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Hsin L, Varese N, Aui PM, Wines BD, von Borstel A, Mascarell L, Hogarth PM, Hew M, O'Hehir RE, van Zelm MC. Accurate determination of house dust mite sensitization in asthma and allergic rhinitis through cytometric detection of Der p 1 and Der p 2 binding on basophils (CytoBas). J Allergy Clin Immunol 2024; 153:1282-1291.e10. [PMID: 38360181 DOI: 10.1016/j.jaci.2024.02.002] [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: 08/15/2023] [Revised: 01/10/2024] [Accepted: 02/06/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND House dust mite (HDM) is the most common allergen trigger globally for allergic rhinitis and atopic asthma. OBJECTIVES To expedite accurate confirmation of allergen sensitization, we designed fluorescent allergen tetramers to directly stain specific IgE on basophils to detect specific allergen sensitization using the flow cytometric CytoBas assay. METHODS Recombinant proteins of major HDM allergens (component), Der f 1, Der p 1, and Der p 2 were biotinylated and conjugated with fluorochrome streptavidins as tetramers. Blood samples from 64 patients who are HDM-allergic and 26 controls that are non-HDM-sensitized were incubated with allergen tetramers for evaluation of basophil binding (CytoBas) and activation (BAT) with flow cytometry. RESULTS The tetramers effectively bound and activated basophils from patients who are allergic but not from controls who are nonsensitized. CytoBas with Der p 1 as a single allergen had comparable sensitivity and specificity (92% and 100%) to BAT (91% and 100%) in detecting allergen sensitization, as did CytoBas with Der p 2 (95% and 96%) to BAT (95% and 87%). A positive staining for Der p 1 and/or Der p 2 in CytoBas was 100% sensitive and 96% specific for HDM allergy. CONCLUSIONS CytoBas has diagnostic accuracy for group 1 and group 2 HDM allergens that is comparable to BAT, but with additional advantages of multiple allergen components in a single tube and no requirement for in vitro basophil activation. These findings endorse a single, multiplex CytoBas assay for accurate and component-resolved diagnosis of aeroallergen sensitization in patients with allergic asthma and/or rhinitis.
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Affiliation(s)
- Lin Hsin
- Department of Immunology, Central Clinical School, Monash University, Melbourne, Australia
| | - Nirupama Varese
- Department of Immunology, Central Clinical School, Monash University, Melbourne, Australia; Allergy, Asthma and Clinical Immunology, Alfred Health, Melbourne, Australia; Immune Therapies Group, Burnet Institute, Melbourne, Australia
| | - Pei Mun Aui
- Department of Immunology, Central Clinical School, Monash University, Melbourne, Australia
| | - Bruce D Wines
- Department of Immunology, Central Clinical School, Monash University, Melbourne, Australia; Immune Therapies Group, Burnet Institute, Melbourne, Australia; Department of Pathology, The University of Melbourne, Parkville, Australia
| | - Anouk von Borstel
- Department of Immunology, Central Clinical School, Monash University, Melbourne, Australia
| | - Laurent Mascarell
- Innovation and Science Department, Stallergenes Greer, Antony, France
| | - P Mark Hogarth
- Department of Immunology, Central Clinical School, Monash University, Melbourne, Australia; Immune Therapies Group, Burnet Institute, Melbourne, Australia; Department of Pathology, The University of Melbourne, Parkville, Australia
| | - Mark Hew
- Allergy, Asthma and Clinical Immunology, Alfred Health, Melbourne, Australia; Department of Pathology, The University of Melbourne, Parkville, Australia
| | - Robyn E O'Hehir
- Department of Immunology, Central Clinical School, Monash University, Melbourne, Australia; Allergy, Asthma and Clinical Immunology, Alfred Health, Melbourne, Australia
| | - Menno C van Zelm
- Department of Immunology, Central Clinical School, Monash University, Melbourne, Australia; Allergy, Asthma and Clinical Immunology, Alfred Health, Melbourne, Australia; Department of Immunology, Erasmus Medical Center, University Medical Center, Rotterdam, The Netherlands.
