asthma receiving a low dose of inhaled budesonide and evaluated sputum eosinophil counts, IL-10 secretion, and IDO activity, as well as their putative signaling pathways. METHODS After a 2-week run-in period without treatment, 50 asthmatic patients were treated with 200 μg of budesonide and randomly assigned to either 10 mg of simvastatin or matched placebo for 8 weeks. Inflammation was evaluated through eosinophil counts, secretory signaling molecules, and immunocytochemistry of macrophages in sputum. RESULTS Sputum eosinophil percentages were reduced significantly by the combined therapy with budesonide and simvastatin compared with budesonide alone (P = .02). Corticosteroids activated glucocorticoid-induced TNF receptor ligand, which induces activation of p52 through the noncanonical nuclear factor κB pathway, leading to the increased transcription and activation of IDO. Simvastatin enhanced corticosteroid-activated noncanonical nuclear factor κB-dependent induction of IDO by activating type I interferons and also enhanced the effect of corticosteroid on IL-10 release. CONCLUSION A statin enhances the anti-inflammatory effect of an inhaled corticosteroid in asthma, and this was mediated through the alteration of IDO activity in macrophages.
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Abstract
There has been an increased understanding, over the past 2 decades, that asthma is a chronic, immunologically mediated condition with a disturbance of the normal airway repair mechanism, which results in inflammatory changes and airway remodeling. The airway inflammation and remodeling together likely explain the clinical manifestations of asthma. The mechanisms by which the external environmental cues, together with the complex genetic actions, propagate the inflammatory process that characterize asthma are beginning to be understood. There is also an evolving awareness of the active participation of structural elements, such as the airway epithelium, airway smooth muscle, and endothelium, in this process. In tandem with this has come the realization that inflammatory cells respond in a coordinated, albeit dysfunctional manner, via an array of complex signaling pathways that facilitate communication between these cells; these structural elements within the lung and the bone marrow serve as reservoirs for and the source of inflammatory cells and their precursors. Although often viewed as separate mechanistic entities, so-called innate and acquired immunity often overlap in the propagation of the asthmatic response. This review examines the newer information on the pathophysiologic characteristics of asthma and focuses on papers published over the past 3 years that have helped to improve current levels of understanding.
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Affiliation(s)
- Desmond M Murphy
- Firestone Institute for Respiratory Health, St Joseph's Healthcare, McMaster University, Hamilton, ON, Canada
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Persson CG, Uller L. Resolution of cell-mediated airways diseases. Respir Res 2010; 11:75. [PMID: 20540713 PMCID: PMC2900258 DOI: 10.1186/1465-9921-11-75] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2010] [Accepted: 06/11/2010] [Indexed: 12/22/2022] Open
Abstract
"Inflammation resolution" has of late become a topical research area. Activation of resolution phase mechanisms, involving select post-transcriptional regulons, transcription factors, 'autacoids', and cell phenotypes, is now considered to resolve inflammatory diseases. Critical to this discourse on resolution is the elimination of inflammatory cells through apoptosis and phagocytosis. For major inflammatory diseases such as asthma and COPD we propose an alternative path to apoptosis for cell elimination. We argue that transepithelial migration of airway wall leukocytes, followed by mucociliary clearance, efficiently and non-injuriously eliminates pro-inflammatory cells from diseased airway tissues. First, it seems clear that numerous infiltrated granulocytes and lymphocytes can be speedily transmitted into the airway lumen without harming the epithelial barrier. Then there are a wide range of 'unexpected' findings demonstrating that clinical improvement of asthma and COPD is not only associated with decreasing numbers of airway wall inflammatory cells but also with increasing numbers of these cells in the airway lumen. Finally, effects of inhibition of transepithelial migration support the present hypothesis. Airway inflammatory processes have thus been much aggravated when transepithelial exit of leukocytes has been inhibited. In conclusion, the present hypothesis highlights risks involved in drug-induced inhibition of transepithelial migration of airway wall leukocytes. It helps interpretation of common airway lumen data, and suggests approaches to treat cell-mediated airway inflammation.
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Affiliation(s)
- Carl G Persson
- Department of Clinical Pharmacology, Lund University Hospital, S-22185 Lund, Sweden.
