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Pathinayake PS, Hsu ACY, Nichol KS, Horvat JC, Hansbro PM, Wark PAB. Endoplasmic reticulum stress enhances the expression of TLR3-induced TSLP by airway epithelium. Am J Physiol Lung Cell Mol Physiol 2024; 326:L618-L626. [PMID: 38469627 DOI: 10.1152/ajplung.00378.2023] [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: 12/05/2023] [Revised: 02/23/2024] [Accepted: 03/06/2024] [Indexed: 03/13/2024] Open
Abstract
Thymic stromal lymphopoietin (TSLP) is an epithelial-derived pleiotropic cytokine that regulates T-helper 2 (Th2) immune responses in the lung and plays a major role in severe uncontrolled asthma. Emerging evidence suggests a role for endoplasmic reticulum (ER) stress in the pathogenesis of asthma. In this study, we determined if ER stress and the unfolded protein response (UPR) signaling are involved in TSLP induction in the airway epithelium. For this, we treated human bronchial epithelial basal cells and differentiated primary bronchial epithelial cells with ER stress inducers and the TSLP mRNA and protein expression was determined. A series of siRNA gene knockdown experiments were conducted to determine the ER stress-induced TSLP signaling pathways. cDNA collected from asthmatic bronchial biopsies was used to determine the gene correlation between ER stress and TSLP. Our results show that ER stress signaling induces TSLP mRNA expression via the PERK-C/EBP homologous protein (CHOP) signaling pathway. AP-1 transcription factor is important in regulating this ER stress-induced TSLP mRNA induction, though ER stress alone cannot induce TSLP protein production. However, ER stress significantly enhances TLR3-induced TSLP protein secretion in the airway epithelium. TSLP and ER stress (PERK) mRNA expression positively correlates in bronchial biopsies from participants with asthma, particularly in neutrophilic asthma. In conclusion, these results suggest that ER stress primes TSLP that is then enhanced further upon TLR3 activation, which may induce severe asthma exacerbations. Targeting ER stress using pharmacological interventions may provide novel therapeutics for severe uncontrolled asthma.NEW & NOTEWORTHY TSLP is an epithelial-derived cytokine and a key regulator in the pathogenesis of severe uncontrolled asthma. We demonstrate a novel mechanism by which endoplasmic reticulum stress signaling upregulates airway epithelial TSLP mRNA expression via the PERK-CHOP signaling pathway and enhances TLR3-mediated TSLP protein secretion.
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Affiliation(s)
- Prabuddha S Pathinayake
- Immune Health Program, Hunter Medical Research Institute and School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Alan C-Y Hsu
- Immune Health Program, Hunter Medical Research Institute and School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
- Signature Research Program in Emerging Infectious Diseases, Duke-National University of Singapore (NUS) Graduate Medical School, Singapore, Singapore
| | - Kristy S Nichol
- Immune Health Program, Hunter Medical Research Institute and School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Jay C Horvat
- Immune Health Program, Hunter Medical Research Institute and School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, New South Wales, Australia
| | - Philip M Hansbro
- Immune Health Program, Hunter Medical Research Institute and School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, New South Wales, Australia
- Faculty of Science, School of Life Sciences, Centre for Inflammation, Centenary Institute, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Peter A B Wark
- Immune Health Program, Hunter Medical Research Institute and School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, New South Wales, Australia
- School of Medicine, Monash University, Melbourne, Victoria, Australia
- AIRMED Alfred Health, Melbourne, Victoria, Australia
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Dey S, Lu W, Haug G, Chia C, Larby J, Weber HC, Gaikwad AV, Bhattarai P, Shahzad AM, Pathinayake PS, Wark PAB, Eapen MS, Sohal SS. Airway inflammatory changes in the lungs of patients with asthma-COPD overlap (ACO): a bronchoscopy endobronchial biopsy study. Respir Res 2023; 24:221. [PMID: 37700291 PMCID: PMC10498556 DOI: 10.1186/s12931-023-02527-x] [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] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 08/31/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND Although asthma and chronic obstructive pulmonary disease (COPD) are two distinct chronic airway inflammatory diseases, they often co-exist in a patient and the condition is referred to as asthma-COPD overlap (ACO). Lack of evidence regarding the inflammatory cells in ACO airways has led to their poor prognosis and treatment. The objective of this endobronchial biopsy (EBB) study was to enumerate inflammatory cellular changes in the airway wall of ACO compared with asthma, COPD current smokers (CS) and ex-smokers (ES), normal lung function smokers (NLFS), and non-smoker controls (HC). METHODS EBB tissues from 74 patients were immunohistochemically stained for macrophages, mast cells, eosinophils, neutrophils, CD8+ T-cells and CD4+ T-cells. The microscopic images of stained tissues were evaluated in the epithelium, reticular basement membrane (RBM) cells/mm RBM length, and lamina propria (LP) cells/mm2 up to a depth of 120 µM using the image analysis software Image-Pro Plus 7.0. The observer was blinded to the images and disease diagnosis. Statistical analysis was performed using GraphPad Prism v9. RESULTS The tissue macrophages in ACO were substantially higher in the epithelium and RBM than in HC (P < 0.001 for both), COPD-ES (P < 0.001 for both), and -CS (P < 0.05 and < 0.0001, respectively). The ACO LP macrophages were significantly higher in number than COPD-CS (P < 0.05). The mast cell numbers in ACO were lower than in NLFS (P < 0.05) in the epithelium, lower than COPD (P < 0.05) and NLFS (P < 0.001) in RBM; and lower than HC (P < 0.05) in LP. We noted lower eosinophils in ACO LP than HC (P < 0.05) and the lowest neutrophils in both ACO and asthma. Furthermore, CD8+ T-cell numbers increased in the ACO RBM than HC (P < 0.05), COPD-ES (P < 0.05), and NLFS (P < 0.01); however, they were similar in number in epithelium and LP across groups. CD4+ T-cells remained lower in number across all regions and groups. CONCLUSION These results suggest that the ACO airway tissue inflammatory cellular profile differed from the contributing diseases of asthma and COPD with a predominance of macrophages.
