Endotypes of difficult-to-control asthma in inner-city African American children

African Americans have higher rates of asthma prevalence, morbidity, and mortality in comparison with other racial groups. We sought to characterize endotypes of childhood asthma severity in African American patients in an inner-city pediatric asthma population. Baseline blood neutrophils, blood eosinophils, and 38 serum cytokine levels were measured in a sample of 235 asthmatic children (6–17 years) enrolled in the NIAID (National Institute of Allergy and Infectious Diseases)-sponsored Asthma Phenotypes in the Inner City (APIC) study (ICAC (Inner City Asthma Consortium)-19). Cytokines were quantified using a MILLIPLEX panel and analyzed on a Luminex analyzer. Patients were classified as Easy-to-Control or Difficult-to-Control based on the required dose of controller medications over one year of prospective management. A multivariate variable selection procedure was used to select cytokines associated with Difficult-to-Control versus Easy-to-Control asthma, adjusting for age, sex, blood eosinophils, and blood neutrophils. In inner-city African American children, 12 cytokines were significant predictors of Difficult-to-Control asthma (n = 235). CXCL-1, IL-5, IL-8, and IL-17A were positively associated with Difficult-to-Control asthma, while IL-4 and IL-13 were positively associated with Easy-to-Control asthma. Using likelihood ratio testing, it was observed that in addition to blood eosinophils and neutrophils, serum cytokines improved the fit of the model. In an inner-city pediatric population, serum cytokines significantly contributed to the definition of Difficult-to-Control asthma endotypes in African American children. Mixed responses characterized by T_H2 (IL-5) and T_H17-associated cytokines were associated with Difficult-to-Control asthma. Collectively, these data may contribute to risk stratification of Difficult-to-Control asthma in the African American population.

Circulating TSLP associates with decreased wheezing in non-atopic preschool children: data from the URECA birth cohort

BACKGROUND

Mouse models of atopic march suggest that systemic, skin-derived thymic stromal lymphopoietin (TSLP) mediates progression from eczema to asthma.

OBJECTIVE

We investigated whether circulating TSLP is associated with eczema, allergic sensitization, or recurrent wheezing in young children.

METHODS

A prospective analysis of the relationship between plasma levels of TSLP to allergic sensitization and recurrent wheezing was conducted in the birth cohort from the Urban Environment and Childhood Asthma (URECA) study. Plasma TSLP levels were measured at 1, 2, and 3 years of age and analysed for correlation with clinical parameters in each of the three years. Only those children with consecutive samples for all three years were included in this analysis.

RESULTS

We detected TSLP in 33% of 236 children for whom plasma samples were available for all three years. Overall, a consistently significant association was not found between TSLP and eczema or allergic sensitization. With regard to recurrent wheezing, children with detectable TSLP at one year of age were significantly less likely to experience recurrent wheezing by 3 years compared with those children without detectable TSLP, but this was only seen in children without aeroallergen sensitization at 3 years (P < 0.01).

CONCLUSIONS AND CLINICAL RELEVANCE

Contrary to our expectations, circulating TSLP was not significantly associated with eczema, allergen sensitization, or recurrent wheezing during the first three years of life. Early presence of circulating TSLP was significantly associated with reduced incidence of recurrent wheeze in those children not sensitized to aeroallergen. These findings suggest a possible underlying distinction between pathogenesis of developing atopic vs. non-atopic recurrent wheeze.

Longitudinal relationship of early life immunomodulatory T cell phenotype and function to development of allergic sensitization in an urban cohort

BACKGROUND

Immunomodulatory T cells are thought to influence development of allergy and asthma, but early life longitudinal data on their phenotype and function are lacking.

OBJECTIVES

As part of the Urban Environment and Childhood Asthma (URECA) study, we investigated the development of immunomodulatory T cell phenotype and function, and characterized their relation to allergic disease progression from birth through to 2 years of age.

METHODS

Immunomodulatory T cell phenotype and function in cord blood mononuclear cells (CBMC) and peripheral blood mononuclear cells (PBMC) at 1 and 2 years of age were characterized by analysing CD25(bright) and FoxP3(+) expression, proliferative responses and cytokine production. The relation of immunomodulatory T cell characteristics to allergic sensitization and disease at 1- and 2-years of age was investigated.