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Roth M, Tamm M. The effects of omalizumab on IgE-induced cytokine synthesis by asthmatic airway smooth muscle cells. Ann Allergy Asthma Immunol 2010; 104:152-60. [PMID: 20306819 DOI: 10.1016/j.anai.2009.11.022] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Human airway smooth muscle cells (ASMCs) express high- and low-affinity IgE receptors and respond to IgE, thereby contributing to airway inflammation. OBJECTIVE To determine whether anti-IgE antibodies (omalizumab) block the response of ASMCs to IgE in patients with asthma. METHODS Airway smooth muscle cells, isolated from the biopsy specimens of patients with asthma, patients with chronic obstructive pulmonary disease, and control participants (6 in each group), were stimulated with IgE with and without omalizumab treatment, and cytokine secretion was determined by enzyme-linked immunosorbent assay, and messenger RNA (mRNA) secretion by real-time polymerase chain reaction, over 24 hours. IgE receptor expression was determined by immunoblotting. RESULTS IgE-stimulated mRNA synthesis encoded for interleukin (IL) 6, IL-8, and tumor necrosis factor a in ASMCs via mitogen-activated protein kinases, extracellular signal-regulated kinase 1/2, or p38. The secretion of the respective cytokines increased significantly: IL-6, IL-8, and tumor necrosis factor a at 6 hours and IL-4 at 24 hours. Cytokine mRNA synthesis and protein secretion were inhibited by omalizumab in a dose-dependent manner. The expression of low- and high-affinity IgE receptors was not altered by omalizumab in ASMCs. CONCLUSIONS Omalizumab reduced IgE-stimulated synthesis and secretion of proinflammatory cytokines by human ASMCs. These findings imply a beneficial action of omalizumab in asthma therapy. This effect is not restricted to inflammatory cells; it also includes tissue-forming cells.
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Affiliation(s)
- Michael Roth
- Division of Pulmonary Cell Research, Department of Research, University Hospital Basel, Basel, Switzerland.
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Halayko AJ, Ghavami S. S100A8/A9: a mediator of severe asthma pathogenesis and morbidity? Can J Physiol Pharmacol 2010; 87:743-55. [PMID: 19898558 DOI: 10.1139/y09-054] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Nearly 12% of children and 6% of adults in Canada have been diagnosed with asthma. Although in most patients symptoms are controlled by inhaled steroids, a subpopulation (approximately 10%) characterized by excessive airway neutrophilia, is refractory to treatment; these patients exhibit severe disease, and account for more than 50% of asthma health care costs. These numbers underscore the need to better understand the biology of severe asthma and identify pro-asthma mediators released by cells, such as neutrophils, that are unresponsive to common steroid therapy. This review focuses on a unique protein complex consisting of S100A8 and S100A9. These subunits belong to the large Ca2+-binding S100 protein family and are some of the most abundant proteins in neutrophils and macrophages. S100A8/A9 is a damage-associated molecular pattern (DAMP) protein complex released in abundance in rheumatoid arthritis, inflammatory bowel disease, and cancer, but there are no definitive studies on its role in inflammation and obstructive airways disease. Two receptors for S100A8/A9, the multiligand receptor for advanced glycation end products (RAGE) and Toll-like receptor 4 (TLR4), are expressed in lung. TLR4 is linked with innate immunity that programs local airway inflammation, and RAGE participates in mediating fibroproliferative remodeling in idiopathic pulmonary fibrosis. S100A8/A9 can induce cell proliferation, or apoptosis, inflammation, collagen synthesis, and cell migration. We hypothesize that this capacity suggests S100A8/A9 could underpin chronic airway inflammation and airway remodeling in asthma by inducing effector responses of resident and infiltrating airway cells. This review highlights some key issues related to this hypothesis and provides a template for future research.
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Affiliation(s)
- Andrew J Halayko
- Department of Physiology, University of Manitoba, Respiratory Hospital, Winnipeg, MB R3A 1R8, Canada.
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Kwong KYC, Morphew T, Huynh P, Scott L, Radjal N, Dale G. Loss of asthma control in inner city children with asthma after withdraw of asthma controller medication. J Asthma 2010; 46:1001-5. [PMID: 19995137 DOI: 10.3109/02770900903281207] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
To determine what percentage of inner-city children with asthma would lose asthma control when taken off asthma controllers, a retrospective analysis was performed on inner-city asthmatic children who achieved asthma control in an asthma specific disease management program. Once disease control was achieved patients had stepwise reduction of asthma controllers based on the National Asthma Education and Prevention Program (NAEPP) Expert Review Panel (EPR) 2 guidelines. In patients who were taken off all controllers, probability of maintaining asthma control at the first visit after cessation of these medications was significantly lower compared to patients kept on inhaled corticosteroids. We conclude that cessation of asthma controllers in previously well controlled inner-city asthmatic children results in loss of asthma control in a significant number of these patients. Data support recommendations from national asthma guidelines to step down controller therapy, but clinical monitoring is important to reduce impairment due to loss of control.
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Affiliation(s)
- Kenny Y C Kwong
- Division of Allergy-Immunology, Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, California 90509, USA.
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Abstract
Acute episodes of airway obstruction followed by periods of apparent wellness are the main clinical manifestations of the disease for many children with persistent asthma. Although currently available asthma controllers decrease the risk for acute asthma exacerbations, 30% of children taking these medicines still have >or=1 episode requiring oral corticosteroid treatment per year. There is increasing evidence that neutrophilic inflammation, against which inhaled corticosteroids are not very effective, plays a major role in the pathogenesis of asthma exacerbations. New therapeutic approaches are needed for this frequent cause of consultation in pediatric practice. One approach could be the development of drugs that target neutrophilic inflammation specifically. Studies in adults have shown that use of inhaled corticosteroids every time a bronchodilator is needed may decrease the frequency of asthma exacerbations. This strategy is currently being tested in a large clinical trial involving children with mild persistent asthma.
