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Gevaert P, Mullol J, Saenz R, Ko J, Steinke JW, Millette LA, Meltzer EO. Omalizumab improves sinonasal outcomes in patients with chronic rhinosinusitis with nasal polyps regardless of allergic status. Ann Allergy Asthma Immunol 2024; 132:355-362.e1. [PMID: 37951571 DOI: 10.1016/j.anai.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 11/01/2023] [Accepted: 11/03/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Patients with chronic rhinosinusitis with nasal polyps (CRSwNP) often have atopic comorbidities, including elevated IgE levels and comorbid asthma. Omalizumab, an IgE monoclonal antibody, is an effective treatment for CRSwNP, but the impact of allergy or asthma status on response to omalizumab in patients with CRSwNP has not been well studied. OBJECTIVE To evaluate the impact of allergy and asthma status on omalizumab treatment in patients with CRSwNP, this posthoc exploratory analysis assessed sinonasal outcomes from subgroups of patients included in POLYP 1 and POLYP 2 and the open-label extension (OLE) trials. METHODS Patients (N = 249) were grouped by the presence/absence of comorbid allergy (≥ 1 physician-reported allergic rhinitis, allergic sinusitis, food allergy, or atopic dermatitis), presence/absence of comorbid asthma, baseline serum total IgE (≥ 150 or <150 IU/mL), and baseline blood eosinophil levels (>300 or ≤ 300 cells/µL). Sinonasal outcomes were the nasal polyps score, nasal congestion score, and sino-nasal outcome test-22. RESULTS During POLYP 1 and POLYP 2 and the OLE, omalizumab treatment improved the nasal polyps score, nasal congestion score, and sino-nasal outcome test-22 score in patients with/without physician-reported allergic comorbidities, with/without asthma, with higher/lower total IgE levels, and with higher/lower blood eosinophil counts. In the OLE, the pattern of improvement was similar in patients who continued or switched to omalizumab. CONCLUSION In patients with CRSwNP, omalizumab improved sinonasal outcomes independent of allergic status, which suggests that a wide range of patients with different endotypes and phenotypes of CRSwNP may benefit from omalizumab treatment. TRIAL REGISTRATION Clinicaltrials.gov Identifier: NCT03280550, NCT03280537, NCT03478930.
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Affiliation(s)
- Philippe Gevaert
- Upper Airway Research Laboratory, Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
| | - Joaquim Mullol
- Rhinology Unit and Smell Clinic, ENT Department, Hospital Clinic, The August Pi i Sunyer Biomedical Research Institute, Universitat de Barcelona, Centro de Investigación Biomédica en Red Instituto de Salud, Madrid, Spain
| | | | - Jinnie Ko
- Genentech, Inc., South San Francisco, California
| | | | | | - Eli O Meltzer
- Division of Allergy and Immunology, University of California, San Diego, La Jolla, California
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Chase NM, Littlejohn M, Holweg CTJ, Millette LA, Seetasith A, Steinke JW, Trzaskoma BL, Hanania NA, Casale TB. Effectiveness of omalizumab across different dosing regimens in patients with moderate-to-severe allergic asthma. Respir Med 2024; 223:107537. [PMID: 38253245 DOI: 10.1016/j.rmed.2024.107537] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/18/2024] [Accepted: 01/19/2024] [Indexed: 01/24/2024]
Abstract
For patients with moderate-to-severe persistent allergic asthma, omalizumab is approved for subcutaneous administration according to a recommended dosing table based on weight and total immunoglobulin E (IgE) level. The aim of this analysis was to assess asthma outcomes including quality of life in patients with allergic asthma initiated on omalizumab in the PROSPERO trial; patients were stratified by where their IgE and body weight fell on the approved dosing table. Patient groups were defined as Inside Dosing Table: patients whose IgE and weight fell within the approved dosing table (n = 506); Insufficient Data to Recommend a Dose: patients who fell into the section of the approved dosing table where not enough clinical data were available to make dosing recommendations (n = 72); and Outside Dosing Table: patients who fell outside the approved dosing table due to baseline IgE and/or weight (n = 209). Overall, asthma and quality of life outcomes were improved after omalizumab initiation for both patients who fall within the recommended dosing table or those who fall outside the recommended dosing table. Our results suggest that omalizumab treatment may be effective in a wide range of patients with moderate-to-severe allergic asthma. ClinicalTrials.gov identifier NCT01922037.
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Affiliation(s)
| | | | | | | | | | | | | | - Nicola A Hanania
- Section of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, TX, USA.
| | - Thomas B Casale
- Division of Allergy and Immunology, University of South Florida, Tampa, FL, USA.
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Meltzer EO, Mullol J, Ko J, Saenz R, Steinke JW, Millette LA, Gevaert P. Omalizumab improves sleep and health status for patients with chronic rhinosinusitis with nasal polyps: An analysis of randomized clinical trials. Int Forum Allergy Rhinol 2024. [PMID: 38197558 DOI: 10.1002/alr.23322] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 12/04/2023] [Accepted: 12/28/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND Patients with chronic rhinosinusitis with nasal polyps (CRSwNP) have high incidence of sleep impairment. We evaluated the impact of omalizumab treatment on sleep characteristics and associated health status in patients with CRSwNP. METHODS Prespecified exploratory analysis assessed outcomes from patients included in the POLYP 1 and POLYP 2 phase 3 clinical trials and the open-label extension. Sleep was assessed by the sleep domain of the Sino-Nasal Outcome Test-22 (SNOT-22; MCID > 4 in patients with CRS) and the Medical Outcomes Study Sleep Scale (MOS-Sleep). Health status was assessed by Healthy Days Core Module (HDCM) and sinonasal-specific Patient Global Impression of Change (PGIC). RESULTS Omalizumab improved sleep as assessed by the SNOT-22 sleep domain. At week 24, adjusted mean (95%CI) SNOT-22 sleep scores had reduced from baseline by -8.5 (-9.9 to -7.1) with omalizumab versus -2.7 (-4.1 to -1.3) with placebo. At week 52 (all patents on OMA), adjusted mean (95%CI) SNOT-22 sleep scores had reduced from baseline by -10.1 (-11.4 to -8.7) with omalizumab. Improvements were observed in all eight items of the SNOT-22 sleep domain: difficulty falling asleep, fatigue, frustration/restlessness/irritability, lack good night's sleep, reduced concentration, reduced productivity, wake up tired, and wake up at night. In addition, omalizumab improved six of eight sleep outcomes on the MOS-Sleep scale. There were concurrent improvements in HDCM and PGIC. CONCLUSION Omalizumab improved sleep and self-reported health status in patients with CRSwNP. This contributes to evidence that omalizumab provides value for patients beyond the reduction of sinonasal symptoms.
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Affiliation(s)
- Eli O Meltzer
- Division of Allergy and Immunology, University of California, San Diego, La Jolla, California, USA
| | - Joaquim Mullol
- Rhinology Unit & Smell Clinic, ENT Department, Hospital Clinic, IDIBAPS, Universitat de Barcelona, CIBERES, Barcelona, Catalonia, Spain
| | - Jinnie Ko
- Genentech, Inc., South San Francisco, California, USA
| | - Rebecca Saenz
- Genentech, Inc., South San Francisco, California, USA
| | | | | | - Philippe Gevaert
- Upper Airway Research Laboratory, Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
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Feng X, Lawrence MG, Payne SC, Mattos J, Etter E, Negri JA, Murphy D, Kennedy JL, Steinke JW, Borish L. Lower viral loads in subjects with rhinovirus-challenged allergy despite reduced innate immunity. Ann Allergy Asthma Immunol 2022; 128:414-422.e2. [PMID: 35031416 PMCID: PMC10666001 DOI: 10.1016/j.anai.2022.01.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/04/2021] [Accepted: 01/05/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Viral infections, especially those caused by rhinovirus, are the most common cause of asthma exacerbations. Previous studies have argued that impaired innate antiviral immunity and, as a consequence, more severe infections contribute to these exacerbations. OBJECTIVE These studies explored the innate immune response in the upper airway of volunteers with allergic rhinitis and asthma in comparison to healthy controls and interrogated how these differences corresponded to severity of infection. METHODS Volunteers with allergic rhinitis, those with asthma, and those who are healthy were inoculated with rhinovirus A16 and monitored for clinical symptoms. Tissue and nasal wash samples were evaluated for antiviral signature and viral load. RESULTS Both subjects with allergic rhinitis and asthma were found to have more severe cold symptoms. Subjects with asthma had worsened asthma control and increased bronchial hyperreactivity in the setting of higher fractional exhaled breath nitric oxide and blood eosinophils. These studies confirmed reduced expression of interferons and virus-specific pattern recognition receptors in both cohorts with atopy. Nevertheless, despite this defect in innate immunity, volunteers with allergic rhinitis/asthma had reduced rhinovirus concentrations in comparison to the controls. CONCLUSION These results confirm that the presence of an allergic inflammatory disorder of the airway is associated with reduced innate immune responsive to rhinovirus infection. Despite this, these volunteers with allergy have reduced viral loads, arguing for the presence of a compensatory mechanism to clear the infection. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02910401.
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Affiliation(s)
- Xin Feng
- Department of Otorhinolaryngology, Qilu Hospital of Shandong University, NHC Key Laboratory of Otorhinolaryngology (Shandong University), Jinan, Shandong, People's Republic of China
| | - Monica G Lawrence
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia; Department of Pediatrics, University of Virginia Health System, Charlottesville, Virginia
| | - Spencer C Payne
- Department of Otolaryngology, University of Virginia Health System, Charlottesville, Virginia
| | - Jose Mattos
- Department of Otolaryngology, University of Virginia Health System, Charlottesville, Virginia
| | - Elaine Etter
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
| | - Julie A Negri
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
| | - Deborah Murphy
- Department of Pediatrics, University of Virginia Health System, Charlottesville, Virginia
| | - Joshua L Kennedy
- Department of Pediatrics and Medicine, University of Arkansas for Medical Sciences, Arkansas Children's Hospital Research Institute, Little Rock, Arkansas
| | - John W Steinke
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
| | - Larry Borish
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia; Department of Microbiology, University of Virginia Health System, Charlottesville, Virginia.
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Lawrence MG, Teague WG, Feng X, Welch C, Etter E, Negri J, Spano M, Wavell K, Braciale T, Steinke JW, Borish L. Interleukin-5 receptor alpha (CD125) expression on human blood and lung neutrophils. Ann Allergy Asthma Immunol 2022; 128:53-60.e3. [PMID: 34391897 PMCID: PMC8671196 DOI: 10.1016/j.anai.2021.08.004] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 07/30/2021] [Accepted: 08/09/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Our previous studies revealed the presence of interleukin-5 (IL-5) receptor alpha chain (IL-5Rα, CD125) on neutrophils in a murine model of influenza and in the lung fluid of children with severe asthma. OBJECTIVE To further evaluate the functional characteristics and effects of clinical factors and inflammatory variables on neutrophil surface IL-5Rα abundance in lung fluid and blood. METHODS IL-5Rα expression was quantified by flow cytometry performed on purified neutrophils from blood and bronchoalveolar lavage fluid samples obtained from healthy controls and individuals with asthma. Expression was further confirmed by immunohistochemistry. Functional signaling through the IL-5Rα was evaluated by measurement of IL-5-inducible modulation of neutrophil surface CD62L and IL-5Rα expression. RESULTS IL-5Rα was consistently present but at a variable magnitude on blood and lung neutrophils. Expression on lung neutrophils was significantly higher than that on blood cells (p"?>P < .001) where their expression was higher in the presence of airway pathogens, especially with respiratory viruses. Increased receptor expression occurred in response to the translocation of preformed receptors from intracellular stores. Receptors were functional as revealed by IL-5-mediated down-regulation of CD62L and the feed-forward up-regulation of reception expression. CONCLUSION In addition to the expression on eosinophils and basophils, the IL-5Rα is consistently and abundantly expressed on the surface of blood and especially air space neutrophils. These observations support the concept that some of the efficacy of IL-5/IL-5R-targeting biologics observed in asthma may reflect their ability to target neutrophilic air space inflammation.
