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Agarwal R, Sehgal IS, Muthu V, Denning DW, Chakrabarti A, Soundappan K, Garg M, Rudramurthy SM, Dhooria S, Armstrong-James D, Asano K, Gangneux JP, Chotirmall SH, Salzer HJF, Chalmers JD, Godet C, Joest M, Page I, Nair P, Arjun P, Dhar R, Jat KR, Joe G, Krishnaswamy UM, Mathew JL, Maturu VN, Mohan A, Nath A, Patel D, Savio J, Saxena P, Soman R, Thangakunam B, Baxter CG, Bongomin F, Calhoun WJ, Cornely OA, Douglass JA, Kosmidis C, Meis JF, Moss R, Pasqualotto AC, Seidel D, Sprute R, Prasad KT, Aggarwal AN. Revised ISHAM-ABPA working group clinical practice guidelines for diagnosing, classifying and treating allergic bronchopulmonary aspergillosis/mycoses. Eur Respir J 2024; 63:2400061. [PMID: 38423624 PMCID: PMC10991853 DOI: 10.1183/13993003.00061-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 02/09/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND The International Society for Human and Animal Mycology (ISHAM) working group proposed recommendations for managing allergic bronchopulmonary aspergillosis (ABPA) a decade ago. There is a need to update these recommendations due to advances in diagnostics and therapeutics. METHODS An international expert group was convened to develop guidelines for managing ABPA (caused by Aspergillus spp.) and allergic bronchopulmonary mycosis (ABPM; caused by fungi other than Aspergillus spp.) in adults and children using a modified Delphi method (two online rounds and one in-person meeting). We defined consensus as ≥70% agreement or disagreement. The terms "recommend" and "suggest" are used when the consensus was ≥70% and <70%, respectively. RESULTS We recommend screening for A. fumigatus sensitisation using fungus-specific IgE in all newly diagnosed asthmatic adults at tertiary care but only difficult-to-treat asthmatic children. We recommend diagnosing ABPA in those with predisposing conditions or compatible clinico-radiological presentation, with a mandatory demonstration of fungal sensitisation and serum total IgE ≥500 IU·mL-1 and two of the following: fungal-specific IgG, peripheral blood eosinophilia or suggestive imaging. ABPM is considered in those with an ABPA-like presentation but normal A. fumigatus-IgE. Additionally, diagnosing ABPM requires repeated growth of the causative fungus from sputum. We do not routinely recommend treating asymptomatic ABPA patients. We recommend oral prednisolone or itraconazole monotherapy for treating acute ABPA (newly diagnosed or exacerbation), with prednisolone and itraconazole combination only for treating recurrent ABPA exacerbations. We have devised an objective multidimensional criterion to assess treatment response. CONCLUSION We have framed consensus guidelines for diagnosing, classifying and treating ABPA/M for patient care and research.
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Affiliation(s)
- Ritesh Agarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Inderpaul Singh Sehgal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Valliappan Muthu
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | - Kathirvel Soundappan
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Mandeep Garg
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shivaprakash M Rudramurthy
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sahajal Dhooria
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Darius Armstrong-James
- Faculty of Medicine, Department of Infectious Disease, Imperial College London, London, UK
| | - Koichiro Asano
- Division of Pulmonary Medicine, Department of Medicine, Tokai University School of Medicine, Kanagawa, Japan
| | - Jean-Pierre Gangneux
- Université Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail), UMR_S 1085, Rennes, France
- CHU Rennes, Laboratoire de Parasitologie-Mycologie, ECMM Excellence Center in Medical Mycology, Rennes, France
- National Reference Center on Mycoses and Antifungals (CNRMA LA-Asp C), Rennes, France
| | - Sanjay H Chotirmall
- Lee Kong Chian School of Medicine, Nanyang Technological University (NTU) and Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Helmut J F Salzer
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine-Pneumology, Kepler University Hospital and Medical Faculty, Johannes Kepler University, Linz, Austria
| | | | - Cendrine Godet
- Université Paris Sorbonne, AP-HP, Hôpital Tenon, Service de Pneumologie et Oncologie Thoracique, Centre Constitutif Maladies Pulmonaires Rares Paris, Paris, France
| | | | - Iain Page
- NHS Lothian, Regional Infectious Diseases Unit, Western General Hospital, Edinburgh, UK
| | - Parameswaran Nair
- McMaster University, McGill University, St Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - P Arjun
- KIMS Hospital, Trivandrum, India
| | - Raja Dhar
- Department of Pulmonology, CK Birla Hospitals, Kolkata, India
| | - Kana Ram Jat
- Division of Pediatric Pulmonology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | | | | | - Joseph L Mathew
- Pediatric Pulmonology Division, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Anant Mohan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Alok Nath
- Department of Pulmonary Medicine, Sanjay Gandhi Postgraduate Institute, Lucknow, India
| | - Dharmesh Patel
- City Clinic and Bhailal Amin General Hospital, Vadodara, India
| | - Jayanthi Savio
- Department of Microbiology, St John's Medical College and Hospital, Bengaluru, India
| | - Puneet Saxena
- Pulmonary and Critical Care Medicine, Army Hospital (R&R), New Delhi, India
| | - Rajeev Soman
- Department of Infectious Diseases, Jupiter Hospital, Pune, India
| | | | - Caroline G Baxter
- Department of Respiratory Medicine, Manchester University NHS Foundation Trust, Manchester, UK
| | - Felix Bongomin
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
- Manchester Fungal Infection Group, Division of Evolution, Infection and Genomics, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - William J Calhoun
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Oliver A Cornely
- Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Excellence Center for Medical Mycology (ECMM), University of Cologne, Cologne, Germany
| | - Jo A Douglass
- University of Melbourne, Royal Melbourne Hospital, Parkville, Australia
| | - Chris Kosmidis
- Division of Evolution, Infection and Genomics, University of Manchester, Manchester University NHS Foundation Trust, Manchester, UK
| | - Jacques F Meis
- Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Excellence Center for Medical Mycology (ECMM), University of Cologne, Cologne, Germany
- Center of Expertise in Mycology Radboudumc/CWZ Nijmegen, Nijmegen, The Netherlands
| | - Richard Moss
- Center of Excellence in Pulmonary Biology, Division of Pulmonary, Asthma and Sleep Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Alessandro C Pasqualotto
- Molecular Biology Laboratory, Santa Casa de Misericordia de Porto Alegre, Porto Alegre, Brazil
- Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | - Danila Seidel
- Department of Internal Medicine, University Hospital, Cologne, Germany
| | - Rosanne Sprute
- Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Excellence Center for Medical Mycology (ECMM), University of Cologne, Cologne, Germany
| | - Kuruswamy Thurai Prasad
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashutosh N Aggarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Kaphalia L, Srinivasan MP, Kaphalia BS, Calhoun WJ. Alcohol and its metabolites dysregulate cellular bioenergetics and induce oxidative and endoplasmic reticulum stress in primary human bronchial epithelial cells. Alcohol Clin Exp Res (Hoboken) 2024; 48:596-611. [PMID: 38339830 PMCID: PMC11015980 DOI: 10.1111/acer.15278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/17/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Chronic alcohol consumption/misuse is a significant risk factor for pneumonia and lung infection leading to the development of chronic pulmonary disorders such as chronic obstructive pulmonary disease (COPD) and lung fibrosis. In this study, we sought to delineate the mechanism of alcohol-associated lung disease. We did so by measuring in vitro mitochondrial, endoplasmic reticulum (ER) oxidative stress in human bronchial epithelial cells (hBECs) treated with ethanol and its oxidative (acetaldehyde) and nonoxidative (fatty acid ethyl esters or FAEEs) metabolites. METHODS Primary hBECs from a normal subject were treated with relevant concentrations of ethanol and its metabolites and incubated at 37°C for 24 h. Viability and cytotoxicity were determined using cell viability and lactate dehydrogenase (LDH) assay kits, respectively. Oxidized glutathione (GSSG) and reduced glutathione (GSH) were measured by colorimetric reaction, and 4-hydroxynenonal (4HNE) by immunohistochemistry. Endoplasmic reticulum stress and dysregulated cellular bioenergetics were determined by western blot analysis. Mitochondrial stress and real-time ATP production rates were determined using a Seahorse Extracellular Flux analyzer. Amelioration of ethanol-induced oxidative/ER stress and mitochondrial energetics was determined using an AMPKα agonist. RESULTS Human bronchial epithelial cells treated with ethanol, acetaldehyde, and FAEEs showed a concentration-dependent increase in the secretion of LDH, oxidative/ER stress, deactivation of AMPKα phosphorylation and mitochondrial stress (decreased spare respiratory capacity) with concomitant decreases in mitochondrial and glycolytic ATP production rates. FAEEs caused greater cytotoxicity, ER stress, and dysregulated cellular bioenergetics than those ethanol and its oxidative metabolite. AMPKα agonist-pretreated cells significantly ameliorated ethanol-induced oxidative/ER stress, deactivation of AMPKα, and dysregulated cellular bioenergetics. CONCLUSIONS Findings of this study suggest that ethanol and its metabolites contribute to cytotoxicity, oxidative/ER stress, and dysregulation of cellular bioenergetics in hBECs. The attenuation of ethanol-induced ER/oxidative stress and mitochondrial respiration by an AMPKα agonist may reflect a potential for it to be developed as a therapeutic agent for chronic alcohol-associated lung disease.
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Affiliation(s)
- Lata Kaphalia
- Department of Internal Medicine, The University of Texas Medical Branch, Galveston, Texas, USA
| | - Mukund P Srinivasan
- Department of Pathology, The University of Texas Medical Branch, Galveston, Texas, USA
| | - Bhupendra S Kaphalia
- Department of Pathology, The University of Texas Medical Branch, Galveston, Texas, USA
| | - William J Calhoun
- Department of Internal Medicine, The University of Texas Medical Branch, Galveston, Texas, USA
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Jin M, Douglass JA, Elborn JS, Agarwal R, Calhoun WJ, Lazarewicz S, Jaumont X, Yan M. Omalizumab in Allergic Bronchopulmonary Aspergillosis: A Systematic Review and Meta-Analysis. J Allergy Clin Immunol Pract 2023; 11:896-905. [PMID: 36581073 DOI: 10.1016/j.jaip.2022.12.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 12/09/2022] [Accepted: 12/12/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND An unmet clinical need exists in the management of treatment-refractory allergic bronchopulmonary aspergillosis (ABPA). Omalizumab has shown promising effects in case series and cohort studies; however, evidence to support its routine clinical use is lacking. OBJECTIVE The aim of this systematic review and meta-analysis was to evaluate the clinical effectiveness and safety of omalizumab in patients with ABPA. METHODS We conducted a systematic search across standard databases using specific key words until May 13, 2021. We performed a meta-analysis to compare the effectiveness (exacerbations, oral corticosteroid [OCS] use, lung function, and patient-reported asthma control) and safety of pre- and post-omalizumab treatment. Subgroup analyses were performed for treatment duration and underlying disease. RESULTS In total, 49 studies (n = 267) were included in the qualitative synthesis and 14 case series (n = 186) in the quantitative meta-analysis. Omalizumab treatment significantly reduced the annualized exacerbation rate compared with pretreatment (mean difference, -2.09 [95% CI, -3.07 to -1.11]; P < .01). There was a reduction in OCS use (risk difference, 0.65 [95% CI, 0.46-0.84]; P < .01), an increase in termination of OCS use (risk difference, 0.53 [95% CI, 0.24-0.82]; P < .01), and a reduction in OCS dose (milligrams per day) (mean difference, -14.62 [95% CI, -19.86 to -9.39]; P < .01) in ABPA patients receiving omalizumab. Omalizumab improved FEV1 % predicted by 11.9% (95% CI, 8.2-15.6; P < .01) and asthma control, and was well-tolerated. CONCLUSIONS Omalizumab treatment reduced exacerbations and OCS use, improved lung function and asthma control in patients with ABPA, and was well-tolerated. The results highlight the potential role of omalizumab in the treatment of ABPA.
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Affiliation(s)
- Meiling Jin
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.
| | - Jo A Douglass
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - J Stuart Elborn
- Faculty of Medicine, Health, and Life Sciences, Queen's University, Belfast, United Kingdom
| | - Ritesh Agarwal
- Department of Pulmonary Medicine, Post-Graduate Institute of Medical Education and Research, Chandigarh, India
| | - William J Calhoun
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas
| | | | | | - Meng Yan
- Novartis Pharma AG, Basel, Switzerland
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Abstract
Globally, a small proportion (5–12%) of asthma patients are estimated to have severe disease. However, severe asthma accounts for disproportionately high healthcare resource utilization. The Global Initiative for Asthma (GINA) management committee recommends treating patients with asthma with inhaled corticosteroids plus long-acting β2-agonists and, when needed, adding a long-acting muscarinic receptor antagonist or biologic agent. Five biologics, targeting different effectors in the type 2 inflammatory pathway, are approved for asthma treatment. However, biologics have not been compared against each other or add-on inhaled therapies in head-to-head clinical trials. As a result, their positioning versus that of current and anticipated small-molecule strategies is largely unknown. Furthermore, with the emergence of biomarkers for predicting response to biologics, a more personalized treatment approach—currently lacking with inhaled therapies—may be possible. To gain perspective, we reviewed recent advances in asthma pathophysiology, phenotypes, and biomarkers; the place of biologics in the management and personalized treatment of severe asthma; and the future of biologics and small-molecule drugs. We propose an algorithm for the stepwise treatment of severe asthma based on recommendations in the GINA strategy document that accounts for the broad range of phenotypes targeted by inhaled therapies and the specificity of biologics. In the future, both biologics and small molecules will continue to play key roles in the individualized treatment of severe asthma. However, as targeted therapies, their application will continue to be focused on patients with certain phenotypes who meet the specific criteria for use as identified in pivotal clinical trials.