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Affiliation(s)
- Surajit Dey
- Respiratory Translational Research Group, Department of Laboratory Medicine, School of Health Sciences, College of Health and Medicine, University of Tasmania, Locked Bag, 1322, Newnham Drive, Launceston, TAS, 7248, Australia
| | - Wenying Lu
- Respiratory Translational Research Group, Department of Laboratory Medicine, School of Health Sciences, College of Health and Medicine, University of Tasmania, Locked Bag, 1322, Newnham Drive, Launceston, TAS, 7248, Australia
- Launceston Respiratory and Sleep Centre, Launceston, TAS, 7250, Australia
| | - Greg Haug
- Department of Respiratory Medicine, Launceston General Hospital, Launceston, TAS, 7250, Australia
| | - Collin Chia
- Launceston Respiratory and Sleep Centre, Launceston, TAS, 7250, Australia
- Department of Respiratory Medicine, Launceston General Hospital, Launceston, TAS, 7250, Australia
| | - Josie Larby
- Department of Respiratory Medicine, Launceston General Hospital, Launceston, TAS, 7250, Australia
| | - Heinrich C Weber
- Department of Respiratory Medicine, Tasmanian Health Services (THS), North-West Hospital, Burnie, TAS, Australia
| | - Archana Vijay Gaikwad
- Respiratory Translational Research Group, Department of Laboratory Medicine, School of Health Sciences, College of Health and Medicine, University of Tasmania, Locked Bag, 1322, Newnham Drive, Launceston, TAS, 7248, Australia
| | - Prem Bhattarai
- Respiratory Translational Research Group, Department of Laboratory Medicine, School of Health Sciences, College of Health and Medicine, University of Tasmania, Locked Bag, 1322, Newnham Drive, Launceston, TAS, 7248, Australia
- Launceston Respiratory and Sleep Centre, Launceston, TAS, 7250, Australia
| | - Affan Mahmood Shahzad
- Respiratory Translational Research Group, Department of Laboratory Medicine, School of Health Sciences, College of Health and Medicine, University of Tasmania, Locked Bag, 1322, Newnham Drive, Launceston, TAS, 7248, Australia
| | - Prabuddha S Pathinayake
- Immune Health Program, Hunter Medical Research Institute, University of Newcastle, New Lambton Heights, Australia
| | - Peter A B Wark
- Immune Health Program, Hunter Medical Research Institute, University of Newcastle, New Lambton Heights, Australia
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton Heights, Australia
| | - Mathew Suji Eapen
- Respiratory Translational Research Group, Department of Laboratory Medicine, School of Health Sciences, College of Health and Medicine, University of Tasmania, Locked Bag, 1322, Newnham Drive, Launceston, TAS, 7248, Australia
| | - Sukhwinder Singh Sohal
- Respiratory Translational Research Group, Department of Laboratory Medicine, School of Health Sciences, College of Health and Medicine, University of Tasmania, Locked Bag, 1322, Newnham Drive, Launceston, TAS, 7248, Australia.
- Launceston Respiratory and Sleep Centre, Launceston, TAS, 7250, Australia.
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Awatade NT, Reid AT, Nichol KS, Budden KF, Veerati PC, Pathinayake PS, Grainge CL, Hansbro PM, Wark PAB. Comparison of commercially available differentiation media on cell morphology, function, and anti-viral responses in conditionally reprogrammed human bronchial epithelial cells. Sci Rep 2023; 13:11200. [PMID: 37433796 DOI: 10.1038/s41598-023-37828-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 06/28/2023] [Indexed: 07/13/2023] Open
Abstract
Primary air liquid interface (ALI) cultures of bronchial epithelial cells are used extensively to model airway responses. A recent advance is the development of conditional reprogramming that enhances proliferative capability. Several different media and protocols are utilized, yet even subtle differences may influence cellular responses. We compared the morphology and functional responses, including innate immune responses to rhinovirus infection in conditionally reprogrammed primary bronchial epithelial cells (pBECs) differentiated using two commonly used culture media. pBECs collected from healthy donors (n = 5) were CR using g-irradiated 3T3 fibroblasts and Rho Kinase inhibitor. CRpBECs were differentiated at ALI in either PneumaCult (PN-ALI) or bronchial epithelial growth medium (BEGM)-based differentiation media (BEBM:DMEM, 50:50, Lonza)-(AB-ALI) for 28 days. Transepithelial electrical resistance (TEER), immunofluorescence, histology, cilia activity, ion channel function, and expression of cell markers were analyzed. Viral RNA was assessed by RT-qPCR and anti-viral proteins quantified by LEGENDplex following Rhinovirus-A1b infection. CRpBECs differentiated in PneumaCult were smaller and had a lower TEER and cilia beat frequency compared to BEGM media. PneumaCult media cultures exhibited increased FOXJ1 expression, more ciliated cells with a larger active area, increased intracellular mucins, and increased calcium-activated chloride channel current. However, there were no significant changes in viral RNA or host antiviral responses. There are distinct structural and functional differences in pBECs cultured in the two commonly used ALI differentiation media. Such factors need to be taken into consideration when designing CRpBECs ALI experiments for specific research questions.
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Affiliation(s)
- Nikhil T Awatade
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.
- Immune Health Program, Hunter Medical Research Institute, University of Newcastle, New Lambton Heights, NSW, Australia.
| | - Andrew T Reid
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Asthma and Breathing Research Program, Hunter Medical Research Institute University of Newcastle, New Lambton Heights, NSW, Australia
| | - Kristy S Nichol
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Immune Health Program, Hunter Medical Research Institute, University of Newcastle, New Lambton Heights, NSW, Australia
| | - Kurtis F Budden
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Immune Health Program, Hunter Medical Research Institute, University of Newcastle, New Lambton Heights, NSW, Australia
| | - Punnam Chander Veerati
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Asthma and Breathing Research Program, Hunter Medical Research Institute University of Newcastle, New Lambton Heights, NSW, Australia
| | - Prabuddha S Pathinayake
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Immune Health Program, Hunter Medical Research Institute, University of Newcastle, New Lambton Heights, NSW, Australia
| | - Christopher L Grainge
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Asthma and Breathing Research Program, Hunter Medical Research Institute University of Newcastle, New Lambton Heights, NSW, Australia
- Dept of Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton Heights, NSW, Australia
| | - Philip M Hansbro
- Immune Health Program, Hunter Medical Research Institute, University of Newcastle, New Lambton Heights, NSW, Australia
- Centre for Inflammation, Centenary Institute and University of Technology Sydney, Sydney, NSW, Australia
| | - Peter A B Wark
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.
- Immune Health Program, Hunter Medical Research Institute, University of Newcastle, New Lambton Heights, NSW, Australia.
- Asthma and Breathing Research Program, Hunter Medical Research Institute University of Newcastle, New Lambton Heights, NSW, Australia.
- Dept of Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton Heights, NSW, Australia.
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Pathinayake PS, Awatade NT, Wark PAB. Type 2 Immunity and Its Impact on COVID-19 Infection in the Airways. Viruses 2023; 15:402. [PMID: 36851616 PMCID: PMC9967553 DOI: 10.3390/v15020402] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/17/2023] [Accepted: 01/28/2023] [Indexed: 02/04/2023] Open
Abstract
Type 2 immune responses are characterized by elevated type 2 cytokines and blood eosinophilia. Emerging evidence suggests that people with chronic type 2 inflammatory lung diseases are not particularly susceptible to SARS-CoV-2 infection. Intriguingly, recent in vitro, ex vivo research demonstrates type 2 cytokines, particularly IL-13, reduce the risk of SARS-CoV-2 infection in the airway epithelium. IL-13 treatment in airway epithelial cells followed by SARS-CoV-2 diminished viral entry, replication, spread, and cell death. IL-13 reduces the expression of the angiotensin-converting enzyme 2 (ACE2) receptor in the airway epithelium and transmembrane serine protease 2 (TMPRSS2), particularly in ciliated cells. It also alters the cellular composition toward a secretory-cell-rich phenotype reducing total ciliated cells and, thus, reducing viral tropism. IL-13 enhances Muc5ac mucin and glycocalyx secretion in the periciliary layer, which acts as a physical barrier to restrict virus attachment. Moreover, type 2 airway immune cells, such as M2 alveolar macrophages, CD4+ tissue-resident memory T cells, and innate lymphoid 2 cells, may also rescue type 2 airways from SARS-CoV-2-induced adverse effects. In this review, we discuss recent findings that demonstrate how type 2 immunity alters immune responses against SARS-CoV-2 and its consequences on COVID-19 pathogenesis.