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Affiliation(s)
- Monica G Lawrence
- Department of Medicine, University of Virginia, Charlottesville, Virginia; Child Health Research Center, Department of Pediatrics, University of Virginia, Charlottesville, Virginia.
| | - W Gerald Teague
- Child Health Research Center, Department of Pediatrics, University of Virginia, Charlottesville, Virginia
| | - Xin Feng
- Department of Otorhinolaryngology, Qilu Hospital of Shandong University, Shandong, People's Republic of China; NHC Key Laboratory of Otorhinolaryngology, Shandong University, Jinan, Shandong, People's Republic of China
| | - Caitlin Welch
- Department of Medicine, University of Virginia, Charlottesville, Virginia
| | - Elaine Etter
- Department of Medicine, University of Virginia, Charlottesville, Virginia
| | - Julie Negri
- Department of Medicine, University of Virginia, Charlottesville, Virginia
| | - Marthajoy Spano
- Department of Pathology, University of Virginia, Charlottesville, Virginia
| | - Kristin Wavell
- Child Health Research Center, Department of Pediatrics, University of Virginia, Charlottesville, Virginia
| | - Thomas Braciale
- Department of Pathology, University of Virginia, Charlottesville, Virginia; Department of Microbiology, University of Virginia, Charlottesville, Virginia
| | - John W Steinke
- Department of Medicine, University of Virginia, Charlottesville, Virginia; Genentech, Charlottesville, Virginia
| | - Larry Borish
- Department of Medicine, University of Virginia, Charlottesville, Virginia; Department of Microbiology, University of Virginia, Charlottesville, Virginia
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Teague WG, Lawrence MG, Williams S, Garrod AS, Froh D, Early SV, Brand W, Middleton JP, Mendoza MV, Hollis KA, Wavell K, Heymann PW, Steinke JW, Borish L. Novel Treatment-Refractory Preschool Wheeze Phenotypes Identified by Cluster Analysis of Lung Lavage Constituents. J Allergy Clin Immunol Pract 2021; 9:2792-2801.e4. [PMID: 33905917 DOI: 10.1016/j.jaip.2021.03.059] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 02/25/2021] [Accepted: 03/24/2021] [Indexed: 01/28/2023]
Abstract
BACKGROUND Preschool children with treatment-refractory wheeze often require unscheduled acute care. Current guidelines advise treatment of persistent wheeze with inhaled corticosteroids. Alternative treatments targeting structural abnormalities and specific inflammatory patterns could be more effective. OBJECTIVE To apply unsupervised analysis of lung lavage (bronchoalveolar lavage [BAL]) variables to identify clusters of preschool children with treatment-refractory wheeze. METHODS A total of 155 children 6 years or younger underwent bronchoscopy with BAL for evaluation of airway structure, inflammatory markers, and pathogens. Variables were screened with factor analysis and sorted into clusters by Ward's method, and membership was confirmed by discriminant analysis. RESULTS The model was repeatable in a 48-case validation sample and accurately classified 86% of cases. Cluster 1 (n = 60) had early-onset wheeze, 85% with structural abnormalities, mostly tracheamalacia, with low total IgE and agranulocytic BAL. Cluster 2 (n = 42) had later-onset wheeze, the highest prevalence of gastroesophageal reflux, little atopy, and two-third had increased BAL lipid-laden macrophages. Cluster 3 (n = 46) had mid-onset wheeze, low total IgE, and two-third had BAL viral transcripts, predominately human rhinovirus, with BAL neutrophilia. Cluster 4 (n = 7) was older, with high total IgE, blood eosinophilia, and mixed BAL eosinophils and neutrophils. CONCLUSIONS Preschool children with recurrent wheeze refractory to inhaled corticosteroid treatment include 4 clusters: airway malacia, gastroesophageal reflux, indolent human rhinovirus bronchoalveolitis, and type-2high inflammation. The results support the risk and cost of invasive bronchoscopy to diagnose causes of treatment-refractory wheeze and develop novel therapies targeting airway malacia, human rhinovirus infection, and BAL neutrophilia in preschool children.
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Affiliation(s)
- W Gerald Teague
- Child Health Research Center, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Va; Division of Respiratory Medicine, Allergy, Immunology, and Sleep, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Va.
| | - Monica G Lawrence
- Division of Respiratory Medicine, Allergy, Immunology, and Sleep, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Va; Division of Allergy, Asthma, and Immunology, Department of Medicine, University of Virginia School of Medicine, Charlottesville, Va
| | - Sanford Williams
- Division of Respiratory Medicine, Allergy, Immunology, and Sleep, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Va; Division of Allergy, Asthma, and Immunology, Department of Medicine, University of Virginia School of Medicine, Charlottesville, Va
| | - Andrea S Garrod
- Division of Respiratory Medicine, Allergy, Immunology, and Sleep, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Va
| | - Deborah Froh
- Division of Respiratory Medicine, Allergy, Immunology, and Sleep, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Va
| | - Stephen V Early
- Department of Otolaryngology, Head and Neck Surgery, University of Virginia School of Medicine, Charlottesville, Va
| | - William Brand
- Department of Otolaryngology, Head and Neck Surgery, University of Virginia School of Medicine, Charlottesville, Va
| | - Jeremy P Middleton
- Division of Gastroenterology and Hepatology, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Va
| | - Michael V Mendoza
- Division of Gastroenterology and Hepatology, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Va
| | - Kerry A Hollis
- Department of Respiratory Therapy and Sleep Technology, University of Virginia Medical Center, Charlottesville, Va
| | - Kristin Wavell
- Division of Respiratory Medicine, Allergy, Immunology, and Sleep, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Va; Division of Allergy, Asthma, and Immunology, Department of Medicine, University of Virginia School of Medicine, Charlottesville, Va
| | - Peter W Heymann
- Child Health Research Center, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Va; Division of Respiratory Medicine, Allergy, Immunology, and Sleep, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Va
| | - John W Steinke
- Division of Allergy, Asthma, and Immunology, Department of Medicine, University of Virginia School of Medicine, Charlottesville, Va
| | - Larry Borish
- Division of Allergy, Asthma, and Immunology, Department of Medicine, University of Virginia School of Medicine, Charlottesville, Va; Department of Microbiology, University of Virginia School of Medicine, Charlottesville, Va
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Steinke JW, Lawrence MG, Teague WG, Braciale TJ, Patrie JT, Borish L. Bronchoalveolar lavage cytokine patterns in children with severe neutrophilic and paucigranulocytic asthma. J Allergy Clin Immunol 2020; 147:686-693.e3. [PMID: 32526308 DOI: 10.1016/j.jaci.2020.05.039] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Revised: 05/11/2020] [Accepted: 05/13/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Asthma is a complex heterogeneous disease occurring in adults and children that is characterized by distinct inflammatory patterns. While numerous studies have been performed in adults, little is known regarding the heterogeneity of severe asthma in children, particularly inflammatory signatures involving the air spaces. OBJECTIVE We sought to determine the relationship of bronchoalveolar lavage (BAL) cytokine/chemokine expression patterns in children with severe therapy-resistant asthma stratified according to neutrophilic versus nonneutrophilic BAL inflammatory cell patterns. METHODS Children with severe asthma with inadequate symptom control despite therapy underwent diagnostic bronchoscopy and BAL. Inflammatory cytokine/chemokine concentrations were determined using a multiplex protein bead assay. RESULTS Analysis of BAL constituents with an unbiased clustering approach revealed distinct cytokine/chemokine patterns, and these aligned with pathways associated with type 2 innate lymphoid cells, monocytes, neutrophil trafficking, and T effector cells. All cytokines examined (n = 27) with 1 exception (vascular endothelial growth factor) were overexpressed with BAL neutrophilia compared with nonneutrophilic asthma, and this was confirmed in a cross-validation analysis. Cytokines specifically responsible for Th17 (IL-17, IL-6, G-CSF) and Th1 differentiation and expression (IL-12, TNF-α, IFN-γ) were enhanced in the neutrophilic cohorts. Neutrophilic groups were also characterized by higher prevalence of bacterial and viral pathogens; however, cytokine expression patterns manifested independently of pathogen expression. CONCLUSIONS The results demonstrate that children with refractory asthma and neutrophilic inflammation had a BAL cytokine pattern consistent with a mixed Th17/Th1/Th2 response. In contrast, nonneutrophilic asthma presented independently of cytokine overexpression.
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Affiliation(s)
- John W Steinke
- Division of Allergy and Immunology, Department of Medicine, University of Virginia School of Medicine, Charlottesville, Va; Carter Immunology Center, University of Virginia School of Medicine, Charlottesville, Va
| | - Monica G Lawrence
- Division of Allergy and Immunology, Department of Medicine, University of Virginia School of Medicine, Charlottesville, Va
| | - W Gerald Teague
- Child Health Research Center, Division of Respiratory Medicine, Allergy, and Immunology, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Va
| | - Thomas J Braciale
- Carter Immunology Center, University of Virginia School of Medicine, Charlottesville, Va
| | - James T Patrie
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, Va
| | - Larry Borish
- Division of Allergy and Immunology, Department of Medicine, University of Virginia School of Medicine, Charlottesville, Va; Carter Immunology Center, University of Virginia School of Medicine, Charlottesville, Va; Department of Microbiology, University of Virginia School of Medicine, Charlottesville, Va.
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Heymann PW, Platts-Mills TAE, Woodfolk JA, Borish L, Murphy DD, Carper HT, Conaway MR, Steinke JW, Muehling L, Gerald Teague W, Kennedy JL, Irani AM, McGraw MD, Early SV, Wheatley LM, Adams AP, Turner RB. Understanding the asthmatic response to an experimental rhinovirus infection: Exploring the effects of blocking IgE. J Allergy Clin Immunol 2020; 146:545-554. [PMID: 32018030 DOI: 10.1016/j.jaci.2020.01.035] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [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: 10/29/2019] [Revised: 12/20/2019] [Accepted: 01/15/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Rhinovirus frequently causes asthma exacerbations among children and young adults who are allergic. The interaction between allergen and rhinovirus-induced symptoms and inflammation over time is unclear. OBJECTIVE Our aim was to compare the response to an experimental inoculation with rhinovirus-16 in allergic asthmatics with the response in healthy controls and to evaluate the effects of administrating omalizumab before and during the infection. METHODS Two clinical trials were run in parallel. In one of these trials, the response to an experimental inoculation with rhinovirus-16 among asthmatics with high levels of total IgE was compared to the response in healthy controls. The other trial compared the effects of administering omalizumab versus placebo to asthmatics in a randomized, double-blind placebo-controlled investigation. The primary outcome for both trials compared lower respiratory tract symptoms (LRTSs) between study groups over the first 4 days of infection. RESULTS Frequent comparisons of symptoms, lung function, and blood eosinophil counts revealed differences that were more pronounced among allergic asthmatics than among controls by days 2 and 3 after virus inoculation. Additionally, an augmentation of upper respiratory tract symptom scores and LRTS scores occurred among the atopic asthmatics versus the controls during the resolution of symptoms (P < .01 for upper respiratory symptom tract scores and P < .001 for LRTS scores). The beneficial effects of administering omalizumab on reducing LRTSs and improving lung function were strongest over the first 4 days. CONCLUSIONS LRTSs and blood eosinophil counts were augmented and lung function was reduced among allergic asthmatics early after rhinovirus inoculation but increased late in the infection during symptom resolution. The effect of administering omalizumab on the response to rhinovirus was most pronounced during the early/innate phase of the infection.
