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Xiao Y, Zhang H, Liu Y, Mo L, Liao Y, Huang Q, Yang L, Zhou C, Liu J, Sun X, Yu H, Yang P. Endoplasmic reticulum stress drives macrophages to produce IL-33 to favor Th2 polarization in the airways. J Leukoc Biol 2024; 115:893-901. [PMID: 38517856 DOI: 10.1093/jleuko/qiad109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 07/23/2023] [Accepted: 07/31/2023] [Indexed: 03/24/2024] Open
Abstract
Interleukin (IL)-33 is a key driver of T helper 2 (Th2) cell polarization. Endoplasmic reticulum (ER) stress plays a role in the skewed T cell activation. The objective of this project is to elucidate the role of IL-33 derived from macrophages in inducing Th2 polarization in the airways. In this study, bronchoalveolar lavage fluids (BALF) were collected from patients with asthma and healthy control subjects. Macrophages were isolated from the BALF by flow cytometry cell sorting. An asthmatic mouse model was established using the ovalbumin/alum protocol. The results showed that increased IL33 gene activity and ER stress-related molecules in BALF-derived M2a macrophages was observed in asthmatic patients. Levels of IL33 gene activity in M2a cells were positively correlated with levels of asthma response in asthma patients. Sensitization exacerbated the ER stress in the airway macrophages, which increased the expression of IL-33 in macrophages of airway in sensitized mice. Conditional ablation of Il33 or Perk or Atf4 genes in macrophages prevented induction of airway allergy in mice. In conclusion, asthma airway macrophages express high levels of IL-33 and at high ER stress status. Inhibition of IL-33 or ER stress in macrophages can effectively alleviate experimental asthma.
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Affiliation(s)
- Yuan Xiao
- International Cooperative Laboratory of Traditional Chinese Medicine Modernization and Innovative Drug Development of Chinese Ministry of Education, College of Pharmacy, Jinan University, Guangzhou 510632, China
| | - Huangping Zhang
- Department of Allergy Medicine, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan 030001, China
| | - Yu Liu
- Department of General Medicine and Respirology, Third Affiliated Hospital of Shenzhen University, Shenzhen 518055, China
| | - Lihua Mo
- Department of General Medicine and Respirology, Third Affiliated Hospital of Shenzhen University, Shenzhen 518055, China
- Guangdong Provincial Regional Disease Key Laboratory, Shenzhen 518055, China
- Institute of Allergy and Immunology, State Key Laboratory of Respiratory Diseases Allergy Division at Shenzhen University, Shenzhen 518055, China
| | - Yun Liao
- Guangdong Provincial Regional Disease Key Laboratory, Shenzhen 518055, China
- Institute of Allergy and Immunology, State Key Laboratory of Respiratory Diseases Allergy Division at Shenzhen University, Shenzhen 518055, China
| | - Qinmiao Huang
- Department of General Medicine and Respirology, Third Affiliated Hospital of Shenzhen University, Shenzhen 518055, China
| | - Liteng Yang
- Department of General Medicine and Respirology, Third Affiliated Hospital of Shenzhen University, Shenzhen 518055, China
| | - Caijie Zhou
- Shenzhen Hospital, Beijing University of Chinese Medicine, Shenzhen 518016, China
| | - Jiangqi Liu
- Institute of Allergy and Immunology, State Key Laboratory of Respiratory Diseases Allergy Division at Shenzhen University, Shenzhen 518055, China
| | - Xizhuo Sun
- Department of General Medicine and Respirology, Third Affiliated Hospital of Shenzhen University, Shenzhen 518055, China
| | - Haiqiong Yu
- Department of Respiratory and Critical Care Medicine, The Eighth Affiliated Hospital of Sun Yat-Sen University, Shenzhen 518055, Guangdong, China
| | - Pingchang Yang
- Guangdong Provincial Regional Disease Key Laboratory, Shenzhen 518055, China
- Institute of Allergy and Immunology, State Key Laboratory of Respiratory Diseases Allergy Division at Shenzhen University, Shenzhen 518055, China
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Voskamp AL, de Jong NW, Jochems SP, Ozir-Fazalalikhan A, van Hengel ORJ, van der Vlugt LEPM, Stam KA, van den Berge M, Nawijn MC, Braunstahl GJ, Möller GM, van Wijk RG, Smits HH. Early expansion of allergen-responsive LAP + B regulatory cells in allergic rhinitis but not in allergic asthma subjects during allergen immunotherapy. Allergy 2024; 79:1060-1064. [PMID: 38169044 DOI: 10.1111/all.15973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 11/19/2023] [Accepted: 11/26/2023] [Indexed: 01/05/2024]
Affiliation(s)
- Astrid L Voskamp
- Department of Parasitology, Leiden University Center for Infectious Diseases (LU-CID), Leiden University Medical Center, Leiden, The Netherlands
| | - Nicolette W de Jong
- Department of Internal Medicine, Section Allergology and Clinical Immunology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Simon P Jochems
- Department of Parasitology, Leiden University Center for Infectious Diseases (LU-CID), Leiden University Medical Center, Leiden, The Netherlands
| | - Arifa Ozir-Fazalalikhan
- Department of Parasitology, Leiden University Center for Infectious Diseases (LU-CID), Leiden University Medical Center, Leiden, The Netherlands
| | - Oscar R J van Hengel
- Department of Parasitology, Leiden University Center for Infectious Diseases (LU-CID), Leiden University Medical Center, Leiden, The Netherlands
| | - Luciën E P M van der Vlugt
- Department of Parasitology, Leiden University Center for Infectious Diseases (LU-CID), Leiden University Medical Center, Leiden, The Netherlands
| | - Koen Alexander Stam
- Department of Parasitology, Leiden University Center for Infectious Diseases (LU-CID), Leiden University Medical Center, Leiden, The Netherlands
| | - Maarten van den Berge
- Department of Pulmonology, University Medical Center Groningen, Groningen, The Netherlands
| | - Martijn C Nawijn
- Department of Pathology and Medical Biology, University Medical Center Groningen, Groningen, The Netherlands
| | - Gert-Jan Braunstahl
- Department of Pulmonology, Franciscus Gasthuis and Vlietland, Rotterdam, The Netherlands
- Department of Pulmonology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Gertrude M Möller
- Netherlands Center of Clinical Occupational Medicine, The Netherlands
| | - Roy Gerth van Wijk
- Department of Internal Medicine, Section Allergology and Clinical Immunology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Hermelijn H Smits
- Department of Parasitology, Leiden University Center for Infectious Diseases (LU-CID), Leiden University Medical Center, Leiden, The Netherlands
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Khalaf JK, Bess LS, Walsh LM, Ward JM, Johnson CL, Livesay MT, Jackson KJ, Evans JT, Ryter KT, Bazin-Lee HG. Diamino Allose Phosphates: Novel, Potent, and Highly Stable Toll-like Receptor 4 Agonists. J Med Chem 2023; 66:13900-13917. [PMID: 37847244 DOI: 10.1021/acs.jmedchem.3c00724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Abstract
Most known synthetic toll-like receptor 4 (TLR4) agonists are carbohydrate-based lipid-A mimetics containing several fatty acyl chains, including a labile 3-O-acyl chain linked to the C-3 position of the non-reducing sugar known to undergo cleavage impacting stability and resulting in loss of activity. To overcome this inherent instability, we rationally designed a new class of chemically more stable synthetic TLR4 ligands that elicit robust innate and adaptive immune responses. This new class utilized a diamino allose phosphate (DAP) scaffold containing a nonhydrolyzable 3-amide bond instead of the classical 3-ester. Accordingly, the DAPs have significantly improved thermostability in aqueous formulations and potency relative to other known natural and synthetic TLR4 ligands. Furthermore, the DAP analogues function as potent vaccine adjuvants to enhance influenza-specific antibodies in mice and provide protection against lethal influenza virus challenges. This novel set of TLR4 ligands show promise as next-generation vaccine adjuvants and stand-alone immunomodulators.
