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Vernisse C, Tuaillon E, Suehs C, Gras D, Bedin AS, Charriot J, Knabe L, Vachier I, Chanez P, Petit A, Bourdin A. Airway epithelial type-2 alarmin profiles: Blood eosinophil counts remain in memory. Eur J Immunol 2023; 53:e2250101. [PMID: 36793156 DOI: 10.1002/eji.202250101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 11/15/2022] [Accepted: 02/07/2023] [Indexed: 02/17/2023]
Abstract
Epithelial cytokines are involved in the orchestration of T1/T2 inflammatory patterns. We question the persistence of this trait in air-liquid interface (ALI) epithelial cultures and whether this local orientation can be related to systemic patterns (e.g., blood eosinophil counts [BECs]). We investigated alarmin release related to high versus low T2 phenotypes associated with chronic airway diseases. ALIs were reconstituted from 32 control, 40 chronic obstructive pulmonary disease, and 20 asthmatic patients. Interleukin-8 (IL-8; a T1-cytokine), IL-25, IL-33, and thymic stromal lymphopoietin (T2-alarmins) concentrations were assessed in subnatants at steady state and used to explain blood neutrophil and eosinophil counts. IL-25 and IL-8 levels were highest in asthma ALI-subnatants, whereas IL-33 was sparsely detected. Thymic stromal lymphopoietin levels were similar among groups. All asthma cell cultures were T1-high/T2-high, while chronic obstructive pulmonary disease and controls tended to be mixed. BECs were independently explained by both disease and in-culture T2-alarmin levels, irrespective of the T2-alarmin considered. The epithelial ALI-T2 signature was more frequently high in patients with a BEC > 300/mm3 . Despite removal from an in vivo environment for ≥2 months, ALIs release disease-specific cytokine "cocktails" into their subnatants, suggesting continued persistence of alarmin orientation in differentiated cell line environments.
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Affiliation(s)
- Charlotte Vernisse
- Department of Respiratory Diseases, CHU Montpellier, University of Montpellier, Montpellier, France.,PhyMedExp, CNRS, INSERM, CHU Montpellier, University of Montpellier, Montpellier, France.,Medicine Biology Mediterranee, Department of Respiratory Diseases and Addictology, Arnaud de Villeneuve Hospital, CHRU Montpellier, Montpellier, France
| | - Edouard Tuaillon
- Pathogenesis and Control of Chronic and Emerging Infections, Inserm U1058, Université de Montpellier, Montpellier, France.,Department of Virology, CHU de Montpellier, Montpellier, France
| | - Carey Suehs
- Department of Respiratory Diseases, CHU Montpellier, University of Montpellier, Montpellier, France.,Department of Medical Information, Université de Montpellier, Montpellier, France
| | - Delphine Gras
- C2VN INSERM INRAE, UMR 1263, Aix Marseille Université, Marseille, France
| | - Anne Sophie Bedin
- Pathogenesis and Control of Chronic and Emerging Infections, Inserm U1058, Université de Montpellier, Montpellier, France.,Department of Virology, CHU de Montpellier, Montpellier, France
| | - Jeremy Charriot
- Department of Respiratory Diseases, CHU Montpellier, University of Montpellier, Montpellier, France.,PhyMedExp, CNRS, INSERM, CHU Montpellier, University of Montpellier, Montpellier, France
| | - Lucie Knabe
- Department of Respiratory Diseases, CHU Montpellier, University of Montpellier, Montpellier, France.,PhyMedExp, CNRS, INSERM, CHU Montpellier, University of Montpellier, Montpellier, France
| | - Isabelle Vachier
- Department of Respiratory Diseases, CHU Montpellier, University of Montpellier, Montpellier, France.,PhyMedExp, CNRS, INSERM, CHU Montpellier, University of Montpellier, Montpellier, France.,Medicine Biology Mediterranee, Department of Respiratory Diseases and Addictology, Arnaud de Villeneuve Hospital, CHRU Montpellier, Montpellier, France
| | - Pascal Chanez
- C2VN INSERM INRAE, UMR 1263, Aix Marseille Université, Marseille, France.,Clinique des bronches, allergies, sommeil, APHM, Marseille, France
| | - Aurélie Petit
- Department of Respiratory Diseases, CHU Montpellier, University of Montpellier, Montpellier, France.,PhyMedExp, CNRS, INSERM, CHU Montpellier, University of Montpellier, Montpellier, France.,Medicine Biology Mediterranee, Department of Respiratory Diseases and Addictology, Arnaud de Villeneuve Hospital, CHRU Montpellier, Montpellier, France
