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Brandsma J, Schofield JPR, Yang X, Strazzeri F, Barber C, Goss VM, Koster G, Bakke PS, Caruso M, Chanez P, Dahlén SE, Fowler SJ, Horváth I, Krug N, Montuschi P, Sanak M, Sandström T, Shaw DE, Chung KF, Singer F, Fleming LJ, Adcock IM, Pandis I, Bansal AT, Corfield J, Sousa AR, Sterk PJ, Sánchez-García RJ, Skipp PJ, Postle AD, Djukanović R. Stratification of asthma by lipidomic profiling of induced sputum supernatant. J Allergy Clin Immunol 2023; 152:117-125. [PMID: 36918039 DOI: 10.1016/j.jaci.2023.02.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 02/07/2023] [Accepted: 02/14/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND Asthma is a chronic respiratory disease with significant heterogeneity in its clinical presentation and pathobiology. There is need for improved understanding of respiratory lipid metabolism in asthma patients and its relation to observable clinical features. OBJECTIVE We performed a comprehensive, prospective, cross-sectional analysis of the lipid composition of induced sputum supernatant obtained from asthma patients with a range of disease severities, as well as from healthy controls. METHODS Induced sputum supernatant was collected from 211 adults with asthma and 41 healthy individuals enrolled onto the U-BIOPRED (Unbiased Biomarkers for the Prediction of Respiratory Disease Outcomes) study. Sputum lipidomes were characterized by semiquantitative shotgun mass spectrometry and clustered using topologic data analysis to identify lipid phenotypes. RESULTS Shotgun lipidomics of induced sputum supernatant revealed a spectrum of 9 molecular phenotypes, highlighting not just significant differences between the sputum lipidomes of asthma patients and healthy controls, but also within the asthma patient population. Matching clinical, pathobiologic, proteomic, and transcriptomic data helped inform the underlying disease processes. Sputum lipid phenotypes with higher levels of nonendogenous, cell-derived lipids were associated with significantly worse asthma severity, worse lung function, and elevated granulocyte counts. CONCLUSION We propose a novel mechanism of increased lipid loading in the epithelial lining fluid of asthma patients resulting from the secretion of extracellular vesicles by granulocytic inflammatory cells, which could reduce the ability of pulmonary surfactant to lower surface tension in asthmatic small airways, as well as compromise its role as an immune regulator.
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Affiliation(s)
- Joost Brandsma
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom; National Institute for Health Research Southampton Biomedical Research Centre, Southampton, United Kingdom.
| | - James P R Schofield
- National Institute for Health Research Southampton Biomedical Research Centre, Southampton, United Kingdom; Centre for Proteomic Research, Biological Sciences, University of Southampton, Southampton, United Kingdom
| | - Xian Yang
- Data Science Institute, Imperial College, London, United Kingdom
| | - Fabio Strazzeri
- Mathematical Sciences, University of Southampton, Southampton, United Kingdom
| | - Clair Barber
- National Institute for Health Research Southampton Biomedical Research Centre, Southampton, United Kingdom
| | - Victoria M Goss
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom; National Institute for Health Research Southampton Biomedical Research Centre, Southampton, United Kingdom
| | - Grielof Koster
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom; National Institute for Health Research Southampton Biomedical Research Centre, Southampton, United Kingdom
| | - Per S Bakke
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Massimo Caruso
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - Pascal Chanez
- Department of Respiratory Diseases, Aix-Marseille University, Marseille, France
| | - Sven-Erik Dahlén
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Stephen J Fowler
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, University of Manchester, Manchester, United Kingdom; Manchester Academic Health Centre and NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - Ildikó Horváth
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Norbert Krug
- Fraunhofer Institute for Toxicology and Experimental Medicine, Hannover, Germany
| | - Paolo Montuschi
- Department of Pharmacology, Faculty of Medicine, Catholic University of the Sacred Heart, Rome, Italy; National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Marek Sanak
- Department of Medicine, Jagiellonian University, Krakow, Poland
| | - Thomas Sandström
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Dominick E Shaw
- National Institute for Health Research Biomedical Research Unit, University of Nottingham, Nottingham, United Kingdom
| | - Kian Fan Chung
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Florian Singer
- Division of Paediatric Respiratory Medicine and Allergology, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Paediatrics and Adolescent Medicine, Division of Paediatric Pulmonology and Allergology, Medical University of Graz, Graz, Austria
| | - Louise J Fleming
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Ian M Adcock
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Ioannis Pandis
- Data Science Institute, Imperial College, London, United Kingdom
| | - Aruna T Bansal
- Acclarogen Ltd, St John's Innovation Centre, Cambridge, United Kingdom
| | | | - Ana R Sousa
- Respiratory Therapy Unit, GlaxoSmithKline, London, United Kingdom
| | - Peter J Sterk
- Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Paul J Skipp
- Centre for Proteomic Research, Biological Sciences, University of Southampton, Southampton, United Kingdom
| | - Anthony D Postle
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Ratko Djukanović
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom; National Institute for Health Research Southampton Biomedical Research Centre, Southampton, United Kingdom
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2
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Kermani NZ, Adcock IM, Djukanović R, Chung F, Schofield JPR. Systems Biology in Asthma. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1426:215-235. [PMID: 37464123 DOI: 10.1007/978-3-031-32259-4_10] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
The application of mathematical and computational analysis, together with the modelling of biological and physiological processes, is transforming our understanding of the pathophysiology of complex diseases. This systems biology approach incorporates large amounts of genomic, transcriptomic, proteomic, metabolomic, breathomic, metagenomic and imaging data from disease sites together with deep clinical phenotyping, including patient-reported outcomes. Integration of these datasets will provide a greater understanding of the molecular pathways associated with severe asthma in each individual patient and determine their personalised treatment regime. This chapter describes some of the data integration methods used to combine data sets and gives examples of the results obtained using single datasets and merging of multiple datasets (data fusion and data combination) from several consortia including the severe asthma research programme (SARP) and the Unbiased Biomarkers Predictive of Respiratory Disease Outcomes (U-BIOPRED) consortia. These results highlight the involvement of several different immune and inflammatory pathways and factors in distinct subsets of patients with severe asthma. These pathways often overlap in patients with distinct clinical features of asthma, which may explain the incomplete or no response in patients undergoing specific targeted therapy. Collaboration between groups will improve the predictions obtained using a systems medicine approach in severe asthma.
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Affiliation(s)
- Nazanin Zounemat Kermani
- Data Science Institute, Imperial College London, London, UK
- National Heart & Lung Institute, Imperial College London, London, UK
| | - Ian M Adcock
- National Heart & Lung Institute, Imperial College London, London, UK
| | - Ratko Djukanović
- NIHR Southampton Biomedical Research Centre, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.
| | - Fan Chung
- National Heart & Lung Institute, Imperial College London, London, UK
- Biomedical Research Unit, Royal Brompton & Harefield NHS Trust, London, UK
| | - James P R Schofield
- Centre for Proteomic Research, Institute for Life Sciences, University of Southampton, Southampton, UK
- TopMD Precision Medicine Ltd, Southampton, UK
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3
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Hoda U, Pavlidis S, Bansal AT, Takahashi K, Hu S, Ng Kee Kwong F, Rossios C, Sun K, Bhavsar P, Loza M, Baribaud F, Chanez P, Fowler SJ, Horvath I, Montuschi P, Singer F, Musial J, Dahlen B, Krug N, Sandstrom T, Shaw DE, Lutter R, Fleming LJ, Howarth PH, Caruso M, Sousa AR, Corfield J, Auffray C, De Meulder B, Lefaudeux D, Dahlen SE, Djukanovic R, Sterk PJ, Guo Y, Adcock IM, Chung KF. Clinical and transcriptomic features of persistent exacerbation-prone severe asthma in U-BIOPRED cohort. Clin Transl Med 2022; 12:e816. [PMID: 35474304 PMCID: PMC9043117 DOI: 10.1002/ctm2.816] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 03/24/2022] [Accepted: 03/29/2022] [Indexed: 01/28/2023] Open
Abstract
Background Exacerbation‐prone asthma is a feature of severe disease. However, the basis for its persistency remains unclear. Objectives To determine the clinical and transcriptomic features of frequent exacerbators (FEs) and persistent FEs (PFEs) in the U‐BIOPRED cohort. Methods We compared features of FE (≥2 exacerbations in past year) to infrequent exacerbators (IE, <2 exacerbations) and of PFE with repeat ≥2 exacerbations during the following year to persistent IE (PIE). Transcriptomic data in blood, bronchial and nasal epithelial brushings, bronchial biopsies and sputum cells were analysed by gene set variation analysis for 103 gene signatures. Results Of 317 patients, 62.4% had FE, of whom 63.6% had PFE, while 37.6% had IE, of whom 61.3% had PIE. Using multivariate analysis, FE was associated with short‐acting beta‐agonist use, sinusitis and daily oral corticosteroid use, while PFE was associated with eczema, short‐acting beta‐agonist use and asthma control index. CEA cell adhesion molecule 5 (CEACAM5) was the only differentially expressed transcript in bronchial biopsies between PE and IE. There were no differentially expressed genes in the other four compartments. There were higher expression scores for type 2, T‐helper type‐17 and type 1 pathway signatures together with those associated with viral infections in bronchial biopsies from FE compared to IE, while there were higher expression scores of type 2, type 1 and steroid insensitivity pathway signatures in bronchial biopsies of PFE compared to PIE. Conclusion The FE group and its PFE subgroup are associated with poor asthma control while expressing higher type 1 and type 2 activation pathways compared to IE and PIE, respectively.
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Affiliation(s)
- Uruj Hoda
- National Heart and Lung Institute, Imperial College London, and Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, UK
| | - Stelios Pavlidis
- Department of Computing & Data Science Institute, Imperial College London
| | | | - Kentaro Takahashi
- National Heart and Lung Institute, Imperial College London, and Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, UK.,Research Centre for Allergy and Clinical Immunology, Asahi General Hospital, Asahi, Japan
| | | | - Francois Ng Kee Kwong
- National Heart and Lung Institute, Imperial College London, and Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, UK
| | - Christos Rossios
- National Heart and Lung Institute, Imperial College London, and Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, UK
| | | | - Pankaj Bhavsar
- National Heart and Lung Institute, Imperial College London, and Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, UK
| | - Matthew Loza
- Janssen Research and Development, High Wycombe, Buckinghamshire, UK
| | | | - Pascal Chanez
- Assistance Publique des Hôpitaux de Marseille, Clinique des Bronches, Allergies et Sommeil, Aix Marseille Université, Marseille, France
| | - Stephen J Fowler
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, School of Biological Sciences, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, and NIHR Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Ildiko Horvath
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | | | - Florian Singer
- Department of Respiratory Medicine, University Children's Hospital Zurich and Childhood Research Center, Zurich, and Department of Paediatrics, Inselspital, University of Bern, Switzerland
| | - Jacek Musial
- Department of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Barbro Dahlen
- Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
| | - Norbert Krug
- Fraunhofer Institute for Toxicology and Experimental Medicine, Hannover, Germany
| | - Thomas Sandstrom
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | | | - Rene Lutter
- Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Louise J Fleming
- National Heart and Lung Institute, Imperial College London, and Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, UK
| | - Peter H Howarth
- NIHR Southampton Biomedical Research Centre, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, UK
| | - Massimo Caruso
- Department of Biochemical and Biotechnological Medicine, University of Catania, Catania, Italy
| | - Ana R Sousa
- Respiratory Therapeutic Unit, GSK, Stockley Park, UK
| | - Julie Corfield
- AstraZeneca R&D, Molndal, Sweden, and Areteva R&D, Nottingham, UK
| | - Charles Auffray
- European Institute for Systems Biology and Medicine, CNRS-ENS-UCBL-INSERM, Lyon, France
| | - Bertrand De Meulder
- European Institute for Systems Biology and Medicine, CNRS-ENS-UCBL-INSERM, Lyon, France
| | - Diane Lefaudeux
- European Institute for Systems Biology and Medicine, CNRS-ENS-UCBL-INSERM, Lyon, France
| | - Sven-Erik Dahlen
- Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
| | - Ratko Djukanovic
- NIHR Southampton Biomedical Research Centre, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, UK
| | - Peter J Sterk
- Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Ian M Adcock
- National Heart and Lung Institute, Imperial College London, and Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, UK
| | - Kian Fan Chung
- National Heart and Lung Institute, Imperial College London, and Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, UK
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Cervantes-Gracia K, Chahwan R, Husi H. Integrative OMICS Data-Driven Procedure Using a Derivatized Meta-Analysis Approach. Front Genet 2022; 13:828786. [PMID: 35186042 PMCID: PMC8855827 DOI: 10.3389/fgene.2022.828786] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 01/12/2022] [Indexed: 12/24/2022] Open
Abstract
The wealth of high-throughput data has opened up new opportunities to analyze and describe biological processes at higher resolution, ultimately leading to a significant acceleration of scientific output using high-throughput data from the different omics layers and the generation of databases to store and report raw datasets. The great variability among the techniques and the heterogeneous methodologies used to produce this data have placed meta-analysis methods as one of the approaches of choice to correlate the resultant large-scale datasets from different research groups. Through multi-study meta-analyses, it is possible to generate results with greater statistical power compared to individual analyses. Gene signatures, biomarkers and pathways that provide new insights of a phenotype of interest have been identified by the analysis of large-scale datasets in several fields of science. However, despite all the efforts, a standardized regulation to report large-scale data and to identify the molecular targets and signaling networks is still lacking. Integrative analyses have also been introduced as complementation and augmentation for meta-analysis methodologies to generate novel hypotheses. Currently, there is no universal method established and the different methods available follow different purposes. Herein we describe a new unifying, scalable and straightforward methodology to meta-analyze different omics outputs, but also to integrate the significant outcomes into novel pathways describing biological processes of interest. The significance of using proper molecular identifiers is highlighted as well as the potential to further correlate molecules from different regulatory levels. To show the methodology’s potential, a set of transcriptomic datasets are meta-analyzed as an example.
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Affiliation(s)
| | - Richard Chahwan
- Institute of Experimental Immunology, University of Zurich, Zurich, Switzerland
- *Correspondence: Richard Chahwan, ; Holger Husi,
| | - Holger Husi
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
- Division of Biomedical Sciences, Centre for Health Science, University of the Highlands and Islands, Inverness, United Kingdom
- *Correspondence: Richard Chahwan, ; Holger Husi,
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5
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Howell D, Verma H, Ho KS, Narasimhan B, Steiger D, Rogers L. Asthma and COVID-19: lessons learned and questions that remain. Expert Rev Respir Med 2021; 15:1377-1386. [PMID: 34570678 DOI: 10.1080/17476348.2021.1985763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Asthma is one of the most common chronic diseases worldwide. As a disease of the respiratory tract, the site of entry for the SARS-CoV-2 virus, there may be an important interplay between asthma and COVID-19 disease. AREAS COVERED We report asthma prevalence among hospitalized cohorts with COVID-19. Those with non-allergic and severe asthma may be at increased risk of a worsened clinical outcome from COVID-19 infection. We explore the epidemiology of asthma as a risk factor for the severity of COVID-19 infection. We then consider the role COVID-19 may play in leading to exacerbations of asthma. The impact of asthma endotype on outcome is discussed. Lastly, we address the safety of common asthma therapeutics. A literature search was performed with relevant terms for each of the sections of the review using PubMed, Google Scholar, and Medline. EXPERT OPINION Asthma diagnosis may be a risk factor for severe COVID-19 especially for those with severe disease or nonallergic phenotypes. COVID-19 does not appear to provoke asthma exacerbations and asthma therapeutics should be continued for patients with exposure to COVID-19. Clearly much regarding this topic remains unknown and we identify some key questions that may be of interest for future researchers.[Figure: see text].
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Affiliation(s)
- Daniel Howell
- Division of Pulmonary and Critical Care, Woodhull Hospital, New York University, New York, USA
| | - Hannah Verma
- Icahn School of Medicine at Mount Sinai, New York, USA
| | - Kam Sing Ho
- Department of Medicine, Mount Sinai Morningside & Mount Sinai West Hospitals, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Bharat Narasimhan
- Department of Medicine, Mount Sinai Morningside & Mount Sinai West Hospitals, Icahn School of Medicine at Mount Sinai, New York, USA
| | - David Steiger
- Division of Pulmonary & Critical Care, Mount Sinai Beth Israel, Mount Sinai Morningside, & Mount Sinai West Hospitals, Icahn School of Medicine at Mount Sinai, New York, USA
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6
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Groth EE, Weber M, Bahmer T, Pedersen F, Kirsten A, Börnigen D, Rabe KF, Watz H, Ammerpohl O, Goldmann T. Exploration of the sputum methylome and omics deconvolution by quadratic programming in molecular profiling of asthma and COPD: the road to sputum omics 2.0. Respir Res 2020; 21:274. [PMID: 33076907 PMCID: PMC7574293 DOI: 10.1186/s12931-020-01544-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 10/11/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND To date, most studies involving high-throughput analyses of sputum in asthma and COPD have focused on identifying transcriptomic signatures of disease. No whole-genome methylation analysis of sputum cells has been performed yet. In this context, the highly variable cellular composition of sputum has potential to confound the molecular analyses. METHODS Whole-genome transcription (Agilent Human 4 × 44 k array) and methylation (Illumina 450 k BeadChip) analyses were performed on sputum samples of 9 asthmatics, 10 healthy and 10 COPD subjects. RNA integrity was checked by capillary electrophoresis and used to correct in silico for bias conferred by RNA degradation during biobank sample storage. Estimates of cell type-specific molecular profiles were derived via regression by quadratic programming based on sputum differential cell counts. All analyses were conducted using the open-source R/Bioconductor software framework. RESULTS A linear regression step was found to perform well in removing RNA degradation-related bias among the main principal components of the gene expression data, increasing the number of genes detectable as differentially expressed in asthma and COPD sputa (compared to controls). We observed a strong influence of the cellular composition on the results of mixed-cell sputum analyses. Exemplarily, upregulated genes derived from mixed-cell data in asthma were dominated by genes predominantly expressed in eosinophils after deconvolution. The deconvolution, however, allowed to perform differential expression and methylation analyses on the level of individual cell types and, though we only analyzed a limited number of biological replicates, was found to provide good estimates compared to previously published data about gene expression in lung eosinophils in asthma. Analysis of the sputum methylome indicated presence of differential methylation in genomic regions of interest, e.g. mapping to a number of human leukocyte antigen (HLA) genes related to both major histocompatibility complex (MHC) class I and II molecules in asthma and COPD macrophages. Furthermore, we found the SMAD3 (SMAD family member 3) gene, among others, to lie within differentially methylated regions which has been previously reported in the context of asthma. CONCLUSIONS In this methodology-oriented study, we show that methylation profiling can be easily integrated into sputum analysis workflows and exhibits a strong potential to contribute to the profiling and understanding of pulmonary inflammation. Wherever RNA degradation is of concern, in silico correction can be effective in improving both sensitivity and specificity of downstream analyses. We suggest that deconvolution methods should be integrated in sputum omics analysis workflows whenever possible in order to facilitate the unbiased discovery and interpretation of molecular patterns of inflammation.