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Chen ZM, Zhao DY, Xiang L, Hong JG. Treatment of pediatric mild persistent asthma with low-dose budesonide inhalation suspension vs. montelukast in China. World J Pediatr 2021; 17:619-625. [PMID: 34613593 DOI: 10.1007/s12519-021-00464-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 09/09/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND There are limited studies comparing budesonide inhalation suspension (BIS) with montelukast in real-world settings where treatment adherence and persistency may be suboptimal. This real-world study aims to investigate the control effectiveness of montelukast or BIS as a monotherapy in Chinese children with mild asthma. METHODS Data were derived from a retrospective questionnaire-based analysis of 2‒14-year-old children with mild persistent asthma, who received either 500 µg of BIS (n = 153) or 4‒5 mg of montelukast (n = 240) once daily. The indicators of asthma control, the Asthma Control Test (ACT)/Childhood ACT (C-ACT) score, and the asthma-related medical costs were assessed. The differences between the two groups were compared using an unpaired t-test (normally distributed), Mann-Whitney U test (non-normally distributed) or chi-squared test (categorical variables). RESULTS Medication compliance in the past 3-month period was better in the montelukast group than in the BIS group (P = 0.042). The montelukast group exhibited better asthma control in the past 4-week period, including lower percentages of asthmatic children with symptoms more than twice a week (P = 0.021), had night waking or night coughing (P = 0.022), or required reliever medication more than twice a week (P < 0.001). The montelukast group had a lower percentage of children with an ACT/C-ACT score ≤ 19 (P = 0.015). Caregivers reported a significantly better exercise tolerance in the children who received montelukast vs. BIS in the past 12 months (P < 0.001). Significantly higher medical expenditures attributable to asthma in the past 12 months were observed in the BIS group vs. montelukast group (P < 0.001). CONCLUSION Both treatments provided acceptable overall asthma control in children with mild persistent asthma; however, more reliever medication and more medical expenditures attributable to asthma were needed for BIS vs. montelukast in real-world settings, where factors such as compliance were also taken into account.
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Affiliation(s)
- Zhi-Min Chen
- Department of Respiratory Diseases, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, China
| | - De-Yu Zhao
- Department of Respiratory Diseases, Children's Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Li Xiang
- Department of Allergy, Beijing Children's Hospital, Capital Medical University, National Children's Hospital Center, Beijing, 100045, China
| | - Jian-Guo Hong
- Department of Pediatrics, Shanghai General Hospital, Shanghai Jiaotong University, No. 100, Haining Road, Hongkou District, Shanghai, 200080, China.
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[Diet and asthma: Better eating for better breathing?]. Rev Mal Respir 2021; 38:278-288. [PMID: 33676796 DOI: 10.1016/j.rmr.2021.02.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 10/13/2020] [Indexed: 11/22/2022]
Abstract
Inhaled therapies are the cornerstone of asthma treatment. However, according to national and international guidelines, non-pharmacological interventions should not be neglected in asthma. It has been demonstrated that a healthy diet is beneficial to general health. Recently, the effect of diet on asthma has been highlighted in many studies. Two diets have been particularly studied: the Mediterranean diet (high in fruits and vegetables and low in fat) and the Western diet (high in saturated fat and low in fruits and vegetables). A beneficial effect of the Mediterranean diet and deleterious effect of the Western diet on the development or control of asthma has been shown in some studies even after adjustment for overweight. Study findings have not been unanimous, probably related to the complexity of conducting studies on a diet that may change from day to day for any individual subject. In addition, the effect of physical exercise, which is known to be beneficial in asthma, is rarely taken into account in these studies. However, studies on diet are becoming more complex with the use of specific dietary indices, which should bring interesting data in the future.