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Affiliation(s)
- Juhienah K Khalaf
- Inimmune Corporation, 1121 E Broadway, Suite 121, Missoula, Montana 59802, United States
| | - Laura S Bess
- Inimmune Corporation, 1121 E Broadway, Suite 121, Missoula, Montana 59802, United States
| | - Lois M Walsh
- Inimmune Corporation, 1121 E Broadway, Suite 121, Missoula, Montana 59802, United States
| | - Janine M Ward
- Inimmune Corporation, 1121 E Broadway, Suite 121, Missoula, Montana 59802, United States
| | - Craig L Johnson
- Inimmune Corporation, 1121 E Broadway, Suite 121, Missoula, Montana 59802, United States
| | - Mark T Livesay
- Inimmune Corporation, 1121 E Broadway, Suite 121, Missoula, Montana 59802, United States
| | - Konner J Jackson
- Inimmune Corporation, 1121 E Broadway, Suite 121, Missoula, Montana 59802, United States
| | - Jay T Evans
- Inimmune Corporation, 1121 E Broadway, Suite 121, Missoula, Montana 59802, United States
| | - Kendal T Ryter
- Inimmune Corporation, 1121 E Broadway, Suite 121, Missoula, Montana 59802, United States
| | - Hélène G Bazin-Lee
- Inimmune Corporation, 1121 E Broadway, Suite 121, Missoula, Montana 59802, United States
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Antón M, Cabañes N, Fernández-Meléndez S, Fernández-Nieto M, Jiménez-Ferrera G, Letrán A, Méndez-Brea P, Montoro J, Moreno F, Mur-Gimeno P, Rodríguez-Vázquez V, Rosado A, Sánchez-Guerrero I, Vega-Chicote JM, Vidal C. Shared Decision-Making in Allergen Immunotherapy (AIT) Options Using a Questionnaire for Respiratory Allergic Patients: A Delphi Consensus Study. Patient Prefer Adherence 2023; 17:1771-1782. [PMID: 37520065 PMCID: PMC10378527 DOI: 10.2147/ppa.s409466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 05/10/2023] [Indexed: 08/01/2023] Open
Abstract
Purpose The objective of this study was to develop and validate a questionnaire, through a Delphi consensus, to be used by allergists in their routine clinical practice to assess the preferences of patients starting allergen immunotherapy (AIT) treatment using an objective approach. Patients and Methods A Delphi consensus-driven process was used. The scientific committee, composed of 15 allergists, led the study and participated in the preparation of the questionnaire. Two-hundred panelists from different Spanish regions were invited to complete a 16-item questionnaire on a nine-point Likert scale covering six topic blocks. Consensus was achieved if ≥66.6% of panelists reached agreement or disagreement. Results Of the 200 experts invited to participate in the Delphi process, a total of 195 (97.5%) answered the questionnaire. The panel experts reached a consensus on "agreement" on a total of 12 of the 16 (75.0%) items, covering a total of six categories: (a) patient knowledge (2 questions), (b) barriers to patient adherence (3 questions), (c) patient behavior (4 questions), (d) future actions (3 questions), (e) treatment costs (2 questions), and (f) final patient preferences (2 questions). Conclusion This Delphi consensus study validated a set of twelve recommended questions for patients objectively assessing their preferences and suitability for the most common AIT options available. The questionnaire intends to assist allergists in making an objective, unconditioned decision regarding the best AIT option for each patient, after informing them about the different routes.
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Affiliation(s)
- Mónica Antón
- Allergy Department, Hospital Universitario San Juan de Alicante, Alicante, Spain
| | - Nieves Cabañes
- Allergy Department, Hospital Universitario de Toledo, Toledo, Spain
| | | | - Mar Fernández-Nieto
- Allergy Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | | | - Antonio Letrán
- Allergy Unit, Centro médico Asisa Doctor Lobatón, Cádiz, Spain
| | - Paula Méndez-Brea
- Allergy Department, Complejo Hospitalario Clínico Universitario de Santiago, Santiago de Compostela, Spain
| | - Javier Montoro
- Allergy Department, Hospital de Llíria, Valencia, Spain
- Department of Medicine, Universidad Católica de Valencia San Vicente Mártir, Valencia, Spain
| | | | - Pilar Mur-Gimeno
- Allergy Department, Hospital de Santa Bárbara, Puertollano, Ciudad Real, Spain
| | - Virginia Rodríguez-Vázquez
- Allergy Department, Complejo Hospitalario Clínico Universitario de Santiago, Santiago de Compostela, Spain
| | - Ana Rosado
- Allergy Department, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
| | | | | | - Carmen Vidal
- Allergy Department, Complejo Hospitalario Clínico Universitario de Santiago, Santiago de Compostela, Spain
- Department of Medicine, Universidad de Santiago de Compostela, Santiago de Compostela, Spain
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Modi S, Norris MR, Nguyen V, Bower R, Craig TJ, Al-Shaikhly T. Racial and Ethnic Disparities in Allergen Immunotherapy Prescription for Allergic Rhinitis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:1528-1535.e2. [PMID: 36736954 PMCID: PMC10164679 DOI: 10.1016/j.jaip.2023.01.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 01/14/2023] [Accepted: 01/17/2023] [Indexed: 02/04/2023]
Abstract
BACKGROUND Racial and ethnic differences exist in the severity of various atopic diseases including allergic rhinitis (AR). Patients of under-represented races and ethnicities may be subjected to disparate subcutaneous allergen immunotherapy (SCIT) prescription practices. OBJECTIVE To explore the racial and ethnic disparities in the use of SCIT among patients with AR. METHODS In this retrospective matched cohort study, we used the TriNetX US Collaborative Network, a multicenter electronic health record-based database to identify patients with AR 18 years and older. Patients were grouped according to their racial and ethnic identification. Study groups were matched for baseline demographics, atopic comorbidities, heart diseases and utilization of β-blockers, and angiotensin-converting enzyme inhibitors. The proportion of patients of under-represented racial and ethnic groups started on SCIT was contrasted to the non-Hispanic White cohort. RESULTS We identified 1,038,000 patients with AR; the mean age (±standard deviation) at the index was 49.7 (±16.1) years, and 64.6% were female. Ethnicity information was available from 87.3% of patients, and the majority (92.3%) were non-Hispanic. Over a 3-year observation period, fewer Black patients (relative risk [RR], 0.40; 95% confidence interval [CI], 0.33-0.48) and Hispanic patients (RR, 0.80; 95% CI, 0.64-0.99) were started on SCIT compared with non-Hispanic White patients. The proportions of Asian patients who were initiated on SCIT tended to be lower when compared with non-Hispanic White patients (RR, 0.69; 95% CI, 0.47-1.009). CONCLUSIONS In the United States, differences in SCIT prescription exist between Black and Hispanic patients relative to White patients. Barriers to treatment should be explored and mitigated.
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Affiliation(s)
- Sunjay Modi
- Department of Medicine, Section of Allergy, Asthma and Immunology, Penn State College of Medicine, Hershey, Pennsylvania, United States
| | - Matthew R. Norris
- Department of Medicine, Section of Allergy, Asthma and Immunology, Penn State College of Medicine, Hershey, Pennsylvania, United States
| | - Victoria Nguyen
- Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania, United States
| | - Robert Bower
- Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania, United States
| | - Timothy J. Craig
- Department of Medicine, Section of Allergy, Asthma and Immunology, Penn State College of Medicine, Hershey, Pennsylvania, United States
| | - Taha Al-Shaikhly
- Department of Medicine, Section of Allergy, Asthma and Immunology, Penn State College of Medicine, Hershey, Pennsylvania, United States
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Wang W, Wang X, Wang H, Wang X. Evaluation of Safety, Efficacy, and Compliance of Intralymphatic Immunotherapy for Allergic Rhinoconjunctivitis: A Systematic Review and Meta-Analysis. Int Arch Allergy Immunol 2023; 184:754-766. [PMID: 37105134 DOI: 10.1159/000529025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 12/13/2022] [Indexed: 04/29/2023] Open
Abstract
INTRODUCTION Intralymphatic immunotherapy (ILIT) is an emerging type of allergen immunotherapy with fewer injections and shorter course for allergic rhinoconjunctivitis (ARC). The efficacy and safety have not been confirmed by informative and powerful evidence yet. METHODS A systematic review and meta-analysis were conducted through electronic searching with PubMed, Web of Science, Embase, Scopus, and China National Knowledge Infrastructure (CNKI). The safety (incidence of adverse events [AEs]), compliance (percent of patients completing treatment), and clinical efficacy of ILIT were evaluated. Clinical efficacy could be assessed by improvement of subjective symptom and rescue medication use or the nasal tolerance to specific allergen. This study is registered with PROSPERO (CRD42022353562). RESULTS 12 randomized controlled trials (RCTs) comparing ILIT with placebo and 3 trials (2 RCTs and one case-control study) comparing ILIT and SCIT were included in this review. Totally, 582 patients diagnosed as AR or ARC were enrolled. Almost all the AEs were mild-to-moderate reactions except 2 patients developed anaphylactic reactions at the intralymphatic injection dose 5,000 SQ-U in one study. ILIT got higher incidence of local AEs than placebo, but their incidence of systemic AEs was similar. ILIT was safer than SCIT (p < 0.05). Almost all the patients could complete ILIT treatment, and the most common reason for discontinuation of ILIT was AEs. The compliance of patients receiving ILIT seemed higher than patients receiving SCIT. ILIT could significantly ameliorate subjective allergic symptoms, especially for seasonal ARC, and increase nasal tolerance, similar to SCIT. CONCLUSION ILIT was a safe and effective treatment for ARC and could achieve comparable clinical improvement with SCIT with shorter duration and higher compliance. Moreover, ILIT was safer than SCIT.