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Affiliation(s)
- Peter W Heymann
- Asthma and Allergic Diseases Center, University of Virginia, Charlottsville, Va; Division of Pediatric Respiratory Medicine, University of Virginia, Charlottsville, Va.
| | | | - Judith A Woodfolk
- Asthma and Allergic Diseases Center, University of Virginia, Charlottsville, Va
| | - Larry Borish
- Asthma and Allergic Diseases Center, University of Virginia, Charlottsville, Va
| | - Deborah D Murphy
- Asthma and Allergic Diseases Center, University of Virginia, Charlottsville, Va; Division of Pediatric Respiratory Medicine, University of Virginia, Charlottsville, Va
| | - Holliday T Carper
- Asthma and Allergic Diseases Center, University of Virginia, Charlottsville, Va; Division of Pediatric Respiratory Medicine, University of Virginia, Charlottsville, Va
| | - Mark R Conaway
- Department of Public Health Sciences, University of Virginia, Charlottsville, Va
| | - John W Steinke
- Asthma and Allergic Diseases Center, University of Virginia, Charlottsville, Va
| | - Lyndsey Muehling
- Asthma and Allergic Diseases Center, University of Virginia, Charlottsville, Va
| | - W Gerald Teague
- Division of Pediatric Respiratory Medicine, University of Virginia, Charlottsville, Va
| | - Joshua L Kennedy
- Division of Allergy and Immunology, University of Arkansas for Medical Sciences, Little Rock, Ark
| | - Anne-Marie Irani
- Division of Pediatric Allergy and Immunology, Virginia Commonwealth University, Richmond, Va
| | - Matthew D McGraw
- Division of Pediatric Pulmonology, University of Rochester, Rochester, NY
| | - Stephen V Early
- Division of Pediatric Otolaryngology, University of Virginia, Charlottsville, Va
| | - Lisa M Wheatley
- Allergy, Asthma and Airways Biology Branch, Division of Allergy, Immunology, and Transplantation/National Institute of Allergy and Infectious Diseases, Bethesda, Md
| | - Amy P Adams
- Department of Pharmacy, University of Virginia, Charlottsville, Va
| | - Ronald B Turner
- Department of Pediatric Infectious Diseases, University of Virginia, Charlottsville, Va
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Eccles JD, Turner RB, Kirk NA, Muehling LM, Borish L, Steinke JW, Payne SC, Wright PW, Thacker D, Lahtinen SJ, Lehtinen MJ, Heymann PW, Woodfolk JA. T-bet+ Memory B Cells Link to Local Cross-Reactive IgG upon Human Rhinovirus Infection. Cell Rep 2020; 30:351-366.e7. [PMID: 31940481 PMCID: PMC6994188 DOI: 10.1016/j.celrep.2019.12.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 11/01/2019] [Accepted: 12/06/2019] [Indexed: 01/01/2023] Open
Abstract
Human rhinoviruses cause the common cold and exacerbate chronic respiratory diseases. Although infection elicits neutralizing antibodies, these do not persist or cross-protect across multiple rhinovirus strains. To analyze rhinovirus-specific B cell responses in humans, we developed techniques using intact RV-A16 and RV-A39 for high-throughput high-dimensional single-cell analysis, with parallel assessment of antibody isotypes in an experimental infection model. Our approach identified T-bet+ B cells binding both viruses that account for ∼5% of CXCR5- memory B cells. These B cells infiltrate nasal tissue and expand in the blood after infection. Their rapid secretion of heterotypic immunoglobulin G (IgG) in vitro, but not IgA, matches the nasal antibody profile post-infection. By contrast, CXCR5+ memory B cells binding a single virus are clonally distinct, absent in nasal tissue, and secrete homotypic IgG and IgA, mirroring the systemic response. Temporal and spatial functions of dichotomous memory B cells might explain the ability to resolve infection while rendering the host susceptible to re-infection.
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Affiliation(s)
- Jacob D Eccles
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA 22908, USA
| | - Ronald B Turner
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA 22908, USA
| | - Nicole A Kirk
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA 22908, USA
| | - Lyndsey M Muehling
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA 22908, USA
| | - Larry Borish
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA 22908, USA
| | - John W Steinke
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA 22908, USA
| | - Spencer C Payne
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA 22908, USA; Department of Otolaryngology, University of Virginia School of Medicine, Charlottesville, VA 22908, USA
| | - Paul W Wright
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA 22908, USA
| | - Deborah Thacker
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA 22908, USA
| | - Sampo J Lahtinen
- DuPont Nutrition & Biosciences, Global Health and Nutrition Science, Sokeritehtaantie 20, 02460 Kantvik, Finland
| | - Markus J Lehtinen
- DuPont Nutrition & Biosciences, Global Health and Nutrition Science, Sokeritehtaantie 20, 02460 Kantvik, Finland
| | - Peter W Heymann
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA 22908, USA
| | - Judith A Woodfolk
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA 22908, USA.
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10
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Pal K, Feng X, Steinke JW, Burdick MD, Shim YM, Sung SS, Teague WG, Borish L. Leukotriene A4 Hydrolase Activation and Leukotriene B4 Production by Eosinophils in Severe Asthma. Am J Respir Cell Mol Biol 2019; 60:413-419. [PMID: 30352167 DOI: 10.1165/rcmb.2018-0175oc] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Asthma is associated with the overproduction of leukotrienes (LTs), including LTB4. Patients with severe asthma can be highly responsive to 5-lipoxygenase (5-LO) inhibition, which blocks production of both the cysteinyl LTs and LTB4. Production of LTB4 has traditionally been ascribed to neutrophils, mononuclear phagocytes, and epithelial cells, and acts as a chemoattractant for inflammatory cells associated with asthma. The source of LTB4 is unclear, especially in eosinophilic asthma. We speculated that the benefit of 5-LO inhibition could be mediated in part by inhibition of eosinophil-derived LTB4. LTB4 concentrations were assayed in BAL fluid from patients with severe asthma characterized by isolated neutrophilic, eosinophilic, and paucigranulocytic inflammation. Expression of LTA4 hydrolase (LTA4H) by airway eosinophils was determined by immunohistochemistry (IHC). Subsequently, peripheral blood eosinophils were activated and secreted LTB4 was quantified by enzyme immunoassay. Blood eosinophil LTA4H expression was determined by flow cytometry, qPCR, and IHC. LTB4 concentrations were elevated in BAL fluid from patients with severe asthma, including those with isolated eosinophilic inflammation, and these eosinophils displayed LTA4H via IHC. LTA4H expression by blood eosinophils was confirmed by flow cytometry, IHC, and qPCR. Robust LTB4 production by blood eosinophils was observed in response to some, but not all, stimuli. We demonstrated that eosinophils express LTA4H transcripts and protein, and can be stimulated to secrete LTB4. We speculate that in many patients with asthma, eosinophil-derived LTB4 is increased, and this may contribute to the efficacy of 5-LO inhibition.
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Affiliation(s)
- Kavita Pal
- 1 Division of Pulmonary and Critical Care Medicine
| | - Xin Feng
- 2 Department of Otorhinolaryngology, QiLu Hospital of Shandong University, Jinan, Shandong, China
| | | | | | - Yun M Shim
- 1 Division of Pulmonary and Critical Care Medicine
| | | | | | - Larry Borish
- 3 Division of Asthma Allergy and Immunology, and.,6 Department of Microbiology, University of Virginia Health System, Charlottesville, Virginia; and
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11
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Abstract
Background Chronic rhinosinusitis is a difficult-to-treat disease that is often characterized by recurrent nasal polyp (NP) growth following surgical removal. The disease has been separated into distinct phenotypes based on cellular infiltrate or underlying physiological mechanisms. NPs are composed in part of an inflammatory cellular infiltrate, blood vessels, and a large amount of extracellular matrix (ECM). Despite the recognition of prominent ECM deposition, few studies have examined the components in detail and how they might differ with disease state. Objective The purpose of this study was to quantitate the expression of ECM components in NPs. Methods NPs were stained with pico-sirius red to determine total collagen content, and immunofluorescence was used to detect collagen I, collagen III, collagen IV, fibronectin, and laminin. Expression of each was quantitated and analyzed in relation to rhinosinusitis phenotype and separately as a function of polyp eosinophil number. Results When analyzed by phenotype, collagen I, collagen III, and fibronectin were expressed at the highest levels in noneosinophilic sinus disease. Collagen IV was not different among any groups, and its location was found predominately around vessels. When analyzed as a function of polyp eosinophil number, total collagen and collagen III showed a significant inverse correlation. Conclusions NP ECM composition differs with disease state with higher expression in cases where eosinophil levels are low. This suggests that in eosinophilic polyps there is a loss of matrix deposition either through break down or a failure to produce the essential components. Understanding these differences may identify new therapeutic targets.
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Affiliation(s)
- Xin Feng
- Department of Otorhinolaryngology, QiLu Hospital of Shandong University, Jinan, China
- NHC Key Laboratory of Otorhinolaryngology, Shangdong University, Jinan, China
| | - Spencer C. Payne
- Asthma and Allergic Disease Center, University of Virginia Health System, Charlottesville, Virginia
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
- Department of Otolaryngology—Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Larry Borish
- Asthma and Allergic Disease Center, University of Virginia Health System, Charlottesville, Virginia
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
- Carter Immunology Center, University of Virginia Health System, Charlottesville, Virginia
- Department of Microbiology, University of Virginia Health System, Charlottesville, Virginia
| | - John W. Steinke
- Asthma and Allergic Disease Center, University of Virginia Health System, Charlottesville, Virginia
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
- Carter Immunology Center, University of Virginia Health System, Charlottesville, Virginia
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12
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Pal K, Ramsden M, Shim YM, Borish L, Payne SC, Steinke JW. Suppression of aspirin-mediated eosinophil activation by prostaglandin E 2: Relevance to aspirin and nonsteroidal anti-inflammatory drug hypersensitivity. Ann Allergy Asthma Immunol 2019; 123:503-506. [PMID: 31513909 DOI: 10.1016/j.anai.2019.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 08/21/2019] [Accepted: 09/03/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Aspirin-exacerbated respiratory disease (AERD) is characterized by severe, sometimes life-threatening reactions to nonsteroidal anti-inflammatory drugs (NSAIDs). Mechanisms driving the disease include overproduction of leukotrienes and loss of anti-inflammatory prostaglandin E2 (PGE2) production. Many cell types contribute to the disease; however, eosinophils are markedly elevated and are important drivers of pathologic findings. OBJECTIVE To investigate the capacity of aspirin and NSAIDs to drive eosinophil activation and the ability of PGE2 to inhibit this activation. METHODS Eosinophils were purified from blood of healthy individuals without AERD and stimulated with lysine aspirin, ketorolac, or sodium salicylate. The role of PGE2 in altering activation was determined by incubating eosinophils with increasing doses of PGE2 before lysine aspirin stimulation. Specific PGE2 receptor use was determined by incubating eosinophils with receptor agonists and antagonists before aspirin stimulation. Cysteinyl leukotrienes (CysLTs), leukotriene B4 (LTB4), and eosinophil-derived neurotoxin (EDN) were quantified by enzyme-linked immunosorbent assay. RESULTS Stimulation of eosinophils with lysine aspirin, ketorolac, or sodium salicylate resulted in secretion of CysLTs and LTB4 in the absence of EDN release. Low doses of PGE2 inhibited LTB4 and CysLT release, an effect lost at higher PGE2 concentrations. Use of butaprost, an EP2 receptor agonist, suppressed lysine aspirin stimulation. This mechanism was supported by blocking activity of the EP1 and EP3 receptors. CONCLUSION Eosinophils can be directly activated by NSAIDs via cyclooxygenase-independent pathways to produce CysLTs and LTB4. This effect can be inhibited by PGE2 acting through the EP2 receptor. The recognized loss of EP2 receptor expression combined with low PGE2 levels explains in part the sensitivity to NSAIDs.