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Long-acting muscarinic antagonists for the treatment of asthma in children — a new kid in town. ALLERGO JOURNAL 2018. [DOI: 10.1007/s15007-018-1720-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Hamelmann E. Long-acting muscarinic antagonists for the treatment of asthma in children-a new kid in town. ALLERGO JOURNAL INTERNATIONAL 2018; 27:220-227. [PMID: 30416934 PMCID: PMC6208794 DOI: 10.1007/s40629-018-0066-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 03/28/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND Asthma is the most prevalent chronic airway disease observed in children and adolescents, yet the variety of treatment options available for this age group is limited. With many factors influencing therapeutic efficacy including patient knowledge, adherence, and therapy choice as well as delivery device, it is important to have more options to tailor to individual patient needs. METHODS This article is an overview of recent scientific articles using a systematic literature search in PubMed and specialist databases. RESULTS Tiotropium is the first long-acting muscarinic antagonist to be licensed for treatment of asthma and has been demonstrated to be an effective add-on therapy across all age groups. Its therapeutic success in clinical trials resulted in Food and Drug Administration and the European Medicines Agency approval for asthma treatment in people over the age of 6 years in the US and EU. CONCLUSION Further studies into the use of tiotropium, especially in younger children, could be of interest for future treatment decisions.
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Affiliation(s)
- Eckard Hamelmann
- Kinderzentrum Bethel, Evangelisches Klinikum Bethel, Grenzweg 10, 33617 Bielefeld, Germany
- Allergy Center of the Ruhr University, Bochum, Germany
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Koopmans T, Gosens R. Revisiting asthma therapeutics: focus on WNT signal transduction. Drug Discov Today 2017; 23:49-62. [PMID: 28890197 DOI: 10.1016/j.drudis.2017.09.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 07/20/2017] [Accepted: 09/01/2017] [Indexed: 12/16/2022]
Abstract
Asthma is a complex disease of the airways that develops as a consequence of both genetic and environmental factors. This interaction has highlighted genes important in early life, particularly those that control lung development, such as the Wingless/Integrase-1 (WNT) signalling pathway. Although aberrant WNT signalling is involved with an array of human conditions, it has received little attention within the context of asthma. Yet it is highly relevant, driving events involved with inflammation, airway remodelling, and airway hyper-responsiveness (AHR). In this review, we revisit asthma therapeutics by examining whether WNT signalling is a valid therapeutic target for asthma.
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Affiliation(s)
- Tim Koopmans
- Department of Molecular Pharmacology, University of Groningen, The Netherlands; Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, The Netherlands
| | - Reinoud Gosens
- Department of Molecular Pharmacology, University of Groningen, The Netherlands; Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, The Netherlands.
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Wan Yau Ming S, Haughney J, Small I, Wolfe S, Hamill J, Gruffydd-Jones K, Daly C, Soriano JB, Gardener E, Skinner D, Stagno d'Alcontres M, Price DB. Initiating or changing to a fixed-dose combination of Fluticasone propionate/Formoterol over Fluticasone propionate/Salmeterol: A real-life effectiveness and cost impact evaluation. Respir Med 2017; 129:199-206. [PMID: 28732831 DOI: 10.1016/j.rmed.2017.06.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 06/21/2017] [Accepted: 06/22/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Asthma has a substantial impact on quality of life and health care resources. The identification of a more cost-effective, yet equally efficacious, treatment could positively influence the economic burden of this disease. Fluticasone propionate/Formoterol (FP/FOR) may be as effective as Fluticasone Salmeterol (FP/SAL). We evaluated non-inferiority of asthma control in terms of the proportion of patients free from exacerbations, and conducted a cost impact analysis. METHODS This historical, matched cohort database study evaluated two treatment groups in the Optimum Patient Care Research Database in the UK: 1) an FP/FOR cohort of patients initiating treatment with FP/FOR or changing from FP/SAL to FP/FOR and; 2) an FP/SAL cohort comprising patients initiating, or remaining on FP/SAL pMDI combination therapy. The main outcome evaluated non-inferiority of effectiveness (defined as prevention of severe exacerbations, lower limit of the 95% confidence interval (CI) of the mean difference between groups in patient proportions with no exacerbations is -3.5% or higher) in patients treated with FP/FOR versus FP/SAL. RESULTS After matching 1:3, we studied a total of 2472 patients: 618 in the FP/FOR cohort (174 patients initiated on FP/FOR and 444 patients changed to FP/FOR) and 1854 in the FP/SAL cohort (522 patients initiated FP/SAL and 1332 continued FP/SAL). The percentage of patients prescribed FP/FOR met non-inferiority as the adjusted mean difference in proportion of no severe exacerbations (95%CI) was 0.008 (-0.032, 0.047) between the two cohorts. No other significant differences were observed except acute respiratory event rates, which were lower for patients prescribed FP/FOR (rate ratio [RR] 0.82, 95% CI 0.71, 0.94). CONCLUSIONS Changing to, or initiating FP/FOR combination therapy, is associated with a non-inferior proportion of patients who are severe exacerbation-free at a lower average annual cost compared with continuing or initiating treatment with FP/SAL.