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Affiliation(s)
- Espen E Groth
- LungenClinic Grosshansdorf, Großhansdorf, Germany. .,Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Großhansdorf, Germany. .,Department of Internal Medicine I, Pneumology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany. .,Department of Oncology, Hematology and BMT with Section Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Melanie Weber
- Program in Applied and Computational Mathematics, Princeton University, Princeton, NJ, USA
| | - Thomas Bahmer
- LungenClinic Grosshansdorf, Großhansdorf, Germany.,Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Großhansdorf, Germany.,Department of Internal Medicine I, Pneumology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Frauke Pedersen
- LungenClinic Grosshansdorf, Großhansdorf, Germany.,Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Großhansdorf, Germany.,Pulmonary Research Institute at LungenClinic Grosshansdorf, Großhansdorf, Germany
| | - Anne Kirsten
- Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Großhansdorf, Germany.,Pulmonary Research Institute at LungenClinic Grosshansdorf, Großhansdorf, Germany
| | - Daniela Börnigen
- Bioinformatics Core Unit, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Klaus F Rabe
- LungenClinic Grosshansdorf, Großhansdorf, Germany.,Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Großhansdorf, Germany
| | - Henrik Watz
- Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Großhansdorf, Germany.,Pulmonary Research Institute at LungenClinic Grosshansdorf, Großhansdorf, Germany
| | - Ole Ammerpohl
- Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Großhansdorf, Germany.,Institute of Human Genetics, University Medical Center Ulm, Ulm, Germany
| | - Torsten Goldmann
- Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Großhansdorf, Germany.,Research Center Borstel, Pathology, Borstel, Germany
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7
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Whole-genome sequencing and gene network modules predict gemcitabine/carboplatin-induced myelosuppression in non-small cell lung cancer patients. NPJ Syst Biol Appl 2020; 6:25. [PMID: 32839457 PMCID: PMC7445166 DOI: 10.1038/s41540-020-00146-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 07/15/2020] [Indexed: 12/17/2022] Open
Abstract
Gemcitabine/carboplatin chemotherapy commonly induces myelosuppression, including neutropenia, leukopenia, and thrombocytopenia. Predicting patients at risk of these adverse drug reactions (ADRs) and adjusting treatments accordingly is a long-term goal of personalized medicine. This study used whole-genome sequencing (WGS) of blood samples from 96 gemcitabine/carboplatin-treated non-small cell lung cancer (NSCLC) patients and gene network modules for predicting myelosuppression. Association of genetic variants in PLINK found 4594, 5019, and 5066 autosomal SNVs/INDELs with p ≤ 1 × 10−3 for neutropenia, leukopenia, and thrombocytopenia, respectively. Based on the SNVs/INDELs we identified the toxicity module, consisting of 215 unique overlapping genes inferred from MCODE-generated gene network modules of 350, 345, and 313 genes, respectively. These module genes showed enrichment for differentially expressed genes in rat bone marrow, human bone marrow, and human cell lines exposed to carboplatin and gemcitabine (p < 0.05). Then using 80% of the patients as training data, random LASSO reduced the number of SNVs/INDELs in the toxicity module into a feasible prediction model consisting of 62 SNVs/INDELs that accurately predict both the training and the test (remaining 20%) data with high (CTCAE 3–4) and low (CTCAE 0–1) maximal myelosuppressive toxicity completely, with the receiver-operating characteristic (ROC) area under the curve (AUC) of 100%. The present study shows how WGS, gene network modules, and random LASSO can be used to develop a feasible and tested model for predicting myelosuppressive toxicity. Although the proposed model predicts myelosuppression in this study, further evaluation in other studies is required to determine its reproducibility, usability, and clinical effect.
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8
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Deepika D, Sharma RP, Schuhmacher M, Kumar V. An integrative translational framework for chemical induced neurotoxicity – a systematic review. Crit Rev Toxicol 2020; 50:424-438. [DOI: 10.1080/10408444.2020.1763253] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Deepika Deepika
- Environmental Engineering Laboratory, Departament d’ Enginyeria Quimica, Universitat Rovira i Virgili, Tarragona, Catalonia, Spain
| | - Raju Prasad Sharma
- Environmental Engineering Laboratory, Departament d’ Enginyeria Quimica, Universitat Rovira i Virgili, Tarragona, Catalonia, Spain
| | - Marta Schuhmacher
- Environmental Engineering Laboratory, Departament d’ Enginyeria Quimica, Universitat Rovira i Virgili, Tarragona, Catalonia, Spain
| | - Vikas Kumar
- Environmental Engineering Laboratory, Departament d’ Enginyeria Quimica, Universitat Rovira i Virgili, Tarragona, Catalonia, Spain
- IISPV, Hospital Universitari Sant Joan de Reus, Universitat Rovira I Virgili, Reus, Spain
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9
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Three Major Efforts to Phenotype Asthma: Severe Asthma Research Program, Asthma Disease Endotyping for Personalized Therapeutics, and Unbiased Biomarkers for the Prediction of Respiratory Disease Outcome. Clin Chest Med 2020; 40:13-28. [PMID: 30691708 DOI: 10.1016/j.ccm.2018.10.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The SARP, ADEPT, and U-BIOPRED programs are all significant efforts in characterizing asthma and reporting clusters that will assist in designing personalized therapies for asthma, and especially severe asthma. Key aspects of the design of these programs are summarized and major findings are reported in this review.
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10
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Tang HHF, Sly PD, Holt PG, Holt KE, Inouye M. Systems biology and big data in asthma and allergy: recent discoveries and emerging challenges. Eur Respir J 2020; 55:13993003.00844-2019. [PMID: 31619470 DOI: 10.1183/13993003.00844-2019] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 09/12/2019] [Indexed: 12/15/2022]
Abstract
Asthma is a common condition caused by immune and respiratory dysfunction, and it is often linked to allergy. A systems perspective may prove helpful in unravelling the complexity of asthma and allergy. Our aim is to give an overview of systems biology approaches used in allergy and asthma research. Specifically, we describe recent "omic"-level findings, and examine how these findings have been systematically integrated to generate further insight.Current research suggests that allergy is driven by genetic and epigenetic factors, in concert with environmental factors such as microbiome and diet, leading to early-life disturbance in immunological development and disruption of balance within key immuno-inflammatory pathways. Variation in inherited susceptibility and exposures causes heterogeneity in manifestations of asthma and other allergic diseases. Machine learning approaches are being used to explore this heterogeneity, and to probe the pathophysiological patterns or "endotypes" that correlate with subphenotypes of asthma and allergy. Mathematical models are being built based on genomic, transcriptomic and proteomic data to predict or discriminate disease phenotypes, and to describe the biomolecular networks behind asthma.The use of systems biology in allergy and asthma research is rapidly growing, and has so far yielded fruitful results. However, the scale and multidisciplinary nature of this research means that it is accompanied by new challenges. Ultimately, it is hoped that systems medicine, with its integration of omics data into clinical practice, can pave the way to more precise, personalised and effective management of asthma.
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Affiliation(s)
- Howard H F Tang
- Cambridge Baker Systems Genomics Initiative, Baker Heart and Diabetes Institute, Melbourne, Australia .,Cambridge Baker Systems Genomics Initiative, Dept of Public Health and Primary Care, University of Cambridge, Cambridge, UK.,School of BioSciences, The University of Melbourne, Parkville, Australia
| | - Peter D Sly
- Queensland Children's Medical Research Institute, The University of Queensland, Brisbane, Australia.,Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Patrick G Holt
- Queensland Children's Medical Research Institute, The University of Queensland, Brisbane, Australia.,Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Kathryn E Holt
- Dept of Infectious Diseases, Central Clinical School, Monash University, Melbourne, Australia.,London School of Hygiene and Tropical Medicine, London, UK
| | - Michael Inouye
- Cambridge Baker Systems Genomics Initiative, Baker Heart and Diabetes Institute, Melbourne, Australia.,Cambridge Baker Systems Genomics Initiative, Dept of Public Health and Primary Care, University of Cambridge, Cambridge, UK.,School of BioSciences, The University of Melbourne, Parkville, Australia.,The Alan Turing Institute, London, UK
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11
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Garcia-Marcos L, Edwards J, Kennington E, Aurora P, Baraldi E, Carraro S, Gappa M, Louis R, Moreno-Galdo A, Peroni DG, Pijnenburg M, Priftis KN, Sanchez-Solis M, Schuster A, Walker S. Priorities for future research into asthma diagnostic tools: A PAN-EU consensus exercise from the European asthma research innovation partnership (EARIP). Clin Exp Allergy 2019; 48:104-120. [PMID: 29290104 DOI: 10.1111/cea.13080] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The diagnosis of asthma is currently based on clinical history, physical examination and lung function, and to date, there are no accurate objective tests either to confirm the diagnosis or to discriminate between different types of asthma. This consensus exercise reviews the state of the art in asthma diagnosis to identify opportunities for future investment based on the likelihood of their successful development, potential for widespread adoption and their perceived impact on asthma patients. Using a two-stage e-Delphi process and a summarizing workshop, a group of European asthma experts including health professionals, researchers, people with asthma and industry representatives ranked the potential impact of research investment in each technique or tool for asthma diagnosis and monitoring. After a systematic review of the literature, 21 statements were extracted and were subject of the two-stage Delphi process. Eleven statements were scored 3 or more and were further discussed and ranked in a face-to-face workshop. The three most important diagnostic/predictive tools ranked were as follows: "New biological markers of asthma (eg genomics, proteomics and metabolomics) as a tool for diagnosis and/or monitoring," "Prediction of future asthma in preschool children with reasonable accuracy" and "Tools to measure volatile organic compounds (VOCs) in exhaled breath."
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Affiliation(s)
- L Garcia-Marcos
- Respiratory and Allergy Units, Arrixaca University Children's Hospital, University of Murcia & IMIB Research Institute, Murcia, Spain
| | | | | | - P Aurora
- Department of Paediatric Respiratory Medicine, Great Ormond Street Hospital for Children, London, UK.,Department of Respiratory, Critical Care and Anaesthesia Unit, University College London (UCL) Great Ormond Street Institute of Child Health, London, UK
| | - E Baraldi
- Women's and Children's Health Department, University of Padua, Padova, Italy
| | - S Carraro
- Women's and Children's Health Department, University of Padua, Padova, Italy
| | - M Gappa
- Children's Hospital & Research Institute, Marienhospital Wesel, Wesel, Germany
| | - R Louis
- Department of Respiratory Medicine, University of Liege, Liege, Belgium
| | - A Moreno-Galdo
- Paediatric Pulmonology Unit, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - D G Peroni
- Department of Clinical and Experimental Medicine, Section of Paediatrics, University of Pisa, Pisa, Italy
| | - M Pijnenburg
- Paediatrics/Paediatric Respiratory Medicine, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - K N Priftis
- Department of Paediatrics, Athens University Medical School, Attikon General Hospital, Athens, Greece
| | - M Sanchez-Solis
- Respiratory and Allergy Units, Arrixaca University Children's Hospital, University of Murcia & IMIB Research Institute, Murcia, Spain
| | - A Schuster
- Department of Paediatrics, University Hospital, Düsseldorf, Germany
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12
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Abstract
The recent Lancet commission has highlighted that "asthma" should be used to describe a clinical syndrome of wheeze, breathlessness, chest tightness, and sometimes cough. The next step is to deconstruct the airway into components of fixed and variable airflow obstruction, inflammation, infection and altered cough reflex, setting the airway disease in the context of extra-pulmonary co-morbidities and social and environmental factors. The emphasis is always on delineating treatable traits, including variable airflow obstruction caused by airway smooth muscle constriction (treated with short- and long-acting β-2 agonists), eosinophilic airway inflammation (treated with inhaled corticosteroids) and chronic bacterial infection (treated with antibiotics with benefit if it is driving the disease). It is also important not to over-treat the untreatable, such as fixed airflow obstruction. These can all be determined using simple, non-invasive tests such as spirometry before and after acute administration of a bronchodilator (reversible airflow obstruction); peripheral blood eosinophil count, induced sputum, exhaled nitric oxide (airway eosinophilia); and sputum or cough swab culture (bacterial infection). Additionally, the pathophysiology of risk domains must be considered: these are risk of an asthma attack, risk of poor airway growth, and in pre-school children, risk of progression to eosinophilic school age asthma. Phenotyping the airway will allow more precise diagnosis and targeted treatment, but it is important to move to endotypes, especially in the era of increasing numbers of biologicals. Advances in -omics technology allow delineation of pathways, which will be particularly important in TH2 low eosinophilic asthma, and also pauci-inflammatory disease. It is very important to appreciate the difficulties of cluster analysis; a patient may have eosinophilic airway disease because of a steroid resistant endotype, because of non-adherence to basic treatment, and a surge in environmental allergen burden. Sophisticated -omics approaches will be reviewed in this manuscript, but currently they are not being used in clinical practice. However, even while they are being evaluated, management of the asthmas can and should be improved by considering the pathophysiologies of the different airway diseases lumped under that umbrella term, using simple, non-invasive tests which are readily available, and treating accordingly.
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Affiliation(s)
- Andrew Bush
- Departments of Paediatrics and Paediatric Respiratory Medicine, Royal Brompton Harefield NHS Foundation Trust and Imperial College, London, United Kingdom
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13
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Brinkman P, Wagener AH, Hekking PP, Bansal AT, Maitland-van der Zee AH, Wang Y, Weda H, Knobel HH, Vink TJ, Rattray NJ, D'Amico A, Pennazza G, Santonico M, Lefaudeux D, De Meulder B, Auffray C, Bakke PS, Caruso M, Chanez P, Chung KF, Corfield J, Dahlén SE, Djukanovic R, Geiser T, Horvath I, Krug N, Musial J, Sun K, Riley JH, Shaw DE, Sandström T, Sousa AR, Montuschi P, Fowler SJ, Sterk PJ. Identification and prospective stability of electronic nose (eNose)-derived inflammatory phenotypes in patients with severe asthma. J Allergy Clin Immunol 2018; 143:1811-1820.e7. [PMID: 30529449 DOI: 10.1016/j.jaci.2018.10.058] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 10/04/2018] [Accepted: 10/22/2018] [Indexed: 01/24/2023]
Abstract
BACKGROUND Severe asthma is a heterogeneous condition, as shown by independent cluster analyses based on demographic, clinical, and inflammatory characteristics. A next step is to identify molecularly driven phenotypes using "omics" technologies. Molecular fingerprints of exhaled breath are associated with inflammation and can qualify as noninvasive assessment of severe asthma phenotypes. OBJECTIVES We aimed (1) to identify severe asthma phenotypes using exhaled metabolomic fingerprints obtained from a composite of electronic noses (eNoses) and (2) to assess the stability of eNose-derived phenotypes in relation to within-patient clinical and inflammatory changes. METHODS In this longitudinal multicenter study exhaled breath samples were taken from an unselected subset of adults with severe asthma from the U-BIOPRED cohort. Exhaled metabolites were analyzed centrally by using an assembly of eNoses. Unsupervised Ward clustering enhanced by similarity profile analysis together with K-means clustering was performed. For internal validation, partitioning around medoids and topological data analysis were applied. Samples at 12 to 18 months of prospective follow-up were used to assess longitudinal within-patient stability. RESULTS Data were available for 78 subjects (age, 55 years [interquartile range, 45-64 years]; 41% male). Three eNose-driven clusters (n = 26/33/19) were revealed, showing differences in circulating eosinophil (P = .045) and neutrophil (P = .017) percentages and ratios of patients using oral corticosteroids (P = .035). Longitudinal within-patient cluster stability was associated with changes in sputum eosinophil percentages (P = .045). CONCLUSIONS We have identified and followed up exhaled molecular phenotypes of severe asthma, which were associated with changing inflammatory profile and oral steroid use. This suggests that breath analysis can contribute to the management of severe asthma.
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Affiliation(s)
- Paul Brinkman
- Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - Ariane H Wagener
- Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Pieter-Paul Hekking
- Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Aruna T Bansal
- Acclarogen, St John's Innovation Centre, Cambridge, United Kingdom
| | | | | | - Hans Weda
- Philips Research, Eindhoven, The Netherlands
| | | | | | - Nicholas J Rattray
- Department of Environmental Health Sciences, Yale School of Public Health, Yale University, New Haven, Conn
| | - Arnaldo D'Amico
- Department of Electronic Engineering, University of Rome "Tor Vergata," Rome, Italy
| | - Giorgio Pennazza
- Center for Integrated Research-CIR, Unit for Electronics for Sensor Systems, Campus Bio-Medico U, Rome, Italy
| | - Marco Santonico
- Center for Integrated Research-CIR, Unit for Electronics for Sensor Systems, Campus Bio-Medico U, Rome, Italy
| | - Diane Lefaudeux
- European Institute for Systems Biology and Medicine, CIRI UMR5308, CNRS-ENS-UCBL-INSERM, Lyon, France
| | - Bertrand De Meulder
- European Institute for Systems Biology and Medicine, CIRI UMR5308, CNRS-ENS-UCBL-INSERM, Lyon, France
| | - Charles Auffray
- European Institute for Systems Biology and Medicine, CIRI UMR5308, CNRS-ENS-UCBL-INSERM, Lyon, France
| | - Per S Bakke
- Institute of Medicine, University of Bergen, Bergen, Norway
| | - Massimo Caruso
- Department of Clinical and Experimental Medicine Hospital University, University of Catania, Catania, Italy
| | - Pascal Chanez
- Département des Maladies Respiratoires APHM,U1067 INSERM, Aix Marseille Université Marseille, Marseille, Italy
| | - Kian F Chung
- National Heart and Lung Institute, Imperial College, London, UK Biomedical Research Unit, Royal Brompton & Harefield NHS Trust, London, United Kingdom
| | - Julie Corfield
- AstraZeneca R&D, Mölndal, Sweden; Areteva R&D, Nottingham, United Kingdom
| | - Sven-Erik Dahlén
- Centre for Allergy Research, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Ratko Djukanovic
- NIHR Southampton Respiratory Biomedical Research Unit, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Thomas Geiser
- the Department of Pulmonary Medicine, University Hospital Bern, Bern, Switzerland
| | - Ildiko Horvath
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Nobert Krug
- Fraunhofer Institute for Toxicology and Experimental Medicine Hannover, Hannover, Germany
| | - Jacek Musial
- Department of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Kai Sun
- Data Science Institute, South Kensington Campus, Imperial College Londont, London, United Kingdom
| | - John H Riley
- Respiratory Therapeutic Unit, GlaxoSmithKline, Stockley Park, United Kingdom
| | - Dominic E Shaw
- Respiratory Research Unit, University of Nottingham, Nottingham, United Kingdom
| | - Thomas Sandström
- Department of Public Health and Clinical Medicine, Department of Medicine, Respiratory Medicine Unit, Umeå University, Umeå, Sweden
| | - Ana R Sousa
- Respiratory Therapeutic Unit, GlaxoSmithKline, Stockley Park, United Kingdom
| | - Paolo Montuschi
- Department of Pharmacology, Faculty of Medicine, Catholic University of the Sacred Heart, Rome, Italy
| | - Stephen J Fowler
- Respiratory Research Group, Faculty of Medical and Human Sciences, University of Manchester, Manchester Academic Healthy Science Centre, and NIHR Translational Research Faculty in Respiratory Medicine, University Hospital of South Manchester, Manchester, United Kingdom; Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom
| | - Peter J Sterk
- Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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14
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Translating Asthma: Dissecting the Role of Metabolomics, Genomics and Personalized Medicine. Indian J Pediatr 2018; 85:643-650. [PMID: 29185231 DOI: 10.1007/s12098-017-2520-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 09/27/2017] [Indexed: 01/26/2023]
Abstract
The management of asthma has largely stagnated over the last 25 years, but we are at the dawning of a new age wherein -omics technology can help us manage the disease objectively and rationally. Even in this new scientific age, getting the basics of asthma management right remains essential. The new technologies which can be applied to multiple biological samples include genomics (study of the genome), transcriptomics (gene transcription), lipidomics, proteomics and metabolomics (lipids, proteins and metabolites, respectively) and breathomics, using exhaled breath as a source of biomarkers, which is of particular interest in view of its non-invasive nature in pediatrics. Important applications will include the diagnosis of airways disease, including its components; the pathways driving airway pathology; monitoring the response to treatment; and measuring future risk (asthma attacks, poor lung growth trajectory). With the advent of a wide range of novel biologicals to treat asthma, -omics technology to personalize therapy will be especially important. The U-BIOPRED (Europe) and SARP (USA) groups have been most active in this field, especially using bronchoscopically obtained samples to perform cluster analyses to define new asthma endotypes. However, stability over time and consistency between investigators is imperfect. This is perhaps unsurprising; results of biomarker studies in asthma will be a composite of the underlying disease, the (variable) effects of adverse drivers such as allergen exposure and pollution, the effects of treatment, and the effects of adherence or otherwise to treatment. Ultimately, the aim should be an exhaled breath based tool with a rapid result that can be used as a routine in the clinic. However, at the moment, there are as yet no clinical applications in children of -omics technology.