| | - Arnaud Bourdin
- Department of Respiratory Diseases, CHU Montpellier, University of Montpellier, Montpellier, France.,PhyMedExp, CNRS, INSERM, CHU Montpellier, University of Montpellier, Montpellier, France
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Elkihel A, Vernisse C, Ouk TS, Lucas-Roper R, Chaleix V, Sol V. Xylan-Porphyrin Hydrogels as Light-Triggered Gram-Positive Antibacterial Agents. Gels 2023; 9:gels9020124. [PMID: 36826294 PMCID: PMC9957218 DOI: 10.3390/gels9020124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/29/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
In the present work, we report on the synthesis of light-triggered antibacterial hydrogels, based on xylan chains covalently bound to meso-tetra(4-carboxyphenyl)porphyrin (TCPP). Not only does TCPP act as a photosensitizer efficient against Gram-positive bacteria, but it also serves as a cross-linking gelator, enabling the simple and easy building of xylan conjugate hydrogels. The hydrogels were characterized by infrared spectroscopy (ATR-FTIR), scanning electron microscopy (SEM), along with swelling and rheological tests. The antimicrobial activity of the hydrogels was tested under visible light irradiation against two Gram-positive bacterial strains, Staphylococcus aureus and Bacillus cereus. The preliminary results showed an interesting activity on these bacteria, indicating that these hydrogels could be of great potential in the treatment of skin bacterial infections with this species by photodynamic antimicrobial chemotherapy (PACT).
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Affiliation(s)
| | | | - Tan-Sothéa Ouk
- University Limoges, LABCiS, UR 22722, 87000 Limoges, France
| | | | | | - Vincent Sol
- University Limoges, LABCiS, UR 22722, 87000 Limoges, France
- Correspondence:
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Elkihel A, Vernisse C, Ouk T, Lucas R, Chaleix V, Sol V. Cover Image, Volume 139, Issue 38. J Appl Polym Sci 2022. [DOI: 10.1002/app.51140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Elkihel A, Vernisse C, Ouk T, Lucas R, Chaleix V, Sol V. Cationic
porphyrin–xylan conjugate hydrogels for photodynamic antimicrobial chemotherapy. J Appl Polym Sci 2022. [DOI: 10.1002/app.52744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | | | - Tan‐Sothéa Ouk
- University of Limoges, Laboratoire PEIRENE, UR 22722 Limoges France
| | - Romain Lucas
- University of Limoges, IRCER, UMR 7315 Limoges France
| | - Vincent Chaleix
- University of Limoges, Laboratoire PEIRENE, UR 22722 Limoges France
| | - Vincent Sol
- University of Limoges, Laboratoire PEIRENE, UR 22722 Limoges France
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Elkihel A, Christie C, Vernisse C, Ouk TS, Lucas R, Chaleix V, Sol V. Xylan-Based Cross-Linked Hydrogel for Photodynamic Antimicrobial Chemotherapy. ACS Appl Bio Mater 2021; 4:7204-7212. [PMID: 35006952 DOI: 10.1021/acsabm.1c00760] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Photodynamic antimicrobial chemotherapy or PACT has been shown to be a promising antibacterial treatment that could overcome the challenge of multidrug-resistant bacteria. However, the use of most existing photosensitizers has been severely hampered by their significant self-quenching effect, poor water solubility, lack of selectivity against bacterial cells, and possible damage to the surrounding tissues. The use of hydrogels may overcome some of these limitations. We herein report a simple strategy to synthesize a cross-linked hydrogel from beech xylan. The hydrogel showed a high swelling ratio, up to 62, an interconnected porous structure, and good mechanical integrity, and 5,10,15,20-tetrakis(1-methylpyridinium-4-yl)porphyrin tetraiodide (TMPyP) was chosen as a model of hydrophilic photosensitizer (PS) and was encapsulated inside the xylan-based hydrogel. TMPyP-loaded hydrogel prolonged release of PS up to 24 h with a cumulative amount that could reach 100%. TMPyP-loaded hydrogel showed a photocytotoxic effect against Pseudomonas aeruginosa, Escherichia coli, Staphylococcus aureus strains, and Bacillus cereus, while no cytotoxicity was observed in the dark.