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Affiliation(s)
- William J Calhoun
- Divisions of Pulmonary, Critical Care, and Sleep Medicine, and Allergy/Immunology; and Institute for Translational Sciences, University of Texas Medical Branch, 4.116 John Sealy Annex, 301 University Blvd, Galveston, TX, 77555-0568, USA.
| | - Geoffrey L Chupp
- Division of Pulmonary, Critical Care, and Sleep Medicine, Yale Center for Asthma and Airway Disease, Yale University School of Medicine, New Haven, CT, USA
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Chipps BE, Jarjour N, Calhoun WJ, Iqbal A, Haselkorn T, Yang M, Brumm J, Corren J, Holweg CTJ, Bafadhel M. A Comprehensive Analysis of the Stability of Blood Eosinophil Levels. Ann Am Thorac Soc 2021; 18:1978-1987. [PMID: 33891831 PMCID: PMC8641810 DOI: 10.1513/annalsats.202010-1249oc] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 04/23/2021] [Indexed: 01/27/2023] Open
Abstract
Rationale: Blood eosinophil counts are used to inform diagnosis/management of eosinophilic asthma. Objectives: Examine blood eosinophil variability and identify factors affecting eosinophil levels to inform clinical interpretation. Methods:Post hoc analysis to understand eosinophil variability using data from four randomized controlled asthma trials. We examined 1) influence of intrinsic/extrinsic factors (comorbidities, medication, and patient history) using baseline data (n = 2,612); 2) monthly variation using placebo-treated patient data (n = 713); 3) stability of eosinophil classification (<150, 150-299, and ⩾300 cells/μl) in placebo-treated patients with monthly measurements over a 1-year period (n = 751); and 4) impact of technical factors (laboratory-to-laboratory differences and time from collection to analysis). Results: Of intrinsic/extrinsic factors examined, nasal polyps increased eosinophil levels by 38%, whereas current smoking decreased levels by 23%. Substantial seasonal differences in eosinophil counts were observed, with differences of ∼20% between July and January. Eosinophil levels between 150 and 299 cells/μl were least stable, with 44% of patients remaining in the same classification for seven of 10 measurements versus 59% and 66% of patients in the <150 and ⩾300 cells/μl subgroups, respectively. Measurements at different laboratories showed high association (Spearman's correlation coefficient, R = 0.89); however, eosinophil counts were reduced, with longer time from collection to analysis, and variability increased with increasing eosinophil counts. Conclusions: Several intrinsic, extrinsic, and technical factors may influence, and should be considered in, clinical interpretation of eosinophil counts. Additionally, a single measurement may not be sufficient when using eosinophil counts for diagnosis/management of eosinophilic asthma.
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Affiliation(s)
- Bradley E. Chipps
- Capital Allergy & Respiratory Disease Center, Sacramento, California
| | | | - William J. Calhoun
- Division of Allergy and Clinical Immunology, University of Texas Medical Branch, Galveston, Texas
| | - Ahmar Iqbal
- Genentech, Inc., South San Francisco, California
| | | | - Ming Yang
- Genentech, Inc., South San Francisco, California
| | - Jochen Brumm
- Genentech, Inc., South San Francisco, California
| | - Jonathan Corren
- David Geffen School of Medicine at UCLA, Los Angeles, California; and
| | | | - Mona Bafadhel
- Respiratory Medicine Unit, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
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Covarrubias-Zambrano O, Motamedi M, Ameredes BT, Tian B, Calhoun WJ, Zhao Y, Brasier AR, Kalubowilage M, Malalasekera AP, Yapa AS, Wang H, Culbertson CT, Troyer DL, Bossmann SH. Optical biosensing of markers of mucosal inflammation. Nanomedicine 2021; 40:102476. [PMID: 34743019 DOI: 10.1016/j.nano.2021.102476] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 09/13/2021] [Accepted: 10/01/2021] [Indexed: 02/07/2023]
Abstract
We report the design and adaptation of iron/iron oxide nanoparticle-based optical nanobiosensors for enzymes or cytokine/chemokines that are established biomarkers of lung diseases. These biomarkers comprise ADAM33, granzyme B, MMP-8, neutrophil elastase, arginase, chemokine (C-C motif) ligand 20 and interleukin-6. The synthesis of nanobiosensors for these seven biomarkers, their calibration with commercially available enzymes and cytokines/chemokines, as well as their validation using bronchoalveolar lavage (BAL) obtained from a mouse model of TLR3-mediated inflammation are discussed here. Exhaled Breath Condensate (EBC) is a minimally invasive approach for sampling airway fluid in the diagnosis and management of various lung diseases in humans (e.g., asthma, COPD and viral infections). We report the proof-of-concept of using human EBC in conjunction with nanobiosensors for diagnosis/monitoring airway inflammation. These findings suggest that, with nanosensor technology, human EBC can be utilized as a liquid biopsy to monitor inflammation/remodeling in lung disease.
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Affiliation(s)
| | - Massoud Motamedi
- Center for Biomedical Engineering, University of Texas Medical Branch, Galveston, TX, USA
| | - Bill T Ameredes
- Institute for Translational Sciences and Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX
| | - Bing Tian
- Institute for Translational Sciences and Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX
| | - William J Calhoun
- Institute for Translational Sciences and Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX
| | - Yingxin Zhao
- Institute for Translational Sciences and Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX
| | - Allan R Brasier
- Institute for Clinical and Translational Research, University of Wisconsin-Madison, School of Medicine and Public Health, Madison, WI
| | | | - Aruni P Malalasekera
- Department of Chemistry, Southwestern College, 100 College Street, Winfield, KS, USA
| | - Asanka S Yapa
- Department of Chemistry, Kansas State University, Manhattan, KS, USA
| | - Hongwang Wang
- Department of Chemistry, Kansas State University, Manhattan, KS, USA
| | | | - Deryl L Troyer
- Department of Anatomy & Physiology, Kansas State University, Manhattan, KS, USA
| | - Stefan H Bossmann
- Department of Chemistry, Kansas State University, Manhattan, KS, USA; The University of Kansas Medical Center, Department of Cancer Biology and The University of Kansas Cancer Center, Kansas City, KS, USA.
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Calhoun WJ, Villasante-Tezanos A. Response to Parenteral Triamcinolone in Severe Asthma: A Useful Induced Phenotype for Clinicians? Am J Respir Crit Care Med 2021; 203:790-791. [PMID: 33449842 PMCID: PMC8017573 DOI: 10.1164/rccm.202012-4485ed] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- William J Calhoun
- Department of Internal Medicine University of Texas Medical Branch Galveston, Texas and
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Ram J, Pineda-Cely J, Calhoun WJ. Forced Oscillometry: A New Tool for Assessing Airway Function-Is It Ready for Prime Time? J Allergy Clin Immunol Pract 2020; 7:2861-2862. [PMID: 31706498 DOI: 10.1016/j.jaip.2019.07.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 07/31/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Jonathan Ram
- Division of Pulmonary, Critical Care, and Sleep, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas
| | - Jenny Pineda-Cely
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas
| | - William J Calhoun
- Division of Pulmonary, Critical Care, and Sleep, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas; Division of Allergy and Clinical Immunology, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas.
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Affiliation(s)
- Mohammed F Zaidan
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Texas Medical Branch, Galveston
| | - Bill T Ameredes
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Texas Medical Branch, Galveston
| | - William J Calhoun
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Texas Medical Branch, Galveston
- Division of Allergy and Clinical Immunology, University of Texas Medical Branch, Galveston
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10
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Affiliation(s)
- Julia W Tripple
- Division of Allergy and Immunology, University of Texas Medical Branch, Galveston
| | - Bill T Ameredes
- Division of Pulmonary Critical Care & Sleep Medicine, University of Texas Medical Branch, Galveston
| | - William J Calhoun
- Division of Allergy and Immunology, University of Texas Medical Branch, Galveston
- Division of Pulmonary Critical Care & Sleep Medicine, University of Texas Medical Branch, Galveston
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Zein J, Gaston B, Bazeley P, DeBoer MD, Igo RP, Bleecker ER, Meyers D, Comhair S, Marozkina NV, Cotton C, Patel M, Alyamani M, Xu W, Busse WW, Calhoun WJ, Ortega V, Hawkins GA, Castro M, Chung KF, Fahy JV, Fitzpatrick AM, Israel E, Jarjour NN, Levy B, Mauger DT, Moore WC, Noel P, Peters SP, Teague WG, Wenzel SE, Erzurum SC, Sharifi N. HSD3B1 genotype identifies glucocorticoid responsiveness in severe asthma. Proc Natl Acad Sci U S A 2020; 117:2187-2193. [PMID: 31932420 PMCID: PMC6995013 DOI: 10.1073/pnas.1918819117] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Asthma resistance to glucocorticoid treatment is a major health problem with unclear etiology. Glucocorticoids inhibit adrenal androgen production. However, androgens have potential benefits in asthma. HSD3B1 encodes for 3β-hydroxysteroid dehydrogenase-1 (3β-HSD1), which catalyzes peripheral conversion from adrenal dehydroepiandrosterone (DHEA) to potent androgens and has a germline missense-encoding polymorphism. The adrenal restrictive HSD3B1(1245A) allele limits conversion, whereas the adrenal permissive HSD3B1(1245C) allele increases DHEA metabolism to potent androgens. In the Severe Asthma Research Program (SARP) III cohort, we determined the association between DHEA-sulfate and percentage predicted forced expiratory volume in 1 s (FEV1PP). HSD3B1(1245) genotypes were assessed, and association between adrenal restrictive and adrenal permissive alleles and FEV1PP in patients with (GC) and without (noGC) daily oral glucocorticoid treatment was determined (n = 318). Validation was performed in a second cohort (SARP I&II; n = 184). DHEA-sulfate is associated with FEV1PP and is suppressed with GC treatment. GC patients homozygous for the adrenal restrictive genotype have lower FEV1PP compared with noGC patients (54.3% vs. 75.1%; P < 0.001). In patients with the homozygous adrenal permissive genotype, there was no FEV1PP difference in GC vs. noGC patients (73.4% vs. 78.9%; P = 0.39). Results were independently confirmed: FEV1PP for homozygous adrenal restrictive genotype in GC vs. noGC is 49.8 vs. 63.4 (P < 0.001), and for homozygous adrenal permissive genotype, it is 66.7 vs. 67.7 (P = 0.92). The adrenal restrictive HSD3B1(1245) genotype is associated with GC resistance. This effect appears to be driven by GC suppression of 3β-HSD1 substrate. Our results suggest opportunities for prediction of GC resistance and pharmacologic intervention.