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15
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Lopez-Campos JL, Centanni S. Current Approaches for Phenotyping as a Target for Precision Medicine in COPD Management. COPD 2018; 15:108-117. [PMID: 29558165 DOI: 10.1080/15412555.2018.1443064] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The study of airway diseases continues to present several challenges for modern medicine. The different disease presentations with variables and overlapping features may result in a real challenge for the clinician. In this context, the concept of precision medicine has started to emerge in order to give answers to some of these challenges from a diagnostic and therapeutic point of view. The main reasons to target for precision medicine in chronic obstructive pulmonary disease (COPD) include that there is variability in the clinical presentation, there is no correlation between the different clinical variables at the patient level, there are a number of relevant clinical variables associated with outcomes, we do have specific therapies for specific patient types, and that there is variability in the clinical response to different therapies. To bring precision medicine into clinical practice several approaches have been used, including the use of independent variables to identify subjects, the use of multidimensional indexes, the so-called clinical phenotypes, and the approximation by the so-called treatable traits. All these approaches have their strengths and weaknesses which are reviewed in the present document. Although there is no universally accepted proposal, the available initiatives provide us with a framework on which to start working and move toward precision medicine in COPD, with the ultimate goal of bringing the best possible medicine to each patient in particular.
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Affiliation(s)
- Jose Luis Lopez-Campos
- a Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla , Seville , Spain.,b Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III , Madrid , Spain
| | - Stefano Centanni
- c Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Health Sciences , Università degli Studi di Milano , Milan , Italy
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16
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Bos LD. Contrary to popular belief, ventilator-associated lower respiratory tract infections are less common in immunocompromised patients. Eur Respir J 2018. [PMID: 29519906 DOI: 10.1183/13993003.00228-2018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Lieuwe D Bos
- Dept of Respiratory Medicine, Academic Medical Center Amsterdam, Amsterdam, The Netherlands .,Intensive Care, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
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17
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Phenotyping of Chronic Obstructive Pulmonary Disease Based on the Integration of Metabolomes and Clinical Characteristics. Int J Mol Sci 2018; 19:ijms19030666. [PMID: 29495451 PMCID: PMC5877527 DOI: 10.3390/ijms19030666] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 02/21/2018] [Accepted: 02/24/2018] [Indexed: 12/13/2022] Open
Abstract
Apart from the refined management-oriented clinical stratification of chronic obstructive pulmonary disease (COPD), the molecular pathologies behind this highly prevalent disease have remained obscure. The aim of this study was the characterization of patients with COPD, based on the metabolomic profiling of peripheral blood and exhaled breath condensate (EBC) within the context of defined clinical and demographic variables. Mass-spectrometry-based targeted analysis of serum metabolites (mainly amino acids and lipid species), untargeted profiles of serum and EBC of patients with COPD of different clinical characteristics (n = 25) and control individuals (n = 21) were performed. From the combined clinical/demographic and metabolomics data, associations between clinical/demographic and metabolic parameters were searched and a de novo phenotyping for COPD was attempted. Adjoining the clinical parameters, sphingomyelins were the best to differentiate COPD patients from controls. Unsaturated fatty acid-containing lipids, ornithine metabolism and plasma protein composition-associated signals from the untargeted analysis differentiated the Global Initiative for COPD (GOLD) categories. Hierarchical clustering did not reveal a clinical-metabolomic stratification superior to the strata set by the GOLD consensus. We conclude that while metabolomics approaches are good for finding biomarkers and clarifying the mechanism of the disease, there are no distinct co-variate independent clinical-metabolic phenotypes.
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18
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Bos LD, Martin-Loeches I, Schultz MJ. ARDS: challenges in patient care and frontiers in research. Eur Respir Rev 2018; 27:27/147/170107. [PMID: 29367411 PMCID: PMC9489095 DOI: 10.1183/16000617.0107-2017] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 12/13/2017] [Indexed: 12/05/2022] Open
Abstract
This review discusses the clinical challenges associated with ventilatory support and pharmacological interventions in patients with acute respiratory distress syndrome (ARDS). In addition, it discusses current scientific challenges facing researchers when planning and performing trials of ventilatory support or pharmacological interventions in these patients. Noninvasive mechanical ventilation is used in some patients with ARDS. When intubated and mechanically ventilated, ARDS patients should be ventilated with low tidal volumes. A plateau pressure <30 cmH2O is recommended in all patients. It is suggested that a plateau pressure <15 cmH2O should be considered safe. Patient with moderate and severe ARDS should receive higher levels of positive end-expiratory pressure (PEEP). Rescue therapies include prone position and neuromuscular blocking agents. Extracorporeal support for decapneisation and oxygenation should only be considered when lung-protective ventilation is no longer possible, or in cases of refractory hypoxaemia, respectively. Tracheotomy is only recommended when prolonged mechanical ventilation is expected. Of all tested pharmacological interventions for ARDS, only treatment with steroids is considered to have benefit. Proper identification of phenotypes, known to respond differently to specific interventions, is increasingly considered important for clinical trials of interventions for ARDS. Such phenotypes could be defined based on clinical parameters, such as the arterial oxygen tension/inspiratory oxygen fraction ratio, but biological marker profiles could be more promising. Treatment of ARDS is mainly through the prevention of ventilation-induced lung injuryhttp://ow.ly/DeJC30hGWfi
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Affiliation(s)
- Lieuwe D Bos
- Dept of Intensive Care and Laboratory of Experimental Intensive Care and Anesthesiology (LEICA), Academic Medical Center, Amsterdam, The Netherlands .,Respiratory Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | | | - Marcus J Schultz
- Dept of Intensive Care and Laboratory of Experimental Intensive Care and Anesthesiology (LEICA), Academic Medical Center, Amsterdam, The Netherlands.,Mahidol Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
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19
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Villaseñor A, Rosace D, Obeso D, Pérez-Gordo M, Chivato T, Barbas C, Barber D, Escribese MM. Allergic asthma: an overview of metabolomic strategies leading to the identification of biomarkers in the field. Clin Exp Allergy 2017; 47:442-456. [PMID: 28160515 DOI: 10.1111/cea.12902] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Allergic asthma is a prominent disease especially during childhood. Indoor allergens, in general, and particularly house dust mites (HDM) are the most prevalent sensitizers associated with allergic asthma. Available data show that 65-130 million people are mite-sensitized world-wide and as many as 50% of these are asthmatic. In fact, sensitization to HDM in the first years of life can produce devastating effects on pulmonary function leading to asthmatic syndromes that can be fatal. To date, there has been considerable research into the pathological pathways and structural changes associated with allergic asthma. However, limitations related to the disease heterogeneity and a lack of knowledge into its pathophysiology have impeded the generation of valuable data needed to appropriately phenotype patients and, subsequently, treat this disease. Here, we report a systematic and integral analysis of the disease, from airway remodelling to the immune response taking place throughout the disease stages. We present an overview of metabolomics, the management of complex multifactorial diseases through the analysis of all possible metabolites in a biological sample, obtaining a global interpretation of biological systems. Special interest is placed on the challenges to obtain biological samples and the methodological aspects to acquire relevant information, focusing on the identification of novel biomarkers associated with specific phenotypes of allergic asthma. We also present an overview of the metabolites cited in the literature, which have been related to inflammation and immune response in asthma and other allergy-related diseases.
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Affiliation(s)
- A Villaseñor
- Faculty of Medicine, Institute of Applied Molecular Medicine (IMMA), CEU San Pablo University, Boadilla del Monte, Madrid, Spain
| | - D Rosace
- Faculty of Medicine, Institute of Applied Molecular Medicine (IMMA), CEU San Pablo University, Boadilla del Monte, Madrid, Spain
| | - D Obeso
- Faculty of Medicine, Institute of Applied Molecular Medicine (IMMA), CEU San Pablo University, Boadilla del Monte, Madrid, Spain.,Faculty of Pharmacy, Centre for Metabolomics and Bioanalysis (CEMBIO), CEU San Pablo University, Boadilla del Monte, Madrid, Spain
| | - M Pérez-Gordo
- Faculty of Pharmacy, Centre for Metabolomics and Bioanalysis (CEMBIO), CEU San Pablo University, Boadilla del Monte, Madrid, Spain.,Basic Medical Sciences Department, Faculty of Medicine, CEU San Pablo University, Boadilla del Monte, Madrid, Spain
| | - T Chivato
- Basic Medical Sciences Department, Faculty of Medicine, CEU San Pablo University, Boadilla del Monte, Madrid, Spain
| | - C Barbas
- Faculty of Pharmacy, Centre for Metabolomics and Bioanalysis (CEMBIO), CEU San Pablo University, Boadilla del Monte, Madrid, Spain
| | - D Barber
- Faculty of Medicine, Institute of Applied Molecular Medicine (IMMA), CEU San Pablo University, Boadilla del Monte, Madrid, Spain
| | - M M Escribese
- Faculty of Medicine, Institute of Applied Molecular Medicine (IMMA), CEU San Pablo University, Boadilla del Monte, Madrid, Spain.,Basic Medical Sciences Department, Faculty of Medicine, CEU San Pablo University, Boadilla del Monte, Madrid, Spain
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20
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Bowler RP, Wendt CH, Fessler MB, Foster MW, Kelly RS, Lasky-Su J, Rogers AJ, Stringer KA, Winston BW. New Strategies and Challenges in Lung Proteomics and Metabolomics. An Official American Thoracic Society Workshop Report. Ann Am Thorac Soc 2017; 14:1721-1743. [PMID: 29192815 PMCID: PMC5946579 DOI: 10.1513/annalsats.201710-770ws] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
This document presents the proceedings from the workshop entitled, "New Strategies and Challenges in Lung Proteomics and Metabolomics" held February 4th-5th, 2016, in Denver, Colorado. It was sponsored by the National Heart Lung Blood Institute, the American Thoracic Society, the Colorado Biological Mass Spectrometry Society, and National Jewish Health. The goal of this workshop was to convene, for the first time, relevant experts in lung proteomics and metabolomics to discuss and overcome specific challenges in these fields that are unique to the lung. The main objectives of this workshop were to identify, review, and/or understand: (1) emerging technologies in metabolomics and proteomics as applied to the study of the lung; (2) the unique composition and challenges of lung-specific biological specimens for metabolomic and proteomic analysis; (3) the diverse informatics approaches and databases unique to metabolomics and proteomics, with special emphasis on the lung; (4) integrative platforms across genetic and genomic databases that can be applied to lung-related metabolomic and proteomic studies; and (5) the clinical applications of proteomics and metabolomics. The major findings and conclusions of this workshop are summarized at the end of the report, and outline the progress and challenges that face these rapidly advancing fields.
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21
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Kupczyk M, Kuna P. How should treatment approaches differ depending on the severity of asthma? Expert Rev Respir Med 2017; 11:991-1001. [PMID: 28976216 DOI: 10.1080/17476348.2017.1388742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Asthma is nowadays regarded as a syndrome of various overlapping phenotypes with defined clinical characteristics, different underlying inflammatory mechanisms, identifiable genetic background, environmental risk factors and possible biomarkers. There are no doubts that due to the diversity of asthma, a 'one size fits all' management of the disease is no longer valid. Areas covered: Nowadays asthma management is based on the control of the disease, and the goals of asthma treatment are defined as good symptom control, decreased future risk of exacerbations, fixed airflow limitation, and side-effects of treatment. Alternative strategies for adjusting asthma treatment such as sputum or exhaled nitric oxide guided protocols have been evaluated and despite some effectiveness, are regarded as impractical in every-day clinical conditions. Further studies in the field of asthma phenotypes/endotypes and biomarkers are warranted with the main goal to define which of those possible subgroups will be useful in clinical practice in regards to the potential allocation of successful treatment. Expert commentary: Despite the availability of guidelines on the diagnosis and management of asthma, it seems that the disease is still not optimally controlled. Addressing unmet needs in every day care, improving education, adherence/compliance and inhalation technique may significantly improve asthma control across all severities of the disease.
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Affiliation(s)
- Maciej Kupczyk
- a Department of Internal Medicine, Asthma and Allergy , Medical University of Lodz , Lodz , Poland
| | - Piotr Kuna
- a Department of Internal Medicine, Asthma and Allergy , Medical University of Lodz , Lodz , Poland
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22
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Kuo CHS, Pavlidis S, Loza M, Baribaud F, Rowe A, Pandis I, Hoda U, Rossios C, Sousa A, Wilson SJ, Howarth P, Dahlen B, Dahlen SE, Chanez P, Shaw D, Krug N, Sandstrӧm T, De Meulder B, Lefaudeux D, Fowler S, Fleming L, Corfield J, Auffray C, Sterk PJ, Djukanovic R, Guo Y, Adcock IM, Chung KF. A Transcriptome-driven Analysis of Epithelial Brushings and Bronchial Biopsies to Define Asthma Phenotypes in U-BIOPRED. Am J Respir Crit Care Med 2017; 195:443-455. [PMID: 27580351 DOI: 10.1164/rccm.201512-2452oc] [Citation(s) in RCA: 136] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
RATIONALE Asthma is a heterogeneous disease driven by diverse immunologic and inflammatory mechanisms. OBJECTIVES Using transcriptomic profiling of airway tissues, we sought to define the molecular phenotypes of severe asthma. METHODS The transcriptome derived from bronchial biopsies and epithelial brushings of 107 subjects with moderate to severe asthma were annotated by gene set variation analysis using 42 gene signatures relevant to asthma, inflammation, and immune function. Topological data analysis of clinical and histologic data was performed to derive clusters, and the nearest shrunken centroid algorithm was used for signature refinement. MEASUREMENTS AND MAIN RESULTS Nine gene set variation analysis signatures expressed in bronchial biopsies and airway epithelial brushings distinguished two distinct asthma subtypes associated with high expression of T-helper cell type 2 cytokines and lack of corticosteroid response (group 1 and group 3). Group 1 had the highest submucosal eosinophils, as well as high fractional exhaled nitric oxide levels, exacerbation rates, and oral corticosteroid use, whereas group 3 patients showed the highest levels of sputum eosinophils and had a high body mass index. In contrast, group 2 and group 4 patients had an 86% and 64% probability, respectively, of having noneosinophilic inflammation. Using machine learning tools, we describe an inference scheme using the currently available inflammatory biomarkers sputum eosinophilia and fractional exhaled nitric oxide levels, along with oral corticosteroid use, that could predict the subtypes of gene expression within bronchial biopsies and epithelial cells with good sensitivity and specificity. CONCLUSIONS This analysis demonstrates the usefulness of a transcriptomics-driven approach to phenotyping that segments patients who may benefit the most from specific agents that target T-helper cell type 2-mediated inflammation and/or corticosteroid insensitivity.
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Affiliation(s)
- Chih-Hsi Scott Kuo
- 1 Department of Computing.,2 Data Science Institute, and.,3 Airways Disease Section, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Stelios Pavlidis
- 1 Department of Computing.,2 Data Science Institute, and.,4 Janssen Research and Development, High Wycombe, United Kingdom
| | - Matthew Loza
- 4 Janssen Research and Development, High Wycombe, United Kingdom
| | - Fred Baribaud
- 4 Janssen Research and Development, High Wycombe, United Kingdom
| | - Anthony Rowe
- 4 Janssen Research and Development, High Wycombe, United Kingdom
| | - Ioannis Pandis
- 1 Department of Computing.,2 Data Science Institute, and
| | - Uruj Hoda
- 3 Airways Disease Section, National Heart and Lung Institute, Imperial College London, London, United Kingdom.,5 Biomedical Research Unit, Royal Brompton & Harefield National Health Service Trust, London, United Kingdom
| | - Christos Rossios
- 3 Airways Disease Section, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Ana Sousa
- 6 Respiratory Therapeutic Unit, GlaxoSmithKline, Stockley Park, United Kingdom
| | - Susan J Wilson
- 7 Faculty of Medicine, Southampton University, Southampton, United Kingdom
| | - Peter Howarth
- 7 Faculty of Medicine, Southampton University, Southampton, United Kingdom
| | - Barbro Dahlen
- 8 Centre for Allergy Research, Karolinska Institute, Stockholm, Sweden
| | - Sven-Erik Dahlen
- 8 Centre for Allergy Research, Karolinska Institute, Stockholm, Sweden
| | | | - Dominick Shaw
- 10 Centre for Respiratory Research, University of Nottingham, Nottingham, United Kingdom
| | - Norbert Krug
- 11 Fraunhofer Institute of Toxicology and Experimental Medicine, Hannover, Germany
| | - Thomas Sandstrӧm
- 12 Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Bertrand De Meulder
- 13 European Institute for Systems Biology and Medicine, CNRS-ENS-UCBL, University of Lyon, Lyon, France
| | - Diane Lefaudeux
- 13 European Institute for Systems Biology and Medicine, CNRS-ENS-UCBL, University of Lyon, Lyon, France
| | - Stephen Fowler
- 14 Centre for Respiratory Medicine and Allergy, University of Manchester, Manchester, United Kingdom
| | - Louise Fleming
- 3 Airways Disease Section, National Heart and Lung Institute, Imperial College London, London, United Kingdom.,5 Biomedical Research Unit, Royal Brompton & Harefield National Health Service Trust, London, United Kingdom
| | - Julie Corfield
- 15 AstraZeneca R&D, Molndal, Sweden.,16 Areteva R&D, Nottingham, United Kingdom; and
| | - Charles Auffray
- 13 European Institute for Systems Biology and Medicine, CNRS-ENS-UCBL, University of Lyon, Lyon, France
| | - Peter J Sterk
- 17 Faculty of Medicine, University of Amsterdam, Amsterdam, the Netherlands
| | - Ratko Djukanovic
- 7 Faculty of Medicine, Southampton University, Southampton, United Kingdom
| | - Yike Guo
- 1 Department of Computing.,2 Data Science Institute, and
| | - Ian M Adcock
- 3 Airways Disease Section, National Heart and Lung Institute, Imperial College London, London, United Kingdom.,5 Biomedical Research Unit, Royal Brompton & Harefield National Health Service Trust, London, United Kingdom
| | - Kian Fan Chung
- 3 Airways Disease Section, National Heart and Lung Institute, Imperial College London, London, United Kingdom.,5 Biomedical Research Unit, Royal Brompton & Harefield National Health Service Trust, London, United Kingdom
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23
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Thamrin C, Frey U, Kaminsky DA, Reddel HK, Seely AJE, Suki B, Sterk PJ. Systems Biology and Clinical Practice in Respiratory Medicine. The Twain Shall Meet. Am J Respir Crit Care Med 2017; 194:1053-1061. [PMID: 27556336 DOI: 10.1164/rccm.201511-2288pp] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Respiratory diseases are highly complex, being driven by host-environment interactions and manifested by inflammatory, structural, and functional abnormalities that vary over time. Traditional reductionist approaches have contributed vastly to our knowledge of biological systems in health and disease to date; however, they are insufficient to provide an understanding of the behavior of the system as a whole. In this Pulmonary Perspective, we discuss systems biology approaches, especially but not limited to the study of the lung as a complex system. Such integrative approaches take into account the large number of dynamic subunits and their interactions found in biological systems. Borrowing methods from physics and mathematics, it is possible to study the collective behavior of these systems over time and in a multidimensional manner. We first examine the physiological basis for complexity in the respiratory system and its implications for disease. We then expand on the potential applications of systems biology methods to study complex systems, within the context of diagnosis and monitoring of respiratory diseases including asthma, chronic obstructive pulmonary disease (COPD), and critical illness. We summarize the significant advances made in recent years using systems approaches for disease phenotyping, applied to data ranging from the molecular to clinical level, obtained from large-scale asthma and COPD networks. We describe new studies using temporal complexity patterns to characterize asthma and COPD and predict exacerbations as well as predict adverse outcomes in critical care. We highlight new methods that are emerging with this approach and discuss remaining questions that merit greater attention in the field.