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Affiliation(s)
- Wenping Wang
- Department of Allergy, Capital Medical University Affiliated Beijing Shijitan Hospital, Beijing, China,
| | - Xiaoyan Wang
- Department of Allergy, Capital Medical University Affiliated Beijing Shijitan Hospital, Beijing, China
| | - Hongtian Wang
- Department of Allergy, Capital Medical University Affiliated Beijing Shijitan Hospital, Beijing, China
| | - Xueyan Wang
- Department of Allergy, Capital Medical University Affiliated Beijing Shijitan Hospital, Beijing, China
- Center of Allergy, Capital Medical University Affiliated Beijing Shijitan Hospital, Beijing, China
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Fiala S, Fleit HB. Clinical and experimental treatment of allergic asthma with an emphasis on allergen immunotherapy and its mechanisms. Clin Exp Immunol 2023; 212:14-28. [PMID: 36879430 PMCID: PMC10081111 DOI: 10.1093/cei/uxad031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 01/23/2023] [Accepted: 03/01/2023] [Indexed: 03/08/2023] Open
Abstract
Allergen immunotherapy (AIT) is currently the only form of treatment that modifies allergic asthma. Pharmacotherapy alone seeks to control the symptoms of allergic asthma, allergic rhinitis, and other atopic conditions. In contrast, AIT can induce long-term physiological modifications through the immune system. AIT enables individuals to live improved lives many years after treatment ends, where they are desensitized to the allergen(s) used or no longer have significant allergic reactions upon allergen provocation. The leading forms of treatment with AIT involve injections of allergen extracts with increasing doses via the subcutaneous route or drops/tablets via the sublingual route for several years. Since the initial attempts at this treatment as early as 1911 by Leonard Noon, the mechanisms by which AIT operates remain unclear. This literature-based review provides the primary care practitioner with a current understanding of the mechanisms of AIT, including its treatment safety, protocols, and long-term efficacy. The primary mechanisms underlying AIT include changes in immunoglobulin classes (IgA, IgE, and IgG), immunosuppressive regulatory T-cell induction, helper T cell type 2 to helper T cell type 1 cell/cytokine profile shifts, decreased early-phase reaction activity and mediators, and increased production of IL-10, IL-35, TGF-β, and IFN-γ. Using the databases PubMed and Embase, a selective literature search was conducted searching for English, full-text, reviews published between 2015 and 2022 using the keywords (with wildcards) "allerg*," "immunotherap*," "mechanis*," and "asthma." Among the cited references, additional references were identified using a manual search.
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Affiliation(s)
- Scott Fiala
- Department of Pathology, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Howard B Fleit
- Department of Pathology, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
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Zhai Y, Zheng P, Sun B, Li J, Wang B. Allergen-specific immunotherapy with Alutard SQ improves allergic inflammation in house-dust mites-induced allergic asthma rats through inactivation of the HMGB1/TLR4/NF-κB pathway. J Thorac Dis 2023; 15:77-89. [PMID: 36794148 PMCID: PMC9922602 DOI: 10.21037/jtd-22-715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 11/25/2022] [Indexed: 01/12/2023]
Abstract
Background Allergen-specific immunotherapy (AIT) is the only available safe, effective, and long-term treatment for allergic airway diseases, including allergic asthma. However, the potential molecular mechanism of AIT in ameliorating airway inflammation remains unknown. Methods Rats were sensitized and challenged with house dust mite (HDM) and administered with Alutard SQ or/and high mobility group box 1 (HMGB1) inhibitor, ammonium glycyrrhizinate (AMGZ) or HMGB1 lentivirus. The total and differential cell counts in rat bronchoalveolar lavage fluid (BALF) were detected. Hematoxylin and eosin staining (H&E) was performed to examine the pathological lesions in lung tissues. Enzyme-linked immunosorbent assay (ELISA) was performed to assess the expression of inflammatory factors in lungs, BALF, and serum. Quantitative real-time PCR (qRT-PCR) was used to measure the levels of inflammatory factors in the lungs. Western blot assay was used to evaluate the expression of HMGB1, Τoll-like receptor 4 (TLR4), and nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) in the lungs. Results Consequently, AIT with Alutard SQ attenuated airway inflammation, the total and differential cells in BALF, and expression of Th (T helper)2 related cytokines and transforming growth factor beta 1 (TGF-β1). The regimen also upregulated Th-1-related cytokine expression by inhibiting the HMGB1/TLR4/NF-κB pathway in HDM-induced asthmatic rats. Furthermore, AMGZ, a HMGB1 antagonist, amplified the functions of AIT with Alutard SQ in the asthma rat model. Nevertheless, overexpression of HMGB1 reversed the functions of AIT with Alutard SQ in the asthma rat model. Conclusions In summary, this work demonstrates the role of AIT with Alutard SQ, which inhibits the HMGB1/TLR4/NF-κB signaling pathway in allergic asthma management.
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Affiliation(s)
- Yingying Zhai
- Department of Pediatrics, Zhujiang Hospital, Southern Medical University, Guangzhou, China;,Department of Pediatrics, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Peiyan Zheng
- Department of Allergy and Clinical Immunology, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Baoqing Sun
- Department of Allergy and Clinical Immunology, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jing Li
- Department of Allergy and Clinical Immunology, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Bin Wang
- Department of Pediatrics, Zhujiang Hospital, Southern Medical University, Guangzhou, China
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Corren J, Larson D, Altman MC, Segnitz RM, Avila PC, Greenberger PA, Baroody F, Moss MH, Nelson H, Burbank AJ, Hernandez ML, Peden D, Saini S, Tilles S, Hussain I, Whitehouse D, Qin T, Villarreal M, Sever M, Wheatley LM, Nepom GT, Sanda S. Effects of combination treatment with tezepelumab and allergen immunotherapy on nasal responses to allergen: A randomized controlled trial. J Allergy Clin Immunol 2023; 151:192-201. [PMID: 36223848 DOI: 10.1016/j.jaci.2022.08.029] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 07/28/2022] [Accepted: 08/04/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Thymic stromal lymphopoietin (TSLP) has been shown to play a central role in the initiation and persistence of allergic responses. OBJECTIVE We evaluated whether tezepelumab, a human monoclonal anti-TSLP antibody, improved the efficacy of subcutaneous allergen immunotherapy (SCIT) and promoted the development of tolerance in patients with allergic rhinitis. METHODS We conducted a double-blind parallel design trial in patients with cat allergy. A total of 121 patients were randomized to receive either intravenous tezepelumab plus subcutaneous cat SCIT, cat SCIT alone, tezepelumab alone, or placebo for 52 weeks, followed by 52 weeks of observation. Nasal allergen challenge (NAC), skin testing, and blood and nasal samples were obtained throughout the study. RESULTS At week 52, the NAC-induced total nasal symptom scores (TNSS) (calculated as area under the curve [AUC0-1h] and as peak score [Peak0-1h] during the first hour after NAC) were significantly reduced in patients receiving tezepelumab/SCIT compared to SCIT alone. At week 104, one year after stopping treatment, the primary end point TNSS AUC0-1h was not significantly different in the tezepelumab/SCIT group compared to SCIT alone, while TNSS Peak0-1h was significantly lower in those receiving combination treatment versus SCIT. Transcriptomic analysis of nasal epithelial samples demonstrated that treatment with the combination of SCIT/tezepelumab, but neither monotherapy, caused persistent downregulation of a gene network related to type 2 inflammation that was associated with improvement in NAC responses. CONCLUSIONS Inhibition of TSLP augments the efficacy of SCIT during therapy and may promote tolerance after a 1-year course of treatment. (ClinicalTrials.gov NCT02237196).