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Affiliation(s)
- Fernando D. Martinez
- Department of Pediatrics and Arizona Respiratory Center, University of Arizona, Tucson, Arizona
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Lewis RE, Kontoyiannis DP. Invasive aspergillosis in glucocorticoid-treated patients. Med Mycol 2009; 47 Suppl 1:S271-81. [DOI: 10.1080/13693780802227159] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Cowburn AS, Condliffe AM, Farahi N, Summers C, Chilvers ER. Advances in neutrophil biology: clinical implications. Chest 2008; 134:606-612. [PMID: 18779195 DOI: 10.1378/chest.08-0422] [Citation(s) in RCA: 139] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Many lung diseases are characterized by neutrophil-dominated inflammation; therefore, an understanding of neutrophil function is of considerable importance to respiratory physicians. This review will focus on recent advances in our understanding of how neutrophils are produced, how these cells leave the circulation, the molecular events regulating neutrophil activation and, ultimately, how these cells die and are removed. The neutrophil is now recognized as a highly versatile and sophisticated cell with significant synthetic capacity and an important role in linking the innate and adaptive arms of the immune response. One of the key challenges in conditions such as COPD, bronchiectasis, cystic fibrosis, and certain forms of asthma is how to manipulate neutrophil function in a way that does not compromise antibacterial and antifungal capacity. The possession by neutrophils of a unique repertoire of surface receptors and signaling proteins may make such targeted therapy possible.
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Affiliation(s)
- Andrew S Cowburn
- Respiratory Medicine Division, Department of Medicine, University of Cambridge School of Clinical Medicine, Addenbrooke's and Papworth Hospitals, Cambridge, UK
| | - Alison M Condliffe
- Respiratory Medicine Division, Department of Medicine, University of Cambridge School of Clinical Medicine, Addenbrooke's and Papworth Hospitals, Cambridge, UK
| | - Neda Farahi
- Respiratory Medicine Division, Department of Medicine, University of Cambridge School of Clinical Medicine, Addenbrooke's and Papworth Hospitals, Cambridge, UK
| | - Charlotte Summers
- Respiratory Medicine Division, Department of Medicine, University of Cambridge School of Clinical Medicine, Addenbrooke's and Papworth Hospitals, Cambridge, UK
| | - Edwin R Chilvers
- Respiratory Medicine Division, Department of Medicine, University of Cambridge School of Clinical Medicine, Addenbrooke's and Papworth Hospitals, Cambridge, UK.
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Alexis NE, Lay JC, Haczku A, Gong H, Linn W, Hazucha MJ, Harris B, Tal-Singer R, Peden DB. Fluticasone propionate protects against ozone-induced airway inflammation and modified immune cell activation markers in healthy volunteers. ENVIRONMENTAL HEALTH PERSPECTIVES 2008; 116:799-805. [PMID: 18560537 PMCID: PMC2430237 DOI: 10.1289/ehp.10981] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2007] [Accepted: 02/27/2008] [Indexed: 05/26/2023]
Abstract
BACKGROUND Ozone exposure induces airway neutrophilia and modifies innate immune monocytic cell-surface phenotypes in healthy individuals. High-dose inhaled corticosteroids can reduce O(3)-induced airway inflammation, but their effect on innate immune activation is unknown. OBJECTIVES We used a human O(3) inhalation challenge model to examine the effectiveness of clinically relevant doses of inhaled corticosteroids on airway inflammation and markers of innate immune activation in healthy volunteers. METHODS Seventeen O(3)-responsive subjects [>10% increase in the percentage of polymorphonuclear leukocytes (PMNs) in sputum, PMNs per milligram vs. baseline sputum] received placebo, or either a single therapeutic dose (0.5 mg) or a high dose (2 mg) of inhaled fluticasone proprionate (FP) 1 hr before a 3-hr O(3) challenge (0.25 ppm) on three separate occasions at least 2 weeks apart. Lung function, exhaled nitric oxide, sputum, and systemic biomarkers were assessed 1-5 hr after the O(3) challenge. To determine the effect of FP on cellular function, we assessed sputum cells from seven subjects by flow cytometry for cell-surface marker activation. RESULTS FP had no effect on O(3)-induced lung function decline. Compared with placebo, 0.5 mg and 2 mg FP reduced O(3)-induced sputum neutrophilia by 18% and 35%, respectively. A similar effect was observed on the airway-specific serum biomarker Clara cell protein 16 (CCP16). Furthermore, FP pretreatment significantly reduced O(3)-induced modification of CD11b, mCD14, CD64, CD16, HLA-DR, and CD86 on sputum monocytes in a dose-dependent manner. CONCLUSIONS This study confirmed and extended data demonstrating the protective effect of FP against O(3)-induced airway inflammation and immune cell activation.
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Affiliation(s)
- Neil E Alexis
- Center for Environmental Medicine, Asthma and Lung Biology, University of North Carolina, Chapel Hill, North Carolina 27599-7310, USA.
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