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Affiliation(s)
- Kavita Pal
- Departments of Medicine, University of Virginia Health System, Charlottesville, Virginia
| | - Madison Ramsden
- Departments of Medicine, University of Virginia Health System, Charlottesville, Virginia
| | - Yun M Shim
- Departments of Medicine, University of Virginia Health System, Charlottesville, Virginia
| | - Larry Borish
- Departments of Medicine, University of Virginia Health System, Charlottesville, Virginia; Department of Microbiology, University of Virginia Health System, Charlottesville, Virginia.
| | - Spencer C Payne
- Department of Otolaryngology, University of Virginia Health System, Charlottesville, Virginia
| | - John W Steinke
- Departments of Medicine, University of Virginia Health System, Charlottesville, Virginia
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13
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Gorski SA, Lawrence MG, Hinkelman A, Spano MM, Steinke JW, Borish L, Teague WG, Braciale TJ. Expression of IL-5 receptor alpha by murine and human lung neutrophils. PLoS One 2019; 14:e0221113. [PMID: 31415658 PMCID: PMC6695150 DOI: 10.1371/journal.pone.0221113] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 07/30/2019] [Indexed: 12/16/2022] Open
Abstract
The role of eosinophilia in atopic diseases, including asthma, is well established, as is the well-known role of IL-5 as a major eosinophilopoeitin and chemoattractant. Following influenza A virus infection of mice, type 2 innate lymphoid cells are recruited to the respiratory tract and produce large quantities of IL-5, which contributes to the recruitment of eosinophils into the infected lungs during the recovery phase of infection. We demonstrate here that while IL-5 is required for optimal recovery from influenza A virus infection in BALB/c and C57BL/6 mice, the protective effect of IL-5 is independent of eosinophils, suggesting an alternative cellular target. We describe the unexpected finding of IL-5 receptor alpha (CD125) expression on neutrophils infiltrating the inflamed mouse lungs, as well as on neutrophils at other anatomic sites. We extend this finding of neutrophil CD125 expression to humans, specifically to neutrophils found in the bronchoalveolar lavage fluid from the inflamed lungs of children with treatment-refractory asthma. We further demonstrate that the IL-5 receptor on neutrophils is capable of signal transduction. Our data provide further evidence that neutrophils can play a role bridging atopic type 2 and innate anti-microbial immunity.
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Affiliation(s)
- Stacey A. Gorski
- Carter Center for Immunology Research, University of Virginia, Charlottesville, VA, United States of America
| | - Monica G. Lawrence
- Department of Medicine, Division of Asthma, Allergy and Immunology, University of Virginia, Charlottesville, VA, United States of America
| | - Amy Hinkelman
- Carter Center for Immunology Research, University of Virginia, Charlottesville, VA, United States of America
| | - MarthaJoy M. Spano
- Carter Center for Immunology Research, University of Virginia, Charlottesville, VA, United States of America
| | - John W. Steinke
- Department of Medicine, Division of Asthma, Allergy and Immunology, University of Virginia, Charlottesville, VA, United States of America
| | - Larry Borish
- Carter Center for Immunology Research, University of Virginia, Charlottesville, VA, United States of America
- Department of Medicine, Division of Asthma, Allergy and Immunology, University of Virginia, Charlottesville, VA, United States of America
| | - W. Gerald Teague
- Department of Pediatrics, Division of Pediatric Respiratory Medicine, Allergy and Immunology, University of Virginia, Charlottesville, VA, United States of America
| | - Thomas J. Braciale
- Carter Center for Immunology Research, University of Virginia, Charlottesville, VA, United States of America
- Department of Pathology, University of Virginia, Charlottesville, VA, United States of America
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14
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Steinke JW. Aspirin desensitization or biologics for AERD? Ann Allergy Asthma Immunol 2019; 123:333-334. [PMID: 31349010 DOI: 10.1016/j.anai.2019.07.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 06/28/2019] [Accepted: 07/16/2019] [Indexed: 11/29/2022]
Affiliation(s)
- John W Steinke
- Asthma and Allergic Disease Center, Carter Immunology Center, University of Virginia Health Systems, Charlottesville, Virginia.
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15
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Hamed A, Preston DC, Eschenbacher W, Khokhar D, Workman L, Steinke JW, Heymann P, Lawrence M, Soto-Quiros M, Platts-Mills TAE, Payne S, Borish L. Nasal IgE production in allergic rhinitis: Impact of rhinovirus infection. Clin Exp Allergy 2019; 49:847-852. [PMID: 30776162 DOI: 10.1111/cea.13372] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 01/18/2019] [Accepted: 02/11/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND Rhinovirus (RV) infections exacerbate asthma in part by enhancing an allergic state, and these exacerbations can be mitigated via administration of anti-IgE. OBJECTIVE We investigated the presence of local IgE production in the nose of allergic and non-allergic subjects and assessed whether this was enhanced by RV. METHODS Local production of specific IgE was determined by comparing ratios of specific to total IgE concentrations between nasal and serum samples. Our initial studies were performed in subjects presenting to the emergency department for allergic and non-allergic respiratory complaints. Subsequently, we investigated influences of experimental RV infection on nasal sIgE production in an allergic cohort. RESULTS We found evidence of local sIgE production to Dermatophagoides pteronyssinus in 30.3% and to Blomia tropicalis in 14.6% of allergic subjects. None of the non-allergic subjects demonstrated local IgE. Subjects with active RV infection were more than twice as likely to have local sIgE (45% vs 14%), and subjects with local sIgE being produced were ~3 times more likely to be having an asthma exacerbation. Experimental RV infection was able to induce local sIgE production. CONCLUSION These studies confirm local IgE production in a large subset of allergic subjects and demonstrate that allergic asthmatics with local IgE are more likely to develop an asthma exacerbation when infected with RV. Our RV challenge studies demonstrate that at least some allergic asthmatics can be induced to secrete locally generated IgE in their nasal airway after RV infection.
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Affiliation(s)
- Ahmed Hamed
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
| | - DeVon C Preston
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
| | - Will Eschenbacher
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
| | - Dilawar Khokhar
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
| | - Lisa Workman
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
| | - John W Steinke
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
| | - Peter Heymann
- Department of Pediatrics, University of Virginia Health System, Charlottesville, Virginia
| | - Monica Lawrence
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
| | | | - Thomas A E Platts-Mills
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia.,Department of Microbiology, University of Virginia Health System, Charlottesville, Virginia
| | - Spencer Payne
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia.,Department of Otolaryngology, University of Virginia Health System, Charlottesville, Virginia
| | - Larry Borish
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia.,Department of Microbiology, University of Virginia Health System, Charlottesville, Virginia
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16
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Sohn JK, Steinke JW, Borish L, McGowan EC. Stimulation of LUVA Mast Cells by Beta-casomorphin 7 and Gliadorphin. J Allergy Clin Immunol 2019. [DOI: 10.1016/j.jaci.2018.12.554] [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: 11/30/2022]
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17
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Teague WG, Lawrence MG, Shirley DAT, Garrod AS, Early SV, Payne JB, Wisniewski JA, Heymann PW, Daniero JJ, Steinke JW, Froh DK, Braciale TJ, Ellwood M, Harris D, Borish L. Lung Lavage Granulocyte Patterns and Clinical Phenotypes in Children with Severe, Therapy-Resistant Asthma. J Allergy Clin Immunol Pract 2019; 7:1803-1812.e10. [PMID: 30654199 DOI: 10.1016/j.jaip.2018.12.027] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 12/29/2018] [Accepted: 12/31/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Children with severe asthma have frequent exacerbations despite guidelines-based treatment with high-dose corticosteroids. The importance of refractory lung inflammation and infectious species as factors contributing to poorly controlled asthma in children is poorly understood. OBJECTIVE To identify prevalent granulocyte patterns and potential pathogens as targets for revised treatment, 126 children with severe asthma underwent clinically indicated bronchoscopy. METHODS Diagnostic tests included bronchoalveolar lavage (BAL) for cell count and differential, bacterial and viral studies, spirometry, and measurements of blood eosinophils, total IgE, and allergen-specific IgE. Outcomes were compared among 4 BAL granulocyte patterns. RESULTS Pauci-granulocytic BAL was the most prevalent granulocyte category (52%), and children with pauci-granulocytic BAL had less postbronchodilator airflow limitation, less blood eosinophilia, and less detection of BAL enterovirus compared with children with mixed granulocytic BAL. Children with isolated neutrophilia BAL were differentiated by less blood eosinophilia than those with mixed granulocytic BAL, but greater prevalence of potential bacterial pathogens compared with those with pauci-granulocytic BAL. Children with isolated eosinophilia BAL had features similar to those with mixed granulocytic BAL. Children with mixed granulocytic BAL took more maintenance prednisone, and had greater blood eosinophilia and allergen sensitization compared with those with pauci-granulocytic BAL. CONCLUSIONS In children with severe, therapy-resistant asthma, BAL granulocyte patterns and infectious species are associated with novel phenotypic features that can inform pathway-specific revisions in treatment. In 32% of children evaluated, BAL revealed corticosteroid-refractory eosinophilic infiltration amenable to anti-TH2 biological therapies, and in 12%, a treatable bacterial pathogen.