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Affiliation(s)
- Jonathan Corren
- Departments of Medicine and Pediatrics, David Geffen School of Medicine, University of California, Los Angeles.
| | | | - Matthew C Altman
- Division of Allergy and Infectious Diseases, University of Washington School of Medicine, Seattle; Benaroya Research Institute, Seattle
| | - R Max Segnitz
- Division of Allergy and Infectious Diseases, University of Washington School of Medicine, Seattle
| | - Pedro C Avila
- Division of Allergy-Immunology, Feinberg School of Medicine, Chicago
| | | | - Fuad Baroody
- University of Chicago Medicine and Comer Children's Hospital, Chicago
| | - Mark H Moss
- Section of Allergy, Pulmonary and Critical Care, University of Wisconsin Hospital and Clinics, Madison
| | - Harold Nelson
- Department of Medicine, Division of Allergy and Clinical Immunology, National Jewish Health, Denver
| | - Allison J Burbank
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill
| | | | - David Peden
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill
| | - Sarbjit Saini
- Division of Allergy & Clinical Immunology, Johns Hopkins University, Baltimore
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Wang C, Bao Y, Chen J, Chen X, Cheng L, Guo YS, Hao C, Lai H, Li H, Li J, Liu C, Liu Y, Liu Z, Lou H, Lv W, Nong G, Qiu Q, Ren X, Shao J, Shen YH, Shi L, Song XC, Song Y, Tang S, Wang H, Wang X, Wang X, Wang Z, Wei Q, Xie H, Xing Z, Xu R, Xu Y, Yang Q, Yao H, Ye J, You Y, Yu H, Yu Y, Zhang H, Zhang G, Zhang Y, Zhi Y, Zhou W, Zhu L, Zhu X, Chai R, Chen D, Guan K, Huang Z, Huang Y, Ma T, Ma Y, Meng Y, Ren L, Wang J, Wang N, Xian M, Xiang R, Zheng M, Zhang L. Chinese Guideline on Allergen Immunotherapy for Allergic Rhinitis: The 2022 Update. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2022; 14:604-652. [PMID: 36426395 PMCID: PMC9709690 DOI: 10.4168/aair.2022.14.6.604] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 10/23/2022] [Accepted: 11/06/2022] [Indexed: 09/16/2023]
Abstract
In the last few decades, there has been a progressive increase in the prevalence of allergic rhinitis (AR) in China, where it now affects approximately 250 million people. AR prevention and treatment include allergen avoidance, pharmacotherapy, allergen immunotherapy (AIT), and patient education, among which AIT is the only curative intervention. AIT targets the disease etiology and may potentially modify the immune system as well as induce allergen-specific immune tolerance in patients with AR. In 2017, a team of experts from the Chinese Society of Allergy (CSA) and the Chinese Allergic Rhinitis Collaborative Research Group (C2AR2G) produced the first English version of Chinese AIT guidelines for AR. Since then, there has been considerable progress in basic research of and clinical practice for AIT, especially regarding the role of follicular regulatory T (TFR) cells in the pathogenesis of AR and the use of allergen-specific immunoglobulin E (sIgE) in nasal secretions for the diagnosis of AR. Additionally, potential biomarkers, including TFR cells, sIgG4, and sIgE, have been used to monitor the incidence and progression of AR. Moreover, there has been a novel understanding of AIT during the coronavirus disease 2019 pandemic. Hence, there was an urgent need to update the AIT guideline for AR by a team of experts from CSA and C2AR2G. This document aims to serve as professional reference material on AIT for AR treatment in China, thus improving the development of AIT across the world.
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Affiliation(s)
- Chengshuo Wang
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Nasal Diseases and Beijing Laboratory of Allergic Diseases, Beijing Institute of Otorhinolaryngology, Beijing, China
- Research Unit of Diagnosis and Treatment of Chronic Nasal Diseases, Chinese Academy of Medical Sciences, Beijing, China
- Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | | | - Jianjun Chen
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Xiaoyang Chen
- Department of Pulmonary and Critical Care Medicine, Second Affiliated Hospitial of Fujian Medical University, Respiratory Medicine Center of Fujian Province, Quanzhou, China
| | - Lei Cheng
- Department of Otorhinolaryngology & Clinical Allergy Center, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Yin Shi Guo
- Department of Allergy & Immunology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Chuangli Hao
- Department of Respiratory Diseases, Children's Hospital of Soochow University, Suzhou, China
| | - He Lai
- Department of Allergy, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Huabin Li
- Department of Otolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Jing Li
- Department of Allergy and Clinical Immunology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Changshan Liu
- Department of Pediatrics, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Yun Liu
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Zheng Liu
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hongfei Lou
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
- Research Unit of Diagnosis and Treatment of Chronic Nasal Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Wei Lv
- Department of Otorhinolaryngology, Peking Union Medical College Hospital, Beijing, China
| | - Guangmin Nong
- Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Qianhui Qiu
- Department of Otolaryngology-Head and Neck Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xiumin Ren
- Department of Otorhinolaryngology Head and Neck Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jie Shao
- Department of Pediatrics, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi-Hong Shen
- Department of Respiratory Diseases, The First Affiliated Hospital of College of Medicine, Zhejiang University, Hangzhou, China
| | - Li Shi
- Department of Otolaryngology,The Second Hospital of Shandong University, Jinan, China
| | - Xi-Cheng Song
- Department of Otorhinolaryngology Head and Neck Surgery, Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Yuxin Song
- Department of Allergy, Harbin Children's Hospital, Harbin, China
| | - Suping Tang
- Department of Allergy, Fuzhou Children's Hospital Affiliated to Fujian Medical University, Fuzhou, China
| | - Hongtian Wang
- Department of Allergy, Beijing ShiJiTan Hospital, Capital Medical University, Beijing, China
| | - Xiangdong Wang
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Nasal Diseases and Beijing Laboratory of Allergic Diseases, Beijing Institute of Otorhinolaryngology, Beijing, China
| | - Xueyan Wang
- Department of Allergy, Beijing ShiJiTan Hospital, Capital Medical University, Beijing, China
| | - Zhenlin Wang
- Department of Otorhinolaryngology Head and Neck Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Qingyu Wei
- Department of Allergy, Shengjing Hospital of China Medical University, Shenyang, China
| | - Hua Xie
- Department of Allergy, Northern Theatre General Hospital, Shenyang, China
| | - Zhimin Xing
- Department of Otolaryngology-Head and Neck Surgery, Peking University People's Hospital, Beijing, China
| | - Rui Xu
- Department of Allergy of Otorhinolaryngology Hospital, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yu Xu
- Department of Otorhinolaryngology Head and Neck Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Qintai Yang
- Department of Otolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Hongmei Yao
- Department of Respiratory and Critical Care Medicine, Guizhou Provincial People's Hospital, Guiyang, China
| | - Jing Ye
- Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yiwen You
- Department of Otolaryngology Head and Neck Surgery, Affiliated Hospital of Nantong University, Nantong, China
| | - Hongmeng Yu
- Department of Otolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Yongmei Yu
- Department of Otorhinolaryngology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Huanping Zhang
- Department of Allergy, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Gehua Zhang
- Department of Otolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yuan Zhang
- Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - Yuxiang Zhi
- Department of Allergy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Weikang Zhou
- Department of Allergy, Chongqing General Hospital, Chongqing, China
| | - Li Zhu
- Department of Otorhinolaryngology, The Third Hospital of Peking University, Beijing, China
| | - Xinhua Zhu
- Department of Otorhinolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Ruonan Chai
- Department of Allergy, Northern Theatre General Hospital, Shenyang, China
| | - Dehua Chen
- Department of Allergy of Otorhinolaryngology Hospital, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Kai Guan
- Department of Allergy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Zizhen Huang
- Department of Otolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yanran Huang
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - Tingting Ma
- Department of Allergy, Beijing ShiJiTan Hospital, Capital Medical University, Beijing, China
| | - Yuemei Ma
- Department of Allergy, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yifan Meng
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - Lei Ren
- Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - Jianxing Wang
- Department of Otorhinolaryngology Head and Neck Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Nan Wang
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Mo Xian
- Department of Allergy and Clinical Immunology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Rong Xiang
- Department of Otorhinolaryngology Head and Neck Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Ming Zheng
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - Luo Zhang
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
- Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, China.