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Affiliation(s)
- Joe Zein
- Lerner Research Institute and the Respiratory Institute, Cleveland Clinic, Cleveland, OH 44195
| | - Benjamin Gaston
- Herman Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, IN 46202
| | - Peter Bazeley
- Lerner Research Institute and the Respiratory Institute, Cleveland Clinic, Cleveland, OH 44195
| | - Mark D DeBoer
- Department of Pediatrics, University of Virginia, Charlottesville, VA 22904
| | - Robert P Igo
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH 44106
| | - Eugene R Bleecker
- Department of Medicine, University of Arizona Health Sciences, Tucson, AZ 85721
| | - Deborah Meyers
- Department of Medicine, University of Arizona Health Sciences, Tucson, AZ 85721
| | - Suzy Comhair
- Lerner Research Institute and the Respiratory Institute, Cleveland Clinic, Cleveland, OH 44195
| | - Nadzeya V Marozkina
- Department of Pediatrics, Rainbow Babies and Children's Hospital, and Case Western Reserve University, Cleveland, OH 44106
| | - Calvin Cotton
- Department of Pediatrics, Rainbow Babies and Children's Hospital, and Case Western Reserve University, Cleveland, OH 44106
| | - Mona Patel
- Lerner Research Institute and the Respiratory Institute, Cleveland Clinic, Cleveland, OH 44195
| | - Mohammad Alyamani
- Lerner Research Institute and the Respiratory Institute, Cleveland Clinic, Cleveland, OH 44195
| | - Weiling Xu
- Lerner Research Institute and the Respiratory Institute, Cleveland Clinic, Cleveland, OH 44195
| | - William W Busse
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI 53706
| | - William J Calhoun
- Department of Medicine, University of Texas Medical Branch, TX 77555
| | - Victor Ortega
- Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27587
| | - Gregory A Hawkins
- Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27587
| | - Mario Castro
- Department of Medicine, University of Kansas School of Medicine, Kansas City, KS 66160
| | - Kian Fan Chung
- The National Heart & Lung Institute, Imperial College London, London SW7 2AZ, United Kingdom
| | - John V Fahy
- Department of Pediatrics, San Francisco School of Medicine, University of California, San Francisco, CA 94143
| | - Anne M Fitzpatrick
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322
| | - Elliot Israel
- Department of Medicine, Harvard Medical School, Boston, MA 02115
| | - Nizar N Jarjour
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI 53706
| | - Bruce Levy
- Department of Medicine, Harvard Medical School, Boston, MA 02115
| | - David T Mauger
- Center for Biostatistics and Epidemiology, Pennsylvania State University School of Medicine, Hershey, PA 16802
| | - Wendy C Moore
- Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27587
| | - Patricia Noel
- Severe Asthma Research Program (SARP), National Heart, Lung, and Blood Institute, NIH, Bethesda, MD 20892
| | - Stephen P Peters
- Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27587
| | - W Gerald Teague
- Department of Pediatrics, University of Virginia, Charlottesville, VA 22904
| | - Sally E Wenzel
- University of Pittsburgh Asthma Institute, University of Pittsburgh Medical Center-University of Pittsburgh School of Medicine, Pittsburgh, PA 15261
| | - Serpil C Erzurum
- Lerner Research Institute and the Respiratory Institute, Cleveland Clinic, Cleveland, OH 44195
| | - Nima Sharifi
- Lerner Research Institute and the Respiratory Institute, Cleveland Clinic, Cleveland, OH 44195;
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12
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Kaphalia L, Srinivasan MP, Kakumanu RD, Kaphalia BS, Calhoun WJ. Ethanol Exposure Impairs AMPK Signaling and Phagocytosis in Human Alveolar Macrophages: Role of Ethanol Metabolism. Alcohol Clin Exp Res 2019; 43:1682-1694. [PMID: 31211863 DOI: 10.1111/acer.14131] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 06/10/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Chronic alcohol consumption impairs alveolar macrophage's (AM) function and increases risk for developing lung infection and pneumonia. However, the mechanism and metabolic basis of alcohol-induced AM dysfunction leading to lung infection are not well defined, but may include altered ethanol (EtOH) and reactive oxygen species metabolism and cellular energetics. Therefore, oxidative stress, endoplasmic reticulum (ER) stress, the formation of fatty acid ethyl esters [FAEEs, nonoxidative metabolites of EtOH], AMP-activated protein kinase (AMPK) signaling, and phagocytic function were examined in freshly isolated AM incubated with EtOH. METHODS AMs separated from bronchoalveolar lavage fluid samples obtained from normal volunteers were incubated with EtOH for 24 hours. AMPK signaling and ER stress were assessed using Western blotting, FAEEs by GC-MS, oxidative stress by immunofluorescence using antibodies to 4-hydroxynonenal, and phagocytosis by latex beads. Oxidative stress was also measured in EtOH-treated AMs with/without AMPK activator [5-aminoimidazole-4-carboxamide ribonucleotide (AICAR)] or inhibitor (Compound C), and in AMs incubated with FAEEs. mRNA expression for interleukins (IL-6 and IL-8), monocyte chemoattractant protein (MCP)-1, and transforming growth factor (TGF)-β was measured in AM treated with EtOH or FAEEs using RT-PCR. RESULTS EtOH exposure to AM increased oxidative stress, ER stress, and synthesis of FAEEs, decreased phosphorylated AMPK, and impaired phagocytosis. Attenuation or exacerbation of EtOH-induced oxidative stress by AICAR or Compound C, respectively, suggests a link between AMPK signaling, EtOH metabolism, and related oxidative stress. The formation of FAEEs may contribute to EtOH-induced oxidative stress as FAEEs also produced concentration-dependent oxidative stress. An increased mRNA expression of IL-6, IL-8, and MCP-1 by FAEEs is key finding to suggest a metabolic basis of EtOH-induced inflammatory response. CONCLUSIONS EtOH-induced impaired phagocytosis, oxidative stress, ER stress, and dysregulated AMPK signaling are plausibly associated with the formation of FAEEs and may participate in the pathogenesis of nonspecific pulmonary inflammation.
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Affiliation(s)
- Lata Kaphalia
- Division of Pulmonary, Critical Care Medicine, and Sleep, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas.,Division of Allergy & Clinical Immunology, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas
| | - Mukund P Srinivasan
- Department of Pathology, University of Texas Medical Branch, Galveston, Texas
| | - Ramu D Kakumanu
- Department of Pathology, University of Texas Medical Branch, Galveston, Texas
| | | | - William J Calhoun
- Division of Pulmonary, Critical Care Medicine, and Sleep, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas.,Division of Allergy & Clinical Immunology, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas
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13
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Puebla-Neira D, Calhoun WJ. Why do asthma patients cough? New insights into cough in allergic asthma. J Allergy Clin Immunol 2019; 144:656-657. [PMID: 31279010 DOI: 10.1016/j.jaci.2019.06.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 06/18/2019] [Accepted: 06/21/2019] [Indexed: 01/05/2023]
Affiliation(s)
- Daniel Puebla-Neira
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Texas Medical Branch, Galveston, Tex
| | - William J Calhoun
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Texas Medical Branch, Galveston, Tex; Division of Allergy and Immunology, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Tex.
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14
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Zhao Y, Tian B, Sun H, Zhang J, Zhang Y, Ivannikov M, Motamedi M, Liu Z, Zhou J, Kaphalia L, Calhoun WJ, Maroto R, Brasier AR. Pharmacoproteomics reveal novel protective activity of bromodomain containing 4 inhibitors on vascular homeostasis in TLR3-mediated airway remodeling. J Proteomics 2019; 205:103415. [PMID: 31195152 DOI: 10.1016/j.jprot.2019.103415] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 05/23/2019] [Accepted: 06/09/2019] [Indexed: 12/19/2022]
Abstract
Small molecule inhibitors of the epigenetic regulator bromodomain-containing protein 4 (BRD4) are potential therapeutics for viral and allergen-induced airway remodeling. A limitation of their preclinical advancement is the lack of detailed understanding of mechanisms of action and biomarkers of effect. We report a systems-level pharmacoproteomics in a standardized murine model of toll-like receptor TLR3-NFκB/RelA innate inflammation in the absence or presence of a highly selective BRD4 inhibitor (ZL0454) or nonselective bromodomain and extraterminal domain inhibitor (JQ1). Proteomics of bronchoalveolar lavage fluid (BALF) secretome and exosomal proteins from this murine model revealed increased, selective, capillary leak associated with pericyte-myofibroblast transition, a phenomenon blocked by BRD4 inhibitors. BALF proteomics also suggested that ZL0454 better reduced the vascular leakage and extracellular matrix deposition than JQ1. A significant subset of inflammation-mediated remodeling factors was also identified in a mouse model of idiopathic pulmonary fibrosis produced by bleomycin. BALF exosome analysis indicated that BRD4 inhibitors reduced the induction of exosomes enriched in coagulation factors whose presence correlated with interstitial fibrin deposition. Finally, BALF samples from humans with severe asthma demonstrated similar upregulations of ORM2, APCS, SPARCL1, FGA, and FN1, suggesting their potential as biomarkers for early detection of airway remodeling and/or monitoring of therapy response. SIGNIFICANCE: Repetitive and chronic viral upper respiratory tract infections trigger toll-like receptor (TLR)3-NFκB/RelA mediated airway remodeling which is linked to a progressive decline in pulmonary function in patients with asthma and chronic obstructive pulmonary disease. Small molecule inhibitors of the epigenetic regulator bromodomain-containing protein 4 (BRD4) are potential therapeutics for viral and allergen-induced airway remodeling. A limitation of their preclinical advancement is the lack of detailed understanding of mechanisms of action and biomarkers of effect. Our study revealed that the activation of (TLR)3-NFκB/RelA pathway in the lung induced an elevation in coagulation, complement, and platelet factors, indicating the increased vascular leak during airway remodeling. The mechanism of vascular leakage was chronic inflammation-induced pericyte-myofibroblast transition, which was blocked by BRD4 inhibitors. Finally, proteomics analysis of the bronchoalveolar lavage fluid samples from humans with severe asthma demonstrated similar findings that we observed in the animal model.
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Affiliation(s)
- Yingxin Zhao
- Department of Internal Medicine, University of Texas Medical Branch (UTMB), Galveston, TX, USA; Institute for Translational Sciences, UTMB, Galveston, TX, USA; Sealy Center for Molecular Medicine, UTMB, Galveston, TX, USA.
| | - Bing Tian
- Department of Internal Medicine, University of Texas Medical Branch (UTMB), Galveston, TX, USA; Sealy Center for Molecular Medicine, UTMB, Galveston, TX, USA
| | - Hong Sun
- Department of Internal Medicine, University of Texas Medical Branch (UTMB), Galveston, TX, USA
| | - Jing Zhang
- Department of Internal Medicine, University of Texas Medical Branch (UTMB), Galveston, TX, USA
| | - Yueqing Zhang
- Department of Internal Medicine, University of Texas Medical Branch (UTMB), Galveston, TX, USA
| | | | | | - Zhiqing Liu
- Department of Pharmacology and Toxicology, UTMB, Galveston, TX, USA
| | - Jia Zhou
- Department of Pharmacology and Toxicology, UTMB, Galveston, TX, USA
| | - Lata Kaphalia
- Department of Internal Medicine, University of Texas Medical Branch (UTMB), Galveston, TX, USA
| | - William J Calhoun
- Department of Internal Medicine, University of Texas Medical Branch (UTMB), Galveston, TX, USA; Institute for Translational Sciences, UTMB, Galveston, TX, USA; Sealy Center for Molecular Medicine, UTMB, Galveston, TX, USA
| | - Rosario Maroto
- Department of Internal Medicine, University of Texas Medical Branch (UTMB), Galveston, TX, USA
| | - Allan R Brasier
- Institute for Clinical and Translational Research, University of Wisconsin-Madison, Madison, WI, USA
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15
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Chipps BE, Calhoun WJ, Iqbal A, Holweg C, Haselkorn T, Yang M, Corren J. Stability of eosinophil classifications using common cut-points over time. J Allergy Clin Immunol 2019. [DOI: 10.1016/j.jaci.2018.12.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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16
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Tian B, Hosoki K, Liu Z, Yang J, Zhao Y, Sun H, Zhou J, Rytting E, Kaphalia L, Calhoun WJ, Sur S, Brasier AR. Mucosal bromodomain-containing protein 4 mediates aeroallergen-induced inflammation and remodeling. J Allergy Clin Immunol 2018; 143:1380-1394.e9. [PMID: 30321559 DOI: 10.1016/j.jaci.2018.09.029] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 09/19/2018] [Accepted: 09/28/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND Frequent exacerbations of allergic asthma lead to airway remodeling and a decrease in pulmonary function, producing morbidity. Cat dander is an aeroallergen associated with asthma risk. OBJECTIVE We sought to elucidate the mechanism of cat dander-induced inflammation-remodeling. METHODS We identified remodeling in mucosal samples from allergic asthma by using quantitative RT-PCR. We developed a model of aeroallergen-induced experimental asthma using repetitive cat dander extract exposure. We measured airway inflammation using immunofluorescence, leukocyte recruitment, and quantitative RT-PCR. Airway remodeling was measured by using histology, collagen content, myofibroblast numbers, and selected reaction monitoring. Inducible nuclear factor κB (NF-κB)-BRD4 interaction was measured by using a proximity ligation assay in situ. RESULTS Enhanced mesenchymal signatures are observed in bronchial biopsy specimens from patients with allergic asthma. Cat dander induces innate inflammation through NF-κB signaling, followed by production of a profibrogenic mesenchymal transition in primary human small airway epithelial cells. The IκB kinase-NF-κB signaling pathway is required for mucosal inflammation-coupled airway remodeling and myofibroblast expansion in the mouse model of aeroallergen exposure. Cat dander induces NF-κB/RelA to complex with and activate BRD4, resulting in modifying the chromatin environment of inflammatory and fibrogenic genes through its atypical histone acetyltransferase activity. A novel small-molecule BRD4 inhibitor (ZL0454) disrupts BRD4 binding to the NF-κB-RNA polymerase II complex and inhibits its histone acetyltransferase activity. ZL0454 prevents epithelial mesenchymal transition, myofibroblast expansion, IgE sensitization, and fibrosis in airways of naive mice exposed to cat dander. CONCLUSIONS NF-κB-inducible BRD4 activity mediates cat dander-induced inflammation and remodeling. Therapeutic modulation of the NF-κB-BRD4 pathway affects allergen-induced inflammation, epithelial cell-state changes, extracellular matrix production, and expansion of the subepithelial myofibroblast population.