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Affiliation(s)
- Cindy Thamrin
- 1 Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Urs Frey
- 2 University Children's Hospital Basel, Basel, Switzerland
| | - David A Kaminsky
- 3 University of Vermont College of Medicine, Burlington, Vermont
| | - Helen K Reddel
- 1 Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Andrew J E Seely
- 4 Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Béla Suki
- 5 Department of Biomedical Engineering, Boston University, Boston, Massachusetts; and
| | - Peter J Sterk
- 6 Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
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24
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Diao W, Shen N, Du Y, Sun X, Liu B, Xu M, He B. Identification of thyroxine-binding globulin as a candidate plasma marker of chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2017; 12:1549-1564. [PMID: 28579773 PMCID: PMC5448702 DOI: 10.2147/copd.s137806] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Biomarkers for the management of chronic obstructive pulmonary disease (COPD) are limited. The aim of this study was to explore new plasma biomarkers in patients with COPD. Thyroxine-binding globulin (THBG) was initially identified by proteomics in a discovery panel and subsequently verified by enzyme-linked immunosorbent assay in another verification panel with a 1-year follow-up. THBG levels were elevated in patients with COPD (9.2±2.3 μg/mL) compared to those of the controls (6.6±2.0 μg/mL). Receiver operating characteristic curves suggested that THBG was able to slightly differentiate between patients with COPD and controls (area under the curve [AUC]: 0.814) and performed better if combined with fibrinogen (AUC: 0.858). THBG was more capable of distinguishing Global Initiative for Obstructive Lung Disease stages I–III and IV (AUC: 0.851) compared with fibrinogen (AUC 0.582). THBG levels were negatively associated with predicted percentage forced expiratory volume in 1 s and positively related to predicted percentage residual volume, RV/percentage total lung capacity, and percentage low-attenuation area. COPD patients with higher baseline THBG levels had a greater risk of acute exacerbation (AE) than those with lower THBG levels (P=0.014, by Kaplan–Meier curve; hazard ratio: 4.229, by Cox proportional hazards model). In summary, THBG is a potential plasma biomarker of COPD and can assist in the management of stable stage and AEs in COPD patients.
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Affiliation(s)
| | | | | | | | | | - Ming Xu
- Department of Cardiology, Institute of Vascular Medicine, Peking University Third Hospital.,Key Laboratory of Molecular Cardiovascular Sciences, Ministry of Education, Beijing, People's Republic of China
| | - Bei He
- Department of Respiratory Medicine
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25
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Horváth I, Barnes PJ, Loukides S, Sterk PJ, Högman M, Olin AC, Amann A, Antus B, Baraldi E, Bikov A, Boots AW, Bos LD, Brinkman P, Bucca C, Carpagnano GE, Corradi M, Cristescu S, de Jongste JC, Dinh-Xuan AT, Dompeling E, Fens N, Fowler S, Hohlfeld JM, Holz O, Jöbsis Q, Van De Kant K, Knobel HH, Kostikas K, Lehtimäki L, Lundberg J, Montuschi P, Van Muylem A, Pennazza G, Reinhold P, Ricciardolo FLM, Rosias P, Santonico M, van der Schee MP, van Schooten FJ, Spanevello A, Tonia T, Vink TJ. A European Respiratory Society technical standard: exhaled biomarkers in lung disease. Eur Respir J 2017; 49:49/4/1600965. [PMID: 28446552 DOI: 10.1183/13993003.00965-2016] [Citation(s) in RCA: 369] [Impact Index Per Article: 52.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 01/09/2017] [Indexed: 12/19/2022]
Abstract
Breath tests cover the fraction of nitric oxide in expired gas (FeNO), volatile organic compounds (VOCs), variables in exhaled breath condensate (EBC) and other measurements. For EBC and for FeNO, official recommendations for standardised procedures are more than 10 years old and there is none for exhaled VOCs and particles. The aim of this document is to provide technical standards and recommendations for sample collection and analytic approaches and to highlight future research priorities in the field. For EBC and FeNO, new developments and advances in technology have been evaluated in the current document. This report is not intended to provide clinical guidance on disease diagnosis and management.Clinicians and researchers with expertise in exhaled biomarkers were invited to participate. Published studies regarding methodology of breath tests were selected, discussed and evaluated in a consensus-based manner by the Task Force members.Recommendations for standardisation of sampling, analysing and reporting of data and suggestions for research to cover gaps in the evidence have been created and summarised.Application of breath biomarker measurement in a standardised manner will provide comparable results, thereby facilitating the potential use of these biomarkers in clinical practice.
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Affiliation(s)
- Ildiko Horváth
- Dept of Pulmonology, National Korányi Institute of Pulmonology, Budapest, Hungary
| | - Peter J Barnes
- National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, London, UK
| | | | - Peter J Sterk
- Dept of Respiratory Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Marieann Högman
- Centre for Research & Development, Uppsala University/Gävleborg County Council, Gävle, Sweden
| | - Anna-Carin Olin
- Occupational and Environmental Medicine, Sahlgrenska Academy and University Hospital, Goteborg, Sweden
| | - Anton Amann
- Innsbruck Medical University, Innsbruck, Austria
| | - Balazs Antus
- Dept of Pathophysiology, National Korányi Institute of Pulmonology, Budapest, Hungary
| | | | - Andras Bikov
- Dept of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Agnes W Boots
- Dept of Pharmacology and Toxicology, University of Maastricht, Maastricht, The Netherlands
| | - Lieuwe D Bos
- Intensive Care, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Paul Brinkman
- Dept of Respiratory Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Caterina Bucca
- Biomedical Sciences and Human Oncology, Universita' di Torino, Turin, Italy
| | | | | | - Simona Cristescu
- Dept of Molecular and Laser Physics, Institute for Molecules and Materials, Radboud University, Nijmegen, The Netherlands
| | - Johan C de Jongste
- Dept of Pediatrics/Respiratory Medicine, Erasmus MC-Sophia Childrens' Hospital, Rotterdam, The Netherlands
| | | | - Edward Dompeling
- Dept of Paediatrics/Family Medicine Research School CAPHRI, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Niki Fens
- Dept of Respiratory Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Stephen Fowler
- Respiratory Research Group, University of Manchester Wythenshawe Hospital, Manchester, UK
| | - Jens M Hohlfeld
- Clinical Airway Research, Fraunhofer Institute of Toxicology and Experimental Medicine (ITEM), Hannover, Germany.,Medizinische Hochschule Hannover, Hannover, Germany
| | - Olaf Holz
- Clinical Airway Research, Fraunhofer Institute of Toxicology and Experimental Medicine (ITEM), Hannover, Germany
| | - Quirijn Jöbsis
- Department of Paediatric Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Kim Van De Kant
- Dept of Paediatrics/Family Medicine Research School CAPHRI, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Hugo H Knobel
- Philips Research, High Tech Campus 11, Eindhoven, The Netherlands
| | | | | | - Jon Lundberg
- Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Paolo Montuschi
- Pharmacology, Catholic University of the Sacred Heart, Rome, Italy
| | - Alain Van Muylem
- Hopital Erasme Cliniques Universitaires de Bruxelles, Bruxelles, Belgium
| | - Giorgio Pennazza
- Faculty of Engineering, University Campus Bio-Medico, Rome, Italy
| | - Petra Reinhold
- Institute of Molecular Pathogenesis, Friedrich Loeffler Institut, Jena, Germany
| | - Fabio L M Ricciardolo
- Clinic of Respiratory Disease, Dept of Clinical and Biological Sciences, University of Torino, Torino, Italy
| | - Philippe Rosias
- Dept of Paediatrics/Family Medicine Research School CAPHRI, Maastricht University Medical Centre, Maastricht, The Netherlands.,Dept of Pediatrics, Maasland Hospital, Sittard, The Netherlands
| | - Marco Santonico
- Faculty of Engineering, University Campus Bio-Medico, Rome, Italy
| | - Marc P van der Schee
- Dept of Respiratory Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | | | | | - Thomy Tonia
- European Respiratory Society, Lausanne, Switzerland
| | - Teunis J Vink
- Philips Research, High Tech Campus 11, Eindhoven, The Netherlands
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26
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Djukanović R, Bruselle G, Walker S, Holgate ST, Škrgat S, Kuna P, Heaney LG, Canonica GW, Vestbo J. The era of research collaborations: new models for working together. Eur Respir J 2017; 49:1601848. [PMID: 28049174 DOI: 10.1183/13993003.01848-2016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 09/20/2016] [Indexed: 12/31/2022]
Affiliation(s)
- Ratko Djukanović
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- NIHR Southampton Respiratory Biomedical Research Unit, Southampton, UK
| | - Guy Bruselle
- Dept of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Samantha Walker
- Asthma UK, London, UK
- European Asthma Research and Innovation Partnership, London, UK
| | - Stephen T Holgate
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- NIHR Southampton Respiratory Biomedical Research Unit, Southampton, UK
| | - Sabina Škrgat
- University Clinic of Respiratory and Allergic Diseases, Golnik, Slovenia
| | - Piotr Kuna
- Division of Internal Medicine, Asthma and Allergy, Faculty of Medicine, Medical University of Lodz, Lodz, Poland
| | - Liam G Heaney
- Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - G Walter Canonica
- Allergy and Respiratory Diseases Clinic, DIMI Dept of Internal Medicine, University of Genoa - IRCCS San Martino, Genoa, Italy
| | - Jørgen Vestbo
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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27
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Bush A. Persistent Bacterial Bronchitis: Time to Venture beyond the Umbrella. Front Pediatr 2017; 5:264. [PMID: 29322037 PMCID: PMC5732151 DOI: 10.3389/fped.2017.00264] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Accepted: 11/27/2017] [Indexed: 01/23/2023] Open
Abstract
Chronic cough in children is common and frequently mismanaged. In the past, cough was diagnosed as asthma and inappropriate asthma therapies prescribed and escalated. It has been realized that persistent bacterial bronchitis (PBB) is a common cause of wet cough and responds to oral antibiotics. The initial definition comprised a history of chronic wet cough, positive bronchoalveolar (BAL) cultures for a respiratory pathogen and response to a 2-week course of oral amoxicillin-clavulanic acid. This is now termed PBB-micro; PBB-clinical eliminates the need for BAL. PBB-extended is PBB-micro or PBB-clinical but resolution necessitating 4 weeks of antibiotics; and recurrent PBB is >3 attacks of PBB-micro or-clinical/year. However, the airway has only a limited range of responses to chronic inflammation and infection, and neutrophilic airway disease is seen in many other conditions, such as cystic fibrosis and primary ciliary dyskinesia, both chronic suppurative lung disease endotypes, whose recognition has led to huge scientific and clinical advances. There is an urgent need to extend endotyping into PBB, especially PBB-recurrent. We need to move from associative studies and, in particular, deploy sophisticated modern -omics technologies and systems biology, rather as has been done in the context of asthma in U-BIOPRED. In summary, the use of the term PBB has done signal service in pointing us away from prescribing asthma therapies to children with infected airways, but we now need to move beyond a simple description to teasing out underlying endotypes.
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Affiliation(s)
- Andrew Bush
- Imperial College London, London, United Kingdom.,National Heart and Lung Institute, London, United Kingdom.,Royal Brompton Harefield NHS Foundation Trust, London, United Kingdom
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28
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Najafi A, Ghanei M, Jamalkandi SA. Airway remodeling: Systems biology approach, from bench to bedside. Technol Health Care 2016; 24:811-819. [PMID: 27315153 DOI: 10.3233/thc-161228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Airway Remodeling, a patho-physiologic process, is considered as a key feature of chronic airway diseases. In recent years, our understanding of the complex diseases has increased significantly by the use of combined approaches, including systems biology, which may contribute to the development of personalized and predictive medicine approaches. Integrative analysis, along with the cooperation of clinicians, computer scientists, research scientists, and bench scientists, has become an important part of the experimental design and therapeutic strategies in the era of omics. The airway remodeling process is the result of the dysregulation of several signaling pathways that modulate the airway regeneration; therefore, high-throughput experiments and systems biology approach can help to understand this process better. The study reviews related literature and is consistent with the existing clinical evidence.
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Affiliation(s)
- Ali Najafi
- Molecular Biology Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mostafa Ghanei
- Chemical Injury Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
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29
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Systems Medicine for Lung Diseases: Phenotypes and Precision Medicine in Cancer, Infection, and Allergy. Methods Mol Biol 2016; 1386:119-33. [PMID: 26677183 PMCID: PMC7153428 DOI: 10.1007/978-1-4939-3283-2_8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Lung diseases cause an enormous socioeconomic burden. Four of them are among the ten most important causes of deaths worldwide: Pneumonia has the highest death toll of all infectious diseases, lung cancer kills the most people of all malignant proliferative disorders, chronic obstructive pulmonary disease (COPD) ranks third in mortality among the chronic noncommunicable diseases, and tuberculosis is still one of the most important chronic infectious diseases. Despite all efforts, for example, by the World Health Organization and clinical and experimental researchers, these diseases are still highly prevalent and harmful. This is in part due to the specific organization of tissue homeostasis, architecture, and immunity of the lung. Recently, several consortia have formed and aim to bring together clinical and molecular data from big cohorts of patients with lung diseases with novel experimental setups, biostatistics, bioinformatics, and mathematical modeling. This "systems medicine" concept will help to match the different disease modalities with adequate therapeutic and possibly preventive strategies for individual patients in the sense of precision medicine.
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30
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Bos LD, Schouten LR, Schultz MJ. Promising but still uncertain steps towards better prediction of functional outcome in ICU patients. J Thorac Dis 2016; 8:E838-40. [PMID: 27619335 DOI: 10.21037/jtd.2016.07.08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Lieuwe D Bos
- Department of Intensive Care, University of Amsterdam, The Netherlands; Department of Respiratory Medicine, University of Amsterdam, The Netherlands; Laboratory for Experimental Intensive Care and Anesthesiology (L·E·I·C·A), University of Amsterdam, The Netherlands
| | - Laura R Schouten
- Department of Intensive Care, University of Amsterdam, The Netherlands; Laboratory for Experimental Intensive Care and Anesthesiology (L·E·I·C·A), University of Amsterdam, The Netherlands; Department of Pediatrics, Academic medical Center, University of Amsterdam, The Netherlands
| | - Marcus J Schultz
- Department of Intensive Care, University of Amsterdam, The Netherlands; Laboratory for Experimental Intensive Care and Anesthesiology (L·E·I·C·A), University of Amsterdam, The Netherlands
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31
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Metabolomics Profiling for Obstructive Sleep Apnea and Simple Snorers. Sci Rep 2016; 6:30958. [PMID: 27480913 PMCID: PMC4969608 DOI: 10.1038/srep30958] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 07/12/2016] [Indexed: 12/17/2022] Open
Abstract
Few clinical studies have explored altered urinary metabolite levels in patients with obstructive sleep apnea (OSA). Thus, we applied a metabolomics approach to analyze urinary metabolites in three groups of participants: patients with polysomnography (PSG)-confirmed OSA, simple snorers (SS), and normal subjects. Ultra-performance liquid chromatography coupled with quadrupole time-of-flight mass spectrometry and gas chromatography coupled with time-of-flight mass spectrometry were used. A total of 21 and 31 metabolites were differentially expressed in the SS and OSA groups, respectively. Patients with OSA had 18 metabolites different from those with SS. Of the 56 metabolites detected among the 3 groups, 24 were consistently higher or lower. A receiver operator curve analysis revealed that the combination of 4-hydroxypentenoic acid, arabinose, glycochenodeoxycholate-3-sulfate, isoleucine, serine, and xanthine produced a moderate diagnostic score with a sensitivity (specificity) of 75% (78%) for distinguishing OSA from those without OSA. The combination of 4-hydroxypentenoic acid, 5-dihydrotestosterone sulfate, serine, spermine, and xanthine distinguished OSA from SS with a sensitivity of 85% and specificity of 80%. Multiple metabolites and metabolic pathways associated with SS and OSA were identified using the metabolomics approach, and the altered metabolite signatures could potentially serve as an alternative diagnostic method to PSG.
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32
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Kumar A, Pathak RK, Gupta SM, Gaur VS, Pandey D. Systems Biology for Smart Crops and Agricultural Innovation: Filling the Gaps between Genotype and Phenotype for Complex Traits Linked with Robust Agricultural Productivity and Sustainability. OMICS-A JOURNAL OF INTEGRATIVE BIOLOGY 2016; 19:581-601. [PMID: 26484978 DOI: 10.1089/omi.2015.0106] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
In recent years, rapid developments in several omics platforms and next generation sequencing technology have generated a huge amount of biological data about plants. Systems biology aims to develop and use well-organized and efficient algorithms, data structure, visualization, and communication tools for the integration of these biological data with the goal of computational modeling and simulation. It studies crop plant systems by systematically perturbing them, checking the gene, protein, and informational pathway responses; integrating these data; and finally, formulating mathematical models that describe the structure of system and its response to individual perturbations. Consequently, systems biology approaches, such as integrative and predictive ones, hold immense potential in understanding of molecular mechanism of agriculturally important complex traits linked to agricultural productivity. This has led to identification of some key genes and proteins involved in networks of pathways involved in input use efficiency, biotic and abiotic stress resistance, photosynthesis efficiency, root, stem and leaf architecture, and nutrient mobilization. The developments in the above fields have made it possible to design smart crops with superior agronomic traits through genetic manipulation of key candidate genes.
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Affiliation(s)
| | - Rajesh Kumar Pathak
- 2 Department of Biotechnology, G. B. Pant Engineering College , Pauri Garhwal-246194, Uttarakhand, India
| | - Sanjay Mohan Gupta
- 3 Molecular Biology and Genetic Engineering Laboratory, Defence Institute of Bio-Energy Research , DRDO, Haldwani, Uttarakhand, India
| | - Vikram Singh Gaur
- 4 College of Agriculture , Waraseoni, Balaghat, Madhya Pradesh, India
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33
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Rootmensen G, van Keimpema A, Zwinderman A, Sterk P. Clinical phenotypes of obstructive airway diseases in an outpatient population. J Asthma 2016; 53:1026-32. [PMID: 27366830 DOI: 10.3109/02770903.2016.1174258] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND OBJECTIVES Historically, obstructive airway diseases such as asthma and COPD are classified as different diseases. Although the definitions are clearly described, classification of patients into these traditional, clinical disease entity can be difficult. Recent evidence that there are complex, overlapping phenotypes of obstructive lung disease. Our aim was to capture clinical phenotypes of obstructive diseases through the use of cluster analysis in a representative patient population at a common Dutch pulmonary outpatient clinic. Clinical physiological and cellular/ molecular markers were used in the analysis. METHODS To carry out the cluster analysis, an imputed dataset was created from a random sample of 191 adult patients chosen from a pulmonary outpatient clinic. The selection criteria from the sample included patients with a doctor's diagnosis for asthma or COPD. Detailed assessment of patient pulmonary function, blood eosinophil counts, allergic sensitisation and smoking history was collected. RESULTS We observed four distinct clusters with different clinical characteristics of obstructive lung diseases. Cluster 1: patients with a history of extensive cigarette smoking, airway obstruction without signs of emphysema; cluster 2: patients with features of the emphysematous type of COPD; cluster 3: patients with characteristics of allergic asthma; cluster 4: patients with features suggesting an overlap syndrome of atopic asthma and COPD. CONCLUSION Four phenotypes of obstructive lung disease were identified amongst patients clinically labelled as asthma or COPD. These findings emphasize the concept that there are different phenotypes of obstructive lung diseases, including overlapping and complementary disease entities. These phenotypes of chronic airways disease can serve to tailor disease management.