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Affiliation(s)
- Prabuddha S. Pathinayake
- School of Medicine and Public Health, The University of Newcastle and Immune Health Program Hunter Medical Research Institute, Newcastle, NSW 2308, Australia
| | - Nikhil T. Awatade
- School of Medicine and Public Health, The University of Newcastle and Immune Health Program Hunter Medical Research Institute, Newcastle, NSW 2308, Australia
| | - Peter A. B. Wark
- School of Medicine and Public Health, The University of Newcastle and Immune Health Program Hunter Medical Research Institute, Newcastle, NSW 2308, Australia
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton Heights, NSW 2305, Australia
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Dey S, Lu W, Weber HC, Young S, Larby J, Chia C, Haug G, Brake SJ, Myers S, Gaikwad AV, Bhattarai P, Pathinayake PS, Wark PAB, Eapen MS, Sohal SS. Differential airway remodelling changes were observed in patients with asthma COPD overlap (ACO) compared to asthma and COPD patients alone. Am J Physiol Lung Cell Mol Physiol 2022; 323:L473-L483. [PMID: 35997281 PMCID: PMC9550567 DOI: 10.1152/ajplung.00137.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Management of patients with asthma COPD overlap (ACO) is clinically challenging due to insufficient evidence of pathological changes in these patients. In this cross-sectional study, we evaluated airway remodeling in endobronchial biopsies from a total of 90 subjects, which included 12 ACO, 14 patients with asthma, 12 COPD exsmokers (ES), 11 current smokers (CS), 28 healthy controls (HC), and 13 normal lung function smokers (NLFS). Tissue was stained with Masson’s trichrome. Epithelium, goblet cells, reticular basement membrane (RBM), cellularity, lamina propria (LP), and smooth muscle (SM) changes were measured using Image-Pro Plus v7 software. Differential airway remodeling pattern was seen in patients with ACO. A limited change was noted in the ACO epithelium compared with other pathological groups. RBM was substantially thicker in patients with ACO than in HC (P < 0.0002) and tended to be thicker than in patients with asthma and NLFS. The total RBM cells were higher in ACO than in the HC (P < 0.0001), COPD-CS (P = 0.0559), -ES (P = 0.0345), and NLFS (P < 0.0002), but did not differ from patients with asthma. Goblet cells were higher in the ACO than in the HC (P = 0.0028) and COPD-ES (P = 0.0081). The total LP cells in ACO appeared to be higher than in HC, COPD-CS, and NLFS but appeared to be lower than in patients with asthma. Finally, SM area was significantly lower in the ACO than in patients with asthma (P = 0.001), COPD-CS (=0.0290), and NLFS (P = 0.0011). This first comprehensive study suggests that patients with ACO had distinguishable tissue remodeling that appeared to be more severe than patients with asthma and COPD. This study will help in informed decision-making for better patient management in clinical practice.
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Affiliation(s)
- Surajit Dey
- Respiratory Translational Research Group, Department of Laboratory Medicine, School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, Tasmania, Australia
| | - Wenying Lu
- Respiratory Translational Research Group, Department of Laboratory Medicine, School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, Tasmania, Australia
| | - Heinrich C Weber
- Respiratory Translational Research Group, Department of Laboratory Medicine, School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, Tasmania, Australia.,Department of Respiratory Medicine, Tasmanian Health Services (THS), North-West Hospital, Burnie, Tasmania, Australia
| | - Sally Young
- Respiratory Translational Research Group, Department of Laboratory Medicine, School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, Tasmania, Australia.,Lung Function Unit, North-West Regional Hospital, Burnie, Tasmania, Australia
| | - Josie Larby
- Respiratory Translational Research Group, Department of Laboratory Medicine, School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, Tasmania, Australia.,Department of Respiratory Medicine, Launceston General Hospital, Launceston, Tasmania, Australia
| | - Collin Chia
- Respiratory Translational Research Group, Department of Laboratory Medicine, School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, Tasmania, Australia.,Department of Respiratory Medicine, Launceston General Hospital, Launceston, Tasmania, Australia
| | - Greg Haug
- Respiratory Translational Research Group, Department of Laboratory Medicine, School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, Tasmania, Australia.,Department of Respiratory Medicine, Launceston General Hospital, Launceston, Tasmania, Australia
| | - Samuel James Brake
- Respiratory Translational Research Group, Department of Laboratory Medicine, School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, Tasmania, Australia
| | - Steve Myers
- Respiratory Translational Research Group, Department of Laboratory Medicine, School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, Tasmania, Australia
| | - Archana Vijay Gaikwad
- Respiratory Translational Research Group, Department of Laboratory Medicine, School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, Tasmania, Australia
| | - Prem Bhattarai
- Respiratory Translational Research Group, Department of Laboratory Medicine, School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, Tasmania, Australia
| | - Prabuddha S Pathinayake
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, University of Newcastle, New Lambton Heights, Australia
| | - Peter A B Wark
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, University of Newcastle, New Lambton Heights, Australia.,Department of Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton Heights, Australia
| | - Mathew Suji Eapen
- Respiratory Translational Research Group, Department of Laboratory Medicine, School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, Tasmania, Australia
| | - Sukhwinder Singh Sohal
- Respiratory Translational Research Group, Department of Laboratory Medicine, School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, Tasmania, Australia
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Pathinayake PS, Waters DW, Nichol KS, Brown AC, Reid AT, Hsu ACY, Horvat JC, Wood LG, Baines KJ, Simpson JL, Gibson PG, Hansbro PM, Wark PAB. Endoplasmic reticulum-unfolded protein response signalling is altered in severe eosinophilic and neutrophilic asthma. Thorax 2021; 77:443-451. [PMID: 34510013 DOI: 10.1136/thoraxjnl-2020-215979] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 07/06/2021] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The significance of endoplasmic reticulum (ER) stress in asthma is unclear. Here, we demonstrate that ER stress and the unfolded protein response (UPR) are related to disease severity and inflammatory phenotype. METHODS Induced sputum (n=47), bronchial lavage (n=23) and endobronchial biopsies (n=40) were collected from participants with asthma with varying disease severity, inflammatory phenotypes and from healthy controls. Markers for ER stress and UPR were assessed. These markers were also assessed in established eosinophilic and neutrophilic murine models of asthma. RESULTS Our results demonstrate increased ER stress and UPR pathways in asthma and these are related to clinical severity and inflammatory phenotypes. Genes associated with ER protein chaperone (BiP, CANX, CALR), ER-associated protein degradation (EDEM1, DERL1) and ER stress-induced apoptosis (DDIT3, PPP1R15A) were dysregulated in participants with asthma and are associated with impaired lung function (forced expiratory volume in 1 s) and active eosinophilic and neutrophilic inflammation. ER stress genes also displayed a significant correlation with classic Th2 (interleukin-4, IL-4/13) genes, Th17 (IL-17F/CXCL1) genes, proinflammatory (IL-1b, tumour necrosis factor α, IL-8) genes and inflammasome activation (NLRP3) in sputum from asthmatic participants. Mice with allergic airway disease (AAD) and severe steroid insensitive AAD also showed increased ER stress signalling in their lungs. CONCLUSION Heightened ER stress is associated with severe eosinophilic and neutrophilic inflammation in asthma and may play a crucial role in the pathogenesis of asthma.