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Affiliation(s)
| | - John Haughney
- Academic Primary Care, University of Aberdeen, Aberdeen, UK
| | | | | | | | | | | | - Joan B Soriano
- Instituto de Investigación Hospital Universitario de la Princesa (IISP) Universidad Autónoma de Madrid, Madrid, Spain
| | | | | | | | - David B Price
- Observational and Pragmatic Research Institute, Singapore; Academic Primary Care, University of Aberdeen, Aberdeen, UK.
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Fowler A, Koenen R, Hilbert J, Blatchford J, Kappeler D, Benediktus E, Wood C, Gupta A. Safety, Tolerability, Pharmacokinetics, and Pharmacodynamics of the Novel CRTH2 Antagonist BI 1021958 at Single Oral Doses in Healthy Men and Multiple Oral Doses in Men and Women With Well-Controlled Asthma. J Clin Pharmacol 2017; 57:1444-1453. [PMID: 28609567 DOI: 10.1002/jcph.947] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 04/21/2017] [Indexed: 11/06/2022]
Abstract
BI 1021958, a novel antagonist of the chemoattractant-receptor-homologous molecule (CRTH2), targets airway inflammation in asthma by inhibiting prostaglandin binding to CRTH2 receptors. Two phase 1 studies assessed BI 1021958 safety/tolerability and pharmacokinetics (PK)/pharmacodynamics (PD) following single doses in healthy men and multiple doses in men/women with well-controlled asthma. Studies 1 had 2 parts: a placebo-controlled, fixed-sequence, single-blind, single-rising-dose part (n = 56) and a randomized, 2-way crossover, open-label, repeated-dose part studying the food effect on PK/PD (n = 12). Study 2 was a placebo-controlled, single-center, double-blind multiple-rising-dose study (n = 84). Primary end points were safety/tolerability and PK/PD (both studies); secondary end points were eosinophil shape change (ESC; study 1) and dose proportionality/linearity following first dose and at steady state (study 2). BI 1021958 was adequately tolerated in both studies; adverse events were infrequent, generally mild to moderate, and occurred similarly in treatment groups. Maximum measured concentration (Cmax ) was achieved in ≤2.5 hours in study 1 and ≤2.0 hours in study 2. BI 1021958 exposure increased proportionally with dose. In study 1, following a single 60-mg dose, AUC parameters and Cmax were 20% and 15% lower, respectively, after a high-fat meal compared with the fasted state. After ≥60-mg single doses (study 1) and >40-mg multiple doses (study 2), >95% ESC inhibition was observed for ≥24 hours. PK/PD was similar in healthy subjects and subjects with well-controlled asthma. Data support further investigation of CRTH2 antagonists for the treatment of asthma.
