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Strobl MR, Demir H, Sánchez Acosta G, Drescher A, Kitzmüller C, Möbs C, Pfützner W, Bohle B. The role of IgG 1 and IgG 4 as dominant IgE-blocking antibodies shifts during allergen immunotherapy. J Allergy Clin Immunol 2023; 151:1371-1378.e5. [PMID: 36657603 DOI: 10.1016/j.jaci.2023.01.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 01/02/2023] [Accepted: 01/06/2023] [Indexed: 01/18/2023]
Abstract
BACKGROUND The induction of allergen-specific IgE-blocking antibodies is a hallmark of allergen immunotherapy (AIT). The inhibitory bioactivity has largely been attributed to IgG4; however, our recent studies indicated the dominance of IgG1 early in AIT. OBJECTIVES Here, the IgE-blocking activity and avidity of allergen-specific IgG1 and IgG4 antibodies were monitored throughout 3 years of treatment. METHODS Serum samples from 24 patients were collected before and regularly during AIT with birch pollen. Bet v 1-specific IgG1 and IgG4 levels were determined by ELISA and ImmunoCAP, respectively. Unmodified and IgG1- or IgG4-depleted samples were compared for their inhibition of Bet v 1-induced basophil activation. The stability of Bet v 1-antibody complexes was compared by ELISA and by surface plasmon resonance. RESULTS Bet v 1-specific IgG1 and IgG4 levels peaked at 12 and 24 months of AIT, respectively. Serological IgE-blocking peaked at 6 months and remained high thereafter. In the first year of therapy, depletion of IgG1 clearly diminished the inhibition of basophil activation while the absence of IgG4 hardly reduced IgE-blocking. Then, IgG4 became the main inhibitory isotype in most individuals. Both isotypes displayed high avidity to Bet v 1 ab initio of AIT, which did not increase during treatment. Bet v 1-IgG1 complexes were enduringly more stable than Bet v 1-IgG4 complexes were. CONCLUSIONS In spite of the constant avidity of AIT-induced allergen-specific IgG1 and IgG4 antibodies, their dominance in IgE-blocking shifted in the course of treatment. The blocking activity of allergen-specific IgG1 should not be underestimated, particularly early in AIT.
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Affiliation(s)
- Maria R Strobl
- Institute of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Hilal Demir
- Institute of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Gabriela Sánchez Acosta
- Institute of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Anja Drescher
- Cytiva Europe GmbH, Freiburg, Department of Dermatology and Allergology, Philipps-Universität Marburg, Freiburg and Marburg, Germany
| | - Claudia Kitzmüller
- Institute of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Christian Möbs
- Clinical and Experimental Allergology, Department of Dermatology and Allergology, Philipps-Universität Marburg, Marburg, Germany
| | - Wolfgang Pfützner
- Clinical and Experimental Allergology, Department of Dermatology and Allergology, Philipps-Universität Marburg, Marburg, Germany
| | - Barbara Bohle
- Institute of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria.