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Affiliation(s)
- Prabuddha S Pathinayake
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - David W Waters
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and School of Biomedical Sciences and Pharmacy, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Kristy S Nichol
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Alexandra C Brown
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and School of Biomedical Sciences and Pharmacy, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Andrew T Reid
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and School of Biomedical Sciences and Pharmacy, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Alan Chen-Yu Hsu
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Jay C Horvat
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and School of Biomedical Sciences and Pharmacy, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Lisa G Wood
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and School of Biomedical Sciences and Pharmacy, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Katherine J Baines
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Jodie L Simpson
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.,Department of Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Peter G Gibson
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.,Department of Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton Heights, New South Wales, Australia.,NHMRC Centre for Clinical Research Excellence in Severe Asthma, New Lambton Heights, New South Wales, Australia
| | - Philip M Hansbro
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and School of Biomedical Sciences and Pharmacy, The University of Newcastle, Callaghan, New South Wales, Australia.,Centre for Inflammation, Centenary Institute, and Faculty of Science, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Peter A B Wark
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia .,Department of Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton Heights, New South Wales, Australia.,NHMRC Centre for Clinical Research Excellence in Severe Asthma, New Lambton Heights, New South Wales, Australia
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7
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Wark PA, Pathinayake PS, Eapen MS, Sohal SS. Asthma, COPD and SARS-CoV-2 infection (COVID-19): potential mechanistic insights. Eur Respir J 2021; 58:13993003.00920-2021. [PMID: 34244320 PMCID: PMC8287734 DOI: 10.1183/13993003.00920-2021] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/24/2021] [Indexed: 12/23/2022]
Abstract
We read with interest the manuscripts [1, 2] and the accompanying editorial [3] describing the risk of severe disease and infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and asthma, but are struck by the difference seen with risk of complications from asthma and coronavirus disease 2019 (COVID-19) compared to the experience during the 2009 influenza pandemic, where people with asthma were clearly at heightened risk, at least of hospitalisation [4]. In contrast, those who smoke or have COPD, appear at greater risk. Observational studies will never be able to provide evidence of cause and effect and a greater understanding of the mechanisms of susceptibility to infection with SARS-CoV-2 is also required. Hence, we would like to take this further and enhance discussion on potential mechanisms (figure 1). Patients with asthma are somewhat protected from COVID-19 complications compared to COPD. This may be due to variability in viral attachment protein, ICS use, smoking/vaping status, a skewed inflammatory pattern, and dysregulated endocytic machinery.https://bit.ly/3qOcyNb
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Affiliation(s)
- Peter Ab Wark
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia.,Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, NSW, Australia
| | - Prabuddha S Pathinayake
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Mathew Suji Eapen
- Respiratory Translational Research Group, Department of Laboratory Medicine, School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, TAS, Australia
| | - Sukhwinder Singh Sohal
- Respiratory Translational Research Group, Department of Laboratory Medicine, School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, TAS, Australia
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Chong WC, Shastri MD, Peterson GM, Patel RP, Pathinayake PS, Dua K, Hansbro NG, Hsu AC, Wark PA, Shukla SD, Johansen MD, Schroder K, Hansbro PM. The complex interplay between endoplasmic reticulum stress and the NLRP3 inflammasome: a potential therapeutic target for inflammatory disorders. Clin Transl Immunology 2021; 10:e1247. [PMID: 33614031 PMCID: PMC7878118 DOI: 10.1002/cti2.1247] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 01/09/2021] [Accepted: 01/10/2021] [Indexed: 12/15/2022] Open
Abstract
Inflammation is the result of a complex network of cellular and molecular interactions and mechanisms that facilitate immune protection against intrinsic and extrinsic stimuli, particularly pathogens, to maintain homeostasis and promote tissue healing. However, dysregulation in the immune system elicits excess/abnormal inflammation resulting in unintended tissue damage and causes major inflammatory diseases including asthma, chronic obstructive pulmonary disease, atherosclerosis, inflammatory bowel diseases, sarcoidosis and rheumatoid arthritis. It is now widely accepted that both endoplasmic reticulum (ER) stress and inflammasomes play critical roles in activating inflammatory signalling cascades. Notably, evidence is mounting for the involvement of ER stress in exacerbating inflammasome-induced inflammatory cascades, which may provide a new axis for therapeutic targeting in a range of inflammatory disorders. Here, we comprehensively review the roles, mechanisms and interactions of both ER stress and inflammasomes, as well as their interconnected relationships in inflammatory signalling cascades. We also discuss novel therapeutic strategies that are being developed to treat ER stress- and inflammasome-related inflammatory disorders.