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11
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Development of a Novel Targeted Metabolomic LC-QqQ-MS Method in Allergic Inflammation. Metabolites 2022; 12:metabo12070592. [PMID: 35888716 PMCID: PMC9319984 DOI: 10.3390/metabo12070592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 06/21/2022] [Accepted: 06/23/2022] [Indexed: 11/17/2022] Open
Abstract
The transition from mild to severe allergic phenotypes is still poorly understood and there is an urgent need of incorporating new therapies, accompanied by personalized diagnosis approaches. This work presents the development of a novel targeted metabolomic methodology for the analysis of 36 metabolites related to allergic inflammation, including mostly sphingolipids, lysophospholipids, amino acids, and those of energy metabolism previously identified in non-targeted studies. The methodology consisted of two complementary chromatography methods, HILIC and reversed-phase. These were developed using liquid chromatography, coupled to triple quadrupole mass spectrometry (LC-QqQ-MS) in dynamic multiple reaction monitoring (dMRM) acquisition mode and were validated using ICH guidelines. Serum samples from two clinical models of allergic asthma patients were used for method application, which were as follows: (1) corticosteroid-controlled (ICS, n = 6) versus uncontrolled (UC, n = 4) patients, and immunotherapy-controlled (IT, n = 23) versus biologicals-controlled (BIO, n = 12) patients. The results showed significant differences mainly in lysophospholipids using univariate analyses in both models. Multivariate analysis for model 1 was able to distinguish both groups, while for model 2, the results showed the correct classification of all BIO samples within their group. Thus, this methodology can be of great importance for further understanding the role of these metabolites in allergic diseases as potential biomarkers for disease severity and for predicting patient treatment response.
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12
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Eremija J, Carr TF. Immunotherapy for Asthma. Semin Respir Crit Care Med 2022; 43:709-719. [PMID: 35714626 DOI: 10.1055/s-0042-1749454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Asthma represents one of the biggest global health concerns with increasing prevalence and influence on global health. Several distinct asthma phenotypes have been identified with one of the most common, earliest recognized, and described being the allergic asthma phenotype, in which allergens trigger asthma through mechanisms involving allergen-specific immunoglobulin E (IgE). Allergen-specific immunotherapy (AIT), in the forms of subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT), has been used for many decades as a tool for reducing IgE-mediated sensitization and controlling symptoms of allergic disease, most commonly for allergic rhinitis, and it remains the only currently available disease modifying therapy in atopic patients. AIT has been studied for use in mild to moderate allergic asthma. While the data are often inconsistent, and utilize a multitude of different methods, antigens, and outcome measures, in general, AIT may have several beneficial effects on asthma disease control, quality of life, and requirement for medication. These benefits are notable when immunotherapy is used as an adjunct to pharmacologic treatment in carefully selected and monitored patients with mild to moderate persistent asthma. Patients with severe asthma are excluded from these trials. Importantly, patients with asthma, and in particular severe asthma, may have a higher rate of systemic adverse reactions to SCIT, including anaphylaxis, however, these events are overall rare. Future research in the area is needed to definitively assess the benefit of SCIT and SLIT for patients with asthma, comparing outcomes with different methods, addressing the role of AIT in severe asthma, significance of multiallergen AIT in allergic asthma, and safety concerns in asthma.
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Affiliation(s)
- Jelena Eremija
- Section of Allergy & Immunology, Department of Medicine, Asthma and Airway Disease Research Center, University of Arizona, Tucson, Arizona
| | - Tara F Carr
- Section of Allergy & Immunology, Department of Medicine, Asthma and Airway Disease Research Center, University of Arizona, Tucson, Arizona
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13
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de Blay F, Gherasim A, Casale TB, Doyen V, Bernstein D. Which patients with asthma are most likely to benefit from allergen immunotherapy? J Allergy Clin Immunol 2022; 149:833-843. [DOI: 10.1016/j.jaci.2022.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/14/2022] [Accepted: 01/17/2022] [Indexed: 10/19/2022]
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14
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Zhang Q, Xi G, Yin J. Artemisia sieversiana pollen allergy and immunotherapy in mice. Am J Transl Res 2021; 13:13654-13664. [PMID: 35035704 PMCID: PMC8748105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 10/12/2021] [Indexed: 06/14/2023]
Abstract
This study developed a murine model of asthma using Artemisia sieversiana pollen extract (ASE) and subcutaneous immunotherapy (SCIT) without an adjuvant. BALB/c mice were sensitized subcutaneously with 25 μg of ASE and challenged with 0.1% ASE aerosol. To investigate the efficacy of SCIT, mice were subcutaneously injected with 0.3 mg ASE without adjuvant once a week for 8 weeks, followed by challenge for 3 additional days. Airway hyperresponsiveness (AHR) to methacholine, pulmonary inflammatory cell infiltration, cytokine levels of bronchoalveolar lavage fluid, histopathology of the lung, and serum allergen-specific serum IgE and IgG2a levels were assessed following the final challenge. Mice sensitized with ASE developed AHR and had significantly higher interleukin (IL)-4, IL-5, and IL-13 levels as well as lower IL-12 level than those of control mice. Moreover, mice sensitized with ASE showed increased plasma levels of allergen-specific IgE, and histologic analyses showed peribranchial infiltration of inflammatory cells and mucosal hyperplasia. After SCIT, allergic symptoms and immunological parameters were effectively improved, and the plasma level of allergen-specific IgG2a was significantly increased cmpared to that in the vehicle group. These findings described successful development of an A. sieversiana pollen-induced asthma model in BALB/c mice, with in vivo findings revealing that SCIT without adjuvant significantly improved the symptoms and pathophysiology of asthmatic mice.
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Affiliation(s)
- Qian Zhang
- Department of Allergy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical CollegeBeijing 100730, China
- Beijing Key Laboratory of Precision Medicine for Diagnosis and Treatment on Allergic DiseasesBeijing 100730, China
- National Clinical Research Center for Dermatologic and Immunologic DiseasesBeijing 100034, China
| | - Guangpeng Xi
- Department of Allergy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical CollegeBeijing 100730, China
- Beijing Key Laboratory of Precision Medicine for Diagnosis and Treatment on Allergic DiseasesBeijing 100730, China
- National Clinical Research Center for Dermatologic and Immunologic DiseasesBeijing 100034, China
| | - Jia Yin
- Department of Allergy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical CollegeBeijing 100730, China
- Beijing Key Laboratory of Precision Medicine for Diagnosis and Treatment on Allergic DiseasesBeijing 100730, China
- National Clinical Research Center for Dermatologic and Immunologic DiseasesBeijing 100034, China
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15
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Baba SM, Rasool R, Gull A, Qureshi TA, Beigh AH, Qadri Q, Shah ZA. Effectiveness of Sublingual Immunotherapy in the Treatment of HDM-Induced Nasobronchial Allergies: A 3-Year Randomized Case-Control Study From Kashmir. Front Immunol 2021; 12:723814. [PMID: 34721385 PMCID: PMC8548833 DOI: 10.3389/fimmu.2021.723814] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 09/06/2021] [Indexed: 11/17/2022] Open
Abstract
Allergen immunotherapy (AIT) is the only disease-modifying treatment for allergic disorders that induces immunological tolerance through administration of specific allergens. Studies on AIT for subcutaneous route are in abundance; however, the efficacy of AIT in tablet form through sublingual route has not been well elucidated. The present prospective, parallel-group, controlled study sought to compare the efficacy of sublingual immunotherapy (SLIT) tablets with pharmacotherapy (PT) in 332 house dust mite (HDM)-specific allergic asthma and/or rhinitis patients over a period of 3 years. Patients were followed up for a 6-month run-in period and then randomly stratified as those who would receive SLIT, SLIT in addition to PT (SLIT+PT), and PT alone. AIT was administered in the form of sublingual tablets. Symptom and medication scores were measured every 3 months. In vitro evaluation of serum total and HDM specific immunoglobulin E (HDM sIgE) levels was carried out every 3 months, whereas in vivo skin prick test was performed annually for 3 years. Our study demonstrated sustained clinical improvement, reduction in inhaled corticosteroid (ICS) dose and duration as well as prevention from development of neosensitization to other aero allergens in HDM-allergic asthmatics and/or rhinitis patients treated with 3 years SLIT. Despite a remarkable clinical improvement with AIT, we observed that SLIT did not significantly change the skin reactivity to HDM at 3 years and there was no significant change in the ratio of serum total and HDM sIgE. Given the immune and disease modifying effects of AIT in allergic diseases, the present study supports the notion of its sublingual mode being an effective long-term immunomodulator in HDM-sensitized nasobronchial allergies.