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Shamji MH, Larson D, Eifan A, Scadding GW, Qin T, Lawson K, Sever ML, Macfarlane E, Layhadi JA, Würtzen PA, Parkin RV, Sanda S, Harris KM, Nepom GT, Togias A, Durham SR. Differential induction of allergen-specific IgA responses following timothy grass subcutaneous and sublingual immunotherapy. J Allergy Clin Immunol 2021; 148:1061-1071.e11. [PMID: 33819508 DOI: 10.1016/j.jaci.2021.03.030] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [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: 09/14/2020] [Revised: 03/03/2021] [Accepted: 03/09/2021] [Indexed: 02/06/2023]
Abstract
INTRODUCTION There is no detailed comparison of allergen-specific immunoglobulin responses following sublingual immunotherapy (SLIT) and subcutaneous immunotherapy (SCIT). OBJECTIVE We sought to compare nasal and systemic timothy grass pollen (TGP)-specific antibody responses during 2 years of SCIT and SLIT and 1 year after treatment discontinuation in a double-blind, double-dummy, placebo-controlled trial. METHODS Nasal fluid and serum were obtained yearly (per-protocol population, n = 84). TGP-specific IgA1, IgA2, IgG4, IgG, and IgE were measured in nasal fluids by ELISA. TGP-specific IgA1, IgA2, and Phleum pratense (Phl p)1, 2, 4, 5b, 6, 7, 11, and 12 IgE and IgG4 were measured in sera by ELISA and ImmunoCAP, respectively. RESULTS At years 2 and 3, TGP-IgA1/2 levels in nasal fluid were elevated in SLIT compared with SCIT (4.2- and 3.0-fold for IgA1, 2.0- and 1.8-fold for IgA2, respectively; all P < .01). TGP-IgA1 level in serum was elevated in SLIT compared with SCIT at years 1, 2, and 3 (4.6-, 5.1-, and 4.7-fold, respectively; all P < .001). Serum TGP-IgG level was higher in SCIT compared with SLIT (2.8-fold) at year 2. Serum TGP-IgG4 level was higher in SCIT compared with SLIT at years 1, 2, and 3 (10.4-, 27.4-, and 5.1-fold, respectively; all P < .01). Serum IgG4 levels to Phl p1, 2, 5b, and 6 were increased at years 1, 2, and 3 in SCIT and SLIT compared with placebo (Phl p1: 11.8- and 3.9-fold; Phl p2: 31.6- and 4.4-fold; Phl p5b: 135.5- and 5.3-fold; Phl p6: 145.4- and 14.7-fold, respectively, all at year 2 when levels peaked; P < .05). IgE to TGP in nasal fluid increased in the SLIT group at year 2 but not at year 3 compared with SCIT (2.8-fold; P = .04) and placebo (3.1-fold; P = .02). IgA to TGP and IgE and IgG4 to TGP components stratified participants according to treatment group and clinical response. CONCLUSIONS The observed induction of IgA1/2 in SLIT and IgG4 in SCIT suggest key differences in the mechanisms of action.
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Affiliation(s)
- Mohamed H Shamji
- National Heart and Lung Institute, Allergy and Clinical Immunology, Imperial College NIHR Biomedical Research Centre, Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom.
| | | | - Aarif Eifan
- National Heart and Lung Institute, Allergy and Clinical Immunology, Imperial College NIHR Biomedical Research Centre, Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom
| | - Guy W Scadding
- National Heart and Lung Institute, Allergy and Clinical Immunology, Imperial College NIHR Biomedical Research Centre, Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom
| | | | | | | | - Ellen Macfarlane
- National Heart and Lung Institute, Allergy and Clinical Immunology, Imperial College NIHR Biomedical Research Centre, Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom
| | - Janice A Layhadi
- National Heart and Lung Institute, Allergy and Clinical Immunology, Imperial College NIHR Biomedical Research Centre, Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom
| | | | - Rebecca V Parkin
- National Heart and Lung Institute, Allergy and Clinical Immunology, Imperial College NIHR Biomedical Research Centre, Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom
| | | | | | - Gerald T Nepom
- Immune Tolerance Network, Bethesda, Md; Benaroya Research Institute at Virginia Mason, Seattle, Wash
| | - Alkis Togias
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Md
| | - Stephen R Durham
- National Heart and Lung Institute, Allergy and Clinical Immunology, Imperial College NIHR Biomedical Research Centre, Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom; Immune Tolerance Network, Bethesda, Md