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Affiliation(s)
- Wai Chin Chong
- Department of Molecular and Translational ScienceMonash UniversityClaytonVICAustralia
- Centre for Cancer ResearchHudson Institute of Medical ResearchClaytonVICAustralia
| | - Madhur D Shastri
- School of Pharmacy and PharmacologyUniversity of TasmaniaHobartTASAustralia
| | - Gregory M Peterson
- School of Pharmacy and PharmacologyUniversity of TasmaniaHobartTASAustralia
| | - Rahul P Patel
- School of Pharmacy and PharmacologyUniversity of TasmaniaHobartTASAustralia
| | - Prabuddha S Pathinayake
- Priority Research Centre for Healthy LungsHunter Medical Research InstituteThe University of NewcastleCallaghanNSWAustralia
| | - Kamal Dua
- Discipline of PharmacyGraduate School of HealthUniversity of Technology SydneyUltimoNSWAustralia
| | - Nicole G Hansbro
- Centre for InflammationCentenary InstituteFaculty of ScienceSchool of Life SciencesUniversity of TechnologySydneyNSWAustralia
| | - Alan C Hsu
- Priority Research Centre for Healthy LungsHunter Medical Research InstituteThe University of NewcastleCallaghanNSWAustralia
| | - Peter A Wark
- Priority Research Centre for Healthy LungsHunter Medical Research InstituteThe University of NewcastleCallaghanNSWAustralia
| | - Shakti Dhar Shukla
- Priority Research Centre for Healthy LungsHunter Medical Research InstituteThe University of NewcastleCallaghanNSWAustralia
| | - Matt D Johansen
- Centre for InflammationCentenary InstituteFaculty of ScienceSchool of Life SciencesUniversity of TechnologySydneyNSWAustralia
| | - Kate Schroder
- Institute for Molecular BioscienceUniversity of QueenslandSt LuciaQLDAustralia
| | - Philip M Hansbro
- Priority Research Centre for Healthy LungsHunter Medical Research InstituteThe University of NewcastleCallaghanNSWAustralia
- Centre for InflammationCentenary InstituteFaculty of ScienceSchool of Life SciencesUniversity of TechnologySydneyNSWAustralia
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9
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Wark PAB, Pathinayake PS, Kaiko G, Nichol K, Ali A, Chen L, Sutanto EN, Garratt LW, Sohal SS, Lu W, Eapen MS, Oldmeadow C, Bartlett N, Reid A, Veerati P, Hsu ACY, Looi K, Iosifidis T, Stick SM, Hansbro PM, Kicic A. ACE2 expression is elevated in airway epithelial cells from older and male healthy individuals but reduced in asthma. Respirology 2021; 26:442-451. [PMID: 33455043 PMCID: PMC8014151 DOI: 10.1111/resp.14003] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 11/10/2020] [Accepted: 12/06/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND OBJECTIVE COVID-19 is complicated by acute lung injury, and death in some individuals. It is caused by SARS-CoV-2 that requires the ACE2 receptor and serine proteases to enter AEC. We determined what factors are associated with ACE2 expression particularly in patients with asthma and COPD. METHODS We obtained lower AEC from 145 people from two independent cohorts, aged 2-89 years, Newcastle (n = 115) and Perth (n = 30), Australia. The Newcastle cohort was enriched with people with asthma (n = 37) and COPD (n = 38). Gene expression for ACE2 and other genes potentially associated with SARS-CoV-2 cell entry was assessed by qPCR, and protein expression was confirmed with immunohistochemistry on endobronchial biopsies and cultured AEC. RESULTS Increased gene expression of ACE2 was associated with older age (P = 0.03) and male sex (P = 0.03), but not with pack-years smoked. When we compared gene expression between adults with asthma, COPD and healthy controls, mean ACE2 expression was lower in asthma patients (P = 0.01). Gene expression of furin, a protease that facilitates viral endocytosis, was also lower in patients with asthma (P = 0.02), while ADAM-17, a disintegrin that cleaves ACE2 from the surface, was increased (P = 0.02). ACE2 protein expression was also reduced in endobronchial biopsies from asthma patients. CONCLUSION Increased ACE2 expression occurs in older people and males. Asthma patients have reduced expression. Altered ACE2 expression in the lower airway may be an important factor in virus tropism and may in part explain susceptibility factors and why asthma patients are not over-represented in those with COVID-19 complications.
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Affiliation(s)
- Peter A B Wark
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia.,Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, NSW, Australia
| | - Prabuddha S Pathinayake
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Gerard Kaiko
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, NSW, Australia
| | - Kristy Nichol
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Ayesha Ali
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, NSW, Australia
| | - Ling Chen
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, NSW, Australia
| | - Erika N Sutanto
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia.,School of Public Health, Curtin University, Perth, WA, Australia
| | - Luke W Garratt
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Sukhwinder S Sohal
- Respiratory Translational Research Group, Department of Laboratory Medicine, School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, TAS, Australia
| | - Wenying Lu
- Respiratory Translational Research Group, Department of Laboratory Medicine, School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, TAS, Australia
| | - Mathew S Eapen
- Respiratory Translational Research Group, Department of Laboratory Medicine, School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, TAS, Australia
| | - Christopher Oldmeadow
- Clinical Research Design and Statistics, Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Nathan Bartlett
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, NSW, Australia
| | - Andrew Reid
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, NSW, Australia
| | - Punnam Veerati
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Alan C-Y Hsu
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Kevin Looi
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia.,School of Public Health, Curtin University, Perth, WA, Australia
| | - Thomas Iosifidis
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia.,School of Public Health, Curtin University, Perth, WA, Australia.,Centre for Cell Therapy and Regenerative Medicine, School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia
| | - Stephen M Stick
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia.,Centre for Cell Therapy and Regenerative Medicine, School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia.,Department of Respiratory and Sleep Medicine, Perth Children's Hospital, Perth, WA, Australia
| | - Philip M Hansbro
- Centre for Inflammation, Centenary Institute, and Faculty of Science, University of Technology Sydney, Sydney, NSW, Australia
| | - Anthony Kicic
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia.,School of Public Health, Curtin University, Perth, WA, Australia.,Centre for Cell Therapy and Regenerative Medicine, School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia.,Department of Respiratory and Sleep Medicine, Perth Children's Hospital, Perth, WA, Australia
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10
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Pathinayake PS, Hsu ACY, Wark PAB. PAT in the ER for Transmembrane Protein Folding: (Trends in Biochemical Sciences 45 (2020) 1007-1008). Trends Biochem Sci 2021; 46:344. [PMID: 33413995 DOI: 10.1016/j.tibs.2020.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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11
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Ali MK, Kim RY, Brown AC, Mayall JR, Karim R, Pinkerton JW, Liu G, Martin KL, Starkey MR, Pillar AL, Donovan C, Pathinayake PS, Carroll OR, Trinder D, Tay HL, Badi YE, Kermani NZ, Guo YK, Aryal R, Mumby S, Pavlidis S, Adcock IM, Weaver J, Xenaki D, Oliver BG, Holliday EG, Foster PS, Wark PA, Johnstone DM, Milward EA, Hansbro PM, Horvat JC. Crucial role for lung iron level and regulation in the pathogenesis and severity of asthma. Eur Respir J 2020; 55:13993003.01340-2019. [PMID: 32184317 DOI: 10.1183/13993003.01340-2019] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 01/28/2020] [Indexed: 01/08/2023]
Abstract
Accumulating evidence highlights links between iron regulation and respiratory disease. Here, we assessed the relationship between iron levels and regulatory responses in clinical and experimental asthma.We show that cell-free iron levels are reduced in the bronchoalveolar lavage (BAL) supernatant of severe or mild-moderate asthma patients and correlate with lower forced expiratory volume in 1 s (FEV1). Conversely, iron-loaded cell numbers were increased in BAL in these patients and with lower FEV1/forced vital capacity (FVC) ratio. The airway tissue expression of the iron sequestration molecules divalent metal transporter 1 (DMT1) and transferrin receptor 1 (TFR1) are increased in asthma, with TFR1 expression correlating with reduced lung function and increased Type-2 (T2) inflammatory responses in the airways. Furthermore, pulmonary iron levels are increased in a house dust mite (HDM)-induced model of experimental asthma in association with augmented Tfr1 expression in airway tissue, similar to human disease. We show that macrophages are the predominant source of increased Tfr1 and Tfr1+ macrophages have increased Il13 expression. We also show that increased iron levels induce increased pro-inflammatory cytokine and/or extracellular matrix (ECM) responses in human airway smooth muscle (ASM) cells and fibroblasts ex vivo and induce key features of asthma in vivo, including airway hyper-responsiveness (AHR) and fibrosis, and T2 inflammatory responses.Together these complementary clinical and experimental data highlight the importance of altered pulmonary iron levels and regulation in asthma, and the need for a greater focus on the role and potential therapeutic targeting of iron in the pathogenesis and severity of disease.