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Affiliation(s)
- W Gerald Teague
- Child Health Research Center, Division of Respiratory Medicine, Allergy, and Immunology, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Va.
| | - Monica G Lawrence
- Division of Allergy, Asthma, and Immunology, Department of Medicine, University of Virginia School of Medicine, Charlottesville, Va
| | - Debbie-Ann T Shirley
- Child Health Research Center, Division of Respiratory Medicine, Allergy, and Immunology, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Va
| | - Andrea S Garrod
- Child Health Research Center, Division of Respiratory Medicine, Allergy, and Immunology, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Va
| | - Stephen V Early
- Department of Otolaryngology, Head and Neck Surgery, University of Virginia School of Medicine, Charlottesville, Va
| | - Jackie B Payne
- Child Health Research Center, Division of Respiratory Medicine, Allergy, and Immunology, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Va
| | - Julia A Wisniewski
- Child Health Research Center, Division of Respiratory Medicine, Allergy, and Immunology, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Va
| | - Peter W Heymann
- Child Health Research Center, Division of Respiratory Medicine, Allergy, and Immunology, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Va
| | - James J Daniero
- Department of Otolaryngology, Head and Neck Surgery, University of Virginia School of Medicine, Charlottesville, Va
| | - John W Steinke
- Division of Allergy, Asthma, and Immunology, Department of Medicine, University of Virginia School of Medicine, Charlottesville, Va
| | - Deborah K Froh
- Child Health Research Center, Division of Respiratory Medicine, Allergy, and Immunology, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Va
| | - Thomas J Braciale
- Beirne Carter Immunology Center, University of Virginia School of Medicine, Charlottesville, Va
| | - Michael Ellwood
- University Physicians Group, University of Virginia School of Medicine, Charlottesville, Va
| | - Drew Harris
- Division of Respiratory and Critical Care Medicine, Department of Medicine, University of Virginia School of Medicine, Charlottesville, Va
| | - Larry Borish
- Division of Allergy, Asthma, and Immunology, Department of Medicine, University of Virginia School of Medicine, Charlottesville, Va; Beirne Carter Immunology Center, University of Virginia School of Medicine, Charlottesville, Va; Department of Microbiology, University of Virginia School of Medicine, Charlottesville, Va
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18
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Bral CM, Steinke JW, Kang CJ, Peterson DO. RNA polymerase II transcription complex assembly in nuclear extracts. Gene Expr 2018; 7:191-204. [PMID: 9840811 PMCID: PMC6151951] [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] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
In vitro transcription systems based on nuclear extracts of eukaryotic cells continue to be valuable experimental systems for assessing function of promoter sequences and defining new activities involved in transcription complex assembly and activity, but many aspects of such systems have not been experimentally examined. Here, transcription complex assembly on the promoter from the long terminal repeat of mouse mammary tumor virus was assessed in vitro with a transcription system derived from nuclear extracts of cultured HeLa cells. The extent of preinitiation complex assembly on the promoter was limited by the availability of template, even though only a small fraction of the template present in the assays participated in transcription. These results support a model for transcription complex assembly in which template DNA has two alternative fates, one leading to assembly of a functional transcription complex, and another that leads to irreversible template inactivation. The observed kinetics of assembly reflects loss of template by both pathways and is dominated by a relatively rapid rate of template inactivation. Supplementing nuclear extracts with purified TATA binding protein increased the extent as well as the apparent rate of assembly. Both effects can be explained by a TATA binding protein-dependent increase in the rate of assembly that leads to altered partitioning of template between competing pathways.
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Affiliation(s)
- Christopher M. Bral
- Department of Biochemistry and Biophysics, Texas A&M University, College Station, TX 77843-2128
| | - John W. Steinke
- Department of Biochemistry and Biophysics, Texas A&M University, College Station, TX 77843-2128
| | - Chang-Joong Kang
- Department of Biochemistry and Biophysics, Texas A&M University, College Station, TX 77843-2128
| | - David O. Peterson
- Department of Biochemistry and Biophysics, Texas A&M University, College Station, TX 77843-2128
- Address correspondence to David O. Peterson. Tel: (409) 845-0953; Fax: (409) 845-9274; E-mail:
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19
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Lawrence MG, Palacios-Kibler TV, Workman LJ, Schuyler AJ, Steinke JW, Payne SC, McGowan EC, Patrie J, Fuleihan RL, Sullivan KE, Lugar PL, Hernandez CL, Beakes DE, Verbsky JW, Platts-Mills TAE, Cunningham-Rundles C, Routes JM, Borish L. Low Serum IgE Is a Sensitive and Specific Marker for Common Variable Immunodeficiency (CVID). J Clin Immunol 2018; 38:225-233. [PMID: 29453744 DOI: 10.1007/s10875-018-0476-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 01/04/2018] [Indexed: 11/26/2022]
Abstract
Although small prior studies have suggested that IgE can be low in common variable immunodeficiency (CVID), the workup for patients with recurrent infections and suspected hypogammaglobulinemia does not include the routine measurement of serum IgE. We sought to test the hypothesis that low/undetectable serum IgE is characteristic of CVID by comparing the frequency of low/undetectable serum IgE in healthy controls and patients with CVID. We measured total serum IgE in a large multi-center cohort of patients with CVID (n = 354) and compared this to large population-based cohorts of children and adults. We further compared IgE levels in patients with CVID to those with other forms of humoral immunodeficiency, and in a subset, measured levels of allergen-specific serum IgE and IgG subclasses. Lastly, we evaluated for the presence of IgE in commercially available immunoglobulin replacement therapy (IgRT) products. An undetectable serum IgE (< 2 IU/ml) occurs in only 3.3% (95% CI, 1.9-5.7%) of the general population. In contrast, an undetectable IgE occurs in 75.6% (95% CI, 65.6-85.7%) of patients with CVID. Conversely, a high IgE (> 180 IU/ml) is very uncommon in CVID (0.3% of patients). IgE is > 2 IU/ml in 91.2% of patients with secondary hypogammaglobulinemia, and thus, an IgE < LLOD is suggestive of a primary humoral immunodeficiency. Allergen-specific IgE is not detectable in 96.5% of patients with CVID. Sufficient quantities of IgE to change the total serum IgE are not contained in IgRT. The IgG1/IgG4 ratio is increased in subjects with low IgE, regardless of whether they are controls or have CVID. These findings support the routine measurement of serum IgE in the workup of patients with hypogammaglobulinemia.
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Affiliation(s)
- Monica G Lawrence
- Department of Medicine, University of Virginia, Box 801355, Charlottesville, VA, 22908, USA.
| | | | - Lisa J Workman
- Department of Medicine, University of Virginia, Box 801355, Charlottesville, VA, 22908, USA
| | - Alexander J Schuyler
- Department of Medicine, University of Virginia, Box 801355, Charlottesville, VA, 22908, USA
| | - John W Steinke
- Department of Medicine, University of Virginia, Box 801355, Charlottesville, VA, 22908, USA
| | - Spencer C Payne
- Department of Medicine, University of Virginia, Box 801355, Charlottesville, VA, 22908, USA
- Department of Otolaryngology, University of Virginia, Charlottesville, VA, USA
| | - Emily C McGowan
- Department of Medicine, University of Virginia, Box 801355, Charlottesville, VA, 22908, USA
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - James Patrie
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Ramsay L Fuleihan
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Kathleen E Sullivan
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Patricia L Lugar
- Department of Medicine, Duke University Health System, Durham, NC, USA
| | - Camellia L Hernandez
- Division of Allergy-Immunology, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Douglas E Beakes
- Division of Allergy-Immunology, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - James W Verbsky
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | | | - John M Routes
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Larry Borish
- Department of Medicine, University of Virginia, Box 801355, Charlottesville, VA, 22908, USA
- Department of Microbiology, Carter Immunology Center, University of Virginia, Charlottesville, VA, USA
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20
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Lawrence MG, Steinke JW, Borish L. Cytokine-targeting biologics for allergic diseases. Ann Allergy Asthma Immunol 2018; 120:376-381. [PMID: 29410215 DOI: 10.1016/j.anai.2018.01.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 01/03/2018] [Accepted: 01/12/2018] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Asthma and allergic diseases continue to increase in prevalence, creating a financial burden on the health care system and affecting the quality of life for those who have these diseases. Many intrinsic and extrinsic factors are involved in the initiation and maintenance of the allergic response. Cytokines are proteins with growth, differentiation, and activation functions that regulate and direct the nature of immune responses. DATA SOURCES clinicaltrials.gov and PubMed. STUDY SELECTIONS Relevant clinical trials and recent basic science studies were chosen for discussion. RESULTS Many cytokines have been implicated in the development and perpetuation of the allergic response. Biologics have been and are continuing to be developed that target these molecules for use in patients with asthma and atopic dermatitis where standard treatment options fail. The current state of cytokine-targeting therapies is discussed. CONCLUSION This review focused on cytokines involved in the allergic response with an emphasis on those for which therapies are being or have been developed.
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Affiliation(s)
- Monica G Lawrence
- Asthma and Allergic Disease Center, University of Virginia Health System, Charlottesville, Virginia
| | - John W Steinke
- Asthma and Allergic Disease Center, University of Virginia Health System, Charlottesville, Virginia; Carter Center for Immunology Research, Charlottesville, Virginia
| | - Larry Borish
- Asthma and Allergic Disease Center, University of Virginia Health System, Charlottesville, Virginia; Carter Center for Immunology Research, Charlottesville, Virginia.
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Preston DC, Hamed AB, Schuyler AJ, Steinke JW, Platts-Mills TA, Heymann PW, Lawrence MG, Borish L. Increased Local IgE Production in Allergic Rhinitis (AR) During Rhinovirus (RV) Infection. J Allergy Clin Immunol 2018. [DOI: 10.1016/j.jaci.2017.12.925] [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: 11/30/2022]
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Teague WG, Lawrence MG, Early S, Steinke JW, Garrod A, Shirley DA, Braciale TJ, Ellwood M, Borish L. Progression of Difficult Wheeze to Persistent Asthma in Children: Ontogeny of Anatomic, Inflammatory, and Physiological Factors with Age. J Allergy Clin Immunol 2018. [DOI: 10.1016/j.jaci.2017.12.023] [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: 10/18/2022]
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Lawrence MG, Spano MM, Hinkelman A, Steinke JW, Borish L, Braciale TJ, Teague WG. IL-5Rα expression on airway neutrophils in children with treatment-refractory asthma. J Allergy Clin Immunol 2018. [DOI: 10.1016/j.jaci.2017.12.904] [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: 11/29/2022]
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Steinke JW. Can Genes Control Asthmatic Lung Function Patterns? Am J Respir Crit Care Med 2017; 194:1439-1440. [PMID: 27976947 DOI: 10.1164/rccm.201607-1433ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- John W Steinke
- 1 Carter Immunology Center University of Virginia Health Systems Charlottesville, Virginia
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Hoyt AEW, Chapman MD, King EM, Platts-Mills TAE, Steinke JW. Food allergen component proteins are not detected in early-childhood vaccines. J Allergy Clin Immunol Pract 2017; 6:677-679. [PMID: 29100866 DOI: 10.1016/j.jaip.2017.09.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 09/19/2017] [Accepted: 09/28/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Alice E W Hoyt
- Department of Medicine, University of Virginia Health System, Charlottesville, Va; Department of Pediatrics, University of Virginia Health System, Charlottesville, Va
| | | | - Eva M King
- Indoor Biotechnologies, Charlottesville, Va
| | - Thomas A E Platts-Mills
- Department of Medicine, University of Virginia Health System, Charlottesville, Va; Carter Immunology Center, University of Virginia Health System, Charlottesville, Va
| | - John W Steinke
- Department of Medicine, University of Virginia Health System, Charlottesville, Va; Carter Immunology Center, University of Virginia Health System, Charlottesville, Va.
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Lawrence MG, Steinke JW, Borish L. Basic science for the clinician: Mechanisms of sublingual and subcutaneous immunotherapy. Ann Allergy Asthma Immunol 2017; 117:138-42. [PMID: 27499541 DOI: 10.1016/j.anai.2016.06.027] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 06/18/2016] [Accepted: 06/27/2016] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To discuss the general immunologic changes that occur during immunotherapy, focusing on the differences between subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT). DATA SOURCES PubMed literature review. STUDY SELECTIONS Articles pertaining to SCIT and SLIT, with specific emphasis on those that included immune mechanistic studies. RESULTS Both SCIT and SLIT are characterized by the induction of regulatory B and T cells, decreased allergen-specific T-cell proliferation, a shift from a TH2 to TH1 cytokine milieu and from an IgE to an IgG4/IgA antibody response. These changes are accompanied by clinical improvement in symptoms. CONCLUSION Immunotherapy using allergen extracts administered via both subcutaneous and sublingual approaches have demonstrated efficacy in the treatment of allergic rhinoconjunctivitis and other allergic conditions. There are subtle differences between the approaches, and understanding these differences may help clinicians select a preferred route of therapy for particular patients or allergens, depending on the immune response that is being targeted.