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Watanabe K, Horita N, Hara Y, Kobayashi N, Kaneko T. Use of Systemic Corticosteroids for Reasons Other than Asthma in Subjects with Asthma. Respiration 2021; 101:109-115. [PMID: 34515214 DOI: 10.1159/000518461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 07/05/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUNDS Recent studies have reported increased risks of adverse events from systemic corticosteroids even with only low-dose or short-term use. Some patients with asthma experience complications requiring systemic corticosteroids. However, few studies have examined issues associated with administration of systemic corticosteroids for reasons other than asthma among subjects with asthma. OBJECTIVES We investigated patterns of systemic corticosteroid exposure for reasons other than asthma in subjects with asthma. METHOD We retrospectively reviewed the records of adult subjects with asthma followed up for >1 year at Yokohama City University Hospital from January 1, 2010, to December 31, 2019. We investigated patterns and reasons for systemic corticosteroid use during follow-up. In addition, factors related to systemic corticosteroid use for reasons likely other than asthma were investigated. RESULTS Among the 568 subjects with asthma analyzed, 326 (57.4%) had received systemic corticosteroids for some reason. Among those 326 patients, 120 (36.8%) had received systemic corticosteroids for reasons likely other than asthma. Multivariable analysis revealed rheumatoid arthritis, eosinophilic granulomatosis with polyangiitis, other collagen vascular diseases, chronic rhinosinusitis, and malignancy as positively associated with systemic corticosteroid exposure for reasons likely other than asthma in subjects with asthma. CONCLUSIONS About 40% of systemic corticosteroid use in subjects with asthma was for reasons likely other than asthma. Clinicians should be aware of their asthma patients' exposures to systemic corticosteroids for nonasthma reasons, to avoid missing adverse events or underestimating the severity of asthma, and to reduce systemic corticosteroid use.
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Affiliation(s)
- Keisuke Watanabe
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Nobuyuki Horita
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yu Hara
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Nobuaki Kobayashi
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Takeshi Kaneko
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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Sabban SS. Computationally grafting an IgE epitope onto a scaffold: Implications for a pan anti-allergy vaccine design. Comput Struct Biotechnol J 2021; 19:4738-4750. [PMID: 34504666 PMCID: PMC8403545 DOI: 10.1016/j.csbj.2021.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 08/04/2021] [Accepted: 08/08/2021] [Indexed: 12/02/2022] Open
Abstract
Allergy is becoming an intensifying disease among the world population, particularly in the developed world. Once allergy develops, sufferers are permanently trapped in a hyper-immune response that makes them sensitive to innocuous substances. The immune pathway concerned with developing allergy is the Th2 immune pathway where the IgE antibody binds to its Fc ∊ RI receptor on Mast and Basophil cells. This paper discusses a protocol that could disrupt the binding between the antibody and its receptor for a potential permanent treatment. Ten proteins were computationally designed to display a human IgE motif very close in proximity to the IgE antibody's Fc ∊ RI receptor's binding site in an effort for these proteins to be used as a vaccine against our own IgE antibody. The motif of interest was the FG loop motif and it was excised and grafted onto a Staphylococcus aureus protein (PDB ID 1YN3), then the motif + scaffold structure had its sequence re-designed around the motif to find an amino acid sequence that would fold to the designed structure correctly. These ten computationally designed proteins showed successful folding when simulated using Rosetta's AbinitioRelax folding simulation and the IgE epitope was clearly displayed in its native three-dimensional structure in all of them. These designed proteins have the potential to be used as a pan anti-allergy vaccine. This work employedin silicobased methods for designing the proteins and did not include any experimental verifications.
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Affiliation(s)
- Sari S. Sabban
- King Abdulaziz University, Faculty of Science, Department of Biological Sciences, Jeddah, Saudi Arabia
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18
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Abellard A, Pappalardo AA. Overview of severe asthma, with emphasis on pediatric patients: a review for practitioners. J Investig Med 2021; 69:1297-1309. [PMID: 34168068 DOI: 10.1136/jim-2020-001752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2021] [Indexed: 11/03/2022]
Abstract
Asthma is the most common life-threatening chronic disease in children. Although guidelines exist for the diagnosis and treatment of asthma, treatment of severe, pediatric asthma remains difficult. Limited studies in the pediatric population on new asthma therapies, complex issues with adolescence and adherence, health disparities, and unequal access to guideline-based care complicate the care of children with severe, persistent asthma. The purpose of this review is to provide an overview of asthma, including asthma subtypes, comorbidities, and risk factors, to discuss diagnostic considerations and pitfalls and existing treatments, and then present existing and emerging therapeutic approaches to asthma management. An improved understanding of asthma heterogeneity, clinical characteristics, inflammatory patterns, and pathobiology can help further guide the management of severe asthma in children. More studies are needed in the pediatric population to understand emerging therapeutics application in children. Effective multimodal strategies tailored to individual characteristics and a commitment to address risk factors, modifiers, and health disparities may help reduce the burden of asthma in the USA.
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Affiliation(s)
- Arabelle Abellard
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Andrea A Pappalardo
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA .,Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois, USA
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19
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Shamji MH, Singh I, Layhadi JA, Ito C, Karamani A, Kouser L, Sharif H, Tang J, Handijiev S, Parkin RV, Durham SR, Kostic A, Orengo JM, DeVeaux M, Kamal M, Stahl N, Yancopoulos GD, Wang CQ, Radin AR. Passive Prophylactic Administration with a Single Dose of Anti-Fel d 1 Monoclonal Antibodies REGN1908-1909 in Cat Allergen-induced Allergic Rhinitis: A Randomized, Double-Blind, Placebo-controlled Clinical Trial. Am J Respir Crit Care Med 2021; 204:23-33. [PMID: 33651675 PMCID: PMC8437124 DOI: 10.1164/rccm.202011-4107oc] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Rationale: Sensitization to Fel d 1 (Felis domesticus allergen 1) contributes to persistent allergic rhinitis and asthma. Existing treatment options for cat allergy, including allergen immunotherapy, are only moderately effective, and allergen immunotherapy has limited use because of safety concerns. Objectives: To explore the relationship among the pharmacokinetic, clinical, and immunological effects of anti–Fel d 1 monoclonal antibodies (REGN1908–1909) in patients after treatment. Methods: Patients received REGN1908–1909 (n = 36) or a placebo (n = 37) in a phase 1b study. Fel d 1–induced basophil and IgE-facilitated allergen binding responses were evaluated at baseline and Days 8, 29, and 85. Cytokine and chemokine concentrations in nasal fluids were measured, and REGN1908–1909 inhibition of allergen–IgE binding in patient serum was evaluated. Measurements and Main Results: Peak serum drug concentrations were concordant with maximal observed clinical response. The anti–Fel d 1 IgE/cat dander IgE ratio in pretreatment serum correlated with Total Nasal Symptom Score improvement. The allergen-neutralizing capacity of REGN1908–1909 was observed in serum and nasal fluid and was detected in an inhibition assay. Type 2 cytokines (IL-4, IL-5, and IL-13) and chemokines (CCL17/TARC, CCL5/RANTES [regulated upon activation, normal T-cell expressed and secreted]) in nasal fluid were inhibited in REGN1908–1909–treated patients compared with placebo (P < 0.05 for all); IL-13 and IL-5 concentrations correlated with Total Nasal Symptom Score improvement. Ex vivo assays demonstrated that REGN1908 and REGN1909 combined were more potent than each alone for inhibiting FcεRI- and FcεRII (CD23)–mediated allergic responses and subsequent T-cell activation. Conclusions: A single, passive-dose administration of Fel d 1–neutralizing IgG antibodies improved nasal symptoms in cat-allergic patients and was underscored by suppression of FcεRI-, FcεRII-, and T-helper cell type 2–mediated allergic responses. Clinical trial registered with www.clinicaltrials.gov (NCT02127801)