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Khodoun MV, Morris SC, Shao WH, Potter C, Angerman E, Kiselev A, Yarawsky AE, Herr AB, Klausz K, Otte A, Peipp M, Finkelman FD. Suppression of IgE-mediated anaphylaxis and food allergy with monovalent anti-FcεRIα mAbs. J Allergy Clin Immunol 2021; 147:1838-1854.e4. [PMID: 33326804 PMCID: PMC8215870 DOI: 10.1016/j.jaci.2020.10.045] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 08/29/2020] [Revised: 10/20/2020] [Accepted: 10/30/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND Mast cell and basophil activation by antigen cross-linking of FcεRI-bound IgE is central to allergy pathogenesis. We previously demonstrated global suppression of this process by rapid desensitization with anti-FcεRIα mAbs. OBJECTIVES We sought to determine whether use of monovalent (mv) anti-FcεRIα mAbs increases desensitization safety without loss of efficacy. METHODS mv anti-human (hu) FcεRIα mAbs were produced with mouse-derived immunoglobulin variable regions and huIgG1 or huIgG4 C regions and were used to suppress murine IgE-mediated anaphylaxis and food allergy. mAbs were administered as a single dose or as serially increasing doses to mice that express hu instead of mouse FcεRIα; mice that additionally have an allergy-promoting IL-4Rα mutation; and hu cord blood-reconstituted immunodeficient, hu cytokine-secreting, mice that have large numbers of activated hu mast cells. Anaphylaxis susceptibility was sometimes increased by treatment with IL-4 or a β-adrenergic receptor antagonist. RESULTS mv anti-hu FcεRIα mAbs are considerably less able than divalent mAbs are to induce anaphylaxis and deplete mast cell and basophil IgE, but mv mAbs still strongly suppress IgE-mediated disease. The mv mAbs can be safely administered as a single large dose to mice with typical susceptibility to anaphylaxis, while a rapid desensitization approach safely suppresses disease in mice with increased susceptibility. Our huIgG4 variant of mv anti-huFcεRIα mAb is safer than our huIgG1 variant is, apparently because reduced interactions with FcεRs decrease ability to indirectly cross-link FcεRI. CONCLUSIONS mv anti-FcεRIα mAbs more safely suppress IgE-mediated anaphylaxis and food allergy than divalent variants of the same mAbs do. These mv mAbs may be useful for suppression of huIgE-mediated disease.
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Affiliation(s)
- Marat V Khodoun
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Suzanne C Morris
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Wen-Hai Shao
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Crystal Potter
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Elizabeth Angerman
- Division of Immunobiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Artem Kiselev
- Institute of Cytology, Russian Academy of Sciences, Saint Petersburg, Russia
| | - Alexander E Yarawsky
- Division of Immunobiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Andrew B Herr
- Division of Immunobiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Katja Klausz
- Division of Stem Cell Transplantation and Immunotherapy, University Hospital Schleswig-Holstein, University of Kiel, Kiel, Germany
| | - Anna Otte
- Division of Stem Cell Transplantation and Immunotherapy, University Hospital Schleswig-Holstein, University of Kiel, Kiel, Germany
| | - Matthias Peipp
- Division of Stem Cell Transplantation and Immunotherapy, University Hospital Schleswig-Holstein, University of Kiel, Kiel, Germany
| | - Fred D Finkelman
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio; Division of Immunobiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
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Suarez-Farinas M, Suprun M, Bahnson HT, Raghunathan R, Getts R, duToit G, Lack G, Sampson HA. Evolution of epitope-specific IgE and IgG 4 antibodies in children enrolled in the LEAP trial. J Allergy Clin Immunol 2021; 148:835-842. [PMID: 33592205 DOI: 10.1016/j.jaci.2021.01.030] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 12/15/2020] [Accepted: 01/15/2021] [Indexed: 01/28/2023]
Abstract
BACKGROUND In the LEAP (Learning Early About Peanut Allergy) trial, early consumption of peanut in high-risk infants was found to decrease the rate of peanut allergy at 5 years of age. Sequential epitope-specific (ses-)IgE is a promising biomarker of clinical peanut reactivity. OBJECTIVE We sought to compare the evolution of ses-IgE and ses-IgG4 in children who developed (or not) peanut allergy and to evaluate the immunomodulatory effects of early peanut consumption on these antibodies. METHODS Sera from 341 children (LEAP cohort) were assayed at baseline, 1, 2.5, and 5 years of age, with allergy status determined by oral food challenge at 5 years. A bead-based epitope assay was used to quantitate ses-IgE and ses-IgG4 to 64 sequential epitopes from Ara h 1 to Ara h 3 and was analyzed using linear mixed-effect models. RESULTS In children avoiding peanut who became peanut allergic, the bulk of peanut ses-IgE did not develop until after 2.5 years. Minimal increases of ses-IgE occurred after 1 year in consumers, but not to the same epitopes as those in children developing peanut allergy. No major changes in ses-IgE were seen in nonallergic or sensitized children. IgE in sensitized consumers was detected against peanut proteins. ses-IgG4 increased over time in most children regardless of consumption or allergy status. CONCLUSIONS Early peanut consumption in infants at high risk of developing peanut allergy appears to divert the immunologic response to a presumably "protective" effect. In general, consumers tend to generate ses-IgG4 earlier and in greater quantities than nonconsumers do, whereas only avoiders tend to generate significant quantities of ses-IgE.