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Affiliation(s)
- Abdechakour Elkihel
- Université de Limoges, Laboratoire PEIRENE, EA 7500, Faculté des Sciences et Techniques, 123 Avenue Albert Thomas, 87060 Limoges Cedex, France
| | - Camille Christie
- Université de Limoges, Laboratoire PEIRENE, EA 7500, Faculté des Sciences et Techniques, 123 Avenue Albert Thomas, 87060 Limoges Cedex, France
| | - Charlotte Vernisse
- Université de Limoges, Laboratoire PEIRENE, EA 7500, Faculté des Sciences et Techniques, 123 Avenue Albert Thomas, 87060 Limoges Cedex, France
| | - Tan-Sothéa Ouk
- Université de Limoges, Laboratoire PEIRENE, EA 7500, Faculté des Sciences et Techniques, 123 Avenue Albert Thomas, 87060 Limoges Cedex, France
| | - Romain Lucas
- Université de Limoges, IRCER, UMR 7315, F-87068 Limoges, France
| | - Vincent Chaleix
- Université de Limoges, Laboratoire PEIRENE, EA 7500, Faculté des Sciences et Techniques, 123 Avenue Albert Thomas, 87060 Limoges Cedex, France
| | - Vincent Sol
- Université de Limoges, Laboratoire PEIRENE, EA 7500, Faculté des Sciences et Techniques, 123 Avenue Albert Thomas, 87060 Limoges Cedex, France
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Reynaud P, Ahmed E, Serre I, Knabe L, Bommart S, Suehs C, Vachier I, Berthet JP, Romagnoli M, Vernisse C, Mallet JP, Gamez AS, Bourdin A. Club Cell Loss as a Feature of Bronchiolization in ILD. Front Immunol 2021; 12:630096. [PMID: 33717159 PMCID: PMC7952638 DOI: 10.3389/fimmu.2021.630096] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 01/25/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Distal airway metaplasia may precede honeycombing in progressive fibrosing interstitial lung disease (ILD). The SCGB1A1+ bronchiolar-specific club cell may play a role in this aberrant regenerative process. Objective: To assess the presence of club cells in the small airways of patients suffering from ILD. Methods: Small airways (internal diameter <2 mm) in lung samples [surgical lung biopsy (SLB) and/or transbronchial lung cryobiopsy (TBLC)] from 14 patients suffering from ILD and 10 controls were morphologically assessed and stained for SCGB1A1. SCGB1A1 was weighted by epithelial height as a marker of airway generation (SCGB1A1/EH). Correlations between clinical, functional, and high-resolution CT (HRCT) prognostic factors and histomorphometry were assessed. Results: Small airways from samples with ILD patterns were significantly less dense in terms of SCGB1A1+ cells [0.064 (0.020–0.172)] as compared to controls' sample's small airways [0.393 (0.082–0.698), p < 0.0001]. Usual interstitial pneumonia (UIP) patterns most frequently contained small airways with limited or absent SCGB1A1 expression (SCGB1A1/EH <0.025): UIP (18/33; 55%) as compared with non-UIP patterns (4/31; 13%) or controls (0/29; 0%): p < 0.0001. In addition, correlations with HRCT indicated a significant negative relationship between SCGB1A1 and bronchiectasis as a feature of bronchiolization (Rho −0.63, p < 0.001) and a positive relationship with both forced vital capacity (FVC) and Hounsfield unit (HU)-distribution pattern in kurtosis (Rho 0.38 and 0.50, respectively, both p < 0.001) as markers of fibrotic changes. Conclusion: Compared with controls, the small airways of patients with ILD more often lack SCGB1A1, especially so in UIP. Low densities of SCGB1A1-marked cells correlate with bronchiectasis and fibrotic changes. Further research investigating SCGB1A1 staining as a pathological feature of the bronchiolization process is merited.