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Affiliation(s)
- Geert Rootmensen
- a Department of Pulmonology , Academic Medical Centre , Amsterdam , the Netherlands.,b Department of Pulmonology , Waterland ziekenhuis , Purmerend , the Netherlands
| | - Anton van Keimpema
- c Department of Pulmonology , Astmacentrum Heideheuvel , the Netherlands
| | - Aeilko Zwinderman
- d Clinical Research Unit, Academic Medical Centre , Amsterdam , the Netherlands
| | - Peter Sterk
- a Department of Pulmonology , Academic Medical Centre , Amsterdam , the Netherlands
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Hoefer CC, Blair RH, Blanco JG. Development of a CART Model to Predict the Synthesis of Cardiotoxic Daunorubicinol in Heart Tissue Samples From Donors With and Without Down Syndrome. J Pharm Sci 2016; 105:2005-2008. [PMID: 27112290 DOI: 10.1016/j.xphs.2016.03.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 02/26/2016] [Accepted: 03/11/2016] [Indexed: 01/16/2023]
Abstract
Daunorubicin (DAUN) and doxorubicin (DOX) are used to treat a variety of cancers. The use of DAUN and DOX is hampered by the development of cardiotoxicity. Clinical evidence suggests that patients with leukemia and Down syndrome are at increased risk for anthracycline-related cardiotoxicity. Carbonyl reductases and aldo-keto reductases (AKRs) catalyze the reduction of DAUN and DOX into cardiotoxic C-13 alcohol metabolites. Anthracyclines also exert cardiotoxicity by triggering mitochondrial dysfunction. In recent studies, a collection of heart samples from donors with and without Down syndrome was used to investigate determinants for anthracycline-related cardiotoxicity including cardiac daunorubicin reductase activity (DA), carbonyl reductase/AKRs protein expression, mitochondrial DNA content (mtDNA), and AKR7A2 DNA methylation status. In this study, the available demographic, biochemical, genetic, and epigenetic data were integrated through classification and regression trees analysis with the aim of pinpointing the most relevant variables for the synthesis of cardiotoxic daunorubicinol (i.e., DA). Seventeen variables were considered as potential predictors. Leave-one-out-cross-validation was performed for model selection and to estimate the generalization error. The classification and regression trees analysis model and variable importance measures suggest that cardiac mtDNA content, mtDNA(4977) deletion frequency, and AKR7A2 protein content are the most important variables in determining DA.
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Affiliation(s)
- Carrie C Hoefer
- Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, The State University of New York at Buffalo, Buffalo, New York 14260
| | - Rachael Hageman Blair
- Department of Biostatistics, School of Public Health and Health Professions, The State University of New York at Buffalo, Buffalo, New York 14260
| | - Javier G Blanco
- Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, The State University of New York at Buffalo, Buffalo, New York 14260.
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Disease-specific dynamic biomarkers selected by integrating inflammatory mediators with clinical informatics in ARDS patients with severe pneumonia. Cell Biol Toxicol 2016; 32:169-84. [PMID: 27095254 PMCID: PMC4882347 DOI: 10.1007/s10565-016-9322-4] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 03/22/2016] [Indexed: 12/18/2022]
Abstract
Acute respiratory distress syndrome (ARDS) is a heterogeneous syndrome that occurs as a result of various risk factors, including either direct or indirect lung injury, and systemic inflammation triggered also by severe pneumonia (SP). SP-ARDS-associated morbidity and mortality remains high also due to the lack of disease-specific biomarkers. The present study aimed at identifying disease-specific biomarkers in SP or SP-ARDS by integrating proteomic profiles of inflammatory mediators with clinical informatics. Plasma was sampled from the healthy as controls or patients with SP infected with bacteria or infection-associated SP-ARDS on the day of admission, day 3, and day 7. About 15 or 52 cytokines showed significant difference between SP and SP-ARDS patients with controls or 13 between SP-ARDS with SP alone and controls, including bone morphogenetic protein-15 (BMP-15), chemokine (C-X-C motif) ligand 16 (CXCL16), chemokine (C-X-C motif) receptor 3 (CXCR3), interleukin-6 (IL-6), protein NOV homolog (NOV/CCN3), glypican 3, insulin-like growth factor binding protein 4 (IGFBP-4), IL-5, IL-5 R alpha, IL-22 BP, leptin, MIP-1d, and orexin B with a significant correlation with Digital Evaluation Score System (DESS) scores. ARDS patients with overexpressed IL-6, CXCL16, or IGFBP-4 had significantly longer hospital stay and higher incidence of secondary infection. We also found higher levels of those mediators were associated with poor survival rates in patients with lung cancer and involved in the process of the epithelial mesenchymal transition of alveolar epithelial cells. Our preliminary study suggested that integration of proteomic profiles with clinical informatics as part of clinical bioinformatics is important to validate and optimize disease-specific and disease-staged biomarkers.
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Levy BD, Noel PJ, Freemer MM, Cloutier MM, Georas SN, Jarjour NN, Ober C, Woodruff PG, Barnes KC, Bender BG, Camargo CA, Chupp GL, Denlinger LC, Fahy JV, Fitzpatrick AM, Fuhlbrigge A, Gaston BM, Hartert TV, Kolls JK, Lynch SV, Moore WC, Morgan WJ, Nadeau KC, Ownby DR, Solway J, Szefler SJ, Wenzel SE, Wright RJ, Smith RA, Erzurum SC. Future Research Directions in Asthma. An NHLBI Working Group Report. Am J Respir Crit Care Med 2016; 192:1366-72. [PMID: 26305520 DOI: 10.1164/rccm.201505-0963ws] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Asthma is a common chronic disease without cure. Our understanding of asthma onset, pathobiology, classification, and management has evolved substantially over the past decade; however, significant asthma-related morbidity and excess healthcare use and costs persist. To address this important clinical condition, the NHLBI convened a group of extramural investigators for an Asthma Research Strategic Planning workshop on September 18-19, 2014, to accelerate discoveries and their translation to patients. The workshop focused on (1) in utero and early-life origins of asthma, (2) the use of phenotypes and endotypes to classify disease, (3) defining disease modification, (4) disease management, and (5) implementation research. This report summarizes the workshop and produces recommendations to guide future research in asthma.
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Affiliation(s)
- Bruce D Levy
- 1 Brigham and Women's Hospital, Boston, Massachusetts
| | - Patricia J Noel
- 2 National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | | | | | | | - Nizar N Jarjour
- 5 University of Wisconsin Hospital and Clinics, Madison, Wisconsin
| | - Carole Ober
- 6 The University of Chicago, Chicago, Illinois
| | | | | | | | | | - Geoff L Chupp
- 11 Yale University School of Medicine, New Haven, Connecticut
| | | | - John V Fahy
- 7 University of California at San Francisco, San Francisco, California
| | | | | | - Ben M Gaston
- 13 Case Western Reserve University, Cleveland, Ohio
| | - Tina V Hartert
- 14 Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Jay K Kolls
- 15 University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Susan V Lynch
- 7 University of California at San Francisco, San Francisco, California
| | - Wendy C Moore
- 16 Wake Forest School of Medicine, Winston Salem, North Carolina
| | | | - Kari C Nadeau
- 18 Stanford School of Medicine, Stanford, California
| | | | | | - Stanley J Szefler
- 20 Children's Hospital Colorado and the University of Colorado School of Medicine, Denver, Colorado
| | - Sally E Wenzel
- 15 University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | - Robert A Smith
- 2 National Heart, Lung, and Blood Institute, Bethesda, Maryland
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Benson M. Clinical implications of omics and systems medicine: focus on predictive and individualized treatment. J Intern Med 2016; 279:229-40. [PMID: 26891944 DOI: 10.1111/joim.12412] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Many patients with common diseases do not respond to treatment. This is a key challenge to modern health care, which causes both suffering and enormous costs. One important reason for the lack of treatment response is that common diseases are associated with altered interactions between thousands of genes, in combinations that differ between subgroups of patients who do or do not respond to a given treatment. Such subgroups, or even distinct disease entities, have been described recently in asthma, diabetes, autoimmune diseases and cancer. High-throughput techniques (omics) allow identification and characterization of such subgroups or entities. This may have important clinical implications, such as identification of diagnostic markers for individualized medicine, as well as new therapeutic targets for patients who do not respond to existing drugs. For example, whole-genome sequencing may be applied to more accurately guide treatment of neurodevelopmental diseases, or to identify drugs specifically targeting mutated genes in cancer. A study published in 2015 showed that 28% of hepatocellular carcinomas contained mutated genes that potentially could be targeted by drugs already approved by the US Food and Drug Administration. A translational study, which is described in detail, showed how combined omics, computational, functional and clinical studies could identify and validate a novel diagnostic and therapeutic candidate gene in allergy. Another important clinical implication is the identification of potential diagnostic markers and therapeutic targets for predictive and preventative medicine. By combining computational and experimental methods, early disease regulators may be identified and potentially used to predict and treat disease before it becomes symptomatic. Systems medicine is an emerging discipline, which may contribute to such developments through combining omics with computational, functional and clinical studies. The aims of this review are to provide a brief introduction to systems medicine and discuss how it may contribute to the clinical implementation of individualized treatment, using clinically relevant examples.
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Affiliation(s)
- M Benson
- Centre for Individualized Medicine, Department of Pediatrics, Faculty of Health Sciences, Linköping University, Linköping, Sweden
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Chung KF. Asthma phenotyping: a necessity for improved therapeutic precision and new targeted therapies. J Intern Med 2016; 279:192-204. [PMID: 26076339 DOI: 10.1111/joim.12382] [Citation(s) in RCA: 104] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Asthma is a common heterogeneous disease with a complex pathophysiology that carries a significant mortality rate and high morbidity. Current therapies based on inhaled corticosteroids and long-acting β-agonists remain effective in a large proportion of patients with asthma, but ~10% (considered to have 'severe asthma') do not respond to these treatments even at high doses or with the use of oral corticosteroids. Analytical clustering methods have revealed phenotypes that include dependence on high-dose corticosteroid treatment, severe airflow obstruction and recurrent exacerbations associated with an allergic background and late onset of disease. One severe phenotype is eosinophilic inflammation-predominant asthma, with late-onset disease, rhinosinusitis, aspirin sensitivity and exacerbations. Blood and sputum eosinophilia have been used to distinguish patients with high Th2 inflammation and to predict therapeutic response to treatments targeted towards Th2-associated cytokines. New therapies in the form of humanized antibodies against Th2 targets, such as anti-IgE, anti-IL4Rα, anti-IL-5 and anti-IL-13 antibodies, have shown encouraging results in terms of reduction in exacerbations and improvement in airflow in patients with a 'Th2-high' expression profile and blood eosinophilia. Research efforts are now focusing on elucidating the phenotypes underlying the non-Th2-high (or Th2-low) group, which constitutes ~50% of severe asthma cases. There is an increasing need to use biomarkers to indicate the group of patients who will respond to a specifically targeted treatment. The use of improved tools to measure activity of disease, a better definition of severe asthma and the delineation of inflammatory pathways with omics analyses using computational tools, will lead to better-defined phenotypes for specific therapies.
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Affiliation(s)
- Kian Fan Chung
- Airway Disease Section, National Heart and Lung Institute, Imperial College London, London, UK.,National Institute for Health Research (NIHR), Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Trust and Imperial College London, London, UK
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Mei H, Feng G, Zhu J, Lin S, Qiu Y, Wang Y, Xia T. A Practical Guide for Exploring Opportunities of Repurposing Drugs for CNS Diseases in Systems Biology. Methods Mol Biol 2016; 1303:531-547. [PMID: 26235090 DOI: 10.1007/978-1-4939-2627-5_33] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Systems biology has shown its potential in facilitating pathway-focused therapy development for central nervous system (CNS) diseases. An integrated network can be utilized to explore the multiple disease mechanisms and to discover repositioning opportunities. This review covers current therapeutic gaps for CNS diseases and the role of systems biology in pharmaceutical industry. We conclude with a Multiple Level Network Modeling (MLNM) example to illustrate the great potential of systems biology for CNS diseases. The system focuses on the benefit and practical applications in pathway centric therapy and drug repositioning.
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Affiliation(s)
- Hongkang Mei
- Informatics and Structure Biology, R&D China, GlaxoSmithKline, 917 Halei Road, Shanghai, 201203, China
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Saqi M, Pellet J, Roznovat I, Mazein A, Ballereau S, De Meulder B, Auffray C. Systems Medicine: The Future of Medical Genomics, Healthcare, and Wellness. Methods Mol Biol 2016; 1386:43-60. [PMID: 26677178 DOI: 10.1007/978-1-4939-3283-2_3] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Recent advances in genomics have led to the rapid and relatively inexpensive collection of patient molecular data including multiple types of omics data. The integration of these data with clinical measurements has the potential to impact on our understanding of the molecular basis of disease and on disease management. Systems medicine is an approach to understanding disease through an integration of large patient datasets. It offers the possibility for personalized strategies for healthcare through the development of a new taxonomy of disease. Advanced computing will be an important component in effectively implementing systems medicine. In this chapter we describe three computational challenges associated with systems medicine: disease subtype discovery using integrated datasets, obtaining a mechanistic understanding of disease, and the development of an informatics platform for the mining, analysis, and visualization of data emerging from translational medicine studies.
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Affiliation(s)
- Mansoor Saqi
- European Institute for Systems Biology and Medicine, CNRS-ENS-UCBL, Université de Lyon, 50 Avenue Tony Garnier, Lyon, 69007, France
| | - Johann Pellet
- European Institute for Systems Biology and Medicine, CNRS-ENS-UCBL, Université de Lyon, 50 Avenue Tony Garnier, Lyon, 69007, France
| | - Irina Roznovat
- European Institute for Systems Biology and Medicine, CNRS-ENS-UCBL, Université de Lyon, 50 Avenue Tony Garnier, Lyon, 69007, France
| | - Alexander Mazein
- European Institute for Systems Biology and Medicine, CNRS-ENS-UCBL, Université de Lyon, 50 Avenue Tony Garnier, Lyon, 69007, France
| | - Stéphane Ballereau
- European Institute for Systems Biology and Medicine, CNRS-ENS-UCBL, Université de Lyon, 50 Avenue Tony Garnier, Lyon, 69007, France
| | - Bertrand De Meulder
- European Institute for Systems Biology and Medicine, CNRS-ENS-UCBL, Université de Lyon, 50 Avenue Tony Garnier, Lyon, 69007, France
| | - Charles Auffray
- European Institute for Systems Biology and Medicine, CNRS-ENS-UCBL, Université de Lyon, 50 Avenue Tony Garnier, Lyon, 69007, France. .,Université Claude Bernard, 3e étage plot 2, 50 Avenue Tony Garnier, Lyon, Cedex 07, 69366, France.
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Smit HA, Pinart M, Antó JM, Keil T, Bousquet J, Carlsen KH, Moons KGM, Hooft L, Carlsen KCL. Childhood asthma prediction models: a systematic review. THE LANCET RESPIRATORY MEDICINE 2015; 3:973-84. [PMID: 26597131 DOI: 10.1016/s2213-2600(15)00428-2] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 10/12/2015] [Accepted: 10/13/2015] [Indexed: 11/26/2022]
Abstract
Early identification of children at risk of developing asthma at school age is crucial, but the usefulness of childhood asthma prediction models in clinical practice is still unclear. We systematically reviewed all existing prediction models to identify preschool children with asthma-like symptoms at risk of developing asthma at school age. Studies were included if they developed a new prediction model or updated an existing model in children aged 4 years or younger with asthma-like symptoms, with assessment of asthma done between 6 and 12 years of age. 12 prediction models were identified in four types of cohorts of preschool children: those with health-care visits, those with parent-reported symptoms, those at high risk of asthma, or children in the general population. Four basic models included non-invasive, easy-to-obtain predictors only, notably family history, allergic disease comorbidities or precursors of asthma, and severity of early symptoms. Eight extended models included additional clinical tests, mostly specific IgE determination. Some models could better predict asthma development and other models could better rule out asthma development, but the predictive performance of no single model stood out in both aspects simultaneously. This finding suggests that there is a large proportion of preschool children with wheeze for which prediction of asthma development is difficult.
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Affiliation(s)
- Henriette A Smit
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands.
| | - Mariona Pinart
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Hospital del Mar Research Institute (IMIM), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain; Department of Experimental and Health Sciences, University of Pompeu Fabra (UPF), Barcelona, Spain
| | - Josep M Antó
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Hospital del Mar Research Institute (IMIM), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain; Department of Experimental and Health Sciences, University of Pompeu Fabra (UPF), Barcelona, Spain
| | - Thomas Keil
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Germany; Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - Jean Bousquet
- WHO Collaborating Center for Asthma and Rhinitis, Montpellier, France; University Hospital of Montpellier, Hôpital Arnaud de Villeneuve, Montpellier, France
| | - Kai H Carlsen
- Department of Paediatrics, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Karel G M Moons
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands; Dutch Cochrane Centre, Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Lotty Hooft
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands; Dutch Cochrane Centre, Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Karin C Lødrup Carlsen
- Department of Paediatrics, Oslo University Hospital and University of Oslo, Oslo, Norway
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Canonica GW, Bachert C, Hellings P, Ryan D, Valovirta E, Wickman M, De Beaumont O, Bousquet J. Allergen Immunotherapy (AIT): a prototype of Precision Medicine. World Allergy Organ J 2015; 8:31. [PMID: 26594303 PMCID: PMC4640346 DOI: 10.1186/s40413-015-0079-7] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 08/23/2015] [Indexed: 11/10/2022] Open
Abstract
Precision medicine is a medical model aiming to deliver customised healthcare - with medical decisions, practices, and/or products tailored to the individual patient informed but not directed by guidelines. Allergen immunotherapy has unique immunological rationale, since the approach is tailored to the specific IgE spectrum of an individual and modifies the natural course of the disease as it has a persistent efficacy after completion of treatment. In this perspective Allergen Immunotherapy - AIT has to be presently considered a prototype of Precision Medicine. Precise information and biomarkers provided by systems medicine and network medicine will address the discovery of Allergen immunotherapy biomarkers for (i) identification of the causes, (ii) stratification of eligible patients for AIT and (iii) the assessment of AIT efficacy. This area of medical technology is evolving rapidly and, compelemented by e-health, will change the way we practice medicine. It will help to monitor patients’ disease control and data for (i) patient stratification, (ii) clinical trials, (iii) monitoring the efficacy and safety of targeted therapies which are critical for reaching an appropriate reimbursement. Biomarkers associated with e-health combined with a clinical decision support system (CDSS) will change the scope of Allergen immunotherapy. The cost/effectiveness of Allergen immunotherapy is a key issue for successful implementation. It should include the long-term benefits in the pharmaco-economic evaluation, since no other allergy treatment has this specific characteristic. AIT is the prototype of current and future precision medicine.