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Affiliation(s)
- Mayte Suarez-Farinas
- Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY; Center for Biostatistics, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Maria Suprun
- Division of Pediatric Allergy and Immunology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Henry T Bahnson
- Benaroya Research Institute and the Immune Tolerance Network, Seattle, Wash
| | - Rohit Raghunathan
- Center for Biostatistics, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - George duToit
- Department of Pediatrics, St Thomas Hospital and King's College London, London, United Kingdom
| | - Gideon Lack
- Department of Pediatrics, St Thomas Hospital and King's College London, London, United Kingdom
| | - Hugh A Sampson
- Division of Pediatric Allergy and Immunology, Icahn School of Medicine at Mount Sinai, New York, NY.
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Nolte H, Waserman S, Ellis AK, Biedermann T, Würtzen PA. Treatment Effect of the Tree Pollen SLIT-Tablet on Allergic Rhinoconjunctivitis During Oak Pollen Season. J Allergy Clin Immunol Pract 2021; 9:1871-1878. [PMID: 33548518 DOI: 10.1016/j.jaip.2021.01.035] [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: 10/12/2020] [Revised: 12/21/2020] [Accepted: 01/20/2021] [Indexed: 01/13/2023]
Abstract
BACKGROUND Birch, alder, hazel, and oak are members of the birch homologous group based on cross-reactivity toward the birch pollen allergen Betula verrucosa 1. Theoretically, allergy to these tree pollens may be treated by immunotherapy with one representative allergen extract. OBJECTIVE To evaluate post hoc whether treatment of birch pollen-induced allergic rhinoconjunctivitis with a standardized tree sublingual immunotherapy (SLIT)-tablet containing birch pollen extract reduces symptoms and symptom-relieving medication use during the oak pollen season (OPS). METHODS In a randomized, multinational, double-blind trial (EudraCT-2015-004821-15), 634 participants (ages 12-65 years) received daily tree SLIT-tablet (12 SQ-Bet) or placebo before and during tree pollen season (alder/hazel plus birch pollen season [BPS]). Symptom-relieving medication was allowed. The primary end point was the average total combined score (sum of rhinoconjunctivitis daily symptom score and daily medication score) during BPS. Outcomes during the OPS (excluding overlapping BPS days) were analyzed post hoc. RESULTS Relative improvements in average total combined score, daily symptom score, and daily medication score with the tree SLIT-tablet versus placebo during the OPS were 25%, 22%, and 32%, respectively (all P < .001). Significant correlations were observed between birch and oak serum immunoglobulin E (sIgE) at baseline (r = 0.86) and between birch and oak IgG4 after treatment (r = 0.72). Oak sIgE and IgG4 kinetics in response to tree SLIT-tablet treatment were similar to birch. CONCLUSIONS The tree SLIT-tablet leads to significant improvement of rhinoconjunctivitis outcomes during the OPS, supporting the clinical relevance of immunological cross-reactivity toward birch and oak allergens.