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Affiliation(s)
- Paul Reynaud
- Department of Respiratory Diseases, Univ Montpellier, CHU Montpellier, Montpellier, France
| | - Engi Ahmed
- Department of Respiratory Diseases, Univ Montpellier, CHU Montpellier, Montpellier, France.,PhyMedExp, Univ Montpellier, CNRS, INSERM, CHU Montpellier, Montpellier, France
| | - Isabelle Serre
- Department of Pathology, Univ Montpellier, CHU Montpellier, Montpellier, France
| | - Lucie Knabe
- Department of Respiratory Diseases, Univ Montpellier, CHU Montpellier, Montpellier, France
| | - Sébastien Bommart
- Department of Radiology, Univ Montpellier, CHU Montpellier, Montpellier, France
| | - Carey Suehs
- Department of Respiratory Diseases, Univ Montpellier, CHU Montpellier, Montpellier, France
| | - Isabelle Vachier
- Department of Respiratory Diseases, Univ Montpellier, CHU Montpellier, Montpellier, France
| | | | - Micaela Romagnoli
- Department of Cardiac, Thoracic and Vascular Surgery, Univ Nice, CHU Nice, Nice, France
| | - Charlotte Vernisse
- Department of Respiratory Diseases, Univ Montpellier, CHU Montpellier, Montpellier, France.,PhyMedExp, Univ Montpellier, CNRS, INSERM, CHU Montpellier, Montpellier, France
| | - Jean Pierre Mallet
- Department of Respiratory Diseases, Univ Montpellier, CHU Montpellier, Montpellier, France
| | - Anne Sophie Gamez
- Department of Respiratory Diseases, Univ Montpellier, CHU Montpellier, Montpellier, France
| | - Arnaud Bourdin
- Department of Respiratory Diseases, Univ Montpellier, CHU Montpellier, Montpellier, France.,PhyMedExp, Univ Montpellier, CNRS, INSERM, CHU Montpellier, Montpellier, France
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Bourguignon C, Vernisse C, Mianné J, Fieldès M, Ahmed E, Petit A, Vachier I, Bertrand TL, Assou S, Bourdin A, De Vos J. [Lung organoids]. Med Sci (Paris) 2020; 36:382-388. [PMID: 32356715 DOI: 10.1051/medsci/2020056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
As burden of chronic respiratory diseases is constantly increasing, improving in vitro lung models is essential in order to reproduce as closely as possible the complex pulmonary architecture, responsible for oxygen uptake and carbon dioxide clearance. The study of diseases that affect the respiratory system has benefited from in vitro reconstructions of the respiratory epithelium with inserts in air/liquid interface (2D) or in organoids able to mimic up to the arborescence of the respiratory tree (3D). Recent development in the fields of pluripotent stem cells-derived organoids and genome editing technologies has provided new insights to better understand pulmonary diseases and to find new therapeutic perspectives.