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Affiliation(s)
| | - Rüdiger Koenen
- Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach, Germany
| | - James Hilbert
- Boehringer Ingelheim Pharma Inc., Ridgefield, CT, USA
| | | | | | | | - Chester Wood
- Boehringer Ingelheim Pharma Inc., Ridgefield, CT, USA
| | - Abhya Gupta
- Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach, Germany
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Chantaphakul H, Ruxrungtham K. Fixed-Dose combination of the inhaled corticosteroid and long-acting beta2-agonist therapy in adults with persistent asthma. Expert Opin Pharmacother 2016; 17:631-42. [PMID: 26799114 DOI: 10.1517/14656566.2016.1145659] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Asthma is a respiratory condition characterized by airway inflammation, airflow obstruction, and bronchial hyperresponsiveness. The standard treatment of asthma comprises inhaled corticosteroid and beta2-agonist. Inhaled short-acting-beta2-agonists have been used as rescue medication for exacerbation. However, long-acting-beta2-agonists (LABA) used as monotherapy for asthma had been reported for having a safety concern. Consequently, it had been recommended as an add-on treatment to inhaled corticosteroid (ICS) in moderate to severe persistent asthma. The fixed-dose combination (FDC) of ICS and LABA has been approved since the year 2000. Evidences revealed using the combination of these medications is more effective in asthma control. AREAS COVERED The rational and phase III onward randomized-controlled studies were reviewed. Sources of evidences were from studies published in Medline until November 2015. EXPERT OPINION There are six FDC inhaler regimens approved worldwide. The significant synergistic effects of ICS and LABA in one device are well evidenced. A FDC reduces the daily dosage of ICS and asthma exacerbation. It is safe to use regularly as controller. The efficacy of each individual combination on asthma treatment is generally similar. Clinical experience, ease of use, cost and side effects of medication would guide the clinician's preferences.
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Affiliation(s)
- Hiroshi Chantaphakul
- a Division of Allergy and Clinical Immunology, Department of Medicine, Faculty of Medicine , Chulalongkorn University , Bangkok , Thailand
| | - Kiat Ruxrungtham
- a Division of Allergy and Clinical Immunology, Department of Medicine, Faculty of Medicine , Chulalongkorn University , Bangkok , Thailand
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Mathematical Modeling of Pro- and Anti-Inflammatory Signaling in Macrophages. Processes (Basel) 2014. [DOI: 10.3390/pr3010001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Xia Y, Kelton CML, Xue L, Guo JJ, Bian B, Wigle PR. Safety of long-acting beta agonists and inhaled corticosteroids in children and adolescents with asthma. Ther Adv Drug Saf 2013; 4:254-63. [PMID: 25114786 PMCID: PMC4125312 DOI: 10.1177/2042098613504124] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The introduction of long-acting beta agonists (LABAs) was considered a major advance in bronchodilator therapy for adult, as well as pediatric, patients with asthma. However, the use of LABAs has raised safety concerns, especially the potential for severe asthma exacerbations (SAEs) resulting in hospitalizations or even death. Meanwhile, the use of inhaled corticosteroids (ICSs), a cornerstone in the treatment of mild-to-severe persistent asthma, has been associated with growth suppression in children. The purpose of this review was to identify and discuss the major published safety studies surrounding LABA, ICS, and combined LABA/ICS usage in children. By way of a critical search for influential published clinical trials, meta-analyses, and observational studies, six studies relevant to the safety of LABA monotherapy, seven studies relevant to ICS monotherapy, and four studies on the subject of LABA/ICS combination usage were identified and reviewed. Based on the reviewed literature, the controversy surrounding these anti-asthma medications was clearly exposed. On the one hand, there is some evidence that LABA monotherapy may be associated with SAEs and asthma-related death, while ICS monotherapy may be associated with a higher risk of growth suppression. On the other hand, the concurrent use of a LABA with an ICS has been associated with positive outcomes including symptom reduction and reduced rate and severity of exacerbations. Further clinical research is warranted and has been called for by the US Food and Drug Administration.