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Affiliation(s)
- Bing Tian
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, Tex; Sealy Center for Molecular Medicine, University of Texas Medical Branch, Galveston, Tex
| | - Koa Hosoki
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, Tex
| | - Zhiqing Liu
- Department of Pharmacology and Toxicology, University of Texas Medical Branch, Galveston, Tex
| | - Jun Yang
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, Tex; Sealy Center for Molecular Medicine, University of Texas Medical Branch, Galveston, Tex
| | - Yingxin Zhao
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, Tex; Sealy Center for Molecular Medicine, University of Texas Medical Branch, Galveston, Tex; Institute for Translational Sciences, University of Texas Medical Branch, Galveston, Tex
| | - Hong Sun
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, Tex
| | - Jia Zhou
- Sealy Center for Molecular Medicine, University of Texas Medical Branch, Galveston, Tex; Department of Pharmacology and Toxicology, University of Texas Medical Branch, Galveston, Tex; Institute for Translational Sciences, University of Texas Medical Branch, Galveston, Tex
| | - Erik Rytting
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Tex
| | - Lata Kaphalia
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, Tex
| | - William J Calhoun
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, Tex; Sealy Center for Molecular Medicine, University of Texas Medical Branch, Galveston, Tex; Institute for Translational Sciences, University of Texas Medical Branch, Galveston, Tex
| | - Sanjiv Sur
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, Tex; Sealy Center for Molecular Medicine, University of Texas Medical Branch, Galveston, Tex; Institute for Translational Sciences, University of Texas Medical Branch, Galveston, Tex
| | - Allan R Brasier
- Institute for Clinical and Translational Research, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wis.
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17
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Veeranki SP, Sharma K, Ohabughiro MU, Mehta HB, Adhikari D, Kuo YF, Calhoun WJ. 30-Day Readmissions in Hospitalized Adults With Asthma Exacerbations: Insights From the Nationwide Readmission Database. Chest 2018; 150:1162-1165. [PMID: 27832886 DOI: 10.1016/j.chest.2016.07.043] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 07/21/2016] [Indexed: 11/19/2022] Open
Affiliation(s)
- Sreenivas P Veeranki
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX.
| | - Kanika Sharma
- Department of Neurosurgery, Louisiana State University Health Science Center, Shreveport, LA
| | | | - Hemalkumar B Mehta
- Department of Surgery, University of Texas Medical Branch, Galveston, TX
| | - Deepak Adhikari
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX
| | - Yong-Fang Kuo
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX
| | - William J Calhoun
- Division of Pulmonary Critical Care & Sleep Medicine, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX
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18
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Li RT, Zahedi S, Trieu J, Lea AS, Calhoun WJ, Duarte AG, Zhao J, Okereke IC. Post-transplant native pneumonectomy for interstitial fibrosis and small cell lung cancer. J Thorac Dis 2018; 9:E1096-E1099. [PMID: 29312773 DOI: 10.21037/jtd.2017.10.106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Lung transplantation is a definitive treatment for select patients with end-stage pulmonary disease. Following transplantation, the reported rate of lung cancer is between 1-9% and is associated with a variety of risk factors, including smoking history and chronic immunosuppression. The majority of post-transplant lung cancer reported in the literature is histologically classified as non-small cell lung carcinoma (NSCLC). We report a unique case of early stage small cell lung carcinoma (SCLC) identified in the native lung following single lung transplantation.
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Affiliation(s)
- Ramon T Li
- School of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Sanam Zahedi
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Judy Trieu
- Department of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Alfred S Lea
- Department of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - William J Calhoun
- Department of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Alexander G Duarte
- Department of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Jianping Zhao
- Department of Pathology, University of Texas Medical Branch, Galveston, TX, USA
| | - Ikenna C Okereke
- Division of Cardiothoracic Surgery, Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
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19
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Veeranki SP, Ohabughiro MU, Moran J, Mehta HB, Ameredes BT, Kuo YF, Calhoun WJ. National estimates of 30-day readmissions among children hospitalized for asthma in the United States. J Asthma 2017; 55:695-704. [PMID: 28837382 DOI: 10.1080/02770903.2017.1365888] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Previous single-center studies have reported that up to 40% of children hospitalized for asthma will be readmitted. The study objectives are to investigate the prevalence and timing of 30-day readmissions in children hospitalized with asthma, and to identify factors associated with 30-day readmissions. METHODS Data (n = 12,842) for children aged 6-18 years hospitalized for asthma were obtained from the 2013 Nationwide Readmission Database (NRD). The primary study outcome was time to readmission within 30 days after discharge attributable to any cause. Several predictors associated with the risk of admission were included: patient (age, sex, median household income, insurance type, county location, and pediatric chronic complex condition), admission (type, day, emergency services utilization, length of stay (LOS), and discharge disposition), and hospital (ownership, bed size, and teaching status). Cox's proportional hazards model was used to identify predictors. RESULTS Of 12,842 asthma-related index hospitalizations, 2.5% were readmitted within 30-days post-discharge. Time to event models identified significantly higher risk of readmission among asthmatic children aged 12-18 years, those who resided in micropolitan counties, those with >4-days LOS during index hospitalization, those who were hospitalized in an urban hospital, who had unfavorable discharge (hazard ratio 2.53, 95% confidence interval 1.33-4.79), and those who were diagnosed with a pediatric complex chronic condition, respectively, than children in respective referent categories. CONCLUSION A multi-dimensional approach including effective asthma discharge action plans and follow-up processes, home-based asthma education, and neighborhood/community-level efforts to address disparities should be integrated into the routine clinical care of asthma children.
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Affiliation(s)
- Sreenivas P Veeranki
- a Department of Preventive Medicine and Community Health , University of Texas Medical Branch , Galveston , TX , USA
| | - Michael U Ohabughiro
- b School of Medicine , University of Texas Medical Branch , Galveston , TX , USA
| | - Jacob Moran
- a Department of Preventive Medicine and Community Health , University of Texas Medical Branch , Galveston , TX , USA
| | - Hemalkumar B Mehta
- c Department of Surgery , University of Texas Medical Branch , Galveston , TX , USA
| | - Bill T Ameredes
- d Division of Pulmonary Critical Care & Sleep Medicine, Department of Internal Medicine , University of Texas Medical Branch , Galveston , TX , USA
| | - Yong-Fang Kuo
- a Department of Preventive Medicine and Community Health , University of Texas Medical Branch , Galveston , TX , USA
| | - William J Calhoun
- d Division of Pulmonary Critical Care & Sleep Medicine, Department of Internal Medicine , University of Texas Medical Branch , Galveston , TX , USA
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20
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Soman KV, Stafford SJ, Pazdrak K, Wu Z, Luo X, White WI, Wiktorowicz JE, Calhoun WJ, Kurosky A. Activation of Human Peripheral Blood Eosinophils by Cytokines in a Comparative Time-Course Proteomic/Phosphoproteomic Study. J Proteome Res 2017; 16:2663-2679. [PMID: 28679203 DOI: 10.1021/acs.jproteome.6b00367] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Activated eosinophils contribute to airway dysfunction and tissue remodeling in asthma and thus are considered to be important factors in asthma pathology. We report here comparative proteomic and phosphoproteomic changes upon activation of eosinophils using eight cytokines individually and in selected cytokine combinations in time-course reactions. Differential protein and phosphoprotein expressions were determined by mass spectrometry after 2-dimensional gel electrophoresis (2DGE) and by LC-MS/MS. We found that each cytokine-stimulation produced significantly different changes in the eosinophil proteome and phosphoproteome, with phosphoproteomic changes being more pronounced and having an earlier onset. Furthermore, we observed that IL-5, GM-CSF, and IL-3 showed the greatest change in protein expression and phosphorylation, and this expression differed markedly from those of the other five cytokines evaluated. Comprehensive univariate and multivariate statistical analyses were employed to evaluate the comparative results. We also monitored eosinophil activation using flow cytometry (FC) analysis of CD69. In agreement with our proteomic studies, FC indicated that IL-5, GM-CSF, and IL-3 were more effective than the other five cytokines studied in stimulating a cell surface CD69 increase indicative of eosinophil activation. Moreover, selected combinations of cytokines revealed proteomic patterns with many proteins in common with single cytokine expression patterns but also showed a greater effect of the two cytokines employed, indicating a more complex signaling pathway that was reflective of a more typical inflammatory pathology.
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Affiliation(s)
- Kizhake V Soman
- Department of Biochemistry & Molecular Biology, University of Texas Medical Branch , Galveston, Texas 77555, United States.,Sealy Center for Molecular Medicine, University of Texas Medical Branch , Galveston, Texas 77555, United States
| | - Susan J Stafford
- Department of Biochemistry & Molecular Biology, University of Texas Medical Branch , Galveston, Texas 77555, United States
| | - Konrad Pazdrak
- Department of Biochemistry & Molecular Biology, University of Texas Medical Branch , Galveston, Texas 77555, United States.,Sealy Center for Molecular Medicine, University of Texas Medical Branch , Galveston, Texas 77555, United States.,Institute for Translational Sciences, University of Texas Medical Branch , Galveston, Texas 77555, United States
| | - Zheng Wu
- Department of Biochemistry & Molecular Biology, University of Texas Medical Branch , Galveston, Texas 77555, United States
| | - Xuemei Luo
- Department of Biochemistry & Molecular Biology, University of Texas Medical Branch , Galveston, Texas 77555, United States
| | - Wendy I White
- MedImmune LLC , One MedImmune Way, Gaithersburg, Maryland 20878, United States
| | - John E Wiktorowicz
- Department of Biochemistry & Molecular Biology, University of Texas Medical Branch , Galveston, Texas 77555, United States.,Sealy Center for Molecular Medicine, University of Texas Medical Branch , Galveston, Texas 77555, United States.,Institute for Translational Sciences, University of Texas Medical Branch , Galveston, Texas 77555, United States.,Institute for Human Immunity & Infection, University of Texas Medical Branch , Galveston, Texas 77555, United States
| | - William J Calhoun
- Department of Internal Medicine, University of Texas Medical Branch , Galveston, Texas 77555, United States
| | - Alexander Kurosky
- Department of Biochemistry & Molecular Biology, University of Texas Medical Branch , Galveston, Texas 77555, United States.,Sealy Center for Molecular Medicine, University of Texas Medical Branch , Galveston, Texas 77555, United States
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Abstract
IMPORTANCE Asthma affects about 7.5% of the adult population. Evidence-based diagnosis, monitoring, and treatment can improve functioning and quality of life in adult patients with asthma. OBSERVATIONS Asthma is a heterogeneous clinical syndrome primarily affecting the lower respiratory tract, characterized by episodic or persistent symptoms of wheezing, dyspnea, and cough. The diagnosis of asthma requires these symptoms and demonstration of reversible airway obstruction using spirometry. Identifying clinically important allergen sensitivities is useful. Inhaled short-acting β2-agonists provide rapid relief of acute symptoms, but maintenance with daily inhaled corticosteroids is the standard of care for persistent asthma. Combination therapy, including inhaled corticosteroids and long-acting β2-agonists, is effective in patients for whom inhaled corticosteroids alone are insufficient. The use of inhaled long-acting β2-agonists alone is not appropriate. Other controller approaches include long-acting muscarinic antagonists (eg, tiotropium), and biological agents directed against proteins involved in the pathogenesis of asthma (eg, omalizumab, mepolizumab, reslizumab). CONCLUSIONS AND RELEVANCE Asthma is characterized by variable airway obstruction, airway hyperresponsiveness, and airway inflammation. Management of persistent asthma requires avoidance of aggravating environmental factors, use of short-acting β2-agonists for rapid relief of symptoms, and daily use of inhaled corticosteroids. Other controller medications, such as long-acting bronchodilators and biologics, may be required in moderate and severe asthma. Patients with severe asthma generally benefit from consultation with an asthma specialist for consideration of additional treatment, including injectable biologic agents.
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Affiliation(s)
- Jennifer L McCracken
- Division of Allergy and Clinical Immunology, University of Texas Medical Branch, Galveston
| | - Sreenivas P Veeranki
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston
| | - Bill T Ameredes
- Division of Pulmonary Critical Care and Sleep, Department of Internal Medicine, University of Texas Medical Branch, Galveston
| | - William J Calhoun
- Division of Allergy and Clinical Immunology, University of Texas Medical Branch, Galveston
- Division of Pulmonary Critical Care and Sleep, Department of Internal Medicine, University of Texas Medical Branch, Galveston
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22
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Nyenhuis SM, Krishnan JA, Berry A, Calhoun WJ, Chinchilli VM, Engle L, Grossman N, Holguin F, Israel E, Kittles RA, Kraft M, Lazarus SC, Lehman EB, Mauger DT, Moy JN, Peters SP, Phipatanakul W, Smith LJ, Sumino K, Szefler SJ, Wechsler ME, Wenzel S, White SR, Ackerman SJ. Race is associated with differences in airway inflammation in patients with asthma. J Allergy Clin Immunol 2017; 140:257-265.e11. [PMID: 28069248 PMCID: PMC5494010 DOI: 10.1016/j.jaci.2016.10.024] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [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: 11/03/2015] [Revised: 09/01/2016] [Accepted: 10/18/2016] [Indexed: 12/24/2022]
Abstract
BACKGROUND African American subjects have a greater burden from asthma compared with white subjects. Whether the pattern of airway inflammation differs between African American and white subjects is unclear. OBJECTIVE We sought to compare sputum airway inflammatory phenotypes of African American and white subjects treated or not with inhaled corticosteroids (ICSs; ICS+ and ICS-, respectively). METHODS We performed a secondary analysis of self-identified African American and white subjects with asthma enrolled in clinical trials conducted by the National Heart, Lung, and Blood Institute-sponsored Asthma Clinical Research Network and AsthmaNet. Demographics, clinical characteristics, and sputum cytology after sputum induction were examined. We used a sputum eosinophil 2% cut point to define subjects with either an eosinophilic (≥2%) or noneosinophilic (<2%) inflammatory phenotype. RESULTS Among 1018 participants, African American subjects (n = 264) had a lower FEV1 percent predicted (80% vs 85%, P < .01), greater total IgE levels (197 vs 120 IU/mL, P < .01), and a greater proportion with uncontrolled asthma (43% vs 28%, P < .01) compared with white subjects (n = 754). There were 922 subjects in the ICS+ group (248 African American and 674 white subjects) and 298 subjects in the ICS- group (49 African American and 249 white subjects). Eosinophilic airway inflammation was not significantly different between African American and white subjects in either group (percentage with eosinophilic phenotype: ICS+ group: 19% vs 16%, P = .28; ICS- group: 39% vs 35%, P = .65; respectively). However, when adjusted for confounding factors, African American subjects were more likely to exhibit eosinophilic airway inflammation than white subjects in the ICS+ group (odds ratio, 1.58; 95% CI, 1.01-2.48; P = .046) but not in the ICS- group (P = .984). CONCLUSION African American subjects exhibit greater eosinophilic airway inflammation, which might explain the greater asthma burden in this population.