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Affiliation(s)
- Md Khadem Ali
- Division of Pulmonary and Critical Care Medicine, Stanford University, Stanford, CA, USA.,Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, Australia
| | - Richard Y Kim
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, Australia.,Centre for Inflammation, Centenary Institute and University of Technology Sydney, Sydney, Australia
| | - Alexandra C Brown
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, Australia
| | - Jemma R Mayall
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, Australia
| | - Rafia Karim
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, Australia
| | - James W Pinkerton
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, Australia.,Respiratory Pharmacology and Toxicology Group, National Heart and Lung Institute, Imperial College London, London, UK
| | - Gang Liu
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, Australia.,Centre for Inflammation, Centenary Institute and University of Technology Sydney, Sydney, Australia
| | - Kristy L Martin
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, Australia
| | - Malcolm R Starkey
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, Australia.,Dept of Immunology and Pathology, Central Clinical School, Monash University, Melbourne, Australia
| | - Amber L Pillar
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, Australia
| | - Chantal Donovan
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, Australia.,Centre for Inflammation, Centenary Institute and University of Technology Sydney, Sydney, Australia
| | - Prabuddha S Pathinayake
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Olivia R Carroll
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, Australia
| | - Debbie Trinder
- Medical School, Harry Perkins Medical Research Institute, University of Western Australia, Fiona Stanley Hospital, Perth, Australia
| | - Hock L Tay
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, Australia
| | - Yusef E Badi
- Airway Disease Section, National Heart and Lung Institute, Imperial College London, London, UK
| | - Nazanin Z Kermani
- Data Science Institute, Dept of Computing, Imperial College London, London, UK
| | - Yi-Ke Guo
- Data Science Institute, Dept of Computing, Imperial College London, London, UK
| | - Ritambhara Aryal
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, Australia
| | - Sharon Mumby
- Airway Disease Section, National Heart and Lung Institute, Imperial College London, London, UK
| | - Stelios Pavlidis
- Airway Disease Section, National Heart and Lung Institute, Imperial College London, London, UK
| | - Ian M Adcock
- Airway Disease Section, National Heart and Lung Institute, Imperial College London, London, UK
| | - Jessica Weaver
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, Australia
| | - Dikaia Xenaki
- Woolcock Institute of Medical Research, University of Sydney and School of Life Sciences, University of Technology Sydney, Sydney, Australia
| | - Brian G Oliver
- Woolcock Institute of Medical Research, University of Sydney and School of Life Sciences, University of Technology Sydney, Sydney, Australia
| | - Elizabeth G Holliday
- Hunter Medical Research Institute, New Lambton, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Paul S Foster
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, Australia
| | - Peter A Wark
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, Australia.,Dept of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, Australia
| | - Daniel M Johnstone
- Discipline of Physiology and Bosch Institute, University of Sydney, Sydney, Australia
| | - Elizabeth A Milward
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, Australia
| | - Philip M Hansbro
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, Australia.,Centre for Inflammation, Centenary Institute and University of Technology Sydney, Sydney, Australia.,These authors contributed equally
| | - Jay C Horvat
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, Australia.,These authors contributed equally
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12
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Waters DW, Blokland KEC, Pathinayake PS, Wei L, Schuliga M, Jaffar J, Westall GP, Hansbro PM, Prele CM, Mutsaers SE, Bartlett NW, Burgess JK, Grainge CL, Knight DA. STAT3 Regulates the Onset of Oxidant-induced Senescence in Lung Fibroblasts. Am J Respir Cell Mol Biol 2020; 61:61-73. [PMID: 30608861 DOI: 10.1165/rcmb.2018-0328oc] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is a chronic lung disease of unknown cause with a median survival of only 3 years. Other investigators and we have shown that fibroblasts derived from IPF lungs display characteristics of senescent cells, and that dysregulated activation of the transcription factor signal transducer and activator of transcription 3 (STAT3) correlates with IPF progression. The question of whether STAT3 activation is involved in fibroblast senescence remains unanswered. We hypothesized that inhibiting STAT3 activation after oxidant-induced senescence would attenuate characteristics of the senescent phenotype. We aimed to characterize a model of oxidant-induced senescence in human lung fibroblasts and to determine the effect of inhibiting STAT3 activity on the development of senescence. Exposing human lung fibroblasts to 150 μM hydrogen peroxide (H2O2) resulted in increased senescence-associated β-galactosidase content and expression of p21 and IL-6, all of which are features of senescence. The shift into senescence was accompanied by an increase of STAT3 translocation to the nucleus and mitochondria. Additionally, Seahorse analysis provided evidence of increased mitochondrial respiration characterized by increased basal respiration, proton leak, and an associated increase in superoxide (O2-) production in senescent fibroblasts. Targeting STAT3 activity using the small-molecule inhibitor STA-21 attenuated IL-6 production, reduced p21 levels, decreased senescence-associated β-galactosidase accumulation, and restored normal mitochondrial function. The results of this study illustrate that stress-induced senescence in lung fibroblasts involves the activation of STAT3, which can be pharmacologically modulated.
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Affiliation(s)
- David W Waters
- 1 School of Biomedical Sciences and Pharmacy and.,2 National Health and Medical Research Council Centre of Research Excellence in Pulmonary Fibrosis, Camperdown, Australia
| | - Kaj E C Blokland
- 1 School of Biomedical Sciences and Pharmacy and.,2 National Health and Medical Research Council Centre of Research Excellence in Pulmonary Fibrosis, Camperdown, Australia.,3 Department of Pathology and Medical Biology, and.,4 Groningen Research Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Lan Wei
- 1 School of Biomedical Sciences and Pharmacy and
| | | | - Jade Jaffar
- 6 Allergy, Immunology and Respiratory Medicine, Alfred Hospital, Prahran, Australia; and
| | - Glen P Westall
- 5 School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | | | - Cecilia M Prele
- 7 Centre for Cell Therapy and Regenerative Medicine, School of Biomedical Sciences, and.,8 Institute for Respiratory Health, University of Western Australia, Nedlands, Australia
| | - Steven E Mutsaers
- 7 Centre for Cell Therapy and Regenerative Medicine, School of Biomedical Sciences, and.,8 Institute for Respiratory Health, University of Western Australia, Nedlands, Australia
| | | | | | - Christopher L Grainge
- 5 School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Darryl A Knight
- 1 School of Biomedical Sciences and Pharmacy and.,2 National Health and Medical Research Council Centre of Research Excellence in Pulmonary Fibrosis, Camperdown, Australia
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13
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Singanayagam A, Loo SL, Calderazzo M, Finney LJ, Trujillo Torralbo MB, Bakhsoliani E, Girkin J, Veerati P, Pathinayake PS, Nichol KS, Reid A, Footitt J, Wark PAB, Grainge CL, Johnston SL, Bartlett NW, Mallia P. Antiviral immunity is impaired in COPD patients with frequent exacerbations. Am J Physiol Lung Cell Mol Physiol 2019; 317:L893-L903. [PMID: 31513433 PMCID: PMC6962603 DOI: 10.1152/ajplung.00253.2019] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Patients with frequent exacerbations represent a chronic obstructive pulmonary disease (COPD) subgroup requiring better treatment options. The aim of this study was to determine the innate immune mechanisms that underlie susceptibility to frequent exacerbations in COPD. We measured sputum expression of immune mediators and bacterial loads in samples from patients with COPD at stable state and during virus-associated exacerbations. In vitro immune responses to rhinovirus infection in differentiated primary bronchial epithelial cells (BECs) sampled from patients with COPD were additionally evaluated. Patients were stratified as frequent exacerbators (≥2 exacerbations in the preceding year) or infrequent exacerbators (<2 exacerbations in the preceding year) with comparisons made between these groups. Frequent exacerbators had reduced sputum cell mRNA expression of the antiviral immune mediators type I and III interferons and reduced interferon-stimulated gene (ISG) expression when clinically stable and during virus-associated exacerbation. A role for epithelial cell-intrinsic innate immune dysregulation was identified: induction of interferons and ISGs during in vitro rhinovirus (RV) infection was also impaired in differentiated BECs from frequent exacerbators. Frequent exacerbators additionally had increased sputum bacterial loads at 2 wk following virus-associated exacerbation onset. These data implicate deficient airway innate immunity involving epithelial cells in the increased propensity to exacerbations observed in some patients with COPD. Therapeutic approaches to boost innate antimicrobial immunity in the lung could be a viable strategy for prevention and treatment of frequent exacerbations.