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Affiliation(s)
- Chloé Bourguignon
- IRMB, Univ Montpellier, CHU de Montpellier, Hôpital Saint Eloi, Inserm, 80 avenue Augustin Fliche, 34295 Montpellier, France
| | - Charlotte Vernisse
- PhyMedExp, Univ Montpellier, CHU de Montpellier, Inserm, Montpellier, France
| | - Joffrey Mianné
- IRMB, Univ Montpellier, CHU de Montpellier, Hôpital Saint Eloi, Inserm, 80 avenue Augustin Fliche, 34295 Montpellier, France
| | - Mathieu Fieldès
- IRMB, Univ Montpellier, CHU de Montpellier, Hôpital Saint Eloi, Inserm, 80 avenue Augustin Fliche, 34295 Montpellier, France
| | - Engi Ahmed
- IRMB, Univ Montpellier, CHU de Montpellier, Hôpital Saint Eloi, Inserm, 80 avenue Augustin Fliche, 34295 Montpellier, France - Département de pneumologie, CHU de Montpellier, Montpellier, France
| | - Aurélie Petit
- PhyMedExp, Univ Montpellier, CHU de Montpellier, Inserm, Montpellier, France
| | - Isabelle Vachier
- PhyMedExp, Univ Montpellier, CHU de Montpellier, Inserm, Montpellier, France
| | | | - Said Assou
- IRMB, Univ Montpellier, CHU de Montpellier, Hôpital Saint Eloi, Inserm, 80 avenue Augustin Fliche, 34295 Montpellier, France
| | - Arnaud Bourdin
- PhyMedExp, Univ Montpellier, CHU de Montpellier, Inserm, Montpellier, France - Département de pneumologie, CHU de Montpellier, Montpellier, France
| | - John De Vos
- IRMB, Univ Montpellier, CHU de Montpellier, Hôpital Saint Eloi, Inserm, 80 avenue Augustin Fliche, 34295 Montpellier, France - Département d'ingénierie cellulaire et tissulaire, CHU de Montpellier, Montpellier, France
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Knabe L, Petit A, Vernisse C, Charriot J, Pugnière M, Henriquet C, Sasorith S, Molinari N, Chanez P, Berthet JP, Suehs C, Vachier I, Ahmed E, Bourdin A. CCSP counterbalances airway epithelial-driven neutrophilic chemotaxis. Eur Respir J 2019; 54:13993003.02408-2018. [DOI: 10.1183/13993003.02408-2018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 04/08/2019] [Indexed: 11/05/2022]
Abstract
Club cell secretory protein (CCSP) knockout mice exhibit increased airway neutrophilia, as found in chronic obstructive pulmonary disease (COPD). We therefore investigated whether treating COPD airway epithelia with recombinant human CCSP (rhCCSP) could dampen exaggerated airway neutrophilia.Control, smoker and COPD air–liquid interface (ALI) cultures exposed to cigarette smoke extract (CSE) were treated with and without rhCCSP. The chemotactic properties of the supernatants were assessed using Dunn chambers. Neutrophil chemotaxis along recombinant human interleukin 8 (rhIL8) gradients (with and without rhCCSP) was also determined. rhCCSP–rhIL8 interactions were tested through co-immunoprecipitation, Biacore surface plasmon resonance (SPR) andin silicomodelling. The relationship between CCSP/IL8 concentration ratios in the supernatant of induced sputum from COPD patientsversusneutrophilic airway infiltration assessed in lung biopsies was assessed.Increased neutrophilic chemotactic activity of CSE-treated ALI cultures followed IL8 concentrations and returned to normal when supplemented with rhCCSP. rhIL8-induced chemotaxis of neutrophils was reduced by rhCCSP. rhCCSP and rhIL8 co-immunoprecipitated. SPR confirmed thisin vitrointeraction (equilibrium dissociation constant=8 µM).In silicomodelling indicated that this interaction was highly likely. CCSP/IL8 ratios in induced sputum correlated well with the level of small airway neutrophilic infiltration (r2=0.746, p<0.001).CCSP is a biologically relevant counter-balancer of neutrophil chemotactic activity. These different approaches used in this study suggest that, among the possible mechanisms involved, CCSP may directly neutralise IL8.