RESULTS

The proportion of CD4(+)CD25(bright) and CD4(+)CD25(+)FoxP3(+)T cells (n = 114, 83, 82 at birth, 1- and 2-years respectively) increased significantly, whereas there were no significant changes in the suppressive function of CD25(+)T cells (n = 78, 71, 81 at birth, 1- and 2-years respectively). Birth immunomodulatory T cell characteristics were not related to subsequent allergic sensitization or disease. However, increases in the numbers of CD4(+)CD25(bright) cells and their ability to suppress lymphoproliferative responses at 1 year of age were associated with reduced allergic sensitization at 1 (P = 0.03) and 2 (P = 0.02) years of age. Production of the anti-inflammatory cytokine IL-10 by CD25(+)T cells appeared to mediate this protective suppressive function. In contrast, by 2 years of age, we observed the emergence of a positive association of CD4(+)CD25(+) FoxP3(+) T cell numbers with allergic sensitization (P = 0.05) and eczema (P = 0.02).

CONCLUSIONS AND CLINICAL RELEVANCE

These findings suggest that the relationship between immunomodulatory T cell subsets, allergic sensitization and eczema is developmentally regulated. In the first year of life, CD4(+)CD25(+) IL-10 producing T cells are associated with a reduced incidence of allergic sensitization. Once allergic sensitization or eczema is established, CD4(+)CD25(+)FoxP3(+)T-reg cells expand to potentially counteract the allergic inflammatory response. Understanding the relationship between development of immunoregulatory T cells and early onset atopy could lead to new preventive strategies for allergic diseases.

Umbilical cord plasma 25-hydroxyvitamin D concentration and immune function at birth: the Urban Environment and Childhood Asthma study

BACKGROUND

Recent studies have reported conflicting data on the association between maternal intake of vitamin D during pregnancy and asthma.

OBJECTIVE

To assess the influence of prenatal vitamin D status on immune function at birth.

METHODS

In an inner-city birth cohort of 568 newborns, 520 of whom had at least one atopic parent, we measured the umbilical cord (UC) plasma concentration of 25-hydroxyvitamin D (25(OH)D) and the cytokine responses of UC blood mononuclear cells (UCMCs) to stimuli including phytohaemagglutinin (PHA), lipopolysaccharide (LPS), and peptidoglycan. In a subset, the UCMC expression of regulatory T cell markers and the suppressive activity of CD4(+) CD25(+) UCMCs were measured. Results The 25th, 50th, and 75th percentiles of UC plasma 25(OH)D level were 15.0, 20.2, and 25.6 ng/mL, respectively. Most cytokine responses of UCMC were not correlated with UC 25(OH)D concentration; however, IFN-γ release after LPS stimulation was weakly positively correlated with UC 25(OH)D concentration (r=0.11, P=0.01). PHA responses were not significantly correlated with 25(OH)D concentration. The UC plasma 25(OH)D concentration was inversely related to the number of CD25(+) (r=-0.20, P=0.06), CD25(Bright) (r=-0.21, P=0.05), and CD25(+) FoxP3 (r=-0.29, P=0.06) cells as a proportion of CD4(+) T cells in UC blood (r=-0.26, P=0.04) but not to the suppressive activity of CD4(+) CD25(+) cells (r=0.17, P=0.22).

CONCLUSION AND CLINICAL RELEVANCE

UC 25(OH)D concentration was not correlated with most UCMC cytokine responses to multiple stimuli. There was a suggestion of a weakly positive correlation with IFN-γ release after LPS stimulation. The proportions of CD25(+) , CD25(Bright) , and CD25(+) FoxP3 cells to total CD4(+) T cells were inversely correlated with UC 25(OH)D concentration. Our findings suggest that higher vitamin D levels at birth may be associated with a lower number of T-regulatory cells. Vitamin D status in utero may influence immune regulation in early life.

Allergen-specific IgE as a biomarker of exposure plus sensitization in inner-city adolescents with asthma

BACKGROUND

Relationships among allergen-specific IgE levels, allergen exposure and asthma severity are poorly understood since sensitization has previously been evaluated as a dichotomous, rather than continuous characteristic.

METHODS

Five hundred and forty-six inner-city adolescents enrolled in the Asthma Control Evaluation study underwent exhaled nitric oxide (FE(NO)) measurement, lung function testing, and completion of a questionnaire. Allergen-specific IgE levels and blood eosinophils were quantified. Dust samples were collected from the participants' bedrooms for quantification of allergen concentrations. Participants were followed for 12 months and clinical outcomes were tracked.