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Affiliation(s)
- Aran Singanayagam
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Su-Ling Loo
- Faculty of Health and Medicine and Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and University of Newcastle, Newcastle, New South Wales, Australia
| | - Maria Calderazzo
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Lydia J Finney
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | | | - Eteri Bakhsoliani
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Jason Girkin
- Faculty of Health and Medicine and Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and University of Newcastle, Newcastle, New South Wales, Australia
| | - Punnam Veerati
- Faculty of Health and Medicine and Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and University of Newcastle, Newcastle, New South Wales, Australia
| | - Prabuddha S Pathinayake
- Faculty of Health and Medicine and Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and University of Newcastle, Newcastle, New South Wales, Australia
| | - Kristy S Nichol
- Faculty of Health and Medicine and Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and University of Newcastle, Newcastle, New South Wales, Australia
| | - Andrew Reid
- Faculty of Health and Medicine and Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and University of Newcastle, Newcastle, New South Wales, Australia
| | - Joseph Footitt
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Peter A B Wark
- National Heart and Lung Institute, Imperial College London, London, United Kingdom.,Faculty of Health and Medicine and Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and University of Newcastle, Newcastle, New South Wales, Australia
| | | | - Sebastian L Johnston
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Nathan W Bartlett
- Faculty of Health and Medicine and Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and University of Newcastle, Newcastle, New South Wales, Australia
| | - Patrick Mallia
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
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14
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Singanayagam A, Glanville N, Girkin JL, Ching YM, Marcellini A, Porter JD, Toussaint M, Walton RP, Finney LJ, Aniscenko J, Zhu J, Trujillo-Torralbo MB, Calderazzo MA, Grainge C, Loo SL, Veerati PC, Pathinayake PS, Nichol KS, Reid AT, James PL, Solari R, Wark PAB, Knight DA, Moffatt MF, Cookson WO, Edwards MR, Mallia P, Bartlett NW, Johnston SL. Corticosteroid suppression of antiviral immunity increases bacterial loads and mucus production in COPD exacerbations. Nat Commun 2018; 9:2229. [PMID: 29884817 PMCID: PMC5993715 DOI: 10.1038/s41467-018-04574-1] [Citation(s) in RCA: 126] [Impact Index Per Article: 21.0] [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: 09/11/2017] [Accepted: 05/10/2018] [Indexed: 12/24/2022] Open
Abstract
Inhaled corticosteroids (ICS) have limited efficacy in reducing chronic obstructive pulmonary disease (COPD) exacerbations and increase pneumonia risk, through unknown mechanisms. Rhinoviruses precipitate most exacerbations and increase susceptibility to secondary bacterial infections. Here, we show that the ICS fluticasone propionate (FP) impairs innate and acquired antiviral immune responses leading to delayed virus clearance and previously unrecognised adverse effects of enhanced mucus, impaired antimicrobial peptide secretion and increased pulmonary bacterial load during virus-induced exacerbations. Exogenous interferon-β reverses these effects. FP suppression of interferon may occur through inhibition of TLR3- and RIG-I virus-sensing pathways. Mice deficient in the type I interferon-α/β receptor (IFNAR1-/-) have suppressed antimicrobial peptide and enhanced mucin responses to rhinovirus infection. This study identifies type I interferon as a central regulator of antibacterial immunity and mucus production. Suppression of interferon by ICS during virus-induced COPD exacerbations likely mediates pneumonia risk and raises suggestion that inhaled interferon-β therapy may protect.
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Affiliation(s)
- Aran Singanayagam
- COPD and Asthma Section, National Heart and Lung Institute, Imperial College London, Norfolk Place, London, W2 1PG, UK
| | - Nicholas Glanville
- COPD and Asthma Section, National Heart and Lung Institute, Imperial College London, Norfolk Place, London, W2 1PG, UK
| | - Jason L Girkin
- Faculty of Health and Medicine and Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and University of Newcastle, Newcastle, NSW, 2305, Australia
| | - Yee Man Ching
- COPD and Asthma Section, National Heart and Lung Institute, Imperial College London, Norfolk Place, London, W2 1PG, UK
| | - Andrea Marcellini
- COPD and Asthma Section, National Heart and Lung Institute, Imperial College London, Norfolk Place, London, W2 1PG, UK
| | - James D Porter
- COPD and Asthma Section, National Heart and Lung Institute, Imperial College London, Norfolk Place, London, W2 1PG, UK
| | - Marie Toussaint
- COPD and Asthma Section, National Heart and Lung Institute, Imperial College London, Norfolk Place, London, W2 1PG, UK
| | - Ross P Walton
- COPD and Asthma Section, National Heart and Lung Institute, Imperial College London, Norfolk Place, London, W2 1PG, UK
| | - Lydia J Finney
- COPD and Asthma Section, National Heart and Lung Institute, Imperial College London, Norfolk Place, London, W2 1PG, UK
| | - Julia Aniscenko
- COPD and Asthma Section, National Heart and Lung Institute, Imperial College London, Norfolk Place, London, W2 1PG, UK
| | - Jie Zhu
- COPD and Asthma Section, National Heart and Lung Institute, Imperial College London, Norfolk Place, London, W2 1PG, UK
| | - Maria-Belen Trujillo-Torralbo
- COPD and Asthma Section, National Heart and Lung Institute, Imperial College London, Norfolk Place, London, W2 1PG, UK
| | - Maria Adelaide Calderazzo
- COPD and Asthma Section, National Heart and Lung Institute, Imperial College London, Norfolk Place, London, W2 1PG, UK
| | - Chris Grainge
- Faculty of Health and Medicine and Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and University of Newcastle, Newcastle, NSW, 2305, Australia
| | - Su-Ling Loo
- Faculty of Health and Medicine and Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and University of Newcastle, Newcastle, NSW, 2305, Australia
| | - Punnam Chander Veerati
- Faculty of Health and Medicine and Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and University of Newcastle, Newcastle, NSW, 2305, Australia
| | - Prabuddha S Pathinayake
- Faculty of Health and Medicine and Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and University of Newcastle, Newcastle, NSW, 2305, Australia
| | - Kristy S Nichol
- Faculty of Health and Medicine and Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and University of Newcastle, Newcastle, NSW, 2305, Australia
| | - Andrew T Reid
- Faculty of Health and Medicine and Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and University of Newcastle, Newcastle, NSW, 2305, Australia
| | - Phillip L James
- Genomic Medicine, National Heart and Lung Institute, Imperial College London, Cale Street, London, SW3 6LY, UK
| | - Roberto Solari
- COPD and Asthma Section, National Heart and Lung Institute, Imperial College London, Norfolk Place, London, W2 1PG, UK
| | - Peter A B Wark
- Faculty of Health and Medicine and Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and University of Newcastle, Newcastle, NSW, 2305, Australia
| | - Darryl A Knight
- Faculty of Health and Medicine and Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and University of Newcastle, Newcastle, NSW, 2305, Australia
| | - Miriam F Moffatt
- Genomic Medicine, National Heart and Lung Institute, Imperial College London, Cale Street, London, SW3 6LY, UK
| | - William O Cookson
- Genomic Medicine, National Heart and Lung Institute, Imperial College London, Cale Street, London, SW3 6LY, UK
| | - Michael R Edwards
- COPD and Asthma Section, National Heart and Lung Institute, Imperial College London, Norfolk Place, London, W2 1PG, UK
| | - Patrick Mallia
- COPD and Asthma Section, National Heart and Lung Institute, Imperial College London, Norfolk Place, London, W2 1PG, UK
| | - Nathan W Bartlett
- COPD and Asthma Section, National Heart and Lung Institute, Imperial College London, Norfolk Place, London, W2 1PG, UK.