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Affiliation(s)
- Ying Xia
- Division of Pharmacy Practice and Administrative Sciences, James L. Winkle College of Pharmacy, University of Cincinnati, Cincinnati, OH, USA
| | - Christina M L Kelton
- Division of Pharmacy Practice & Administrative Sciences, James L. Winkle College of Pharmacy, and Carl H. Lindner College of Business, University of Cincinnati, Cincinnati, OH, USA
| | - Liang Xue
- College of Medicine, State University of New York at Buffalo, Buffalo, NY, USA
| | - Jeff J Guo
- University of Cincinnati, James L. Winkle College of Pharmacy, 3225 Eden Avenue, Cincinnati, OH 45267-0004, USA
| | - Boyang Bian
- Division of Pharmacy Practice and Administrative Sciences, James L. Winkle College of Pharmacy, University of Cincinnati, Cincinnati, OH, USA
| | - Patricia R Wigle
- Division of Pharmacy Practice and Administrative Sciences, James L. Winkle College of Pharmacy, University of Cincinnati, Cincinnati, OH, USA
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Hofmann B, Steinhilber D. 5-Lipoxygenase inhibitors: a review of recent patents (2010-2012). Expert Opin Ther Pat 2013; 23:895-909. [PMID: 23600432 DOI: 10.1517/13543776.2013.791678] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION 5-Lipoxygenase (5-LO) is a crucial enzyme of the arachidonic acid (AA) cascade and catalyzes the formation of bioactive leukotrienes (LTs) with the help of FLAP, the 5-LO-activating protein. LTs are inflammatory mediators playing a pathophysiological role in different diseases like asthma, allergic rhinitis as well as cardiovascular diseases and certain types of cancer. With the rising number of indications for anti-LT therapy, 5-LO inhibitor drug development becomes increasingly important. AREAS COVERED Here, both recent findings regarding the pathophysiological role of 5-LO and the patents claimed for 5-LO inhibitors are discussed. Focusing on direct inhibitors, several patents disclosing FLAP antagonists are also subject of this review. Novel compounds include 1,5-diarylpyrazoles, indolizines and indoles and several natural product extracts. EXPERT OPINION Evaluation of the patent activities revealed only quite moderate action. Nevertheless, several auspicious drug-like molecules were disclosed. It seems that in the near future, FLAP inhibitors can be expected to enter the market for the treatment of asthma. With the resolved structure of 5-LO, structure-based drug design is now applicable. Together with the identification of downstream enzyme inhibitors and dual-targeting drugs within the AA cascade, several tools are at hand to cope with 5-LOs increasing pathophysiological roles.
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Affiliation(s)
- Bettina Hofmann
- Goethe University Frankfurt, Institute of Pharmaceutical Chemistry, Max-von-Laue-Str. 9, 60438, Frankfurt, Germany
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Zhong N, Lin J, Mehta P, Ngamjanyaporn P, Wu TC, Yunus F. Real-life effectiveness of budesonide/formoterol maintenance and reliever therapy in asthma patients across Asia: SMARTASIA study. BMC Pulm Med 2013; 13:22. [PMID: 23557023 PMCID: PMC3637584 DOI: 10.1186/1471-2466-13-22] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Accepted: 03/15/2013] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The use of budesonide/formoterol in a single inhaler for both maintenance and reliever therapy is a recommended option for treatment of persistent asthma not responding well to inhaled corticosteroid (ICS) alone. METHODS This was a multi-centre open-label study on patients whose asthma condition remained inadequately controlled by various asthma treatments other than budesonide/formoterol. After a 2-week run-in period, eligible patients underwent a 12-week treatment period with budesonide/formoterol (Symbicort SMART(®), 160/4.5 μg) twice daily plus as needed. Patient's asthma control and quality of life were assessed using the 5-item Asthma Control Questionnaire (ACQ-5) and the standardized Asthma Quality of Life Questionnaire (AQLQ-S), respectively. RESULTS A total of 862 eligible asthma patients who have had asthma for a mean duration of 10.73 ± 