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Affiliation(s)
- Monica G Lawrence
- Asthma and Allergic Disease Center, University of Virginia Health System, Charlottesville, Virginia; Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
| | - John W Steinke
- Asthma and Allergic Disease Center, University of Virginia Health System, Charlottesville, Virginia; Department of Medicine, University of Virginia Health System, Charlottesville, Virginia; Carter Immunology Center, University of Virginia Health System, Charlottesville, Virginia
| | - Larry Borish
- Asthma and Allergic Disease Center, University of Virginia Health System, Charlottesville, Virginia; Department of Medicine, University of Virginia Health System, Charlottesville, Virginia; Carter Immunology Center, University of Virginia Health System, Charlottesville, Virginia; Department of Microbiology, University of Virginia Health System, Charlottesville, Virginia.
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Abstract
Acute asthma exacerbations are responsible for urgent care visits and hospitalizations; they interfere with school and work productivity, thereby driving much of the morbidity and mortality associated with asthma. Approximately 80 to 85 % of asthma exacerbations in children, adolescents, and less frequently adults are associated with viral upper respiratory tract viral infections, and rhinovirus (RV) accounts for ∼60-70 % of these virus-associated exacerbations. Evidence suggests that it is not the virus itself but the nature of the immune response to RV that drives this untoward response. In particular, evidence supports the concept that RV acts to exacerbate an ongoing allergic inflammatory response to environmental allergens present at the time of the infection. The interaction of the ongoing IgE- and T cell-mediated response to allergen superimposed on the innate and adaptive immune responses to the virus and how this leads to triggering of an asthma exacerbation is discussed.
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Affiliation(s)
- John W Steinke
- Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA.,Carter Immunology Center, University of Virginia Health System, Charlottesville, VA, USA.,Asthma and Allergic Disease Center, University of Virginia Health System, Charlottesville, VA, 22908-1355, USA
| | - Larry Borish
- Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA. .,Department of Microbiology, University of Virginia Health System, Charlottesville, VA, USA. .,Carter Immunology Center, University of Virginia Health System, Charlottesville, VA, USA. .,Asthma and Allergic Disease Center, University of Virginia Health System, Charlottesville, VA, 22908-1355, USA.
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Heymann PW, Nguyen HT, Steinke JW, Turner RB, Woodfolk JA, Platts-Mills TAE, Martin L, He H, Biagini Myers J, Lindsey M, Sivaprasad U, Medvedovic M, Mahi N, Carper H, Murphy DD, Patrie J, Khurana Hershey GK. Rhinovirus infection results in stronger and more persistent genomic dysregulation: Evidence for altered innate immune response in asthmatics at baseline, early in infection, and during convalescence. PLoS One 2017; 12:e0178096. [PMID: 28552993 PMCID: PMC5446117 DOI: 10.1371/journal.pone.0178096] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 05/07/2017] [Indexed: 12/30/2022] Open
Abstract
Background Rhinovirus (HRV) is associated with the large majority of virus-induced asthma exacerbations in children and young adults, but the mechanisms remain poorly defined. Methods Asthmatics and non-asthmatic controls were inoculated with HRV-A16, and nasal epithelial samples were obtained 7 days before, 36 hours after, and 7 days after viral inoculation. RNA was extracted and subjected to RNA-seq analysis. Results At baseline, 57 genes were differentially expressed between asthmatics and controls, and the asthmatics had decreased expression of viral replication inhibitors and increased expression of genes involved in inflammation. At 36 hours (before the emergence of peak symptoms), 1329 genes were significantly altered from baseline in the asthmatics compared to 62 genes in the controls. At this time point, asthmatics lacked an increase in IL-10 signaling observed in the controls. At 7 days following HRV inoculation, 222 genes were significantly dysregulated in the asthmatics, whereas only 4 genes were dysregulated among controls. At this time point, the controls but not asthmatics demonstrated upregulation of SPINK5. Conclusions As judged by the magnitude and persistence of dysregulated genes, asthmatics have a substantially different host response to HRV-A16 infection compared with non-asthmatic controls. Gene expression differences illuminate biologically plausible mechanisms that contribute to a better understanding of the pathogenesis of HRV-induced asthma exacerbations.
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Affiliation(s)
- Peter W. Heymann
- Division of Allergy, Immunology and Respiratory Medicine, Department of Pediatrics, University of Virginia, Charlottesville, Virginia, United States of America
- Department of Internal Medicine, Asthma and Allergic Diseases Center, University of Virginia, Charlottesville, Virginia, United States of America
| | - Huyen-Tran Nguyen
- Division of Asthma Research, Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, United States of America
- Division of Allergy and Immunology, Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, United States of America
| | - John W. Steinke
- Department of Internal Medicine, Asthma and Allergic Diseases Center, University of Virginia, Charlottesville, Virginia, United States of America
| | - Ronald B. Turner
- Division of Infectious Diseases, Department of Pediatrics, University of Virginia, Charlottesville, Virginia, United States of America
| | - Judith A. Woodfolk
- Department of Internal Medicine, Asthma and Allergic Diseases Center, University of Virginia, Charlottesville, Virginia, United States of America
| | - Thomas A. E. Platts-Mills
- Department of Internal Medicine, Asthma and Allergic Diseases Center, University of Virginia, Charlottesville, Virginia, United States of America
| | - Lisa Martin
- Division of Human Genetics, Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, United States of America
| | - Hua He
- Division of Human Genetics, Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, United States of America
| | - Jocelyn Biagini Myers
- Division of Asthma Research, Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, United States of America
| | - Mark Lindsey
- Division of Asthma Research, Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, United States of America
| | - Umasundari Sivaprasad
- Division of Asthma Research, Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, United States of America
| | - Mario Medvedovic
- Department of Environmental Health, University of Cincinnati, Cincinnati, Ohio, United States of America
| | - Naim Mahi
- Department of Environmental Health, University of Cincinnati, Cincinnati, Ohio, United States of America
| | - Holliday Carper
- Division of Allergy, Immunology and Respiratory Medicine, Department of Pediatrics, University of Virginia, Charlottesville, Virginia, United States of America
| | - Deborah D. Murphy
- Division of Allergy, Immunology and Respiratory Medicine, Department of Pediatrics, University of Virginia, Charlottesville, Virginia, United States of America
| | - James Patrie
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, United States of America
| | - Gurjit K. Khurana Hershey
- Division of Asthma Research, Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, United States of America
- * E-mail:
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Steinke JW, Smith AR, Carpenter DJ, Patrie JT, Payne SC, Borish L. Lack of Efficacy of Symptoms and Medical History in Distinguishing the Degree of Eosinophilia in Nasal Polyps. J Allergy Clin Immunol Pract 2017; 5:1582-1588.e3. [PMID: 28499777 DOI: 10.1016/j.jaip.2017.04.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 03/15/2017] [Accepted: 04/04/2017] [Indexed: 01/12/2023]
Abstract
BACKGROUND Distinguishing eosinophilic nasal polyps (NP) from noneosinophilic NP will impact prognosis and therapeutic responsiveness. OBJECTIVE To investigate the ability of clinical history and biomarkers to distinguish these conditions. METHODS A total of 74 consecutive patients undergoing surgery for NP were enrolled. Clinical presentations were evaluated using the 22-item sinonasal outcome test (SNOT-22). Biomarkers included absolute eosinophil count, IgE, and extent of tissue hyperplasia on sinus computed tomography scan. Tissue eosinophilia was quantified in 10 random hpf and data analyzed addressing both peak and average results. RESULTS No component of the SNOT-22 was predictive of tissue eosinophilia. Similarly, a medical history of allergic rhinitis, asthma, or aspirin-exacerbated respiratory disease was not predictive. An absolute eosinophil count of more than 300 was associated with NP tissue eosinophilia. In contrast, neither IgE nor extent of sinus computed tomography hyperplasia was predictive. CONCLUSIONS The ability to individualize therapies for NP is dependent on identifying clinical features or biomarkers of eosinophilia. However, with the exception of circulating eosinophilia, we could not identify a clinical feature or biomarker that robustly predicted the presence of tissue eosinophilia. Even more problematic, even the seeming "criterion standard" determination of tissue pathology was of limited value, as our cohort displayed a continuous spectrum of tissue eosinophil expression, making arbitrary any definitive cutoff distinguishing these conditions.
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Affiliation(s)
- John W Steinke
- Department of Medicine, University of Virginia Health Systems, Charlottesville, Va
| | - Anna R Smith
- Department of Medicine, University of Virginia Health Systems, Charlottesville, Va
| | - Delaney J Carpenter
- Department of Otolaryngology, University of Virginia Health Systems, Charlottesville, Va
| | - James T Patrie
- Department of Public Health Science, University of Virginia Health Systems, Charlottesville, Va
| | - Spencer C Payne
- Department of Medicine, University of Virginia Health Systems, Charlottesville, Va; Department of Otolaryngology, University of Virginia Health Systems, Charlottesville, Va
| | - Larry Borish
- Department of Medicine, University of Virginia Health Systems, Charlottesville, Va; Department of Microbiology, University of Virginia Health Systems, Charlottesville, Va.
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Kennedy JL, Steinke JW, Liu L, Negri J, Borish L, Payne SC. Failure of itraconazole to prevent T-helper type 2 cell immune deviation: Implications for chronic rhinosinusitis. Am J Rhinol Allergy 2017; 30:379-384. [PMID: 28124646 DOI: 10.2500/ajra.2016.30.4362] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND T-helper (Th) type 2 cell inflammation is the hallmark of several disease processes, including asthma, atopic dermatitis, and some forms of chronic rhinosinusitis. Itraconazole has been used as both an antifungal and an anti-inflammatory agent, with some success in many of these diseases, in part, by altering Th2 cytokine expression by T cells. It is not known whether this merely reflects inhibition of established Th2-like cells or the inhibition of differentiation of naive T cells into Th2-like cells. OBJECTIVE To evaluate the role of itraconazole in the differentiation of naive T cells during activation. METHODS Naive CD45RA+ T cells were isolated from peripheral blood mononuclear cells from healthy volunteers. Th1 and Th2 type cells were differentiated in the presence of varying concentrations of itraconazole. After stimulation with anti-CD3 and anti-CD28 beads, carboxyfluorescein succinimidyl ester dilution was performed to evaluate proliferation and intracellular cytokine staining for interleukin (IL) 4 and interferon (IFN) gamma within proliferating T cells was measured along with enzyme-linked immunosorbent assay for secreted IL-5, IL-13, and IFN gamma. RESULTS Itraconazole had no effect on proliferation of unbiased, Th1, or Th2 cells. Similarly, there was no effect of itraconazole on either intracellular cytokine staining of IL-4 and IFN gamma or secreted cytokine expression of IFN gamma, IL-5, and IL-13 in any of the cell populations. CONCLUSION Itraconazole did not alter the ability of naive T cells to proliferate or secrete cytokines under Th1 or Th2 deviating conditions in vitro. As such, reported inhibition of Th2-like lymphocyte function by itraconazole reflected action on mature effector cells and may have underscored why antifungal treatment failed in many clinical trials of eosinophilic chronic rhinosinusitis.