- Faculty of Health and Medicine and Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and University of Newcastle, Newcastle, NSW, 2305, Australia.
| | - Sebastian L Johnston
- COPD and Asthma Section, National Heart and Lung Institute, Imperial College London, Norfolk Place, London, W2 1PG, UK.
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15
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Waters DW, Blokland KEC, Pathinayake PS, Burgess JK, Mutsaers SE, Prele CM, Schuliga M, Grainge CL, Knight DA. Fibroblast senescence in the pathology of idiopathic pulmonary fibrosis. Am J Physiol Lung Cell Mol Physiol 2018; 315:L162-L172. [PMID: 29696986 DOI: 10.1152/ajplung.00037.2018] [Citation(s) in RCA: 102] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is a chronic fibrosing interstitial pneumonia of unknown cause with a median survival of only three years. Little is known about the mechanisms that precede the excessive collagen deposition seen in IPF, but cellular senescence has been strongly implicated in disease pathology. Senescence is a state of irreversible cell-cycle arrest accompanied by an abnormal secretory profile and is thought to play a critical role in both development and wound repair. Normally, once a senescent cell has contributed to wound repair, it is promptly removed from the environment via infiltrating immune cells. However, if immune clearance fails, the persistence of senescent cells is thought to drive disease pathology through their altered secretory profile. One of the major cell types involved in wound healing is fibroblasts, and senescent fibroblasts have been identified in the lungs of patients with IPF and in fibroblast cultures from IPF lungs. The question of what is driving abnormally high numbers of fibroblasts into senescence remains unanswered. The transcription factor signal transducer and activator of transcription 3 (STAT3) plays a role in a myriad of processes, including cell-cycle progression, gene transcription, as well as mitochondrial respiration, all of which are dysregulated during senescence. Activation of STAT3 has previously been shown to correlate with IPF progression and therefore is a potential molecular target to modify early-stage senescence and restore normal fibroblast function. This review summarizes what is presently known about fibroblast senescence in IPF and how STAT3 may contribute to this phenotype.
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Affiliation(s)
- David W Waters
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, New South Wales , Australia.,Faculty of Health and Medicine, University of Newcastle , Callaghan , Australia
| | - Kaj E C Blokland
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, New South Wales , Australia.,University of Groningen, University Medical Center Groningen, Department of Pathology and Medical Biology, Groningen Research Institute for Asthma and COPD , Groningen , The Netherlands.,Faculty of Health and Medicine, University of Newcastle , Callaghan , Australia
| | - Prabuddha S Pathinayake
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales , Australia
| | - Janette K Burgess
- University of Groningen, University Medical Center Groningen, Department of Pathology and Medical Biology, Groningen Research Institute for Asthma and COPD , Groningen , The Netherlands
| | - Steven E Mutsaers
- Centre for Cell Therapy and Regenerative Medicine, School of Biomedical Sciences, University of Western Australia , Nedlands, Western Australia , Australia.,Institute for Respiratory Health, University of Western Australia , Nedlands, Western Australia , Australia
| | - Cecilia M Prele
- Centre for Cell Therapy and Regenerative Medicine, School of Biomedical Sciences, University of Western Australia , Nedlands, Western Australia , Australia.,Institute for Respiratory Health, University of Western Australia , Nedlands, Western Australia , Australia
| | - Michael Schuliga
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, New South Wales , Australia
| | - Christopher L Grainge
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales , Australia.,Faculty of Health and Medicine, University of Newcastle , Callaghan , Australia
| | - Darryl A Knight
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, New South Wales , Australia.,Faculty of Health and Medicine, University of Newcastle , Callaghan , Australia
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16
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Pathinayake PS, Gayan Chathuranga WA, Lee HC, Chowdhury MYE, Sung MH, Lee JS, Kim CJ. Inactivated enterovirus 71 with poly-γ-glutamic acid/Chitosan nano particles (PC NPs) induces high cellular and humoral immune responses in BALB/c mice. Arch Virol 2018; 163:2073-2083. [DOI: 10.1007/s00705-018-3837-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 02/26/2018] [Indexed: 01/08/2023]
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17
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Pathinayake PS, Hsu ACY, Waters DW, Hansbro PM, Wood LG, Wark PAB. Understanding the Unfolded Protein Response in the Pathogenesis of Asthma. Front Immunol 2018; 9:175. [PMID: 29472925 PMCID: PMC5810258 DOI: 10.3389/fimmu.2018.00175] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 01/19/2018] [Indexed: 01/14/2023] Open
Abstract
Asthma is a heterogeneous, chronic inflammatory disease of the airways. It is a complex disease with different clinical phenotypes and results in a substantial socioeconomic burden globally. Poor understanding of pathogenic mechanisms of the disease hinders the investigation into novel therapeutics. Emerging evidence of the unfolded protein response (UPR) in the endoplasmic reticulum (ER) has demonstrated previously unknown functions of this response in asthma development. A worsening of asthmatic condition can be brought on by stimuli such as oxidative stress, pathogenic infections, and allergen exposure. All of which can induce ER stress and activate UPR leading to activation of different inflammatory responses and dysregulate the innate immune functions in the airways. The UPR as a central regulator of asthma pathogenesis may explain several unknown mechanism of the disease onset, which leads us in new directions for future asthma treatments. In this review, we summarize and discuss the causes and impact of ER–UPR in driving the pathogenesis of asthma and highlight its importance in clinical implications.
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Affiliation(s)
- Prabuddha S Pathinayake
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
| | - Alan C-Y Hsu
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
| | - David W Waters
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
| | - Philip M Hansbro
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
| | - Lisa G Wood
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
| | - Peter A B Wark
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia.,Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, NSW, Australia
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