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Affiliation(s)
- Sharmilee M Nyenhuis
- Department of Medicine, University of Illinois at Chicago, Chicago, Ill; University of Illinois Hospital & Health Sciences System, Chicago, Ill.
| | - Jerry A Krishnan
- Department of Medicine, University of Illinois at Chicago, Chicago, Ill; University of Illinois Hospital & Health Sciences System, Chicago, Ill
| | - Alalia Berry
- Division of Allergy, Pulmonary and Critical Care, Department of Medicine, the University of Wisconsin School of Medicine and Public Health, University of Wisconsin, Madison, Wis
| | - William J Calhoun
- Division of Pulmonary Critical Care & Sleep Medicine, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Tex
| | - Vernon M Chinchilli
- Department of Public Health Sciences, Pennsylvania State University, Hershey, Pa
| | - Linda Engle
- Department of Public Health Sciences, Pennsylvania State University, Hershey, Pa
| | - Nicole Grossman
- Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Mass
| | - Fernando Holguin
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pa
| | - Elliot Israel
- Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Mass
| | | | - Monica Kraft
- University of Arizona College of Medicine, Tucson, Ariz
| | - Stephen C Lazarus
- Division of Pulmonary and Critical Care, Department of Medicine, University of California, San Francisco, Calif
| | - Erik B Lehman
- Department of Public Health Sciences, Pennsylvania State University, Hershey, Pa
| | - David T Mauger
- Department of Public Health Sciences, Pennsylvania State University, Hershey, Pa
| | - James N Moy
- Stroger Hospital of Cook County, Chicago, Ill
| | - Stephen P Peters
- Division of Pulmonary, Critical Care, Allergy and Immunologic Diseases, Department of Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Wanda Phipatanakul
- Division of Allergy and Immunology, Department of Pediatrics, Boston Children's Hospital, Boston, Mass
| | - Lewis J Smith
- Division of Pulmonary and Critical Care, Department of Medicine Northwestern University, Feinberg School of Medicine, Chicago, Ill
| | - Kaharu Sumino
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University School of Medicine, St Louis, Mo
| | - Stanley J Szefler
- Division of Pulmonary Medicine, Department of Pediatrics, Children's Hospital of Colorado, Aurora, Colo
| | - Michael E Wechsler
- Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Mass; Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, National Jewish Health, Denver, Colo
| | - Sally Wenzel
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pa
| | - Steven R White
- Division of Pulmonary/Critical Care, Department of Medicine, University of Chicago, Chicago, Ill
| | - Steven J Ackerman
- Department of Medicine, University of Illinois at Chicago, Chicago, Ill
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Pazdrak K, Straub C, Maroto R, Stafford S, White WI, Calhoun WJ, Kurosky A. Cytokine-Induced Glucocorticoid Resistance from Eosinophil Activation: Protein Phosphatase 5 Modulation of Glucocorticoid Receptor Phosphorylation and Signaling. J Immunol 2016; 197:3782-3791. [PMID: 27742828 DOI: 10.4049/jimmunol.1601029] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 09/21/2016] [Indexed: 01/01/2023]
Abstract
The mechanisms contributing to persistent eosinophil activation and poor eosinopenic response to glucocorticoids in severe asthma are poorly defined. We examined the effect of cytokines typically overexpressed in the asthmatic airways on glucocorticoid signaling in in vitro activated eosinophils. An annexin V assay used to measure eosinophil apoptosis showed that cytokine combinations of IL-2 plus IL-4 as well as TNF-α plus IFN-γ, or IL-3, GM-CSF, and IL-5 alone significantly diminished the proapoptotic response to dexamethasone. We found that IL-2 plus IL-4 resulted in impaired phosphorylation and function of the nuclear glucocorticoid receptor (GCR). Proteomic analysis of steroid sensitive and resistant eosinophils identified several differentially expressed proteins, namely protein phosphatase 5 (PP5), formyl peptide receptor 2, and annexin 1. Furthermore, increased phosphatase activity of PP5 correlated with impaired phosphorylation of the GCR. Importantly, suppression of PP5 expression with small interfering RNA restored proper phosphorylation and the proapoptotic function of the GCR. We also examined the effect of lipoxin A4 on PP5 activation by IL-2 plus IL-4. Similar to PP5 small interfering RNA inhibition, pretreatment of eosinophils with lipoxin A4 restored GCR phosphorylation and the proaptoptotic function of GCs. Taken together, our results showed 1) a critical role for PP5 in cytokine-induced resistance to GC-mediated eosinophil death, 2) supported the dependence of GCR phosphorylation on PP5 activity, and 3) revealed that PP5 is a target of the lipoxin A4-induced pathway countering cytokine-induced resistance to GCs in eosinophils.
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Affiliation(s)
- Konrad Pazdrak
- Department of Biochemistry and Molecular Biology, The University of Texas Medical Branch, Galveston, TX 77555.,National Heart, Lung, and Blood Institute Proteomics Center Program in Airway Inflammation, The University of Texas Medical Branch, Galveston, TX 77555
| | - Christof Straub
- Department of Biochemistry and Molecular Biology, The University of Texas Medical Branch, Galveston, TX 77555
| | - Rosario Maroto
- Department of Biochemistry and Molecular Biology, The University of Texas Medical Branch, Galveston, TX 77555.,National Heart, Lung, and Blood Institute Proteomics Center Program in Airway Inflammation, The University of Texas Medical Branch, Galveston, TX 77555
| | - Susan Stafford
- Department of Biochemistry and Molecular Biology, The University of Texas Medical Branch, Galveston, TX 77555.,National Heart, Lung, and Blood Institute Proteomics Center Program in Airway Inflammation, The University of Texas Medical Branch, Galveston, TX 77555
| | | | - William J Calhoun
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, The University of Texas Medical Branch, Galveston, TX 77555.,National Heart, Lung, and Blood Institute Proteomics Center Program in Airway Inflammation, The University of Texas Medical Branch, Galveston, TX 77555
| | - Alexander Kurosky
- Department of Biochemistry and Molecular Biology, The University of Texas Medical Branch, Galveston, TX 77555; .,National Heart, Lung, and Blood Institute Proteomics Center Program in Airway Inflammation, The University of Texas Medical Branch, Galveston, TX 77555
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Zein JG, Udeh BL, Teague WG, Koroukian SM, Schlitz NK, Bleecker ER, Busse WB, Calhoun WJ, Castro M, Comhair SA, Fitzpatrick AM, Israel E, Wenzel SE, Holguin F, Gaston BM, Erzurum SC. Impact of Age and Sex on Outcomes and Hospital Cost of Acute Asthma in the United States, 2011-2012. PLoS One 2016; 11:e0157301. [PMID: 27294365 PMCID: PMC4905648 DOI: 10.1371/journal.pone.0157301] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 05/26/2016] [Indexed: 12/20/2022] Open
Abstract
Background Worldwide, asthma is a leading cause of morbidity, mortality and economic burden, with significant gender and racial disparities. However, little attention has been given to the independent role of age on lifetime asthma severity and hospitalization. We aimed to assess the effect of age, gender, race and ethnicity on indicators of asthma severity including asthma related hospitalization, mortality, hospital cost, and the rate of respiratory failure. Methods We analyzed the 2011 and 2012 Healthcare Cost and Utilization Project- National Inpatient Sample (NIS). We validated and extended those results using the National Heart, Lung, and Blood Institute-Severe Asthma Research Program (SARP; 2002–2011) database. Severe asthma was prospectively defined using the stringent American Thoracic Society (ATS) definition. Results Hospitalization for asthma was reported in 372,685 encounters in 2012 and 368,528 in 2011. The yearly aggregate cost exceeded $2 billion. There were distinct bimodal distributions for hospitalization age, with an initial peak at 5 years and a second at 50 years. Likewise, this bimodal age distribution of patients with severe asthma was identified using SARP. Males comprised the majority of individuals in the first peak, but women in the second. Aggregate hospital cost mirrored the bimodal peak distribution. The probability of respiratory failure increased with age until the age of 60, after which it continued to increase in men, but not in women. Conclusions Severe asthma is primarily a disease of young boys and middle age women. Greater understanding of the biology of lung aging and influence of sex hormones will allow us to plan for targeted interventions during these times in order to reduce the personal and societal burdens of asthma.
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Affiliation(s)
- Joe G. Zein
- Department of Pathobiology, Lerner Research Institute, and Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
- * E-mail:
| | - Belinda L. Udeh
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - W. Gerald Teague
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia, United States of America
| | - Siran M. Koroukian
- Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Nicholas K. Schlitz
- Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Eugene R. Bleecker
- Center for Genomics and Personalized Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States of America
| | - William B. Busse
- Department of Medicine, the University of Wisconsin, School of Medicine and Public Health, Madison, Wisconsin, United States of America
| | - William J. Calhoun
- Department of Medicine, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Mario Castro
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Suzy A. Comhair
- Department of Pathobiology, Lerner Research Institute, and Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Anne M. Fitzpatrick
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Elliot Israel
- Pulmonary Division, Harvard Medical School, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Sally E. Wenzel
- The Asthma Institute, the University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Fernando Holguin
- The Asthma Institute, the University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Benjamin M. Gaston
- Department of Pediatric, Rainbow Babies & Children’s Hospital, Cleveland, Ohio, United States of America
| | - Serpil C. Erzurum
- Department of Pathobiology, Lerner Research Institute, and Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
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26
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Riley CM, Wenzel SE, Castro M, Erzurum SC, Chung KF, Fitzpatrick AM, Gaston B, Israel E, Moore WC, Bleecker ER, Calhoun WJ, Jarjour NN, Busse WW, Peters SP, Teague WG, Sorkness R, Holguin F. Clinical Implications of Having Reduced Mid Forced Expiratory Flow Rates (FEF25-75), Independently of FEV1, in Adult Patients with Asthma. PLoS One 2015; 10:e0145476. [PMID: 26717486 PMCID: PMC4696666 DOI: 10.1371/journal.pone.0145476] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [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: 09/03/2015] [Accepted: 11/12/2015] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION FEF25-75 is one of the standard results provided in spirometry reports; however, in adult asthmatics there is limited information on how this physiological measure relates to clinical or biological outcomes independently of the FEV1 or the FEV1/FVC ratio. PURPOSE To determine the association between Hankinson's percent-predicted FEF25-75 (FEF25-75%) levels with changes in healthcare utilization, respiratory symptom frequency, and biomarkers of distal airway inflammation. METHODS In participants enrolled in the Severe Asthma Research Program 1-2, we compared outcomes across FEF25-75% quartiles. Multivariable analyses were done to avoid confounding by demographic characteristics, FEV1, and the FEV1/FVC ratio. In a sensitivity analysis, we also compared outcomes across participants with FEF25-75% below the lower limit of normal (LLN) and FEV1/FVC above LLN. RESULTS Subjects in the lowest FEF25-75% quartile had greater rates of healthcare utilization and higher exhaled nitric oxide and sputum eosinophils. In multivariable analysis, being in the lowest FEF25-75% quartile remained significantly associated with nocturnal symptoms (OR 3.0 [95%CI 1.3-6.9]), persistent symptoms (OR 3.3 [95%CI 1-11], ICU admission for asthma (3.7 [1.3-10.8]) and blood eosinophil % (0.18 [0.07, 0.29]). In the sensitivity analysis, those with FEF25-75% CONCLUSIONS After controlling for demographic variables, FEV1 and FEV1/FVC, a reduced FEF25-75% is independently associated with previous ICU admission, persistent symptoms, nocturnal symptoms, blood eosinophilia and bronchial hyperreactivity. This suggests that in some asthmatics, a reduced FEF25-75% is an independent biomarker for more severe asthma.