RESULTS

Among sensitized participants, allergen-specific IgE levels were correlated with the corresponding settled dust allergen levels for cockroach, dust mite, and mouse (r = 0.38, 0.34, 0.19, respectively; P < 0.0001 for cockroach and dust mite and P = 0.03 for mouse), but not cat (r = -0.02, P = 0.71). Higher cockroach-, mite-, mouse-, and cat-specific IgE levels were associated with higher FE(NO) concentrations, poorer lung function, and higher blood eosinophils. Higher cat, dust mite, and mouse allergen-specific IgE levels were also associated with an increasing risk of exacerbations or hospitalization.

CONCLUSIONS

Allergen-specific IgE levels were correlated with allergen exposure among sensitized participants, except for cat. Allergen-specific IgE levels were also associated with more severe asthma across a range of clinical and biologic markers. Adjusting for exposure did not provide additional predictive value, suggesting that higher allergen-specific IgE levels may be indicative of both higher exposure and a greater degree of sensitization, which in turn may result in greater asthma severity.

Measurement of 60Co high gamma dose using gamma activation of 115 In and 111 Cd foils

Cobalt-60 gamma irradiation facilities are used in many industrial and medical applications. Gamma activation technique of (115)In and (111)Cd foils was used in this work to assess the performance of ethanol-chlorobenzene gamma dosimeter at high dose range of (60)Co irradiation facility. Dose mapping was also performed using (115)In foils. These measurements are required to control the irradiation quality and to validate dose calculations.

Impact of HER2 Status on Risk of Sentinel Node Metastasis: An Independently Validated Multivariable Model

Purpose The presence of axillary lymph node metastases is dictated by tumor biology and is a strong prognostic indicator in breast cancer. We have previously published a user-friendly nomogram that provides a risk estimate for sentinel lymph node (SLN) metastasis in women with breast cancer (Bevilacqua et al. 2007, J Clin Oncol 25: 3670). At that time, HER2 testing was not uniformly performed, but is now standard of care. The purpose of this study was to determine if the addition of HER2 status or grouping of patients by molecular subtype improves the prediction of SLN metastasis.Patients and Methods: The ability of clinical and pathologic features to predict the presence of SLN metastasis in patients presenting with clinically node negative invasive breast cancer, was assessed with multivariable logistic regression (MVA) for 4723 sequential SLN biopsy procedures with known ER, PR, and HER2 from 1996 to 2004. HER2 status was defined as positive if IHC=3+ and/or FISH≥2. The modeling (n=3297) and validation (n=1426) groups were identified by simple random sampling. Two models were created using the modeling population: one included ER, PR, and HER2 as separate variables and one combined these markers into 4 subtypes defined as: Luminal A-like=ER or PR +, HER2 −; Luminal B-like=ER or PR +, HER2 +; HER2-like=ER and PR −, HER2 +; Basal-like=ER and PR −, HER2 −. The validation group was used to assess the calibration (intercept, slope, Emax, Eavg) and discrimination (AUC, area under the receiver operating curve) of the models.Results: In addition to age, tumor size, tumor type, lymphovascular invasion, tumor location, and multifocality, subtype was found to be an independent predictor of SLN metastasis on MVA (p=0.003). The Basal-like subtype was associated with a significantly lower risk of SLN metastasis (compared with referent Luminal A-like subtype, OR=0.58). HER2 alone was not found to be an independent predictor of SLN metastasis (p=0.56), while ER and PR remained significant (p=.05, p=.02). Compared to our previous model without HER2, the AUC was slightly decreased by the addition of either HER2 or subtype into the model, but the calibration was slightly improved (Table 1). DiscriminationCalibrationModelAUCInterceptSlopeEmaxEavgPrevious Model0.735- 0.0440.8690.0390.020Mew model with HER20.733- 0.0030.8890.0270.019New model with subtype0.731- 0.0010.8870.0270.020Table 1: Discrimination and calibration measures comparing the new model (with HER2 alone or subtype) with the previously published model (without HER2 or subtype).Conclusion: The addition of subtype, defined by combining HER2 status with ER and PR, slightly increases the calibration of the new model but does not increase its discrimination compared to the previous model. Breast tumor subtype is a significant independent predictor of risk of SLN metastasis, with basal-like subtype having a lower risk of SLN metastasis.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1004.