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Affiliation(s)
- Mohamed H Shamji
- Immunomodulation and Tolerance Group, Allergy and Clinical Immunology, Inflammation, Repair and Development, Medical Research Center-Asthma United Kingdom Centre in Allergic Mechanisms of Asthma, National Heart and Lung Institute, Imperial College London, London, United Kingdom; and
| | - Iesha Singh
- Immunomodulation and Tolerance Group, Allergy and Clinical Immunology, Inflammation, Repair and Development, Medical Research Center-Asthma United Kingdom Centre in Allergic Mechanisms of Asthma, National Heart and Lung Institute, Imperial College London, London, United Kingdom; and
| | - Janice A Layhadi
- Immunomodulation and Tolerance Group, Allergy and Clinical Immunology, Inflammation, Repair and Development, Medical Research Center-Asthma United Kingdom Centre in Allergic Mechanisms of Asthma, National Heart and Lung Institute, Imperial College London, London, United Kingdom; and
| | - Constance Ito
- Immunomodulation and Tolerance Group, Allergy and Clinical Immunology, Inflammation, Repair and Development, Medical Research Center-Asthma United Kingdom Centre in Allergic Mechanisms of Asthma, National Heart and Lung Institute, Imperial College London, London, United Kingdom; and
| | - Angeliki Karamani
- Immunomodulation and Tolerance Group, Allergy and Clinical Immunology, Inflammation, Repair and Development, Medical Research Center-Asthma United Kingdom Centre in Allergic Mechanisms of Asthma, National Heart and Lung Institute, Imperial College London, London, United Kingdom; and
| | - Lubna Kouser
- Immunomodulation and Tolerance Group, Allergy and Clinical Immunology, Inflammation, Repair and Development, Medical Research Center-Asthma United Kingdom Centre in Allergic Mechanisms of Asthma, National Heart and Lung Institute, Imperial College London, London, United Kingdom; and
| | - Hanisah Sharif
- Immunomodulation and Tolerance Group, Allergy and Clinical Immunology, Inflammation, Repair and Development, Medical Research Center-Asthma United Kingdom Centre in Allergic Mechanisms of Asthma, National Heart and Lung Institute, Imperial College London, London, United Kingdom; and
| | - Jiaqian Tang
- Immunomodulation and Tolerance Group, Allergy and Clinical Immunology, Inflammation, Repair and Development, Medical Research Center-Asthma United Kingdom Centre in Allergic Mechanisms of Asthma, National Heart and Lung Institute, Imperial College London, London, United Kingdom; and
| | - Sava Handijiev
- Immunomodulation and Tolerance Group, Allergy and Clinical Immunology, Inflammation, Repair and Development, Medical Research Center-Asthma United Kingdom Centre in Allergic Mechanisms of Asthma, National Heart and Lung Institute, Imperial College London, London, United Kingdom; and
| | - Rebecca V Parkin
- Immunomodulation and Tolerance Group, Allergy and Clinical Immunology, Inflammation, Repair and Development, Medical Research Center-Asthma United Kingdom Centre in Allergic Mechanisms of Asthma, National Heart and Lung Institute, Imperial College London, London, United Kingdom; and
| | - Stephen R Durham
- Immunomodulation and Tolerance Group, Allergy and Clinical Immunology, Inflammation, Repair and Development, Medical Research Center-Asthma United Kingdom Centre in Allergic Mechanisms of Asthma, National Heart and Lung Institute, Imperial College London, London, United Kingdom; and
| | - Ana Kostic
- Regeneron Pharmaceuticals, Inc., Tarrytown, New York
| | | | | | - Mohamed Kamal
- Regeneron Pharmaceuticals, Inc., Tarrytown, New York
| | - Neil Stahl
- Regeneron Pharmaceuticals, Inc., Tarrytown, New York
| | | | - Claire Q Wang
- Regeneron Pharmaceuticals, Inc., Tarrytown, New York
| | - Allen R Radin
- Regeneron Pharmaceuticals, Inc., Tarrytown, New York
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20
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Tabar AI, Delgado J, González-Mancebo E, Arroabarren E, Soto Retes L, Domínguez-Ortega J. Recent Advances in Allergen-Specific Immunotherapy as Treatment for Allergic Asthma: A Practical Overview. Int Arch Allergy Immunol 2021; 182:496-514. [PMID: 33631755 DOI: 10.1159/000513811] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 12/11/2020] [Indexed: 11/19/2022] Open
Abstract
The Global Initiative for Asthma Report updated in 2019 stated that potential benefits of allergen immunotherapy (AIT), compared to pharmacological and avoidance options, must be weighed against the risk of adverse effects and the inconvenience and cost of the prolonged course of therapy in asthma. Thus, with the aim of clarifying some aspects with regard to the possible use of AIT in allergic asthma treatment armamentarium, a group of expert allergists from the Spanish Allergy and Clinical Immunology Scientific Society (SEAIC), particularly from the Immunotherapy and Asthma Interest Groups developed a frequently asked questions in clinical practice. This document updates relevant topics on the use of AIT in asthma and could facilitate physician clinical decisions and improve health outcomes for individual patients.
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Affiliation(s)
- Ana I Tabar
- Department of Allergy, Hospital Complex of Navarra, Pamplona, Spain, .,Navarra Institute for Health Research (IdiSNA), Cooperative Health Research Thematic Networks (RETICs) for Asthma, Adverse Reactions to Drugs, and Allergy (ARADYAL) Research Network, Pamplona, Spain,
| | - Julio Delgado
- Clinical Management for Allergy Unit, University Hospital Virgen Macarena, Seville, Spain
| | - Eloina González-Mancebo
- Department of Allergy, University Hospital Fuenlabrada, La Paz Hospital Institute for Health Research (IdiPAZ), Madrid, Spain.,Cooperative Health Research Thematic Networks (RETICs) for Asthma, Adverse Reactions to Drugs and Allergy (ARADYAL) Research Network, Madrid, Spain
| | | | - Lorena Soto Retes
- Department of Pneumology and Allergy, Santa Creu i Sant Pau Hospital, Barcelona, Spain.,Department of Medicine, Sant Pau Biomedical Research Institute (IIB Sant Pau), Autonomous University of Barcelona (UAB), Barcelona, Spain
| | - Javier Domínguez-Ortega
- Department of Allergy, La Paz Hospital Institute for Health Research (IdiPAZ), CIBER of Respiratory Diseases, CIBERES, Madrid, Spain
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21
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Kathuria PC, Rai M. Clinical efficacy and safety of combined house dust mite subcutaneous immunotherapy and omalizumab in five cases of allergic rhinitis and asthma. INDIAN JOURNAL OF MEDICAL SPECIALITIES 2021. [DOI: 10.4103/injms.injms_7_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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22
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Miller MH, Shehat MG, Tigno-Aranjuez JT. Immune Modulation of Allergic Asthma by Early Pharmacological Inhibition of RIP2. Immunohorizons 2020; 4:825-836. [PMID: 33443037 DOI: 10.4049/immunohorizons.2000073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 12/01/2020] [Indexed: 11/19/2022] Open
Abstract
Exposure to house dust mite (HDM) is highly associated with the development of allergic asthma. The adaptive immune response to HDM is largely Th2 and Th17 dominant, and a number of innate immune receptors have been identified that recognize HDM to initiate these responses. Nucleotide-binding oligomerization domain-containing protein 2 (NOD2) is a cytosolic sensor of peptidoglycan, which is important for Th2 and Th17 polarization. NOD2 mediates its signaling through its downstream effector kinase, receptor-interacting serine/threonine protein kinase 2 (RIP2). We have previously shown that RIP2 promotes HDM-associated allergic airway inflammation and Th2 and Th17 immunity, acting early in the HDM response and likely within airway epithelial cells. However, the consequences of inhibiting RIP2 during this critical period has not yet been examined. In this study, we pharmacologically inhibited RIP2 activity during the initial exposure to allergen in an acute HDM model of asthma and determined the effect on the subsequent development of allergic airway disease. We show that early inhibition of RIP2 was sufficient to reduce lung histopathology and local airway inflammation while reducing the Th2 immune response. Using a chronic HDM asthma model, we demonstrate that inhibition of RIP2, despite attenuating airway inflammation and airway remodeling, was insufficient to reduce airway hyperresponsiveness. These data demonstrate the potential of pharmacological targeting of this kinase in asthma and support further development and optimization of RIP2-targeted therapies.