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Affiliation(s)
- Craig M. Riley
- Department of Medicine, Division of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States of America
| | - Sally E. Wenzel
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - Mario Castro
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri, United States of America
| | - Serpil C. Erzurum
- Department of Pathobiology, Cleveland Clinic Foundation, Cleveland, Ohio, United States of America
| | - Kian Fan Chung
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Anne M. Fitzpatrick
- Department of Pediatrics, Emory University School of Medicine, Atlanta, George, United States of America
| | - Benjamin Gaston
- Department of Pediatrics, Division of Pediatric Pulmonary Medicine, University Hospitals, Cleveland, Ohio, United States of America
| | - Elliot Israel
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Wendy C. Moore
- Department of Medicine, Division of Pulmonary, Critical Care, Allergy and Immunologic Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States of America
| | - Eugene R. Bleecker
- Department of Medicine, Division of Pulmonary, Critical Care, Allergy and Immunologic Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States of America
| | - William J. Calhoun
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Nizar N. Jarjour
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States of America
| | - William W. Busse
- Department of Medicine, Division of Allergy and Immunology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States of America
| | - Stephen P. Peters
- Department of Medicine, Division of Pulmonary, Critical Care, Allergy and Immunologic Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States of America
| | - W. Gerald Teague
- Department of Pediatrics, Division of Respiratory Medicine, University of Virginia Children’s Hospital, Charlottesville, Virginia, United States of America
| | - Ronald Sorkness
- School of Pharmacy, University of Wisconsin at Madison, Madison, Wisconsin, United States of America
| | - Fernando Holguin
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
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Kaphalia L, Kalita M, Kaphalia BS, Calhoun WJ. Effects of acute ethanol exposure on cytokine production by primary airway smooth muscle cells. Toxicol Appl Pharmacol 2015; 292:85-93. [PMID: 26721307 DOI: 10.1016/j.taap.2015.12.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [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: 06/10/2015] [Revised: 12/08/2015] [Accepted: 12/17/2015] [Indexed: 01/17/2023]
Abstract
Both chronic and binge alcohol abuse can be significant risk factors for inflammatory lung diseases such as acute respiratory distress syndrome and chronic obstructive pulmonary disease. However, metabolic basis of alcohol-related lung disease is not well defined, and may include key metabolites of ethanol [EtOH] in addition to EtOH itself. Therefore, we investigated the effects of EtOH, acetaldehyde [ACE], and fatty acid ethyl esters [FAEEs] on oxidative stress, endoplasmic reticulum (ER) stress, AMP-activated protein kinase (AMPK) signaling and nuclear translocation of phosphorylated (p)-NF-κB p65 in primary human airway smooth muscle (HASM) cells stimulated to produce cytokines using LPS exposure. Both FAEEs and ACE induced evidence of cellular oxidative stress and ER stress, and increased p-NF-κB in nuclear extracts. EtOH and its metabolites decreased p-AMPKα activation, and induced expression of fatty acid synthase, and decreased expression of sirtuin 1. In general, EtOH decreased secretion of IP-10, IL-6, eotaxin, GCSF, and MCP-1. However, FAEEs and ACE increased these cytokines, suggesting that both FAEEs and ACE as compared to EtOH itself are proinflammatory. A direct effect of EtOH could be consistent with blunted immune response. Collectively, these two features of EtOH exposure, coupled with the known inhibition of innate immune response in our model might explain some clinical manifestations of EtOH exposure in the lung.
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Affiliation(s)
- Lata Kaphalia
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, United States
| | - Mridul Kalita
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, United States
| | - Bhupendra S Kaphalia
- Department of Pathology, University of Texas Medical Branch, Galveston, TX, United States
| | - William J Calhoun
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, United States.
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Hasegawa K, Calhoun WJ, Pei YV, Chasm RM, Youngquist ST, Bittner JC, Camargo CA. Sex differences in hospital length of stay in children and adults hospitalized for asthma exacerbation. Ann Allergy Asthma Immunol 2015; 115:533-5.e1. [PMID: 26481171 DOI: 10.1016/j.anai.2015.09.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 09/17/2015] [Accepted: 09/18/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Kohei Hasegawa
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
| | - William J Calhoun
- Division of Pulmonary Critical Care and Sleep Medicine, Department of Internal Medicine, University of Texas Medical Branch Galveston, Galveston, Texas
| | - Y Veronica Pei
- Department of Emergency Medicine, University of Maryland Medical Center, Baltimore, Maryland
| | - Rose M Chasm
- Department of Emergency Medicine, University of Maryland Medical Center, Baltimore, Maryland
| | - Scott T Youngquist
- Department of Emergency Medicine, University of Utah Medical Center, Salt Lake City, Utah
| | - Jane C Bittner
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Zein JG, Dweik RA, Comhair SA, Bleecker ER, Moore WC, Peters SP, Busse WW, Jarjour NN, Calhoun WJ, Castro M, Chung KF, Fitzpatrick A, Israel E, Teague WG, Wenzel SE, Love TE, Gaston BM, Erzurum SC. Asthma Is More Severe in Older Adults. PLoS One 2015. [PMID: 26200463 PMCID: PMC4511639 DOI: 10.1371/journal.pone.0133490] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background Severe asthma occurs more often in older adult patients. We hypothesized that the greater risk for severe asthma in older individuals is due to aging, and is independent of asthma duration. Methods This is a cross-sectional study of prospectively collected data from adult participants (N=1130; 454 with severe asthma) enrolled from 2002 – 2011 in the Severe Asthma Research Program. Results The association between age and the probability of severe asthma, which was performed by applying a Locally Weighted Scatterplot Smoother, revealed an inflection point at age 45 for risk of severe asthma. The probability of severe asthma increased with each year of life until 45 years and thereafter increased at a much slower rate. Asthma duration also increased the probability of severe asthma but had less effect than aging. After adjustment for most comorbidities of aging and for asthma duration using logistic regression, asthmatics older than 45 maintained the greater probability of severe asthma [OR: 2.73 (95 CI: 1.96; 3.81)]. After 45, the age-related risk of severe asthma continued to increase in men, but not in women. Conclusions Overall, the impact of age and asthma duration on risk for asthma severity in men and women is greatest over times of 18-45 years of age; age has a greater effect than asthma duration on risk of severe asthma.
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Affiliation(s)
- Joe G. Zein
- Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
- * E-mail:
| | - Raed A. Dweik
- Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Suzy A. Comhair
- Department of Pathobiology, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Eugene R. Bleecker
- Center for Genomics and Personalized Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States of America
| | - Wendy C. Moore
- Center for Genomics and Personalized Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States of America
| | - Stephen P. Peters
- Center for Genomics and Personalized Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States of America
| | - William W. Busse
- Department of Medicine, The University of Wisconsin, School of Medicine and Public Health, Madison, Wisconsin, United States of America
| | - Nizar N. Jarjour
- Department of Medicine, The University of Wisconsin, School of Medicine and Public Health, Madison, Wisconsin, United States of America
| | - William J. Calhoun
- Department of Medicine, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Mario Castro
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - K. Fan Chung
- The National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Anne Fitzpatrick
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Elliot Israel
- Pulmonary Division, Harvard Medical School, Brigham and Women’s Hospital, Boston, Massachussets, United States of America
| | - W. Gerald Teague
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia, United States of America
| | - Sally E. Wenzel
- Asthma Institute, The University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Thomas E. Love
- Department of Epidemiology and Biostatistics, Case Western Reserve University-MetroHealth Medical Center, Cleveland, Ohio, United States of America
| | - Benjamin M. Gaston
- Department of Pediatric, Rainbow Babies and Children’s Hospital, Cleveland, Ohio, United States of America
| | - Serpil C. Erzurum
- Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
- Department of Pathobiology, Cleveland Clinic, Cleveland, Ohio, United States of America
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Calhoun WJ, Haselkorn T, Miller DP, Omachi TA. Asthma exacerbations and lung function in patients with severe or difficult-to-treat asthma. J Allergy Clin Immunol 2015; 136:1125-7.e4. [PMID: 26104221 DOI: 10.1016/j.jaci.2015.05.014] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 05/13/2015] [Accepted: 05/15/2015] [Indexed: 10/23/2022]
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Chu DK, Al-Garawi A, Llop-Guevara A, Pillai RA, Radford K, Shen P, Walker TD, Goncharova S, Calhoun WJ, Nair P, Jordana M. Therapeutic potential of anti-IL-6 therapies for granulocytic airway inflammation in asthma. Allergy Asthma Clin Immunol 2015; 11:14. [PMID: 25878673 PMCID: PMC4397814 DOI: 10.1186/s13223-015-0081-1] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [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: 09/20/2014] [Accepted: 04/07/2015] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Determining the cellular and molecular phenotypes of inflammation in asthma can identify patient populations that may best benefit from targeted therapies. Although elevated IL-6 and polymorphisms in IL-6 signalling are associated with lung dysfunction in asthma, it remains unknown if elevated IL-6 levels are associated with a specific cellular inflammatory phenotype, and how IL-6 blockade might impact such inflammatory responses. METHODS Patients undergoing exacerbations of asthma were phenotyped according to their airway inflammatory characteristics (normal cell count, eosinophilic, neutrophilic, mixed granulocytic), sputum cytokine profiles, and lung function. Mice were exposed to the common allergen, house dust-mite (HDM), in the presence or absence of endogenous IL-6. The intensity and nature of lung inflammation, and levels of pro-granulocytic cytokines and chemokines under these conditions were analyzed. RESULTS Elevated IL-6 was associated with a lower FEV1 in patients with mixed eosinophilic-neutrophilic bronchitis. In mice, allergen exposure increased lung IL-6 and IL-6 was produced by dendritic cells and alveolar macrophages. Loss-of-function of IL-6 signalling (knockout or antibody-mediated neutralization) abrogated elevations of eosinophil and neutrophil recruiting cytokines/chemokines and allergen-induced airway inflammation in mice. CONCLUSIONS We demonstrate the association of pleiotropic cellular airway inflammation with IL-6 using human and animal data. These data suggest that exacerbations of asthma, particularly those with a combined eosinophilic and neutrophilic bronchitis, may respond to therapies targeting the IL-6 pathway and therefore, provide a rational basis for initiation of clinical trials to evaluate this.
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Affiliation(s)
- Derek K Chu
- Department of Pathology & Molecular Medicine, McMaster Immunology Research Centre, Hamilton, ON Canada
| | - Amal Al-Garawi
- Department of Pathology & Molecular Medicine, McMaster Immunology Research Centre, Hamilton, ON Canada
| | - Alba Llop-Guevara
- Department of Pathology & Molecular Medicine, McMaster Immunology Research Centre, Hamilton, ON Canada
| | - Regina A Pillai
- Division of Pulmonary and Critical Care Medicine, and Institute for Translational Sciences, University of Texas Medical Branch, Galveston, Texas USA
| | - Katherine Radford
- Division of Respirology, Department of Medicine, McMaster University, Hamilton, Ontario Canada
| | - Pamela Shen
- Department of Pathology & Molecular Medicine, McMaster Immunology Research Centre, Hamilton, ON Canada
| | - Tina D Walker
- Department of Pathology & Molecular Medicine, McMaster Immunology Research Centre, Hamilton, ON Canada
| | - Susanna Goncharova
- Department of Pathology & Molecular Medicine, McMaster Immunology Research Centre, Hamilton, ON Canada
| | - William J Calhoun
- Division of Pulmonary and Critical Care Medicine, and Institute for Translational Sciences, University of Texas Medical Branch, Galveston, Texas USA
| | - Parameswaran Nair
- Division of Respirology, Department of Medicine, McMaster University, Hamilton, Ontario Canada
| | - Manel Jordana
- Department of Pathology & Molecular Medicine, McMaster Immunology Research Centre, Hamilton, ON Canada
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Wooten KC, Calhoun WJ, Bhavnani S, Rose RM, Ameredes B, Brasier AR. Evolution of Multidisciplinary Translational Teams (MTTs): Insights for Accelerating Translational Innovations. Clin Transl Sci 2015; 8:542-52. [PMID: 25801998 DOI: 10.1111/cts.12266] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
There is growing consensus about the factors critical for development and productivity of multidisciplinary teams, but few studies have evaluated their longitudinal changes. We present a longitudinal study of 10 multidisciplinary translational teams (MTTs), based on team process and outcome measures, evaluated before and after 3 years of CTSA collaboration. Using a mixed methods approach, an expert panel of five judges (familiar with the progress of the teams) independently rated team performance based on four process and four outcome measures, and achieved a rating consensus. Although all teams made progress in translational domains, other process and outcome measures were highly variable. The trajectory profiles identified four categories of team performance. Objective bibliometric analysis of CTSA-supported MTTs with positive growth in process scores showed that these teams tended to have enhanced scientific outcomes and published in new scientific domains, indicating the conduct of innovative science. Case exemplars revealed that MTTs that experienced growth in both process and outcome evaluative criteria also experienced greater innovation, defined as publications in different areas of science. Of the eight evaluative criteria, leadership-related behaviors were the most resistant to the interventions introduced. Well-managed MTTs demonstrate objective productivity and facilitate innovation.