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Affiliation(s)
- Joshua L Kennedy
- Department of Pediatrics and Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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Turner RB, Woodfolk JA, Borish L, Steinke JW, Patrie JT, Muehling LM, Lahtinen S, Lehtinen MJ. Effect of probiotic on innate inflammatory response and viral shedding in experimental rhinovirus infection - a randomised controlled trial. Benef Microbes 2017; 8:207-215. [PMID: 28343401 DOI: 10.3920/bm2016.0160] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [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: 12/12/2022]
Abstract
Ingestion of probiotics appears to have modest effects on the incidence of viral respiratory infection. The mechanism of these effects is not clear; however, there is evidence from animal models that the probiotic may have an effect on innate immune responses to pathogens. The purpose of this randomised, placebo-controlled study was to determine the effect of administration of Bifidobacterium animalis subspecies lactis Bl-04 on innate and adaptive host responses to experimental rhinovirus challenge. The effect on the response of chemokine (C-X-C motif) ligand 8 (CXCL8) to rhinovirus infection was defined as the primary endpoint for the study. 152 seronegative volunteers who had been supplemented for 28 days, 73 with probiotic and 79 with placebo, were challenged with RV-A39. Supplement or placebo administration was then continued for five days during collection of specimens for assessment of host response, infection, and symptoms. 58 probiotic and 57 placebo-supplemented volunteers met protocol-defined criteria for analysis. Probiotic resulted in higher nasal lavage CXCL8 on day 0 prior to virus challenge (90 vs 58 pg/ml, respectively, P=0.04, ANCOVA). The CXCL8 response to rhinovirus infection in nasal lavage was significantly reduced in the probiotic treated group (P=0.03, ANCOVA). Probiotic was also associated with a reduction in nasal lavage virus titre and the proportion of subjects shedding virus in nasal secretions (76% in the probiotic group, 91% in the placebo group, P=0.04, Fisher Exact test). The administration of probiotic did not influence lower respiratory inflammation (assessed by exhaled nitric oxide), subjective symptom scores, or infection rate. This study demonstrates that ingestion of Bl-04 may have an effect on the baseline state of innate immunity in the nose and on the subsequent response of the human host to rhinovirus infection. Clinicaltrials.gov registry number: NCT01669603.
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Affiliation(s)
- R B Turner
- 1 Departments of Pediatrics, University of Virginia School of Medicine, P.O. Box 800386, Charlottesville, 22908 VA, USA
| | - J A Woodfolk
- 2 Department of Medicine, University of Virginia School of Medicine, P.O. Box 801355, Charlottesville, 22908 VA, USA
| | - L Borish
- 2 Department of Medicine, University of Virginia School of Medicine, P.O. Box 801355, Charlottesville, 22908 VA, USA.,3 Department of Microbiology, Immunology and Cancer Biology, University of Virginia School of Medicine, Charlottesville, P.O. Box 800734, 22908 VA, USA
| | - J W Steinke
- 2 Department of Medicine, University of Virginia School of Medicine, P.O. Box 801355, Charlottesville, 22908 VA, USA
| | - J T Patrie
- 4 Department of Public Health Sciences, University of Virginia School of Medicine, P.O. Box 800717, Charlottesville, 22908 VA, USA
| | - L M Muehling
- 2 Department of Medicine, University of Virginia School of Medicine, P.O. Box 801355, Charlottesville, 22908 VA, USA
| | - S Lahtinen
- 5 DuPont Nutrition and Health, Kantvik Active Nutrition, Sokeritehtaantie 20, 02460 Kantvik, Finland
| | - M J Lehtinen
- 5 DuPont Nutrition and Health, Kantvik Active Nutrition, Sokeritehtaantie 20, 02460 Kantvik, Finland
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Payne SC, Peters RD, Negri JA, Steinke JW, Borish L. Activation of Basophils and Eosinophils By EtOH in Alcohol Sensitive Patients with CRS and Asthma. J Allergy Clin Immunol 2017. [DOI: 10.1016/j.jaci.2016.12.246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Borish L, Braciale TJ, Shirley DA, Steinke JW, Williams S, Pollack K, Capaldo BJ, Teague WG. Isolated BAL Neutrophilia and Unimodal Airway Epithelial IL-13 Inducible Gene Signatures Characterize Children with Treatment-Resistant Asthma. J Allergy Clin Immunol 2017. [DOI: 10.1016/j.jaci.2016.12.591] [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: 10/20/2022]
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Hamed A, Palacios T, Khokhar D, Schuyler AJ, Steinke JW, Platts-Mills TA, Lawrence MG, Borish L. Local IgE Production in Allergic (AR) and Non-Allergic Rhinitis (NAR). J Allergy Clin Immunol 2017. [DOI: 10.1016/j.jaci.2016.12.510] [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: 10/20/2022]
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Hoyt AE, Schuyler AJ, Workman LJ, Conaway M, Heymann PW, Steinke JW, Borish L, Platts-Mills TA. Changes in production of total immunoglobulin E but not food allergen-specific IgE or IgG4 in at-risk children after exposure to aluminum adjuvant. J Allergy Clin Immunol 2017. [DOI: 10.1016/j.jaci.2016.12.467] [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: 11/30/2022]
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Steinke JW, Pochan SL, James HR, Platts-Mills TAE, Commins SP. Altered metabolic profile in patients with IgE to galactose-alpha-1,3-galactose following in vivo food challenge. J Allergy Clin Immunol 2016; 138:1465-1467.e8. [PMID: 27448448 DOI: 10.1016/j.jaci.2016.05.021] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 04/18/2016] [Accepted: 05/04/2016] [Indexed: 10/21/2022]
Affiliation(s)
- John W Steinke
- Department of Medicine, University of Virginia Health System, Charlottesville, Va; Carter Immunology Center, University of Virginia Health System, Charlottesville, Va
| | - Shawna L Pochan
- Department of Medicine, University of Virginia Health System, Charlottesville, Va
| | - Hayley R James
- Department of Medicine, University of Virginia Health System, Charlottesville, Va
| | - Thomas A E Platts-Mills
- Department of Medicine, University of Virginia Health System, Charlottesville, Va; Carter Immunology Center, University of Virginia Health System, Charlottesville, Va
| | - Scott P Commins
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC.
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Feng X, Ramsden MK, Negri J, Baker MG, Payne SC, Borish L, Steinke JW. Eosinophil production of prostaglandin D 2 in patients with aspirin-exacerbated respiratory disease. J Allergy Clin Immunol 2016; 138:1089-1097.e3. [PMID: 27423494 DOI: 10.1016/j.jaci.2016.04.042] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 04/21/2016] [Accepted: 04/29/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Aspirin-exacerbated respiratory disease (AERD) differs from aspirin-tolerant disease in part because of eosinophilic tissue infiltration and overexpression of arachidonic acid metabolic pathway components that lead to enhanced secretion of cysteinyl leukotrienes and prostaglandin (PG) D2 observed constitutively and paradoxically in response to aspirin and other COX inhibitors. We have previously demonstrated the capacity of IFN-γ to drive cysteinyl leukotriene expression and response. OBJECTIVE We investigated eosinophils as a source of PGD2 production in patients with AERD. METHODS Eosinophils were enriched from tissue and peripheral blood obtained from control subjects, patients with aspirin-tolerant disease, and patients with AERD. mRNA was extracted and evaluated for expression of hematopoietic prostaglandin D synthase (hPGDS). Expression of hPGDS protein was confirmed with Western hybridization and immunofluorescence staining. Cells were stimulated with aspirin, and secretion of PGD2 was quantified. CD34+ progenitor cells were isolated and matured into eosinophils in the presence or absence of IFN-γ and hPGDS mRNA, and PGD2 release was measured. RESULTS Gene expression analysis revealed that eosinophils from tissue and blood of patients with AERD display increased levels of hPGDS compared with asthmatic and control samples. Western hybridization confirmed the increase in hPGDS mRNA translated to increased protein expression. Immunofluorescence confirmed mast cells and eosinophils from tissue of patients with AERD and asthma demonstrated hPGDS expression, with higher levels in eosinophils from patients with AERD. Incubation of eosinophils from blood and tissue with aspirin stimulated PGD2 release. IFN-γ-matured eosinophil progenitors showed enhanced hPGDS expression and increased levels of PGD2 release at baseline and after aspirin stimulation. CONCLUSIONS In addition to mast cells, eosinophils represent an important source of PGD2 in patients with AERD and identify a new target for therapeutic intervention.
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Affiliation(s)
- Xin Feng
- Department of Otolaryngology, QiLu Hospital of Shandong University, Jinan, China
| | - Madison K Ramsden
- Asthma and Allergic Disease Center, University of Virginia Health System, Charlottesville, Va
| | - Julie Negri
- Asthma and Allergic Disease Center, University of Virginia Health System, Charlottesville, Va
| | - Mary Grace Baker
- Asthma and Allergic Disease Center, University of Virginia Health System, Charlottesville, Va
| | - Spencer C Payne
- Asthma and Allergic Disease Center, University of Virginia Health System, Charlottesville, Va; Department of Medicine, University of Virginia Health System, Charlottesville, Va; Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, Va
| | - Larry Borish
- Asthma and Allergic Disease Center, University of Virginia Health System, Charlottesville, Va; Carter Immunology Center, University of Virginia Health System, Charlottesville, Va; Department of Medicine, University of Virginia Health System, Charlottesville, Va; Department of Microbiology, University of Virginia Health System, Charlottesville, Va
| | - John W Steinke
- Asthma and Allergic Disease Center, University of Virginia Health System, Charlottesville, Va; Carter Immunology Center, University of Virginia Health System, Charlottesville, Va; Department of Medicine, University of Virginia Health System, Charlottesville, Va.
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Cahill KN, Raby BA, Zhou X, Guo F, Thibault D, Baccarelli A, Byun HM, Bhattacharyya N, Steinke JW, Boyce JA, Laidlaw TM. Impaired E Prostanoid2 Expression and Resistance to Prostaglandin E2 in Nasal Polyp Fibroblasts from Subjects with Aspirin-Exacerbated Respiratory Disease. Am J Respir Cell Mol Biol 2016; 54:34-40. [PMID: 26051534 DOI: 10.1165/rcmb.2014-0486oc] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Recurrent, rapidly growing nasal polyps are hallmarks of aspirin-exacerbated respiratory disease (AERD), although the mechanisms of polyp growth have not been identified. Fibroblasts are intimately involved in tissue remodeling, and the growth of fibroblasts is suppressed by prostaglandin E2 (PGE2), which elicits antiproliferative effects mediated through the E prostanoid (EP)2 receptor. We now report that cultured fibroblasts from the nasal polyps of subjects with AERD resist this antiproliferative effect. Fibroblasts from polyps of subjects with AERD resisted the antiproliferative actions of PGE2 and a selective EP2 agonist (P < 0.0001 at 1 μM) compared with nasal fibroblasts from aspirin-tolerant control subjects undergoing polypectomy or from healthy control subjects undergoing concha bullosa resections. Cell surface expression of the EP2 receptor protein was lower in fibroblasts from subjects with AERD than in fibroblasts from healthy control subjects and aspirin-tolerant subjects (P < 0.01 for both). Treatment of the fibroblasts with trichostatin A, a histone deacetylase inhibitor, significantly increased EP2 receptor mRNA in fibroblasts from AERD and aspirin-tolerant subjects but had no effect on cyclooxygenase-2, EP4, and microsomal PGE synthase 1 (mPGES-1) mRNA levels. Histone acetylation (H3K27ac) at the EP2 promoter correlated strongly with baseline EP2 mRNA (r = 0.80; P < 0.01). These studies suggest that the EP2 promotor is under epigenetic control, and one explanation for PGE2 resistance in AERD is an epigenetically mediated reduction of EP2 receptor expression, which could contribute to the refractory nasal polyposis typically observed in this syndrome.