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Affiliation(s)
- Madelyn H Miller
- Immunity and Pathogenesis Division, Burnett School of Biomedical Sciences, University of Central Florida College of Medicine, Orlando, FL 32827
| | - Michael G Shehat
- Immunity and Pathogenesis Division, Burnett School of Biomedical Sciences, University of Central Florida College of Medicine, Orlando, FL 32827
| | - Justine T Tigno-Aranjuez
- Immunity and Pathogenesis Division, Burnett School of Biomedical Sciences, University of Central Florida College of Medicine, Orlando, FL 32827
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23
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Beigh AH, Rasool R, Kawoosa F, Manzoor S, Rashid R, Andrabi KI, Shah ZA, Qureshi T. Improved pulmonary function test (PFT) after 1 one year of Sublingual Immunotherapy (SLIT) in unison with pharmacotherapy in mild allergic asthmatics. Immunol Lett 2020; 230:36-41. [PMID: 33340589 DOI: 10.1016/j.imlet.2020.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 12/09/2020] [Accepted: 12/11/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Allergen immunotherapy (AIT) is a promising treatment for allergic disease that induces immunological tolerance through the administration of specific allergens. The study of AIT is in its early stage and its clinical effects are not well elucidated. The present study was aimed at determining the effect of AIT on pulmonary function and serum variables of mild allergic asthma patients. METHODS A total of 80 patients with mild allergic asthma were recruited for the study. Allergen Specific Immunotherapy was administered in the form of Sublingual Immunotherapy and consisted of a build up phase followed by a maintenance phase (six months each respectively). Total serum IgE and vitamin D levels were quantified by ELISA. The percent eosinophill count was determined by cell analyzers. Pulmonary function test was performed at the baseline and after the end of study period. Subjective symptom score was recorded in the form of asthma control questionnaire score. RESULTS There was a significant increase in the pre FEV1% and pre FEV1/FVC post AIT administration. A significant decrease in the total serum IgE was found post AIT. A decrease in Asthma control Questionnaire (ACQ) scores indicated an improvement in clinical symptoms. Besides there was a significant effect on ICS discontinuation after AIT. CONCLUSION The study supports SLIT as an effective treatment for Immunomodulation in mild allergic asthmatics besides it gives us significant information regarding the safety and efficacy of SLIT in such patients.
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Affiliation(s)
- Afaq H Beigh
- Allergy Clinic, Department of Immunology, and Molecular Medicine, Sher I Kashmir Institute of Medical Sciences Srinagar Kashmir, India
| | - Roohi Rasool
- Allergy Clinic, Department of Immunology, and Molecular Medicine, Sher I Kashmir Institute of Medical Sciences Srinagar Kashmir, India.
| | - Fizalah Kawoosa
- Allergy Clinic, Department of Immunology, and Molecular Medicine, Sher I Kashmir Institute of Medical Sciences Srinagar Kashmir, India
| | - Sharika Manzoor
- Allergy Clinic, Department of Immunology, and Molecular Medicine, Sher I Kashmir Institute of Medical Sciences Srinagar Kashmir, India
| | - Rabiya Rashid
- Allergy Clinic, Department of Immunology, and Molecular Medicine, Sher I Kashmir Institute of Medical Sciences Srinagar Kashmir, India
| | | | - Zafar A Shah
- Allergy Clinic, Department of Immunology, and Molecular Medicine, Sher I Kashmir Institute of Medical Sciences Srinagar Kashmir, India
| | - Taha Qureshi
- Allergy Clinic, Department of Immunology, and Molecular Medicine, Sher I Kashmir Institute of Medical Sciences Srinagar Kashmir, India
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24
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Hughes-Visentin A, Paul ABM. Asthma and COVID-19: What do we know now. Clin Med Insights Circ Respir Pulm Med 2020; 14:1179548420966242. [PMID: 33173369 PMCID: PMC7588760 DOI: 10.1177/1179548420966242] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 09/23/2020] [Indexed: 01/08/2023] Open
Abstract
The COVID-19 pandemic has presented challenges in symptomology identification, diagnosis, management and follow-up in common respiratory diseases, and in particular asthma. Research is rapidly ongoing to try and understand how the SARS-CoV-2 virus affects individuals with asthma, as well as, how underlying asthma affects Covid-19 risk, symptomology and prognosis. In light of this unique medical challenge, clinicians are faced with case-by-case based decisions to implement or continue current asthma therapy. This review will discuss the current literature regarding asthma and COVID-19 based on best available evidence at this time (See box 1).
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25
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Abstract
Allergen immunotherapy (AIT) is an effective treatment for patients with allergic diseases; it has been shown to modify the underlying cause of the disease. The house dust mite (HDM) is a major perennial allergen source and a significant cause of allergic-related diseases such as allergic rhinitis, asthma, and atopic dermatitis. HDM allergen is an important factor in the pathogenesis of allergic diseases. Sensitization to HDM allergen often occurs early in life and appears to play an important role in the progression from allergic rhinitis to asthma in children. The role of HDM AIT results in immunologic tolerance, provides an alternative option for treating HDM allergy through targeting the mechanisms of allergic reaction, and creates a long-term benefit. There are two forms of testing for aeroallergen, either detect by skin testing or by in vitro IgE assays. Both subcutaneous immunotherapy and sublingual immunotherapy are effective in the treatment of allergic diseases. In the future, new forms of allergen extracts can help improve safety and efficacy of AIT. Novel approaches to immunotherapy currently being explored include the use of adjuvants, allergen-derived peptides, modified recombinant allergen vaccines, and gene-specific immunotherapy.
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Affiliation(s)
- Ren-Bin Tang
- Department of Pediatrics, Cheng Hsin General Hospital, Taipei, Taiwan, ROC
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26
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Role of early life immune regulation in asthma development. Semin Immunopathol 2019; 42:29-42. [PMID: 31873782 PMCID: PMC7079989 DOI: 10.1007/s00281-019-00774-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 11/15/2019] [Indexed: 02/07/2023]
Abstract
Development of childhood asthma is complex with a strong interaction of genetic, epigenetic, and environmental factors. Ultimately, it is critical how the immune system of a child responds to these influences and whether effective strategies for a balanced and healthy immune maturation can be assured. Pregnancy and early childhood are particularly susceptible for exogenous influences due to the developing nature of a child’s immune system. While endogenous influences such as family history and the genetic background are immutable, epigenetic regulations can be modulated by both heredity and environmental exposures. Prenatal influences such as a mother’s nutrition, smoking, or infections influence the complex interplay of innate and adaptive immune regulation as well as peri- and postnatal influences including mode of delivery. Early in life, induction and continuous training of healthy maturation include balanced innate immunity (e.g., via innate lymphoid cells) and an equilibrium of T-cell subpopulations (e.g., via regulatory T cells) to counter-regulate potential pro-inflammatory or exuberant immune reactions. Later in childhood, rather compensatory immune mechanisms are required to modulate deviant regulation of a child’s already primed immune trajectory. The specific effects of exogenous and endogenous influences on a child’s maturing immune system are summarized in this review, and its importance and potential intervention for early prevention and treatment strategies are delineated.
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27
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Virchow JC. Allergen immunotherapy (AIT) in asthma. Semin Immunol 2019; 46:101334. [PMID: 31711771 DOI: 10.1016/j.smim.2019.101334] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 10/21/2019] [Indexed: 12/16/2022]
Abstract
Bronchial asthma remains one of the most common chronic diseases with a high degree of morbidity and still a considerable mortality with an increasing prevalence in many countries. Although remarkable progress has been made in the past decades in the medical treatment for asthma, curative or disease modifying approaches are still limited to allergen immunotherapy (AIT). Despite a plethora of potential immunological actions observed during AIT, the precise mechamisms that might exert beneficial effects especially in asthma remain unclear. Clinical studies in the past have suggested clinical benefits in symptom control and medication use with a small reduction in allergen-specific and non-specific bronchial hyperresponsiveness but these results were mainly derived from small, frequently suboptimally designed studies which were poorly comparable. Only recently have larger, dose ranging studies with well standardized allergens with patient relevant endpoints such as corticosteroid requirements for asthma control or the onset of exacerbations following inhaled corticosteroid (ICS) withdrawal corroborated the potential clinical effects of AIT in asthma, suggesting that it might replace some of the controller effects of ICS. In addition, newer, up-do-date designed studies support previous data that in patient populations at risk to develop asthma AIT might have a role in secondary prevention. Further studies on the long term effects as well as comparative studies are needed to further corroborate the role of AIT in the prevention and the control of asthma are needed.
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Affiliation(s)
- J Christian Virchow
- Departments of Pneumology / Intensive Care Medicine, Universitätsmedizin Rostock, Ernst-Heydemann Strasse 6, 18055 Rostock, Germany.
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