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Affiliation(s)
- Kevin C Wooten
- Institute for Translational Sciences, University of Texas Medical Branch (UTMB), Galveston, Texas, USA.,School of Business, University of Houston-Clear Lake, Houston, Texas, USA
| | - William J Calhoun
- Institute for Translational Sciences, University of Texas Medical Branch (UTMB), Galveston, Texas, USA.,Department of Internal Medicine, UTMB, Galveston, Texas, USA
| | - Suresh Bhavnani
- Institute for Translational Sciences, University of Texas Medical Branch (UTMB), Galveston, Texas, USA
| | - Robert M Rose
- Institute for Translational Sciences, University of Texas Medical Branch (UTMB), Galveston, Texas, USA
| | - Bill Ameredes
- Institute for Translational Sciences, University of Texas Medical Branch (UTMB), Galveston, Texas, USA.,Department of Internal Medicine, UTMB, Galveston, Texas, USA
| | - Allan R Brasier
- Institute for Translational Sciences, University of Texas Medical Branch (UTMB), Galveston, Texas, USA.,Department of Internal Medicine, UTMB, Galveston, Texas, USA
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Ain Rashid QT, Kaphalia L, Calhoun WJ. Regulation of Glucocorticoid Receptor (GR) Translocation of Airway Smooth Muscle Cells (ASM) By Pparγ Agonist Rosiglitazone and Insulin. J Allergy Clin Immunol 2015. [DOI: 10.1016/j.jaci.2014.12.1129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Kaphalia L, Boroumand N, Hyunsu J, Kaphalia BS, Calhoun WJ. Ethanol metabolism, oxidative stress, and endoplasmic reticulum stress responses in the lungs of hepatic alcohol dehydrogenase deficient deer mice after chronic ethanol feeding. Toxicol Appl Pharmacol 2014; 277:109-17. [PMID: 24625836 PMCID: PMC4021019 DOI: 10.1016/j.taap.2014.02.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Revised: 02/17/2014] [Accepted: 02/24/2014] [Indexed: 01/09/2023]
Abstract
Consumption and over-consumption of alcoholic beverages are well-recognized contributors to a variety of pulmonary disorders, even in the absence of intoxication. The mechanisms by which alcohol (ethanol) may produce disease include oxidative stress and prolonged endoplasmic reticulum (ER) stress. Many aspects of these processes remain incompletely understood due to a lack of a suitable animal model. Chronic alcohol over-consumption reduces hepatic alcohol dehydrogenase (ADH), the principal canonical metabolic pathway of ethanol oxidation. We therefore modeled this situation using hepatic ADH-deficient deer mice fed 3.5% ethanol daily for 3 months. Blood ethanol concentration was 180 mg% in ethanol fed mice, compared to <1.0% in the controls. Acetaldehyde (oxidative metabolite of ethanol) was minimally, but significantly increased in ethanol-fed vs. pair-fed control mice. Total fatty acid ethyl esters (FAEEs, nonoxidative metabolites of ethanol) were 47.6 μg/g in the lungs of ethanol-fed mice as compared to 1.5 μg/g in pair-fed controls. Histological and immunohistological evaluation showed perivascular and peribronchiolar lymphocytic infiltration, and significant oxidative injury, in the lungs of ethanol-fed mice compared to pair-fed controls. Several fold increases for cytochrome P450 2E1, caspase 8 and caspase 3 found in the lungs of ethanol-fed mice as compared to pair-fed controls suggest role of oxidative stress in ethanol-induced lung injury. ER stress and unfolded protein response signaling were also significantly increased in the lungs of ethanol-fed mice. Surprisingly, no significant activation of inositol-requiring enzyme-1α and spliced XBP1 was observed indicating a lack of activation of corrective mechanisms to reinstate ER homeostasis. The data suggest that oxidative stress and prolonged ER stress, coupled with formation and accumulation of cytotoxic FAEEs may contribute to the pathogenesis of alcoholic lung disease.
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Affiliation(s)
- Lata Kaphalia
- Department of Internal Medicine, The University of Texas Medical Branch, Galveston, TX 775555, USA
| | - Nahal Boroumand
- Department of Pathology, The University of Texas Medical Branch, Galveston, TX 775555, USA
| | - Ju Hyunsu
- Department of Preventive Medicine & Community Health, The University of Texas Medical Branch, Galveston, TX 775555, USA
| | - Bhupendra S Kaphalia
- Department of Pathology, The University of Texas Medical Branch, Galveston, TX 775555, USA.
| | - William J Calhoun
- Department of Internal Medicine, The University of Texas Medical Branch, Galveston, TX 775555, USA
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Abstract
There has been an increased interest in studying other factors that affect asthma pathogenesis and cause heterogeneity in prevalence and incidence of asthma. The reason there are such varied expression patterns of disease in asthmatics is because of multiple variables that affect the pathogenesis of asthma. As an exemplar of an epidemiologic variable, we will discuss geographical location, obesity and vitamin D status of the individual, and their effects on asthma burden in humans. There is varying data regarding the prevalence or severity of asthma in urban versus rural setting which is likely related to the difference of the populations studied, complexity of causal variables involved, and local geographic factors. In addition to cross-sectional and cohort studies in humans, animal models and studies have established a link between asthma and obesity by investigating the mechanisms affecting both disease processes. The complicated interrelationship between obesity and asthma is an active area of epidemiological and experimental research with new insights being discovered at a rapid pace. Finally, vitamin D, an important immunomodulator thought to be important in pathogenesis of asthma, has both mechanistic and therapeutic implications in treatment of asthma. The influences of these factors on the clinical expression of asthma are discussed below.
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Affiliation(s)
- Rohit Divekar
- Division of Allergy and Immunology, University of Texas Medical Branch, 301, University Boulevard, Galveston, TX, 77555, USA,
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Abstract
Asthma is an inflammatory disorder characterized by airway obstruction, airway hyperresponsiveness, and airway inflammation, all of which are variable among patients and variable in time within any specific patient. Understanding the mechanism that underlies this observed variability, and using that understanding to advance the science of asthma and the care of asthmatic patients, is an essential purpose of developing phenotypes. Clinical phenotypes have been used for decades, but overlap each other, and do not map cleanly to either pathophysiologic mechanism or with therapeutic response. Molecular phenotyping, although as yet only partially developed, offers the promise of dissecting the mechanistic underpinnings of the variability of asthma and of providing predictive therapeutics for the benefit of patients with this common and troubling disease.
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Affiliation(s)
- Regina A Pillai
- Department of Internal Medicine, University of Texas Medical Branch, 4.118 John Sealy Annex, 301 University Blvd, Galveston, TX, 77555-0568, USA
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Calhoun WJ. Heterogeneity of response to therapy. Adv Exp Med Biol 2014; 795:117-22. [PMID: 24162906 DOI: 10.1007/978-1-4614-8603-9_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
As noted in prior chapters, US national and international guidelines provide a consistent approach to initial management of asthma, based on easily observed physical and physiologic findings, and a detailed history. From those data, a rational initial therapeutic regimen can be prescribed. In many cases, such therapy results in near complete control of asthma symptoms, restoration of normal lung physiology, and elimination of exacerbations. In fact, such improvement is frequent enough that therapeutic responsiveness to asthma treatments was thought to be nearly universal. However, it is not uncommon for patients to return with incomplete, or even trivial improvement in these clinical metrics of control (Langmack and Martin Curr Opin Pulm Med 16:13-18, 2010). In this chapter, we review the current literature on the variability of response to commonly used therapeutic agents in asthma.
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Affiliation(s)
- William J Calhoun
- Department of Internal Medicine, University of Texas Medical Branch, 4.118 John Sealy Annex, 301 University Blvd, Galveston, TX, 77555-0568, USA,
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Wooten KC, Rose RM, Ostir GV, Calhoun WJ, Ameredes BT, Brasier AR. Assessing and evaluating multidisciplinary translational teams: a mixed methods approach. Eval Health Prof 2014; 37:33-49. [PMID: 24064432 PMCID: PMC4180502 DOI: 10.1177/0163278713504433] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
A case report illustrates how multidisciplinary translational teams can be assessed using outcome, process, and developmental types of evaluation using a mixed-methods approach. Types of evaluation appropriate for teams are considered in relation to relevant research questions and assessment methods. Logic models are applied to scientific projects and team development to inform choices between methods within a mixed-methods design. Use of an expert panel is reviewed, culminating in consensus ratings of 11 multidisciplinary teams and a final evaluation within a team-type taxonomy. Based on team maturation and scientific progress, teams were designated as (a) early in development, (b) traditional, (c) process focused, or (d) exemplary. Lessons learned from data reduction, use of mixed methods, and use of expert panels are explored.
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Wu W, Bleecker E, Moore W, Busse WW, Castro M, Chung KF, Calhoun WJ, Erzurum S, Gaston B, Israel E, Curran-Everett D, Wenzel SE. Unsupervised phenotyping of Severe Asthma Research Program participants using expanded lung data. J Allergy Clin Immunol 2014; 133:1280-8. [PMID: 24589344 DOI: 10.1016/j.jaci.2013.11.042] [Citation(s) in RCA: 193] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2013] [Revised: 10/08/2013] [Accepted: 11/11/2013] [Indexed: 12/29/2022]
Abstract
BACKGROUND Previous studies have identified asthma phenotypes based on small numbers of clinical, physiologic, or inflammatory characteristics. However, no studies have used a wide range of variables using machine learning approaches. OBJECTIVES We sought to identify subphenotypes of asthma by using blood, bronchoscopic, exhaled nitric oxide, and clinical data from the Severe Asthma Research Program with unsupervised clustering and then characterize them by using supervised learning approaches. METHODS Unsupervised clustering approaches were applied to 112 clinical, physiologic, and inflammatory variables from 378 subjects. Variable selection and supervised learning techniques were used to select relevant and nonredundant variables and address their predictive values, as well as the predictive value of the full variable set. RESULTS Ten variable clusters and 6 subject clusters were identified, which differed and overlapped with previous clusters. Patients with traditionally defined severe asthma were distributed through subject clusters 3 to 6. Cluster 4 identified patients with early-onset allergic asthma with low lung function and eosinophilic inflammation. Patients with later-onset, mostly severe asthma with nasal polyps and eosinophilia characterized cluster 5. Cluster 6 asthmatic patients manifested persistent inflammation in blood and bronchoalveolar lavage fluid and exacerbations despite high systemic corticosteroid use and side effects. Age of asthma onset, quality of life, symptoms, medications, and health care use were some of the 51 nonredundant variables distinguishing subject clusters. These 51 variables classified test cases with 88% accuracy compared with 93% accuracy with all 112 variables. CONCLUSION The unsupervised machine learning approaches used here provide unique insights into disease, confirming other approaches while revealing novel additional phenotypes.
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Affiliation(s)
- Wei Wu
- Lane Center for Computational Biology, School of Computer Science, Carnegie Mellon University, Pittsburgh, Pa.
| | - Eugene Bleecker
- Center for Human Genomics, School of Medicine, Wake Forest University, Winston-Salem, NC
| | - Wendy Moore
- Center for Human Genomics, School of Medicine, Wake Forest University, Winston-Salem, NC
| | - William W Busse
- Division of Allergy and Immunology, University of Wisconsin, Madison, Wis
| | - Mario Castro
- Division of Pulmonary & Critical Care Medicine, Washington University School of Medicine, St Louis, Mo
| | - Kian Fan Chung
- National Heart & Lung Institute, Imperial College, London, United Kingdom
| | - William J Calhoun
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, Tex
| | - Serpil Erzurum
- Department of Pulmonary, Allergy and Critical Care Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Benjamin Gaston
- Division of Pediatric Pulmonology, and Allergy/Immunology, Department of Pediatrics, School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Elliot Israel
- Pulmonary Division, Brigham and Women's Hospital, Boston, Mass
| | - Douglas Curran-Everett
- National Jewish Medical and Research Center, University of Colorado Health Sciences Center, Denver, Colo
| | - Sally E Wenzel
- National Jewish Medical and Research Center, University of Colorado Health Sciences Center, Denver, Colo; Asthma Institute, Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pa.
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Abstract
Appropriate management of persistent asthma, according to US and international guidelines, requires daily use of controller medications, most generally, inhaled corticosteroids (ICS). This approach, although effective and well established, imposes burdens of treatment and side effects onto asthma patients. A growing body of evidence suggests that patients with persistent asthma need not be managed with daily ICS, but rather can use them on an intermittent basis, occasioned by the occurrence of symptoms sufficient to warrant treatment with a rescue inhaler. Large, randomized, controlled studies, over a range of asthma severity, and in a range of ages from pediatrics to adults, suggest that, in well-selected patients, a symptom-based approach to administering controller therapy may produce equivalent outcomes, while reducing exposure to ICS. The concept of providing anti-inflammatory treatment to the patient, at the time inflammation is developing, is termed 'temporal personalization'. The evidence to date suggests that symptom-based controller therapy is broadly useful in selected asthma patients, and is a management approach that could be incorporated into US and international guidelines for asthma.