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Affiliation(s)
- Katherine N Cahill
- Departments of 1 Medicine and.,2 Division of Rheumatology, Immunology, and Allergy
| | - Benjamin A Raby
- Departments of 1 Medicine and.,3 Channing Division of Network Medicine, and
| | - Xiaobo Zhou
- Departments of 1 Medicine and.,3 Channing Division of Network Medicine, and
| | - Feng Guo
- 3 Channing Division of Network Medicine, and
| | | | | | - Hyang-Min Byun
- 4 Harvard School of Public Health, Boston, Massachusetts; and
| | - Neil Bhattacharyya
- 5 Surgery, Harvard Medical School, Boston, Massachusetts.,6 Department of Otology and Laryngology, Brigham and Women's Hospital, Boston, Massachusetts
| | - John W Steinke
- 7 Asthma and Allergic Disease Center, Carter Immunology Center, University of Virginia Health System, Charlottesville, Virginia
| | - Joshua A Boyce
- Departments of 1 Medicine and.,2 Division of Rheumatology, Immunology, and Allergy
| | - Tanya M Laidlaw
- Departments of 1 Medicine and.,2 Division of Rheumatology, Immunology, and Allergy
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Abstract
Asthma and chronic rhinosinusitis are heterogeneous airway diseases of the lower and upper airways, respectively. Molecular and cellular studies indicate that these diseases can be categorized into unique endotypes, which have therapeutic implications. One such endotype is aspirin-exacerbated respiratory disease (AERD), which encompasses the triad of asthma, aspirin (or nonsteroidal anti-inflammatory drug) hypersensitivity, and nasal polyposis. AERD has unique pathophysiological features that distinguish it from aspirin-tolerant asthma and other forms of chronic rhinosinusitis. This review details molecular and cellular features of AERD and highlights current and future therapies that are based on these insights.
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Affiliation(s)
- John W Steinke
- Asthma and Allergic Disease Center, Carter Immunology Center, Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA
| | - Jeff M Wilson
- Asthma and Allergic Disease Center, Carter Immunology Center, Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA
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Nguyen HT, Heymann PW, Lindsey M, Sivaprasad U, Medvedovic M, Mahi N, Platts-Mills TA, Turner RB, Steinke JW, Woodfolk JA, Borish L, Khurana Hershey GK. Rhinovirus Infection Results in Increased and More Persistent Dysregulation of Gene Expression. J Allergy Clin Immunol 2016. [DOI: 10.1016/j.jaci.2015.12.420] [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: 11/25/2022]
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41
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Pollack K, Williams S, Wavell K, Shirley DA, Steinke JW, Borish L, Teague WG. Suppression of IL-13-Associated Gene Signature in Airway Epithelial Cells By Dexamethasone Is Decreased in Poorly Controlled Asthma. J Allergy Clin Immunol 2016. [DOI: 10.1016/j.jaci.2015.12.748] [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: 10/22/2022]
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Steinke JW, Negri J, Baker MG, Payne S, Borish L, Feng X. Eosinophil Production of PGD2 in Aspirin-Exacerbated Respiratory Disease. J Allergy Clin Immunol 2016. [DOI: 10.1016/j.jaci.2015.12.742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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43
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Baker MG, Steinke JW, Borish L, Chupp GL. Leukotriene C4 Synthase Expression in Sputum Correlates with Disease Severity Amongst Patients with Different Clinical Phenotypes of Asthma. J Allergy Clin Immunol 2016. [DOI: 10.1016/j.jaci.2015.12.1118] [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: 10/22/2022]
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Steinke JW, Platts-Mills TAE, Schuyler A, Commins SP. Reply: To PMID 25747720. J Allergy Clin Immunol 2015; 136:1709-1710. [PMID: 26518093 DOI: 10.1016/j.jaci.2015.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 09/18/2015] [Indexed: 11/30/2022]
Affiliation(s)
- John W Steinke
- Asthma and Allergic Disease Center, Carter Immunology Center, Department of Medicine, University of Virginia Health System, Charlottesville, Va
| | - Thomas A E Platts-Mills
- Asthma and Allergic Disease Center, Carter Immunology Center, Department of Medicine, University of Virginia Health System, Charlottesville, Va.
| | - Alex Schuyler
- Asthma and Allergic Disease Center, Carter Immunology Center, Department of Medicine, University of Virginia Health System, Charlottesville, Va
| | - Scott P Commins
- Asthma and Allergic Disease Center, Carter Immunology Center, Department of Medicine, University of Virginia Health System, Charlottesville, Va
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Abstract
BACKGROUND Aspirin-exacerbated respiratory disease (AERD) is explained in part by overexpression of 5-lipoxygenase and leukotriene C4 synthase (LTC4S), resulting in constitutive overproduction of cysteinyl leukotrienes (CysLTs) and driving the surge in CysLT production that occurs with aspirin ingestion. Similarly, AERD is characterized by the overexpression of CysLT receptors. Increased levels of both interleukin (IL)-4 and interferon (IFN)-γ are present in the tissue of AERD subjects. Previous studies demonstrated that IL-4 is primarily responsible for the up-regulation of LTC4S by mast cells. METHODS Literature review. RESULTS Our previous studies demonstrated that IFN-γ, but not IL-4, drives this process in eosinophils. These published studies also extend to both IL-4 and IFN-γ the ability to up-regulate CysLT receptors. Prostaglandin E2 (PGE2) acts to prevent CysLT secretion by inhibiting mast cell and eosinophil activation. PGE2 concentrations are reduced in AERD, and our published studies confirm that this reflects diminished expression of cyclooxygenase (COX)-2. A process again that is driven by IL-4. Thus, IL-4 and IFN-γ together play an important pathogenic role in generating the phenotype of AERD. Finally, induction of LTC4S and CysLT1 receptors by IL-4 reflects in part the IL-4-mediated activation of signal transducer and activator of transcription 6 (STAT6). Our previous studies demonstrated that aspirin blocks trafficking of STAT6 into the nucleus and thereby prevents IL-4-mediated induction of these transcripts, thereby suggesting a modality by which aspirin desensitization could provide therapeutic benefit for AERD patients. CONCLUSION This review will examine the evidence supporting this model.
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Affiliation(s)
- John W Steinke
- Asthma and Allergic Disease Center, University of Virginia Health System, Charlottesville, VA, USA
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Steinke JW, Platts-Mills TAE, Commins SP. The alpha-gal story: lessons learned from connecting the dots. J Allergy Clin Immunol 2015; 135:589-96; quiz 597. [PMID: 25747720 DOI: 10.1016/j.jaci.2014.12.1947] [Citation(s) in RCA: 224] [Impact Index Per Article: 24.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 11/21/2014] [Accepted: 12/10/2014] [Indexed: 10/23/2022]
Abstract
Anaphylaxis is a severe allergic reaction that can be rapidly progressing and fatal, and therefore establishing its cause is pivotal to long-term risk management. Our recent work has identified a novel IgE antibody response to a mammalian oligosaccharide epitope, galactose-alpha-1,3-galactose (alpha-gal). IgE to alpha-gal has been associated with 2 distinct forms of anaphylaxis: (1) immediate-onset anaphylaxis during first exposure to intravenous cetuximab and (2) delayed-onset anaphylaxis 3 to 6 hours after ingestion of mammalian food products (eg, beef and pork). Results of our studies and those of others strongly suggest that tick bites are a cause, if not the only significant cause, of IgE antibody responses to alpha-gal in the southern, eastern, and central United States; Europe; Australia; and parts of Asia. Typical immune responses to carbohydrates are considered to be T-cell independent, whereas IgE antibody production is thought to involve sequential class-switching that requires input from T cells. Therefore, establishing the mechanism of the specific IgE antibody response to alpha-gal will be an important aspect to address as this area of research continues.
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Affiliation(s)
- John W Steinke
- Asthma and Allergic Diseases Center, Carter Immunology Center, Department of Medicine, University of Virginia Health System, Charlottesville, Va
| | - Thomas A E Platts-Mills
- Asthma and Allergic Diseases Center, Carter Immunology Center, Department of Medicine, University of Virginia Health System, Charlottesville, Va.
| | - Scott P Commins
- Asthma and Allergic Diseases Center, Carter Immunology Center, Department of Medicine, University of Virginia Health System, Charlottesville, Va
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Word CR, Soto-Quiros M, Avila L, Jorge PP, Carper HT, Steinke JW, Kennedy JL, Murphy DD, Platts-Mills TA, Heymann PW. (1) Production of CCR4-Binding Chemokines in Response to Rhinovirus Infections in Asthmatic Children. J Allergy Clin Immunol 2015. [DOI: 10.1016/j.jaci.2014.12.1409] [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: 10/24/2022]
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Baker MG, Negri J, Steinke JW, Borish L. Increased Expression of Leukotriene C4 Synthase Is a Feature of Circulating CD34+ Hematopoietic Stem Cells but Not Circulating Eosinophils in Aspirin-Exacerbated Respiratory Disease (AERD). J Allergy Clin Immunol 2015. [DOI: 10.1016/j.jaci.2014.12.1662] [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: 10/24/2022]
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Smith AR, Steinke JW, Payne S, Borish L. Sinonasal Outcome Test Questionnaire Does Not Predict Pathological Diagnosis of Chronic Sinus Disease. J Allergy Clin Immunol 2015. [DOI: 10.1016/j.jaci.2014.12.1113] [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: 10/24/2022]
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Steinke JW, Liu L, Turner RB, Braciale TJ, Borish L. Immune surveillance by rhinovirus-specific circulating CD4+ and CD8+ T lymphocytes. PLoS One 2015; 10:e0115271. [PMID: 25584821 PMCID: PMC4293146 DOI: 10.1371/journal.pone.0115271] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 11/22/2014] [Indexed: 11/19/2022] Open
Abstract
Background It is difficult to experimentally infect volunteers with RV strains to which the subject demonstrates serological immunity. However, in RV challenges, viral clearance begins before de novo adaptive immune responses would develop. We speculated that adaptive immunity to RV reflects heterologous immunity by effector memory cells. Methods DCs were generated from monocytes using GM-CSF and IL-4 and RV39 loading accomplished with a dose of ∼350 TCID50/105 cells. RV-induced maturation was established as modulation of MHC class II, CD80, CD83, and CD86. Circulating RV targeting CD4 and CD8 T cells were investigated as induction of RV-specific proliferation (CFSE-dilution). Results Maturation of DC by RV was confirmed as upregulation of MHC Class II (83.3±5.0% to 87.8±4.1%), CD80 (39.4±7.2% to 47.6±7.7%) and CD86 (78.4±4.7% to 84.1±3.4%). Both CD4 and CD8 memory T cells were recognized in the circulation of healthy subjects. Conclusions RV drives DC maturation and results in their ability to present RV antigens to both T helper and cytotoxic lymphocytes. Both CD4 and CD8 cells capable of recognizing RV-associated antigens are present in the circulation of healthy subjects where they are presumably involved in immune surveillance and explain the rapid recruitment of an adaptive immune response during RV infection.
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Affiliation(s)
- John W. Steinke
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, United States of America
- Carter Immunology Center, University of Virginia, Charlottesville, Virginia, United States of America
- * E-mail:
| | - Lixia Liu
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, United States of America
| | - Ronald B. Turner
- Department of Pediatrics, University of Virginia Health System, Charlottesville, Virginia, United States of America
| | - Thomas J. Braciale
- Carter Immunology Center, University of Virginia, Charlottesville, Virginia, United States of America
- Department of Pathology, University of Virginia Health System, Charlottesville, Virginia, United States of America
| | - Larry Borish
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, United States of America
- Carter Immunology Center, University of Virginia, Charlottesville, Virginia, United States of America
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