Race/ethnicity, literacy, and prostate cancer: Initial findings from the COMPARE registry

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Background: Comprehensive Multicenter Prostate Adenocarcinoma Registry (COMPARE) evaluates variations in initial prostate cancer (PCa) therapy according to race/ethnicity. Similar studies for prostate cancer patients with PSA failure following radiation therapy or radical prostatectomy are unreported. Poor health literacy and African American race are predictive of advanced stage prostate cancers at diagnosis. Methods: COMPARE includes 778 men (62% >70 yr; 80% white and 13% AA) with rising PSA post-localized PCa therapy. Median follow-up post-registry entry is 5 months. Enrollment at 146 sites to date: urology (N = 129), radiation oncology (n = 12), other (n = 5). Most sites are private practice (n = 132) vs academic (n = 14). Health literacy was tested with a 7-item validated word recognition test; scores of ≥4 correlate with ≥6th grade literacy. Variations in therapy, both initial and after PSA failure, were assessed as a function of patient/regional factors. Results: Initial therapy included radical prostatectomy (RP) 44.5%, external beam radiation therapy (EBRT) 30.7%, brachytherapy (BT) 13.1%, other (11.5%). Literacy data are available for 725 men, one fifth had poor literacy skills (<4); higher rates of low literacy were present in AA vs white men (p < 0.05). Significant variations in initial care were associated with poor vs normal literacy skills (brachytherapy: 8% vs 16%; radical prostatectomy: 52% vs 44%, p < 0.05). Watchful waiting was the most common management for PSA failure patients, 82% for men aged ≤70 yr and 77% for men >70 yr. Among prostate cancer patients >70 yr, after adjustment for literacy and Gleason score, African American men were only 41% as likely as whites to undergo watchful waiting (95% CI, 19% to 92%). Conclusions: Poor health literacy is common among men with prostate cancer; these men are more likely to receive radical prostatectomy. With men >70 yr with PSA failure post-radical prostatectomy or post-radiation therapy, African American men were 2.5× more likely than white men to choose therapy (primarily castration) over watchful waiting. Findings from smaller cohorts found that urologic symptoms were the most important factor associated with use of castration versus watchful waiting for PSA failure.

No significant financial relationships to disclose.

Body mass index and the risk of asthma in adults

Asthma and obesity are both chronic conditions and their prevalences have risen in affluent societies. A positive association between asthma and being overweight or obese has been reported in children and women, but associations in men are less clearly described. The objective of this study was to explore the association between body mass index (BMI) and asthma in men and women of diverse ethnic and socioeconomic background living in New York State, USA. In this study, we analyzed cross-sectional data on 5524 subjects aged 18 years and older who were interviewed by telephone in the 1996 and 1997 New York State Behavioral Risk Factor Surveillance System. Asthma (doctor-diagnosed), and weight and height were self-reported. BMI (kg/m2) was used as a measure of adiposity. Weighted logistic regression analysis, with stratification by gender and age, was used to examine the relationship between asthma prevalence and BMI, adjusting for race/ethnicity, education, health insurance, time since last physical examination, physical activity and smoking status. The results showed that the prevalence of asthma was 4.6% (CI: 3.6-5.5%) among men and 8.1% (CI: 7.1-9.1%) among women. In women, the prevalence of asthma was significantly increased in those with a BMI 25 kg/m2 or higher (BMI 25-27.5: OR = 1.76, 95% CI: 1.06-2.94; BMI 27.5-29.9: OR = 2.45, 95% CI: 1.41-4.25; BMI > or = 30: OR = 2.67, 95% CI: 1.66-4.29) when compared to the reference category (BMI: 22-24.9 kg/m2). In men, the prevalence of asthma was increased in the lowest weight category, BMI < 22 kg/m2 (OR = 3.05, 95% CI: 1.37-6.78) and in the highest category, BMI > or = 30 kg/m2 (OR = 2.92, 95% CI: 1.39-6.14). This U-shaped association persisted when restricting the analysis to men who had never smoked and was more pronounced for those between 18 and 49 years of age. In conclusion, this cross-sectional study showed that men and women differ significantly in the association between BMI and asthma prevalence only with respect to the lowest weight category. While women had a monotonic association, men showed a U-shaped relationship, indicating that both extremes of weight are associated with a higher prevalence of asthma.