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Alagha K, Bourdin A, Vernisse C, Garulli C, Tummino C, Charriot J, Vachier I, Suehs C, Chanez P, Gras D. Goblet cell hyperplasia as a feature of neutrophilic asthma. Clin Exp Allergy 2019; 49:781-788. [PMID: 30710420 DOI: 10.1111/cea.13359] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 12/06/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Goblet cell hyperplasia (GCH) is a pathological finding classically reported across asthma severity levels and usually associated with smoking. Multiple biological mechanisms may contribute to excessive mucus production. OBJECTIVE We aimed to decipher the clinical meanings and biological pathways related to GCH in non-smokers with asthma. METHODS Cough and sputum assessment questionnaire (CASA-Q) responses at entry and 1 year later were compared to clinical and functional outcomes in 59 asthmatic patients. GCH was assessed through periodic-acid shift (PAS) staining on endobronchial biopsies obtained at entry in a subset of 32 patients. RESULTS Periodic-acid shift-staining analysis revealed a double wave distribution discriminating patients with (>10% of the epithelial area) or without GCH. CASA-Q scores were mostly driven by overall asthma severity (P < 0.0001). CASA-Q scores remained stable at 1 year and were independently associated with BAL eosinophil content irrespective of the presence of GCH. GCH was unrelated to the presence of bronchiectasis at CT, GERD or chronic rhinosinusitis, but correlated well with neutrophilic inflammatory patterns observed upon BAL cellular analysis (P = 0.002 at multivariate analysis). BALF bacterial loads were unrelated to GCH or to CASA-Q. CONCLUSIONS AND CLINICAL RELEVANCE Goblet cell hyperplasia is disconnected from chronic cough and sputum when assessed by a specific questionnaire. GCH is related to neutrophilic asthma whereas symptoms are related to airway eosinophilia. The clinical counterpart of GCH is unlikely assessed by the CASA-Q.
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Affiliation(s)
- Khuder Alagha
- Département de Pneumologie et Addictologie, University of Montpellier, Montpellier, France.,Aix Marseille University, INSERM, INRA, C2VN, Marseille, France
| | - Arnaud Bourdin
- Département de Pneumologie et Addictologie, University of Montpellier, Montpellier, France.,PhyMedExp, Hôpital Arnaud de Villeneuve, INSERM U1046, CNRS, UMR 9214, University of Montpellier, Montpellier, France.,CHU Montpellier, Montpellier, France
| | - Charlotte Vernisse
- PhyMedExp, Hôpital Arnaud de Villeneuve, INSERM U1046, CNRS, UMR 9214, University of Montpellier, Montpellier, France.,CHU Montpellier, Montpellier, France
| | - Céline Garulli
- Aix Marseille University, INSERM, INRA, C2VN, Marseille, France
| | - Céline Tummino
- Clinique des Bronches, Allergies et Sommeil, Hôpital Nord, AP-HM, Aix Marseille Université Marseille, Marseille, France
| | - Jérémy Charriot
- Département de Pneumologie et Addictologie, University of Montpellier, Montpellier, France
| | - Isabelle Vachier
- Département de Pneumologie et Addictologie, University of Montpellier, Montpellier, France
| | - Carey Suehs
- Département de Pneumologie et Addictologie, University of Montpellier, Montpellier, France
| | - Pascal Chanez
- Aix Marseille University, INSERM, INRA, C2VN, Marseille, France.,Clinique des Bronches, Allergies et Sommeil, Hôpital Nord, AP-HM, Aix Marseille Université Marseille, Marseille, France
| | - Delphine Gras
- Aix Marseille University, INSERM, INRA, C2VN, Marseille, France
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