12.03 years entered a 12-week treatment with budesonide/formoterol maintenance and reliever therapy. During treatment, ACQ-5 score improved significantly by 0.58 ± 0.93 (95% CI, 0.51 to 0.64, P < 0.0001) from the baseline level of 1.62 ± 1.00. AQLQ(S) score improved by 0.70 ± 0.89 (95% CI, 0.64 to 0.76, P < 0.0001) from baseline. Asthma symptom score was also reduced significantly (P < 0.0001); between run-in and treatment periods, night- and day-time symptom scores were reduced by 0.32 ± 0.54 (95% CI, 0.28 to 0.35) and 0.30 ± 0.52 (95% CI, 0.27 to 0.34), respectively. The percentage of nights with awakenings due to asthma symptoms was reduced by 11.09 ± 26.13% (95% CI, 9.34 to 12.85%), while the percentage of asthma-control and symptom-free days increased by 20.90 ± 34.40% (95% CI, 18.59 to 23.21%) and 23.89 ± 34.62% (95% CI, 21.56 to 26.21%), respectively (P < 0.0001). Together with the improvement in asthma control, the number of night- and day-time inhalations of as-needed reliever medication decreased by 0.30 ± 0.82 (95% CI, 0.24 to 0.35) inhalations and 0.30 ± 0.97 (95% CI, 0.23 to 0.36) inhalations, respectively (P < 0.0001). No unexpected adverse events were reported. CONCLUSION During treatment of inadequately controlled asthmatic patients with budesonide/formoterol maintenance and reliever therapy, significant improvement in patients' asthma control and reductions in asthma symptoms and as-needed medication use was observed. Patients' quality of life was improved and the treatment was well tolerated. TRIAL REGISTRATION ClinicalTrial.gov: (NCT00939341).
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Affiliation(s)
- Nanshan Zhong
- Respiratory Research Institute, 1st Affiliated Hospital of Guangzhou Medical College, Guangzhou, China
| | | | - Parthiv Mehta
- Mehta’s Hospital and Cardiopulmonary Care Centre, Gujarat, India
| | - Pintip Ngamjanyaporn
- Allergy Immunology and Rheumatology Division, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Tzu-Chin Wu
- Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Faisal Yunus
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, University of Indonesia, Persahabatan Hospital, Persahabatan, Indonesia
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Mahmoud YI. Grape seed extract attenuates lung parenchyma pathology in ovalbumin-induced mouse asthma model: an ultrastructural study. Micron 2012; 43:1050-9. [PMID: 22609098 DOI: 10.1016/j.micron.2012.04.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2011] [Revised: 04/07/2012] [Accepted: 04/24/2012] [Indexed: 01/31/2023]
Abstract
Due to the growing incidence of asthma and because of the non-specificity and side effects of the conventional drugs, the development of novel agents for the treatment of asthma has become considerably important. Natural plant products offer promising alternatives for the development of effective and safe treatments. Grape seed extract (GSE) is one such phytochemical supplement that has been shown to have potent antioxidant and anti-inflammatory effects. Thus, the present study aimed to investigate the effect of GSE to suppress lung parenchyma pathology and inflammation in ovalbumin-induced murine asthma model. Ovalbumin exposure was associated with many pathological and morphometric alterations in the lungs of asthmatic mice. The alterations involved alveolar size reduction, alveolar wall thickening, cellular infiltration and blood capillary congestion, as well as significant increase in the number of type II pneumocytes and lamellar bodies. However, GSE significantly ameliorated of the pathological changes of ovalbumin-induced asthma. The results support the possibility of GSE as an effective, safe anti-inflammatory dietary supplement to attenuate the pathogenicity of asthma. While these preliminary results appear promising, further studies are required to elucidate the precise mechanism of the modulatory effect of GSE on asthma remodeling.
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Affiliation(s)
- Yomna Ibrahim Mahmoud
- Zoology Department, Faculty of Science, Ain Shams University, P.O. Box 11566, Abbassia, Cairo, Egypt. yomna
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