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Affiliation(s)
- G W Canonica
- Allergy and Respiratory Diseases -DIMI Department of Internal Medicine, University of Genova, IRCCS AOU San Martino, Genova, 16132 Italy
| | - C Bachert
- Upper Airways Research Laboratory, ENT-Department, University of Ghent, 9000 Ghent, Belgium
| | - P Hellings
- Department of Otorhinolaryngology, University of Leuven, Leuven, Belgium ; Department of Otorhinolaryngology, University of Amsterdam, Amsterdam, The Netherlands
| | - D Ryan
- Allergy and Respiratory Research Group, Centre for Population Health Sciences, University of Edinburgh, Edinburgh, EH8 9AG UK
| | - E Valovirta
- Department of Pulmonary and Allergic Diseases and Clinical Allergology, University of Turku, Turku, Finland
| | - M Wickman
- Department of Environmental Medecine, Karolinska Institutet, Sachs' Children's Hospital, Stockholm, Sweden
| | | | - J Bousquet
- University hospital, Montpellier, MACVIA-LR, Contre les Maladies Chronique spour un Vieillissement Actif en Languedoc Roussilon, European Innovation Partnership on Active and Healthy Ageing Reference Site, Montpellier, France ; INSERM, VIMA : Ageing and chronic diseases Epidemiological and public health approaches, U1168 Paris, France ; UVSQ, UMR-S 1168, Université Versailles St-Quentin-en-Yvelines, Versailles, France
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Fleming L, Murray C, Bansal AT, Hashimoto S, Bisgaard H, Bush A, Frey U, Hedlin G, Singer F, van Aalderen WM, Vissing NH, Zolkipli Z, Selby A, Fowler S, Shaw D, Chung KF, Sousa AR, Wagers S, Corfield J, Pandis I, Rowe A, Formaggio E, Sterk PJ, Roberts G. The burden of severe asthma in childhood and adolescence: results from the paediatric U-BIOPRED cohorts. Eur Respir J 2015; 46:1322-33. [PMID: 26405287 DOI: 10.1183/13993003.00780-2015] [Citation(s) in RCA: 153] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 08/23/2015] [Indexed: 11/05/2022]
Abstract
U-BIOPRED aims to characterise paediatric and adult severe asthma using conventional and innovative systems biology approaches. A total of 99 school-age children with severe asthma and 81 preschoolers with severe wheeze were compared with 49 school-age children with mild/moderate asthma and 53 preschoolers with mild/moderate wheeze in a cross-sectional study. Despite high-dose treatment, the severe cohorts had more severe exacerbations compared with the mild/moderate ones (annual medians: school-aged 3.0 versus 1.1, preschool 3.9 versus 1.8; p<0.001). Exhaled tobacco exposure was common in the severe wheeze cohort. Almost all participants in each cohort were atopic and had a normal body mass index. Asthma-related quality of life, as assessed by the Paediatric Asthma Quality of Life Questionnaire (PAQLQ) and the Paediatric Asthma Caregiver's Quality of Life Questionnaire (PACQLQ), was worse in the severe cohorts (mean±se school-age PAQLQ: 4.77±0.15 versus 5.80±0.19; preschool PACQLQ: 4.27±0.18 versus 6.04±0.18; both p≤0.001); however, mild/moderate cohorts also had significant morbidity. Impaired quality of life was associated with poor control and airway obstruction. Otherwise, the severe and mild/moderate cohorts were clinically very similar. Children with severe preschool wheeze or severe asthma are usually atopic and have impaired quality of life that is associated with poor control and airflow limitation: a very different phenotype from adult severe asthma. In-depth phenotyping of these children, integrating clinical data with high-dimensional biomarkers, may help to improve and tailor their clinical management.
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Affiliation(s)
- Louise Fleming
- National Heart and Lung Institute, Imperial College London, London, UK NIHR Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, UK NIHR Biomedical Research Unit, Royal Brompton NHS Trust, London, UK
| | - Clare Murray
- Centre for Respiratory Medicine and Allergy, The University of Manchester, Manchester Academic Health Science Centre, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
| | - Aruna T Bansal
- Acclarogen Ltd, St John's Innovation Centre, Cambridge, UK
| | - Simone Hashimoto
- Dept of Respiratory Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Hans Bisgaard
- Copenhagen Prospective Studies on Asthma in Childhood, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Andrew Bush
- National Heart and Lung Institute, Imperial College London, London, UK NIHR Biomedical Research Unit, Royal Brompton NHS Trust, London, UK Dept of Paediatrics, Imperial College London, London, UK Dept of Respiratory Paediatrics, Royal Brompton Hospital, London, UK
| | - Urs Frey
- University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland
| | - Gunilla Hedlin
- Dept of Women's and Children's Health and Center for Allergy Research, Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden
| | - Florian Singer
- University Children's Hospital Zurich, Zurich, Switzerland University Children's Hospital Bern, Bern, Switzerland
| | - Wim M van Aalderen
- Dept of Paediatric Respiratory Medicine and Allergy, Emma Children's Hospital, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Nadja H Vissing
- Copenhagen Prospective Studies on Asthma in Childhood, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Zaraquiza Zolkipli
- NIHR Southampton Respiratory Biomedical Research Unit, Clinical and Experimental Sciences and Human Development and Health, Southampton, UK Faculty of Medicine, University of Southampton, Southampton, UK The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Isle of Wight, UK
| | - Anna Selby
- NIHR Southampton Respiratory Biomedical Research Unit, Clinical and Experimental Sciences and Human Development and Health, Southampton, UK Faculty of Medicine, University of Southampton, Southampton, UK The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Isle of Wight, UK
| | - Stephen Fowler
- Centre for Respiratory Medicine and Allergy, The University of Manchester, Manchester Academic Health Science Centre, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK Airways Clinic, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Dominick Shaw
- Respiratory Research Unit, University of Nottingham, Nottingham, UK
| | - Kian Fan Chung
- National Heart and Lung Institute, Imperial College London, London, UK NIHR Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, UK NIHR Biomedical Research Unit, Royal Brompton NHS Trust, London, UK
| | - Ana R Sousa
- Respiratory Therapeutic Unit, GlaxoSmithKline, Stockley Park, UK
| | | | - Julie Corfield
- AstraZeneca R&D, Mölndal, Sweden Areteva, Nottingham, UK
| | - Ioannis Pandis
- Data Science Institute, South Kensington Campus, Imperial College London, London, UK
| | | | | | - Peter J Sterk
- Dept of Respiratory Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Graham Roberts
- NIHR Southampton Respiratory Biomedical Research Unit, Clinical and Experimental Sciences and Human Development and Health, Southampton, UK Faculty of Medicine, University of Southampton, Southampton, UK The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Isle of Wight, UK
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Navarro-Torné A, Vidal M, Trzaska DK, Passante L, Crisafulli A, Laang H, van de Loo JW, Berkouk K, Draghia-Akli R. Chronic respiratory diseases and lung cancer research: a perspective from the European Union. Eur Respir J 2015; 46:1270-80. [DOI: 10.1183/13993003.00395-2015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 08/17/2015] [Indexed: 02/06/2023]
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45
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Bousquet J, Schunemann HJ, Fonseca J, Samolinski B, Bachert C, Canonica GW, Casale T, Cruz AA, Demoly P, Hellings P, Valiulis A, Wickman M, Zuberbier T, Bosnic-Anticevitch S, Bedbrook A, Bergmann KC, Caimmi D, Dahl R, Fokkens WJ, Grisle I, Lodrup Carlsen K, Mullol J, Muraro A, Palkonen S, Papadopoulos N, Passalacqua G, Ryan D, Valovirta E, Yorgancioglu A, Aberer W, Agache I, Adachi M, Akdis CA, Akdis M, Annesi-Maesano I, Ansotegui IJ, Anto JM, Arnavielhe S, Arshad H, Baiardini I, Baigenzhin AK, Barbara C, Bateman ED, Beghé B, Bel EH, Ben Kheder A, Bennoor KS, Benson M, Bewick M, Bieber T, Bindslev-Jensen C, Bjermer L, Blain H, Boner AL, Boulet LP, Bonini M, Bonini S, Bosse I, Bourret R, Bousquet PJ, Braido F, Briggs AH, Brightling CE, Brozek J, Buhl R, Burney PG, Bush A, Caballero-Fonseca F, Calderon MA, Camargos PAM, Camuzat T, Carlsen KH, Carr W, Cepeda Sarabia AM, Chavannes NH, Chatzi L, Chen YZ, Chiron R, Chkhartishvili E, Chuchalin AG, Ciprandi G, Cirule I, Correia de Sousa J, Cox L, Crooks G, Costa DJ, Custovic A, Dahlen SE, Darsow U, De Carlo G, De Blay F, Dedeu T, Deleanu D, Denburg JA, Devillier P, Didier A, Dinh-Xuan AT, Dokic D, Douagui H, Dray G, Dubakiene R, Durham SR, Dykewicz MS, El-Gamal Y, Emuzyte R, Fink Wagner A, Fletcher M, Fiocchi A, Forastiere F, Gamkrelidze A, Gemicioğlu B, Gereda JE, González Diaz S, Gotua M, Grouse L, Guzmán MA, Haahtela T, Hellquist-Dahl B, Heinrich J, Horak F, Hourihane JO', Howarth P, Humbert M, Hyland ME, Ivancevich JC, Jares EJ, Johnston SL, Joos G, Jonquet O, Jung KS, Just J, Kaidashev I, Kalayci O, Kalyoncu AF, Keil T, Keith PK, Khaltaev N, Klimek L, Koffi N'Goran B, Kolek V, Koppelman GH, Kowalski ML, Kull I, Kuna P, Kvedariene V, Lambrecht B, Lau S, Larenas-Linnemann D, Laune D, Le LTT, Lieberman P, Lipworth B, Li J, Louis R, Magard Y, Magnan A, Mahboub B, Majer I, Makela MJ, Manning P, De Manuel Keenoy E, Marshall GD, Masjedi MR, Maurer M, Mavale-Manuel S, Melén E, Melo-Gomes E, Meltzer EO, Merk H, Miculinic N, Mihaltan F, Milenkovic B, Mohammad Y, Molimard M, Momas I, Montilla-Santana A, Morais-Almeida M, Mösges R, Namazova-Baranova L, Naclerio R, Neou A, Neffen H, Nekam K, Niggemann B, Nyembue TD, O'Hehir RE, Ohta K, Okamoto Y, Okubo K, Ouedraogo S, Paggiaro P, Pali-Schöll I, Palmer S, Panzner P, Papi A, Park HS, Pavord I, Pawankar R, Pfaar O, Picard R, Pigearias B, Pin I, Plavec D, Pohl W, Popov TA, Portejoie F, Postma D, Potter P, Price D, Rabe KF, Raciborski F, Radier Pontal F, Repka-Ramirez S, Robalo-Cordeiro C, Rolland C, Rosado-Pinto J, Reitamo S, Rodenas F, Roman Rodriguez M, Romano A, Rosario N, Rosenwasser L, Rottem M, Sanchez-Borges M, Scadding GK, Serrano E, Schmid-Grendelmeier P, Sheikh A, Simons FER, Sisul JC, Skrindo I, Smit HA, Solé D, Sooronbaev T, Spranger O, Stelmach R, Strandberg T, Sunyer J, Thijs C, Todo-Bom A, Triggiani M, Valenta R, Valero AL, van Hage M, Vandenplas O, Vezzani G, Vichyanond P, Viegi G, Wagenmann M, Walker S, Wang DY, Wahn U, Williams DM, Wright J, Yawn BP, Yiallouros PK, Yusuf OM, Zar HJ, Zernotti ME, Zhang L, Zhong N, Zidarn M, Mercier J. MACVIA-ARIA Sentinel NetworK for allergic rhinitis (MASK-rhinitis): the new generation guideline implementation. Allergy 2015; 70:1372-92. [PMID: 26148220 DOI: 10.1111/all.12686] [Citation(s) in RCA: 137] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2015] [Indexed: 12/20/2022]
Abstract
Several unmet needs have been identified in allergic rhinitis: identification of the time of onset of the pollen season, optimal control of rhinitis and comorbidities, patient stratification, multidisciplinary team for integrated care pathways, innovation in clinical trials and, above all, patient empowerment. MASK-rhinitis (MACVIA-ARIA Sentinel NetworK for allergic rhinitis) is a simple system centred around the patient which was devised to fill many of these gaps using Information and Communications Technology (ICT) tools and a clinical decision support system (CDSS) based on the most widely used guideline in allergic rhinitis and its asthma comorbidity (ARIA 2015 revision). It is one of the implementation systems of Action Plan B3 of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA). Three tools are used for the electronic monitoring of allergic diseases: a cell phone-based daily visual analogue scale (VAS) assessment of disease control, CARAT (Control of Allergic Rhinitis and Asthma Test) and e-Allergy screening (premedical system of early diagnosis of allergy and asthma based on online tools). These tools are combined with a clinical decision support system (CDSS) and are available in many languages. An e-CRF and an e-learning tool complete MASK. MASK is flexible and other tools can be added. It appears to be an advanced, global and integrated ICT answer for many unmet needs in allergic diseases which will improve policies and standards.
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Affiliation(s)
- J Bousquet
- University Hospital, Montpellier, France.,MACVIA-LR, Contre les MAladies Chroniques pour un VIeillissement Actif en Languedoc - Roussillon, European Innovation Partnership on Active and Healthy Ageing Reference Site, Montpellier, France.,INSERM, VIMA: Ageing and Chronic Diseases, Epidemiological and Public Health Approaches, Paris, France.,UVSQ, UMR-S 1168, Université Versailles St-Quentin-en-Yvelines, Paris, France
| | - H J Schunemann
- Department of Clinical Epidemiology and Biostatistics and Medicine, McMaster University, Hamilton, ON, Canada
| | - J Fonseca
- Center for Research in Health Technologies and Information Systems - CINTESIS, Universidade do Porto, Porto, Portugal.,Allergy Unit, Instituto CUF Porto e Hospital CUF Porto, Porto, Portugal.,Health Information and Decision Sciences Department - CIDES, Faculdade de Medicina, Universidade do Porto, Porto, Portugal.,Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - B Samolinski
- Department of Prevention of Environmental Hazards and Allergology, Medical University of Warsaw, Warsaw, Poland
| | - C Bachert
- Upper Airways Research Laboratory, ENT Department, Ghent University Hospital, Ghent, Belgium
| | - G W Canonica
- Allergy and Respiratory Diseases Clinic, DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - T Casale
- Division of Allergy/Immunology, University of South Florida, Tampa, FL, USA
| | - A A Cruz
- ProAR - Nucleo de Excelencia em Asma, Federal University of Bahia, Bahia, Brasil.,GARD Executive Committee, Bahia, Brasil
| | - P Demoly
- Department of Respiratory Diseases, Montpellier University Hospital, Montpellier, France.,EPAR U707 INSERM, Paris, France.,EPAR UMR-S UPMC, Paris, France
| | - P Hellings
- Laboratory of Clinical Immunology, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - A Valiulis
- Vilnius University Clinic of Children's Diseases, Vilnius, Lithuania
| | - M Wickman
- Sachs' Children's Hospital, Stockholm, Sweden.,Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - T Zuberbier
- Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Member of the Global Allergy and Asthma European Network (GA2LEN), Oslo, Norway
| | - S Bosnic-Anticevitch
- Woolcock Institute of Medical Research, University of Sydney and Sydney Local Health District, Glebe, NSW, Australia
| | - A Bedbrook
- MACVIA-LR, Contre les MAladies Chroniques pour un VIeillissement Actif en Languedoc - Roussillon, European Innovation Partnership on Active and Healthy Ageing Reference Site, Montpellier, France
| | - K C Bergmann
- Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Member of the Global Allergy and Asthma European Network (GA2LEN), Oslo, Norway
| | - D Caimmi
- Department of Respiratory Diseases, Montpellier University Hospital, Montpellier, France
| | - R Dahl
- Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark
| | - W J Fokkens
- Department of Otorhinolaryngology, Academic Medical Centre, Amsterdam, The Netherlands
| | - I Grisle
- Latvian Association of Allergists, Center of Tuberculosis and Lung Diseases of Latvia, Riga, Latvia
| | - K Lodrup Carlsen
- Department of Paediatrics, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - J Mullol
- Unitat de Rinologia i Clínica de l'Olfacte, Servei d'ORL, Hospital Clínic, Clinical & Experimental Respiratory Immunoallergy, IDIBAPS, Barcelona, Catalonia, Spain
| | - A Muraro
- Food Allergy Referral Centre Veneto Region, Department of Women and Child Health, Padua General University Hospital, Padua, Italy
| | - S Palkonen
- EFA European Federation of Allergy and Airways Diseases Patients' Associations, Brussels, Belgium
| | - N Papadopoulos
- Center for Pediatrics and Child Health, Institute of Human Development, Royal Manchester Children's Hospital, University of Manchester, Manchester, UK.,Allergy Department, 2nd Pediatric Clinic, Athens General Children's Hospital "P&A Kyriakou", University of Athens, Athens, Greece
| | - G Passalacqua
- Allergy and Respiratory Diseases Clinic, DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - D Ryan
- General Practitioner, Woodbrook Medical Centre, Loughborough, UK.,Honorary Clinical Research Fellow, Allergy and Respiratory Research Group, The University of Edinburgh, Edinburgh, UK
| | - E Valovirta
- Department of Lung Diseases and Clinical Allergology, University of Turku, Turku, Finland
| | - A Yorgancioglu
- Department of Pulmonology, Celal Bayar University, Manisa, Turkey
| | - W Aberer
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - I Agache
- Transylvania University Brasov, Brasov, Romania
| | - M Adachi
- Department of Clinical Research Center, International University of Health and Welfare/Sanno Hospital, Tokyo, Japan
| | - C A Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - M Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | | | - I J Ansotegui
- Department of Allergy and Immunology, Hospital Quirón Bizkaia, Erandio, Spain
| | - J M Anto
- Centre for Research in Environmental Epidemiology, Barcelona, Spain.,Hospital del Mar Research Institute, Barcelona, Spain.,CIBER Epidemiología y Salud Pública, Barcelona, Spain.,Department of Experimental and Health Sciences, University of Pompeu Fabra, Barcelona, Spain
| | | | - H Arshad
- David Hide Asthma and Allergy Research Centre, Isle of Wight, UK
| | - I Baiardini
- Allergy and Respiratory Diseases Clinic, DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | | | - C Barbara
- Faculdade de Medicina de Lisboa, Portuguese National Programme for Respiratory Diseases, Lisbon, Portugal
| | - E D Bateman
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - B Beghé
- Section of Respiratory Disease, Department of Oncology, Haematology and Respiratory Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - E H Bel
- Department of Respiratory Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - A Ben Kheder
- Service de Pneumologie IV, Hôpital Abderrahman Mami, Ariana, Tunisie
| | - K S Bennoor
- Department of Respiratory Medicine, National Institute of Diseases of the Chest and Hospital, Dhaka, Bangladesh
| | - M Benson
- Centre for Individualized Medicine, Department of Pediatrics, Faculty of Medicine, Linköping University, Linköping, Sweden
| | - M Bewick
- Deputy National Medical Director, NHS England, England, UK
| | - T Bieber
- Department of Dermatology and Allergy, Rheinische Friedrich-Wilhelms-University Bonn, Bonn, Germany
| | - C Bindslev-Jensen
- Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark
| | - L Bjermer
- Department of Respiratory Medicine and Allergology, University Hospital, Lund, Sweden
| | - H Blain
- Department of Geriatrics, Montpellier University Hospital, Montpellier, France.,EA 2991 Movement To Health, Euromov, University Montpellier, Montpellier, France
| | - A L Boner
- Pediatric Department, University of Verona Hospital, Verona, Italy
| | - L P Boulet
- Québec Heart and Lung Institute, Laval University, Québec City, QC, Canada
| | - M Bonini
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - S Bonini
- Second University of Naples and Institute of Translational Medicine, Italian National Research Council, Naples, Italy
| | - I Bosse
- Allergist, La Rochelle, France
| | - R Bourret
- Directeur Général Adjoint, Montpellier University Hospital, Montpellier, France
| | - P J Bousquet
- EPAR U707 INSERM, Paris, France.,EPAR UMR-S UPMC, Paris, France
| | - F Braido
- Allergy and Respiratory Diseases Clinic, DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - A H Briggs
- Health Economics and Health Technology Assessment, Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - C E Brightling
- Institute of Lung Health, Respiratory Biomedical Unit, University Hospitals of Leicester NHS Trust, Leicestershire, UK.,Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK
| | - J Brozek
- Department of Clinical Epidemiology and Biostatistics and Medicine, McMaster University, Hamilton, ON, Canada
| | - R Buhl
- Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - P G Burney
- National Heart and Lung Institute, Imperial College, London, UK.,Wellcome Centre for Global Health, Imperial College, London, UK.,MRC-PHE Centre for Environment and Health, Imperial College, London, UK
| | - A Bush
- Imperial College and Royal Brompton Hospital, London, UK
| | | | - M A Calderon
- Imperial College London - National Heart and Lung Institute, Royal Brompton Hospital NHS, London, UK
| | - P A M Camargos
- Federal University of Minas Gerais, Medical School, Department of Pediatrics, Belo Horizonte, Brazil
| | - T Camuzat
- Assitant Director General, Montpellier, France.,Région Languedoc Roussillon, Roussillon, France
| | - K H Carlsen
- Department of Paediatrics, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - W Carr
- Allergy and Asthma Associates of Southern California, Mission Viejo, CA, USA
| | - A M Cepeda Sarabia
- Allergy and Immunology Laboratory, Metropolitan University, Simon Bolivar University, Barranquilla, Colombia.,SLaai, Sociedad Latinoamericana de Allergia, Asma e Immunologia, Barranquilla, Colombia
| | - N H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - L Chatzi
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Y Z Chen
- National Cooperative Group of Paediatric Research on Asthma, Asthma Clinic and Education Center of the Capital Institute of Pediatrics, Peking and Center for Asthma Research and Education, Beijing, China
| | - R Chiron
- Department of Respiratory Diseases, Montpellier University Hospital, Montpellier, France
| | - E Chkhartishvili
- Chachava Clinic, David Tvildiani Medical University-AIETI Medical School, Grigol Robakidze University, Tbilisi, Georgia
| | - A G Chuchalin
- Pulmonolory Research Institute FMBA, Moscow, Russia.,GARD Executive Committee, Moscow, Russia
| | - G Ciprandi
- Medicine Department, IRCCS-Azienda Ospedaliera Universitaria San Martino, Genoa, Italy
| | - I Cirule
- Latvian Association of Allergists, University Children Hospital of Latvia, Riga, Latvia
| | - J Correia de Sousa
- Life and Health Sciences Research Institute, ICVS, School of Health Sciences, University of Minho, Braga, Portugal
| | - L Cox