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Affiliation(s)
- Rohit Divekar
- Division of Allergy and Clinical Immunology, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX, 77555, USA
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Ho S, Luxon B, Baker W, Spratt H, Divekar R, Aaron E, Calhoun WJ. Metabolomic Profiles Of Exhaled Breath Condensate In Asthmatics. J Allergy Clin Immunol 2014. [DOI: 10.1016/j.jaci.2013.12.317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Rashid QTA, Kaphalia L, Calhoun WJ. Differential Regulation Of Pro-Inflammatory Cytokine Expression Of Airway Smooth Muscle Cells (ASM) By Insulin, Glucose, and Rosiglitazone. J Allergy Clin Immunol 2014. [DOI: 10.1016/j.jaci.2013.12.222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Omachi TA, Haselkorn T, Miller DP, Calhoun WJ. Impact Of Asthma Exacerbations On Lung Function In a Large Cohort Of Patients With Severe Or Difficult-To-Treat Asthma. J Allergy Clin Immunol 2014. [DOI: 10.1016/j.jaci.2013.12.580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Calhoun WJ. The spectrum of asthma: an introduction. Adv Exp Med Biol 2014; 795:1-4. [PMID: 24851269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Peters SP, Bleecker ER, Kunselman SJ, Icitovic N, Moore WC, Pascual R, Ameredes BT, Boushey HA, Calhoun WJ, Castro M, Cherniack RM, Craig T, Denlinger LC, Engle LL, Dimango EA, Israel E, Kraft M, Lazarus SC, Lemanske RF, Lugogo N, Martin RJ, Meyers DA, Ramsdell J, Sorkness CA, Sutherland ER, Wasserman SI, Walter MJ, Wechsler ME, Chinchilli VM, Szefler SJ. Predictors of response to tiotropium versus salmeterol in asthmatic adults. J Allergy Clin Immunol 2013; 132:1068-1074.e1. [PMID: 24084072 DOI: 10.1016/j.jaci.2013.08.003] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Revised: 08/09/2013] [Accepted: 08/12/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Tiotropium has activity as an asthma controller. However, predictors of a positive response to tiotropium have not been described. OBJECTIVE We sought to describe individual and differential responses of asthmatic patients to salmeterol and tiotropium when added to an inhaled corticosteroid, as well as predictors of a positive clinical response. METHODS Data from the double-blind, 3-way, crossover National Heart, Lung, and Blood Institute's Asthma Clinical Research Network's Tiotropium Bromide as an Alternative to Increased Inhaled Glucocorticoid in Patients Inadequately Controlled on a Lower Dose of Inhaled Corticosteroid (ClinicalTrials.gov number, NCT00565266) trial were analyzed for individual and differential treatment responses to salmeterol and tiotropium and predictors of a positive response to the end points FEV1, morning peak expiratory flow (PEF), and asthma control days (ACDs). RESULTS Although approximately equal numbers of patients showed a differential response to salmeterol and tiotropium in terms of morning PEF (n = 90 and 78, respectively) and ACDs (n = 49 and 53, respectively), more showed a differential response to tiotropium for FEV1 (n = 104) than salmeterol (n = 62). An acute response to a short-acting bronchodilator, especially albuterol, predicted a positive clinical response to tiotropium for FEV1 (odds ratio, 4.08; 95% CI, 2.00-8.31; P < .001) and morning PEF (odds ratio, 2.12; 95% CI, 1.12-4.01; P = 0.021), as did a decreased FEV1/forced vital capacity ratio (FEV1 response increased 0.39% of baseline for every 1% decrease in FEV1/forced vital capacity ratio). Higher cholinergic tone was also a predictor, whereas ethnicity, sex, atopy, IgE level, sputum eosinophil count, fraction of exhaled nitric oxide, asthma duration, and body mass index were not. CONCLUSION Although these results require confirmation, predictors of a positive clinical response to tiotropium include a positive response to albuterol and airway obstruction, factors that could help identify appropriate patients for this therapy.
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Kaphalia L, Calhoun WJ. Alcoholic lung injury: metabolic, biochemical and immunological aspects. Toxicol Lett 2013; 222:171-9. [PMID: 23892124 DOI: 10.1016/j.toxlet.2013.07.016] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [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: 06/27/2013] [Revised: 07/12/2013] [Accepted: 07/16/2013] [Indexed: 02/07/2023]
Abstract
Chronic alcohol abuse is a systemic disorder and a risk factor for acute respiratory distress syndrome (ARDS) and chronic obstructive pulmonary disease (COPD). A significant amount of ingested alcohol reaches airway passages in the lungs and can be metabolized via oxidative and non-oxidative pathways. About 90% of the ingested alcohol is metabolized via hepatic alcohol dehydrogenase (ADH)-catalyzed oxidative pathway. Alcohol can also be metabolized by cytochrome P450 2E1 (CYP2E1), particularly during chronic alcohol abuse. Both the oxidative pathways, however, are associated with oxidative stress due to the formation of acetaldehyde and/or reactive oxygen species (ROS). Alcohol ingestion is also known to cause endoplasmic reticulum (ER) stress, which can be mediated by oxidative and/or non-oxidative metabolites of ethanol. An acute as well as chronic alcohol ingestions impair protective antioxidants, oxidize reduced glutathione (GSH, cellular antioxidant against ROS and oxidative stress), and suppress innate and adaptive immunity in the lungs. Oxidative stress and suppressed immunity in the lungs of chronic alcohol abusers collectively are considered to be major risk factors for infection and development of pneumonia, and such diseases as ARDS and COPD. Prior human and experimental studies attempted to identify common mechanisms by which alcohol abuse directly causes toxicity to alveolar epithelium and respiratory tract, particularly lungs. In this review, the metabolic basis of lung injury, oxidative and ER stress and immunosuppression in experimental models and alcoholic patients, as well as potential immunomodulatory therapeutic strategies for improving host defenses against alcohol-induced pulmonary infections are discussed.
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Affiliation(s)
- Lata Kaphalia
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Texas Medical Branch, Galveston, TX, United States
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Pillai RR, Divekar R, Brasier A, Bhavnani S, Calhoun WJ. Strategies for molecular classification of asthma using bipartite network analysis of cytokine expression. Curr Allergy Asthma Rep 2013; 12:388-95. [PMID: 22777399 DOI: 10.1007/s11882-012-0279-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Asthma is a chronic inflammatory disease of the airways that leads to various degrees of recurrent respiratory symptoms affecting patients globally. Specific subgroups of asthma patients have severe disease leading to increased healthcare costs and socioeconomic burden. Despite the overwhelming prevalence of the asthma, there are limitations in predicting response to therapy and identifying patients who are at increased risk of morbidity. This syndrome presents with common clinical signs and symptoms; however, awareness of subgroups of asthma patients with distinct characteristics has surfaced in recent years. Investigators attempt to describe the phenotypes of asthma to ultimately assist with diagnostic and therapeutic applications. Approaches to asthma phenotyping are multifold; however, it can be partitioned into 2 essential groups, clinical phenotyping and molecular phenotyping. Innovative techniques such as bipartite network analysis and visual analytics introduce a new dimension of data analysis to identify underlying mechanistic pathways.
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Affiliation(s)
- Regina R Pillai
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Medical Branch, 5.140 John Sealy Annex, 301 University Blvd, Galveston, TX 77555-0561, USA.
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Li X, Hawkins GA, Ampleford EJ, Moore WC, Li H, Hastie AT, Howard TD, Boushey HA, Busse WW, Calhoun WJ, Castro M, Erzurum SC, Israel E, Lemanske RF, Szefler SJ, Wasserman SI, Wenzel SE, Peters SP, Meyers DA, Bleecker ER. Genome-wide association study identifies TH1 pathway genes associated with lung function in asthmatic patients. J Allergy Clin Immunol 2013; 132:313-20.e15. [PMID: 23541324 DOI: 10.1016/j.jaci.2013.01.051] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [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: 09/24/2012] [Revised: 12/18/2012] [Accepted: 01/18/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND Recent meta-analyses of genome-wide association studies in general populations of European descent have identified 28 loci for lung function. OBJECTIVE We sought to identify novel lung function loci specifically for asthma and to confirm lung function loci identified in general populations. METHODS Genome-wide association studies of lung function (percent predicted FEV1 [ppFEV1], percent predicted forced vital capacity, and FEV1/forced vital capacity ratio) were performed in 4 white populations of European descent (n = 1544), followed by meta-analyses. RESULTS Seven of 28 previously identified lung function loci (HHIP, FAM13A, THSD4, GSTCD, NOTCH4-AGER, RARB, and ZNF323) identified in general populations were confirmed at single nucleotide polymorphism (SNP) levels (P < .05). Four of 32 loci (IL12A, IL12RB1, STAT4, and IRF2) associated with ppFEV1 (P < 10(-4)) belong to the TH1 or IL-12 cytokine family pathway. By using a linear additive model, these 4 TH1 pathway SNPs cumulatively explained 2.9% to 7.8% of the variance in ppFEV1 values in 4 populations (P = 3 × 10(-11)). Genetic scores of these 4 SNPs were associated with ppFEV1 values (P = 2 × 10(-7)) and the American Thoracic Society severe asthma classification (P = .005) in the Severe Asthma Research Program population. TH2 pathway genes (IL13, TSLP, IL33, and IL1RL1) conferring asthma susceptibility were not associated with lung function. CONCLUSION Genes involved in airway structure/remodeling are associated with lung function in both general populations and asthmatic subjects. TH1 pathway genes involved in anti-virus/bacterial infection and inflammation modify lung function in asthmatic subjects. Genes associated with lung function that might affect asthma severity are distinct from those genes associated with asthma susceptibility.
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Affiliation(s)
- Xingnan Li
- Center for Genomics and Personalized Medicine Research, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA.
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Yadav UCS, Naura AS, Aguilera-Aguirre L, Boldogh I, Boulares HA, Calhoun WJ, Ramana KV, Srivastava SK. Aldose reductase inhibition prevents allergic airway remodeling through PI3K/AKT/GSK3β pathway in mice. PLoS One 2013; 8:e57442. [PMID: 23460857 PMCID: PMC3584054 DOI: 10.1371/journal.pone.0057442] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 01/21/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Long-term and unresolved airway inflammation and airway remodeling, characteristic features of chronic asthma, if not treated could lead to permanent structural changes in the airways. Aldose reductase (AR), an aldo-sugar and lipid aldehyde metabolizing enzyme, mediates allergen-induced airway inflammation in mice, but its role in the airway remodeling is not known. In the present study, we have examined the role of AR on airway remodeling using ovalbumin (OVA)-induced chronic asthma mouse model and cultured human primary airway epithelial cells (SAECs) and mouse lung fibroblasts (mLFs). METHODS Airway remodeling in chronic asthma model was established in mice sensitized and challenged twice a week with OVA for 6 weeks. AR inhibitor, fidarestat, was administered orally in drinking water after first challenge. Inflammatory cells infiltration in the lungs and goblet cell metaplasia, airway thickening, collagen deposition and airway hyper-responsiveness (AHR) in response to increasing doses of methacholine were assessed. The TGFβ1-induced epithelial-mesenchymal transition (EMT) in SAECs and changes in mLFs were examined to investigate AR-mediated molecular mechanism(s) of airway remodeling. RESULTS In the OVA-exposed mice for 6 wks inflammatory cells infiltration, levels of inflammatory cytokines and chemokines, goblet cell metaplasia, collagen deposition and AHR were significantly decreased by treatment with AR inhibitor, fidarestat. Further, inhibition of AR prevented TGFβ1-induced altered expression of E-cadherin, Vimentin, Occludin, and MMP-2 in SAECs, and alpha-smooth muscle actin and fibronectin in mLFs. Further, in SAECs, AR inhibition prevented TGFβ1- induced activation of PI3K/AKT/GSK3β pathway but not the phosphorylation of Smad2/3. CONCLUSION Our results demonstrate that allergen-induced airway remodeling is mediated by AR and its inhibition blocks the progression of remodeling via inhibiting TGFβ1-induced Smad-independent and PI3K/AKT/GSK3β-dependent pathway.
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Affiliation(s)
- Umesh C. S. Yadav
- Department of Biochemistry and Molecular Biology, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Amarjit S. Naura
- Department of Medicine and Stanley Scot Cancer Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana, United States of America
| | - Leopoldo Aguilera-Aguirre
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Istvan Boldogh
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Hamid A. Boulares
- Department of Pharmacology and Experimental Therapeutics and Stanley Scot Cancer Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana, United States of America
| | - William J. Calhoun
- Department of Internal Medicine-Pulmonary/Critical Care, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Kota V. Ramana
- Department of Biochemistry and Molecular Biology, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Satish K. Srivastava
- Department of Biochemistry and Molecular Biology, University of Texas Medical Branch, Galveston, Texas, United States of America
- * E-mail:
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Kaphalia L, Ameredes BT, Calhoun WJ. Non-Canonical Activation and Phosphorylation of the Glucocorticoid Receptor [GR] Phosphorylation Reduces Pro-Inflammatory in Human Bronchial Smooth Muscle Cells [Hbsmc]. J Allergy Clin Immunol 2013. [DOI: 10.1016/j.jaci.2012.12.848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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