- Department of Medicine, Nova Southeastern University, Davie, FL, USA
| | - G Crooks
- European Innovation Partnership on Active and Healthy Ageing, Reference Site, NHS Scotland, Glasgow, UK
| | - D J Costa
- MACVIA-LR, Contre les MAladies Chroniques pour un VIeillissement Actif en Languedoc - Roussillon, European Innovation Partnership on Active and Healthy Ageing Reference Site, Montpellier, France.,Department of Respiratory Diseases, Montpellier University Hospital, Montpellier, France
| | - A Custovic
- Centre for Respiratory Medicine and Allergy, Institute of Inflammation and Repair, University of Manchester and University Hospital of South Manchester, Manchester, UK
| | - S E Dahlen
- The Centre for Allergy Research, The Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - U Darsow
- Department of Dermatology and Allergy, Technische Universität Mänchen, Munich, Germany.,ZAUM-Center for Allergy and Environment, Helmholtz Center Munich, Technische Universität München, Munich, Germany
| | - G De Carlo
- EFA European Federation of Allergy and Airways Diseases Patients' Associations, Brussels, Belgium
| | - F De Blay
- Allergy Division, Chest Disease Department, University Hospital of Strasbourg, Strasbourg, France
| | - T Dedeu
- European Regional and Local Health Association, Brussels, Belgium
| | - D Deleanu
- Allergology and Immunology Discipline, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - J A Denburg
- Department of Medicine, Division of Clinical Immunology and Allergy, McMaster University, Hamilton, ON, Canada
| | - P Devillier
- Laboratoire de Pharmacologie Respiratoire UPRES EA220, Hôpital Foch, Suresnes Université Versailles Saint-Quentin, Versailles Saint-Quentin, France
| | - A Didier
- Respiratory Diseases Department, Rangueil-Larrey Hospital, Toulouse, France
| | - A T Dinh-Xuan
- Service de physiologie, Hôpital Cochin, Université Paris-Descartes, Assistance publique-Hôpitaux de Paris, Paris, France
| | - D Dokic
- Medical Faculty Skopje, University Clinic of Pulmology and Allergy, Skopje, R. Macedonia
| | - H Douagui
- Service de Pneumo-Allergologie, Centre Hospitalo-Universitaire de Béni-Messous, Algers, Algeria
| | - G Dray
- Ecole des Mines, Alès, France
| | - R Dubakiene
- Medical Faculty, Vilnius University, Vilnius, Lithuania
| | - S R Durham
- Allergy and Clinical Immunology Section, National Heart and Lung Institute, Imperial College London, London, UK
| | - M S Dykewicz
- Section of Allergy and Immunology, Saint Louis University School of Medicine, Saint Louis, MI, USA
| | - Y El-Gamal
- Pediatric Allergy and Immunology Unit, Ain Shams University, Cairo, Egypt
| | - R Emuzyte
- Clinic of Children's Diseases, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - A Fink Wagner
- Global Allergy and Asthma Platform GAAPP, Vienna, Austria
| | | | - A Fiocchi
- Allergy Department, The Bambino Gesù Children's Research Hospital Holy see, Rome, Italy
| | - F Forastiere
- Department of Epidemiology, Regional Health Service Lazio Region, Rome, Italy
| | - A Gamkrelidze
- National Center for Disease Control and Public Health of Georgia, Tbilisi, Georgia
| | - B Gemicioğlu
- Turkish Thoracic Society Asthma-Allergy Working Group, Kocaeli, Turkey
| | - J E Gereda
- Allergy and Immunology Division, Clinica Ricardo Palma, Lima, Peru
| | - S González Diaz
- Sociedad Latinoamericana de Allergia, Asma e Immunologia, Mexico City, Mexico
| | - M Gotua
- Center of Allergy and Immunology, Georgian Association of Allergology and Clinical Immunology, Tbilisi, Georgia
| | - L Grouse
- Faculty of the Department of Neurology, University of Washington School of Medicine, Seattle, WA, USA
| | - M A Guzmán
- Immunology and Allergy Division, Clinical Hospital, University of Chile, Santiago, Chile
| | - T Haahtela
- Skin and Allergy Hospital, Helsinki University Hospital, Helsinki, Finland
| | - B Hellquist-Dahl
- Department of Respiratory Diseases, Odense University Hospital, Odense, Denmark
| | - J Heinrich
- Institute of Epidemiology I, German Research Centre for Environmental Health, Helmholtz Zentrum München, Neuherberg, Germany
| | - F Horak
- Vienna Challenge Chamber, Vienna, Austria
| | - J O 'b Hourihane
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - P Howarth
- University of Southampton Faculty of Medicine, University Hospital Southampton, Southampton, UK
| | - M Humbert
- Université Paris-Sud, Le Kremlin Bicêtre, France.,Service de Pneumologie, Hôpital Bicêtre, Inserm UMR_S999, Le Kremlin Bicêtre, France
| | - M E Hyland
- School of Psychology, Plymouth University, Plymouth, UK
| | - J C Ivancevich
- Servicio de Alergia e Immunologia, Clinica Santa Isabel, Buenos Aires, Argentina
| | - E J Jares
- Libra Foundation, Buenos Aires, Argentina
| | - S L Johnston
- Airway Disease Infection Section, National Heart and Lung Institute, Imperial College, London, UK.,MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, London, UK
| | - G Joos
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - O Jonquet
- Medical Commission, Montpellier University Hospital, Montpellier, France
| | - K S Jung
- Hallym University College of Medicine, Hallym University Sacred Heart Hospital, Gyeonggi-do, South Korea
| | - J Just
- Allergology Department, Centre de l'Asthme et des Allergies. Hôpital d'Enfants Armand-Trousseau, Paris, France.,Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Equipe EPAR, Paris, France
| | - I Kaidashev
- Ukrainian Medical Stomatological Academy, Poltava, Ukraine
| | - O Kalayci
- Pediatric Allergy and Asthma Unit, Hacettepe University School of Medicine, Ankara, Turkey
| | - A F Kalyoncu
- School of Medicine, Department of Chest Diseases, Immunology and Allergy Division, Hacettepe University, Ankara, Turkey
| | - T Keil
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Institute for Clinical Epidemiology and Biometry, University of Wuerzburg, Wuerzburg, Germany
| | - P K Keith
- Department of Medicine, McMaster University, Health Sciences Centre 3V47, Hamilton, ON, Canada
| | | | - L Klimek
- Center for Rhinology and Allergology, Wiesbaden, Germany
| | - B Koffi N'Goran
- Société de Pneumologie de Langue Française et Espace Francophone de Pneumologie, Paris, France
| | - V Kolek
- Department of Respiratory Medicine, Faculty of Medicine and Dentistry, University Hospital Olomouc, Olomouc, Czech Republic
| | - G H Koppelman
- Department of Pediatric Pulmonology and Pediatric Allergology, Beatrix Children's Hospital, GRIAC Research Institute, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - M L Kowalski
- Department of Immunology, Rheumatology and Allergy, Medical University of Lodz, Lodz, Poland
| | - I Kull
- Sachs' Children's Hospital, Stockholm, Sweden.,Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - P Kuna
- Division of Internal Medicine, Asthma and Allergy, KUNA, Barlicki University Hospital, Medical University of Lodz, Lodz, Poland
| | - V Kvedariene
- Pulmonology and Allergology Center, Vilnius University, Vilnius, Lithuania
| | - B Lambrecht
- VIB Inflammation Research Center, Ghent University, Ghent, Belgium
| | - S Lau
- Department for Pediatric Pneumology and Immunology, Charité Medical University, Berlin, Germany
| | - D Larenas-Linnemann
- Clínica de Alergia, Asma y Pediatría, Hospital Médica Sur, México City, México
| | - D Laune
- Digi Health, Montpellier, France
| | - L T T Le
- University of Medicine and Pharmacy, Hochiminh City, Vietnam
| | - P Lieberman
- Departments of Internal Medicine and Pediatrics (Divisions of Allergy and Immunology), University of Tennessee College of Medicine, Germantown, TN, USA
| | - B Lipworth
- Scottish Centre for Respiratory Research, Cardiovascular & Diabetes Medicine, Medical Research Institute, Ninewells Hospital, University of Dundee, Dundee, UK
| | - J Li
- State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - R Louis
- Department of Pulmonary Medicine, CHU Sart-Tilman, Liege, Belgium
| | - Y Magard
- Service de Pneumo-allergologie, Hôpital Saint-Joseph, Paris, France
| | - A Magnan
- Service de Pneumologie, University of Nantes, UMR INSERM, UMR1087/CNR 6291, l'Institut du Thorax, Nantes, France
| | - B Mahboub
- Department of Pulmonary Medicine, Rashid Hospital, Dubai, UAE
| | - I Majer
- Department of Respiratory Medicine, University Hospital, Bratislava, Slovakia
| | - M J Makela
- Skin and Allergy Hospital, Helsinki University Hospital, Helsinki, Finland
| | - P Manning
- Department of Medicine (RCSI), Bon Secours Hospital, Glasnevin, Dublin, Ireland
| | | | - G D Marshall
- Division of Clinical Immunology and Allergy, Laboratory of Behavioral Immunology Research, The University of Mississippi Medical Center, Jackson, MS, USA
| | - M R Masjedi
- Respiratory Disease Research, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - M Maurer
- Allergie-Centrum-Charité at the Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - S Mavale-Manuel
- Department of Paediatrics, Maputo Central Hospital, Maputo, Mozambique
| | - E Melén
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - E Melo-Gomes
- Faculdade de Medicina de Lisboa, Portuguese National Programme for Respiratory Diseases, Lisbon, Portugal
| | - E O Meltzer
- Allergy and Asthma Medical Group and Research Center, San Diego, CA, USA
| | - H Merk
- Hautklinik - Klinik für Dermatologie & Allergologie, Universitätsklinikum der RWTH Aachen, Aachen, Deutschland
| | | | - F Mihaltan
- National Institute of Pneumology M. Nasta, Bucharest, Romania
| | - B Milenkovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Serbian Association for Asthma and COPD, Belgrade, Serbia
| | - Y Mohammad
- National Center for Research in Chronic Respiratory Diseases, Tishreen University School of Medicine, Latakia, Syria
| | - M Molimard
- Département de Pharmacologie, CHU de Bordeaux, Université Bordeaux, INSERM U657, Bordeaux Cedex, France
| | - I Momas
- Department of Public Health and Biostatistics, Paris Descartes University, Paris, France.,Paris Municipal Department of Social Action, Childhood and Health, Paris, France
| | | | - M Morais-Almeida
- Allergy and Clinical Immunology Department, Hospital CUF-Descobertas, Lisboa, Portugal
| | - R Mösges
- Institute of Medical Statistics, Informatics and Epidemiology, Medical Faculty, University of Cologne, Cologne, Germany
| | - L Namazova-Baranova
- Scientific Centre of Children's Health under the Russian Academy of Medical Sciences, Moscow, Russia
| | - R Naclerio
- Section of Otolaryngology-Head and Neck Surgery, The University of Chicago Medical Center and The Pritzker School of Medicine, The University of Chicago, Chicago, IL, USA
| | - A Neou
- Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Member of the Global Allergy and Asthma European Network (GA2LEN), Oslo, Norway
| | - H Neffen
- Hospital de Niños Orlando Alassia, Santa Fe, Argentina
| | - K Nekam
- Hospital of the Hospitaller Brothers in Buda, Budapest, Hungary
| | - B Niggemann
- Pediatric Pneumology and Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - T D Nyembue
- ENT Department, University Hospital of Kinshasa, Kinshasa, Congo
| | - R E O'Hehir
- Department of Allergy, Immunology and Respiratory Medicine, Alfred Hospital and Central Clinical School, Monash University, Melbourne, Vic., Australia.,Department of Immunology, Monash University, Melbourne, Vic., Australia
| | - K Ohta
- National Hospital Organization, Tokyo National Hospital, Tokyo, Japan
| | - Y Okamoto
- Depatment of Otorhinolaryngology, Chiba University Hospital, Chiba, Japan
| | - K Okubo
- Depatment of Otolaryngology, Nippon Medical School, Tokyo, Japan
| | - S Ouedraogo
- Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle, Ouagadougou, Burkina Faso
| | - P Paggiaro
- Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | - I Pali-Schöll
- Dept. of Comparative Medicine, Messerli Research Institute of the University of Veterinary Medicine Vienna, Medical University and University Vienna, Vienna, Austria.,Messerli Research Institute of the University of Veterinary Medicine Vienna, Medical University and University Vienna, Vienna, Austria
| | - S Palmer
- Centre for Health Economics, University of York, York, UK
| | - P Panzner
- Department of Immunology and Allergology, Faculty of Medicine and Faculty Hospital in Pilsen, Charles University in Prague, Pilsen, Czech Republic
| | - A Papi
- Respiratory Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - H S Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, South Korea
| | - I Pavord
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - R Pawankar
- Department of Pediatrics, Nippon Medical School, Tokyo, Japan
| | - O Pfaar
- Center for Rhinology and Allergology, Wiesbaden, Germany.,Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty Mannheim, Universitätsmedizin Mannheim, Heidelberg University, Mannheim, Germany
| | - R Picard
- Conseil Général de l'Economie. Ministère de l'Economie, de l'Industrie et du Numérique, Paris, France
| | - B Pigearias
- Société de Pneumologie de Langue Française et Espace Francophone de Pneumologie, Paris, France
| | - I Pin
- Département de pédiatrie, CHU de Grenoble, Grenoble cedex 9, France
| | - D Plavec
- Children's Hospital Srebrnjak, Zagreb, School of Medicine, University J.J. Strossmayer, Osijek, Croatia
| | - W Pohl
- Karl Landsteiner Institute for Clinical and Experimental Pneumology, Hietzing Hospital, Vienna, Austria
| | - T A Popov
- Clinic of Allergy & Asthma, Medical University Sofia, Sofia, Bulgaria
| | - F Portejoie
- MACVIA-LR, Contre les MAladies Chroniques pour un VIeillissement Actif en Languedoc - Roussillon, European Innovation Partnership on Active and Healthy Ageing Reference Site, Montpellier, France
| | - D Postma
- Department of Pulmonary Medicine and Tuberculosis, GRIAC Research Institute, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - P Potter
- Allergy Diagnostic and Clinical Research Unit, University of Cape Town Lung Institute, Cape Town, South Africa
| | - D Price
- Academic Centre of Primary Care, University of Aberdeen, Aberdeen, UK.,Research in Real-Life, Cambridge, UK
| | - K F Rabe
- LungenClinic Grosshansdorf, Airway Research Center North, Member of the German Center for Lung Research, Grosshansdorf, Germany.,Department of Medicine, Christian Albrechts University, Airway Research Center North, Member of the German Center for Lung Research, Kiel, Germany
| | - F Raciborski
- Department of Prevention of Environmental Hazards and Allergology, Medical University of Warsaw, Warsaw, Poland
| | - F Radier Pontal
- Conseil Départemental de l'Ordre des Pharmaciens, Maison des Professions Libérales, Montpellier, France
| | | | - C Robalo-Cordeiro
- Allergy and Clinical Immunology Department, Hospitais da Universidade de Coimbra, Coimbra, Portugal
| | - C Rolland
- Association Asthme et Allergie, Paris, France
| | - J Rosado-Pinto
- Serviço de Imunoalergologia, Hospital da Luz, Lisboa, Portugal
| | - S Reitamo
- Skin and Allergy Hospital, Helsinki University Hospital, Helsinki, Finland
| | - F Rodenas
- Polibienestar Research Institute, University of Valencia, Valencia, Spain
| | - M Roman Rodriguez
- Primary Care Respiratory Research Unit, Institutode Investigación Sanitaria de Palma IdisPa, Palma de Mallorca, Spain
| | - A Romano
- Allergy Unit, Complesso Integrato Columbus, Rome, Italy
| | - N Rosario
- Hospital de Clinicas, University of Parana, Parana, Brazil
| | - L Rosenwasser
- Department of Allergy, Asthma and Immunology, Children's Mercy Hospitals and Clinics and Pediatrics and Medicine University of Misouri-Kansas City School of Medicine, Kansas City, MI, USA
| | - M Rottem
- Division of Allergy Asthma and Clinical Immunology, Emek Medical Center, Afula, Israel
| | - M Sanchez-Borges
- Allergy and Clinical Immunology Department, Centro Médico-Docente la, Trinidad, Venezuela.,Clínica El Avila, 6a transversal Urb, Caracas, Venezuela
| | - G K Scadding
- The Royal National TNE Hospital, University College London, London, UK
| | - E Serrano
- Otolaryngology and Head & Neck Surgery, CHU Rangueil-Larrey, Toulouse, France
| | - P Schmid-Grendelmeier
- Allergy Unit, Department of Dermatology, University Hospital of Zurich, Zürich, Switzerland
| | - A Sheikh
- Allergy and Respiratory Research Group, Medical School, Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, UK
| | - F E R Simons
- Department of Pediatrics & Child Health, Department of Immunology, Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - J C Sisul
- Sociedad Paraguaya de Alergia Asma e Inmunologıa, Paraguay, Paraguay
| | - I Skrindo
- Department of Paediatrics, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - H A Smit
- Julius Center of Health Sciences and Primary Care, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - D Solé
- Division of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil
| | - T Sooronbaev
- Kyrgyzstan National Centre of Cardiology and Internal medicine, Euro-Asian respiratory Society, Bishkek, Kyrgyzstan
| | - O Spranger
- Global Allergy and Asthma Platform GAAPP, Vienna, Austria
| | - R Stelmach
- Pulmonary Division, Heart Institute (InCor), Hospital da Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - T Strandberg
- European Union GeriatricMedicine Society, Vienna, Austria
| | - J Sunyer
- Centre for Research in Environmental Epidemiology, Barcelona, Spain.,Hospital del Mar Research Institute, Barcelona, Spain.,CIBER Epidemiología y Salud Pública, Barcelona, Spain.,Department of Experimental and Health Sciences, University of Pompeu Fabra, Barcelona, Spain
| | - C Thijs
- Department of Epidemiology, CAPHRI School of Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - A Todo-Bom
- Centre of Pneumology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - M Triggiani
- Division of Allergy and Clinical Immunology, University of Salerno, Salerno, Italy
| | - R Valenta
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - A L Valero
- Pneumology and Allergy Department, Hospital Clínic, Clinical & Experimental Respiratory Immunoallergy, IDIBAPS, Barcelona, Spain
| | - M van Hage
- Clinical Immunology and Allergy Unit, Department of Medicine Solna, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - O Vandenplas
- Department of Chest Medicine, Centre Hospitalier Universitaire Dinant-Godinne, Université Catholique de Louvain, Yvoir, Belgium
| | - G Vezzani
- Pulmonary Unit, Department of Cardiology, Thoracic and Vascular Medicine, Arcispedale S.Maria Nuova/IRCCS, Research Hospital, Reggio Emilia, Italy.,Regional Agency for Health and Social Care, Reggio Emilia, Italy
| | - P Vichyanond
- Division of Allergy and Immunology, Department of Pediatrics, Siriraj Hospital, Mahidol University Faculty of Medicine, Bangkok, Thailand
| | - G Viegi
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology, Pisa, Italy.,CNR Institute of Biomedicine and Molecular Immunology "A. Monroy", Palermo, Italy
| | - M Wagenmann
- Department of Otorhinolaryngology, HNO-Klinik, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | | | - D Y Wang
- Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
| | - U Wahn
- Pediatric Pneumology and Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - D M Williams
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - J Wright
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UJ, USA
| | - B P Yawn
- Department of Research, Olmsted Medical Center, Rochester, MN, USA
| | - P K Yiallouros
- Cyprus International Institute for Environmental & Public Health in Association with Harvard School of Public Health, Cyprus University of Technology, Limassol, Cyprus.,Department of Pediatrics, Hospital "Archbishop Makarios III", Nicosia, Cyprus
| | - O M Yusuf
- The Allergy and Asthma Institute, Islamabad, Pakistan
| | - H J Zar
- Department of Paediatrics and Child Health, Red Cross Children's Hospital, MRC Unit on Child & Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - M E Zernotti
- Universidad Católica de Córdoba, Córdoba, Argentina
| | - L Zhang
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - N Zhong
- State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - M Zidarn
- University Clinic of Respiratory and Allergic Diseases, Golnik, Slovenia
| | - J Mercier
- Vice President for Research, University Montpellier, Montpellier, France
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Shaw DE, Sousa AR, Fowler SJ, Fleming LJ, Roberts G, Corfield J, Pandis I, Bansal AT, Bel EH, Auffray C, Compton CH, Bisgaard H, Bucchioni E, Caruso M, Chanez P, Dahlén B, Dahlen SE, Dyson K, Frey U, Geiser T, Gerhardsson de Verdier M, Gibeon D, Guo YK, Hashimoto S, Hedlin G, Jeyasingham E, Hekking PPW, Higenbottam T, Horváth I, Knox AJ, Krug N, Erpenbeck VJ, Larsson LX, Lazarinis N, Matthews JG, Middelveld R, Montuschi P, Musial J, Myles D, Pahus L, Sandström T, Seibold W, Singer F, Strandberg K, Vestbo J, Vissing N, von Garnier C, Adcock IM, Wagers S, Rowe A, Howarth P, Wagener AH, Djukanovic R, Sterk PJ, Chung KF. Clinical and inflammatory characteristics of the European U-BIOPRED adult severe asthma cohort. Eur Respir J 2015; 46:1308-21. [PMID: 26357963 DOI: 10.1183/13993003.00779-2015] [Citation(s) in RCA: 370] [Impact Index Per Article: 41.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 07/03/2015] [Indexed: 01/24/2023]
Abstract
U-BIOPRED is a European Union consortium of 20 academic institutions, 11 pharmaceutical companies and six patient organisations with the objective of improving the understanding of asthma disease mechanisms using a systems biology approach.This cross-sectional assessment of adults with severe asthma, mild/moderate asthma and healthy controls from 11 European countries consisted of analyses of patient-reported outcomes, lung function, blood and airway inflammatory measurements.Patients with severe asthma (nonsmokers, n=311; smokers/ex-smokers, n=110) had more symptoms and exacerbations compared to patients with mild/moderate disease (n=88) (2.5 exacerbations versus 0.4 in the preceding 12 months; p<0.001), with worse quality of life, and higher levels of anxiety and depression. They also had a higher incidence of nasal polyps and gastro-oesophageal reflux with lower lung function. Sputum eosinophil count was higher in severe asthma compared to mild/moderate asthma (median count 2.99% versus 1.05%; p=0.004) despite treatment with higher doses of inhaled and/or oral corticosteroids.Consistent with other severe asthma cohorts, U-BIOPRED is characterised by poor symptom control, increased comorbidity and airway inflammation, despite high levels of treatment. It is well suited to identify asthma phenotypes using the array of "omic" datasets that are at the core of this systems medicine approach.
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Affiliation(s)
- Dominick E Shaw
- Respiratory Research Unit, University of Nottingham, Nottingham, UK Joint first authors
| | - Ana R Sousa
- Respiratory Therapeutic Unit, GSK, Stockley Park, UK Joint first authors
| | - Stephen J Fowler
- Respiratory and Allergy Research Group, University of Manchester, Manchester, UK
| | | | - Graham Roberts
- NIHR Southampton Respiratory Biomedical Research Unit, Clinical and Experimental Sciences and Human Development and Health, Southampton, UK Faculty of Medicine, University of Southampton, Southampton, UK The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Isle of Wight, UK
| | - Julie Corfield
- AstraZeneca R&D, Mölndal, Sweden Areteva R&D, Nottingham, UK
| | - Ioannis Pandis
- Data Science Institute, South Kensington Campus, Imperial College London, London, UK
| | - Aruna T Bansal
- Acclarogen Ltd, St John's Innovation Centre, Cambridge, UK
| | - Elisabeth H Bel
- Dept of Respiratory Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Charles Auffray
- European Institute for Systems Biology and Medicine, CNRS-ENS-UCBL, Université de Lyon, Lyon, France
| | | | - Hans Bisgaard
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Massimo Caruso
- Dept of Clinical and Experimental Medicine Hospital University, University of Catania, Catania, Italy
| | - Pascal Chanez
- Département des Maladies Respiratoires, Laboratoire d'immunologie, Aix Marseille Université Marseille, Marseille, France
| | - Barbro Dahlén
- Lung/Allergy Clinic, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Sven-Erik Dahlen
- The Centre for Allergy Research, The Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | - Urs Frey
- University Children's Hospital Basel, Basel, Switzerland
| | | | | | - David Gibeon
- National Heart and Lung Institute, Imperial College, London, UK
| | - Yi-Ke Guo
- Data Science Institute, South Kensington Campus, Imperial College London, London, UK
| | - Simone Hashimoto
- Dept of Respiratory Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Gunilla Hedlin
- Dept of Women's and Children's Health and Center for Allergy Research, Karolinska Institutet, Stockholm, Sweden
| | | | - Pieter-Paul W Hekking
- Dept of Respiratory Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Ildikó Horváth
- Dept of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Alan J Knox
- Respiratory Research Unit, University of Nottingham, Nottingham, UK
| | - Norbert Krug
- Fraunhofer Institute for Toxicology and Experimental Medicine Hannover, Hannover, Germany
| | - Veit J Erpenbeck
- Translational Medicine - Respiratory Profiling, Novartis Institutes for BioMedical Research, Basel, Switzerland
| | | | - Nikos Lazarinis
- Lung/Allergy Clinic, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - John G Matthews
- Respiratory and Allergic Diseases, Product Development Immunology, Genentech, San Francisco, CA, USA
| | | | - Paolo Montuschi
- Faculty of Medicine, Catholic University of the Sacred Heart, Rome, Italy
| | - Jacek Musial
- Dept of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - David Myles
- Respiratory Therapy Area Unit, GlaxoSmithKline, Stevenage, UK
| | - Laurie Pahus
- Assistance publique des Hôpitaux de Marseille, Hôpital NORD, Clinique des bronches, allergies et sommeil, Marseille, France
| | - Thomas Sandström
- Dept of Medicine, Dept of Public Health and Clinical Medicine Respiratory Medicine Unit, Umeå University, Umeå, Sweden
| | | | - Florian Singer
- University Children's Hospital Zurich, Zurich, Switzerland
| | - Karin Strandberg
- Lung/Allergy Clinic, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Jorgen Vestbo
- Respiratory Research Group, Manchester Academic Health Science Centre, University Hospital South Manchester NHS Foundation Trust, Manchester, UK
| | - Nadja Vissing
- The Danish Pediatric Asthma Center, University of Copenhagen, Copenhagen, Denmark
| | | | - Ian M Adcock
- National Heart and Lung Institute, Imperial College, London, UK Biomedical Research Unit, Royal Brompton & Harefield NHS Trust, London, UK
| | | | - Anthony Rowe
- Janssen Research and Development Ltd, High Wycombe, UK
| | - Peter Howarth
- NIHR Southampton Respiratory Biomedical Research Unit, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Ariane H Wagener
- Dept of Respiratory Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Ratko Djukanovic
- NIHR Southampton Respiratory Biomedical Research Unit, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Peter J Sterk
- Dept of Respiratory Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands Joint last authors
| | - Kian Fan Chung
- National Heart and Lung Institute, Imperial College, London, UK Biomedical Research Unit, Royal Brompton & Harefield NHS Trust, London, UK Joint last authors
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47
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Clinical phenotypes of asthma should link up with disease mechanisms. Curr Opin Allergy Clin Immunol 2015; 15:56-62. [PMID: 25504141 DOI: 10.1097/aci.0000000000000134] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW Asthma is a common disease which presents in various clinical forms and levels of severity. The current 'one size fits all' approach to treatment is suboptimal. Using unbiased cluster analysis has identified several asthma phenotypes. Understanding the underlying mechanisms driving these clusters may lead to better patient-orientated medicines. RECENT FINDINGS Clustering was initially performed on clinical features only, but the addition of biomarkers that characterize sputum and blood cellular profiles has enabled the prediction of responses to targeted therapies. Clusters of severe asthma include those on high-dose corticosteroid treatment associated with severe airflow obstruction and those with discordance between symptoms and sputum eosinophilia. Sputum eosinophilia can predict therapeutic responses to T-helper type 2 cytokine blockade. Further molecular phenotyping or endotyping of asthma will be necessary to determine new treatment strategies. Low T-helper type 2 expression may be predictive of poor therapeutic response to inhaled corticosteroids, but much less is known about this type of asthma. SUMMARY Phenotype-driven treatment of asthma will be further boosted by the integration of genetic, transcriptomic and proteomic technologies to defining distinct severe asthma phenotypes and biomarkers of therapeutic responses. This will lead towards stratified medicine for asthma.
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48
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Garcia-Aymerich J, Benet M, Saeys Y, Pinart M, Basagaña X, Smit HA, Siroux V, Just J, Momas I, Rancière F, Keil T, Hohmann C, Lau S, Wahn U, Heinrich J, Tischer CG, Fantini MP, Lenzi J, Porta D, Koppelman GH, Postma DS, Berdel D, Koletzko S, Kerkhof M, Gehring U, Wickman M, Melén E, Hallberg J, Bindslev-Jensen C, Eller E, Kull I, Lødrup Carlsen KC, Carlsen KH, Lambrecht BN, Kogevinas M, Sunyer J, Kauffmann F, Bousquet J, Antó JM. Phenotyping asthma, rhinitis and eczema in MeDALL population-based birth cohorts: an allergic comorbidity cluster. Allergy 2015; 70:973-84. [PMID: 25932997 DOI: 10.1111/all.12640] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2015] [Indexed: 01/31/2023]
Abstract
BACKGROUND Asthma, rhinitis and eczema often co-occur in children, but their interrelationships at the population level have been poorly addressed. We assessed co-occurrence of childhood asthma, rhinitis and eczema using unsupervised statistical techniques. METHODS We included 17 209 children at 4 years and 14 585 at 8 years from seven European population-based birth cohorts (MeDALL project). At each age period, children were grouped, using partitioning cluster analysis, according to the distribution of 23 variables covering symptoms 'ever' and 'in the last 12 months', doctor diagnosis, age of onset and treatments of asthma, rhinitis and eczema; immunoglobulin E sensitization; weight; and height. We tested the sensitivity of our estimates to subject and variable selections, and to different statistical approaches, including latent class analysis and self-organizing maps. RESULTS Two groups were identified as the optimal way to cluster the data at both age periods and in all sensitivity analyses. The first (reference) group at 4 and 8 years (including 70% and 79% of children, respectively) was characterized by a low prevalence of symptoms and sensitization, whereas the second (symptomatic) group exhibited more frequent symptoms and sensitization. Ninety-nine percentage of children with comorbidities (co-occurrence of asthma, rhinitis and/or eczema) were included in the symptomatic group at both ages. The children's characteristics in both groups were consistent in all sensitivity analyses. CONCLUSION At 4 and 8 years, at the population level, asthma, rhinitis and eczema can be classified together as an allergic comorbidity cluster. Future research including time-repeated assessments and biological data will help understanding the interrelationships between these diseases.
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49
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Abstract
Asthma is a common disease with a complex pathophysiology. It can present in various clinical forms and with different levels of severity. Unbiased cluster analytic methods have unravelled several phenotypes in cohorts representative of the whole spectrum of severity. Clusters of severe asthma include those on high-dose corticosteroid treatment, often with both inhaled and oral treatment, usually associated with severe airflow obstruction. Phenotypes with concordance between symptoms and sputum eosinophilia have been reported, including an eosinophilic inflammation-predominant group with few symptoms and late-onset disease who have a high prevalence of rhinosinusitis, aspirin sensitivity, and exacerbations. Sputum eosinophilia is also a biomarker that can predict therapeutic responses to antibody-based treatments to block the effects of the T-helper (Th)-2 cytokine, interleukin (IL)-5. Low Th2-expression has been predictive of poor therapeutic response to inhaled corticosteroid therapy. Current asthma schedules emphasise a step-up approach to treating asthma in relation to increasing severity, but, in more severe disease, phenotyping or endotyping of asthma will be necessary to determine new treatment strategies as severe asthma is recognized as being a particularly heterogeneous disease. Much less is known about 'non-eosinophilic' asthma. Phenotypic characterisation of corticosteroid insensitivity and chronic airflow obstruction of severe asthma is also needed. Phenotype-driven treatment of asthma will be further boosted by the advent of transcriptomic and proteomic technologies, with the application of systems biology or medicine approaches to defining phenotypes and biomarkers of disease and therapeutic response. This will pave the way towards personalized medicine and healthcare for asthma.
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Affiliation(s)
- Kian Fan Chung
- Experimental Studies, National Heart and Lung Institute, Imperial College London, Dovehouse St, London, SW3 6LY, UK,
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50
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Hinks TSC, Zhou X, Staples KJ, Dimitrov BD, Manta A, Petrossian T, Lum PY, Smith CG, Ward JA, Howarth PH, Walls AF, Gadola SD, Djukanović R. Innate and adaptive T cells in asthmatic patients: Relationship to severity and disease mechanisms. J Allergy Clin Immunol 2015; 136:323-33. [PMID: 25746968 PMCID: PMC4534770 DOI: 10.1016/j.jaci.2015.01.014] [Citation(s) in RCA: 160] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 01/12/2015] [Accepted: 01/16/2015] [Indexed: 01/10/2023]
Abstract
Background Asthma is a chronic inflammatory disease involving diverse cells and mediators whose interconnectivity and relationships to asthma severity are unclear. Objective We performed a comprehensive assessment of TH17 cells, regulatory T cells, mucosal-associated invariant T (MAIT) cells, other T-cell subsets, and granulocyte mediators in asthmatic patients. Methods Sixty patients with mild-to-severe asthma and 24 control subjects underwent detailed clinical assessment and provided induced sputum, endobronchial biopsy, bronchoalveolar lavage, and blood samples. Adaptive and invariant T-cell subsets, cytokines, mast cells, and basophil mediators were analyzed. Results Significant heterogeneity of T-cell phenotypes was observed, with levels of IL-13–secreting T cells and type 2 cytokines increased at some, but not all, asthma severities. TH17 cells and γδ-17 cells, proposed drivers of neutrophilic inflammation, were not strongly associated with asthma, even in severe neutrophilic forms. MAIT cell frequencies were strikingly reduced in both blood and lung tissue in relation to corticosteroid therapy and vitamin D levels, especially in patients with severe asthma in whom bronchoalveolar lavage regulatory T-cell numbers were also reduced. Bayesian network analysis identified complex relationships between pathobiologic and clinical parameters. Topological data analysis identified 6 novel clusters that are associated with diverse underlying disease mechanisms, with increased mast cell mediator levels in patients with severe asthma both in its atopic (type 2 cytokine–high) and nonatopic forms. Conclusion The evidence for a role for TH17 cells in patients with severe asthma is limited. Severe asthma is associated with a striking deficiency of MAIT cells and high mast cell mediator levels. This study provides proof of concept for disease mechanistic networks in asthmatic patients with clusters that could inform the development of new therapies.
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Affiliation(s)
- Timothy S C Hinks
- Clinical and Experimental Sciences, University of Southampton Faculty of Medicine, Sir Henry Wellcome Laboratories, Southampton University Hospital, Southampton, United Kingdom; NIHR Southampton Respiratory Biomedical Research Unit, Southampton University Hospital, Southampton, United Kingdom
| | - Xiaoying Zhou
- Clinical and Experimental Sciences, University of Southampton Faculty of Medicine, Sir Henry Wellcome Laboratories, Southampton University Hospital, Southampton, United Kingdom
| | - Karl J Staples
- Clinical and Experimental Sciences, University of Southampton Faculty of Medicine, Sir Henry Wellcome Laboratories, Southampton University Hospital, Southampton, United Kingdom
| | - Borislav D Dimitrov
- NIHR Southampton Respiratory Biomedical Research Unit, Southampton University Hospital, Southampton, United Kingdom; Primary Care and Population Sciences, University of Southampton Faculty of Medicine, Southampton University Hospital, Southampton, United Kingdom
| | | | | | | | - Caroline G Smith
- Primary Care and Population Sciences, University of Southampton Faculty of Medicine, Southampton University Hospital, Southampton, United Kingdom
| | - Jon A Ward
- Clinical and Experimental Sciences, University of Southampton Faculty of Medicine, Sir Henry Wellcome Laboratories, Southampton University Hospital, Southampton, United Kingdom; NIHR Southampton Respiratory Biomedical Research Unit, Southampton University Hospital, Southampton, United Kingdom
| | - Peter H Howarth
- Clinical and Experimental Sciences, University of Southampton Faculty of Medicine, Sir Henry Wellcome Laboratories, Southampton University Hospital, Southampton, United Kingdom; NIHR Southampton Respiratory Biomedical Research Unit, Southampton University Hospital, Southampton, United Kingdom
| | - Andrew F Walls
- Clinical and Experimental Sciences, University of Southampton Faculty of Medicine, Sir Henry Wellcome Laboratories, Southampton University Hospital, Southampton, United Kingdom
| | - Stephan D Gadola
- Clinical and Experimental Sciences, University of Southampton Faculty of Medicine, Sir Henry Wellcome Laboratories, Southampton University Hospital, Southampton, United Kingdom; Novartis Institute of Biomedical Research, Novartis, Basel, Switzerland
| | - Ratko Djukanović
- Clinical and Experimental Sciences, University of Southampton Faculty of Medicine, Sir Henry Wellcome Laboratories, Southampton University Hospital, Southampton, United Kingdom; NIHR Southampton Respiratory Biomedical Research Unit, Southampton University Hospital, Southampton, United Kingdom.
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