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Affiliation(s)
| | - Susan Waserman
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Anne K Ellis
- Division of Allergy and Immunology, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Tilo Biedermann
- Department of Dermatology and Allergology, Technical University of Munich, Munich, Germany
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Satitsuksanoa P, van de Veen W, Akdis M. B cells in food allergy. J Allergy Clin Immunol 2020; 147:49-51. [PMID: 33242492 DOI: 10.1016/j.jaci.2020.11.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 10/09/2020] [Accepted: 11/10/2020] [Indexed: 12/26/2022]
Affiliation(s)
| | - Willem van de Veen
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland; Christine Kühne - Center for Allergy Research and Education (CK-CARE), Davos, Switzerland
| | - Mübeccel Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland.
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Suprun M, Sicherer SH, Wood RA, Jones SM, Leung DYM, Henning AK, Dawson P, Burks AW, Lindblad R, Getts R, Suárez-Fariñas M, Sampson HA. Early epitope-specific IgE antibodies are predictive of childhood peanut allergy. J Allergy Clin Immunol 2020; 146:1080-1088. [PMID: 32795587 DOI: 10.1016/j.jaci.2020.08.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/31/2020] [Accepted: 08/05/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Peanut allergy is characterized by the development of IgE against peanut antigen. OBJECTIVE We sought to evaluate the evolution of epitope-specific (es)IgE and esIgG4 in a prospective cohort of high-risk infants to determine whether antibody profiles can predict peanut allergy after age 4 years. METHODS The end point was allergy status at age 4+ years; samples from 293 children were collected at age 3 to 15 months and 2 to 3 and 4+ years. Levels of specific (s)IgE and sIgG4 to peanut and component proteins, and 50 esIgE and esIgG4 were quantified. Changes were analyzed with mixed-effects models. Machine learning algorithms were developed to identify a combination of antigen- and epitope-specific antibodies that using 3- to 15-month or 2- to 3-year samples can predict allergy status at age 4+ years. RESULTS At age 4+ years, 38% of children were Tolerant or 14% had Possible, 8% Convincing, 24% Serologic, and 16% Confirmed allergy. At age 3 to 15 months, esIgE profiles were similar among groups, whereas marked increases were evident at age 2 and 4+ years only in Confirmed and Serologic groups. In contrast, peanut sIgE level was significantly lower in the Tolerant group at age 3 to 15 months, increased in Confirmed and Serologic groups but decreased in Convincing and Possibly Allergic groups over time. An algorithm combining esIgEs with peanut sIgE outperformed different clinically relevant IgE cutoffs, predicting allergy status on an "unseen" set of patients with area under the curves of 0.84 at age 3 to 15 months and 0.87 at age 2 to 3 years. CONCLUSIONS Early epitope-specific plus peanut-specific IgE is predictive of allergy status at age 4+ years.
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Affiliation(s)
- Maria Suprun
- Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Robert A Wood
- Johns Hopkins University School of Medicine, Baltimore, Md
| | - Stacie M Jones
- University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, Ark
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Mikus M, Zandian A, Sjöberg R, Hamsten C, Forsström B, Andersson M, Greiff L, Uhlén M, Levin M, Nilsson P, van Hage M, Ohlin M. Allergome-wide peptide microarrays enable epitope deconvolution in allergen-specific immunotherapy. J Allergy Clin Immunol 2020; 147:1077-1086. [PMID: 32791163 DOI: 10.1016/j.jaci.2020.08.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 07/22/2020] [Accepted: 08/04/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The interaction of allergens and allergen-specific IgE initiates the allergic cascade after crosslinking of receptors on effector cells. Antibodies of other isotypes may modulate such a reaction. Receptor crosslinking requires binding of antibodies to multiple epitopes on the allergen. Limited information is available on the complexity of the epitope structure of most allergens. OBJECTIVES We sought to allow description of the complexity of IgE, IgG4, and IgG epitope recognition at a global, allergome-wide level during allergen-specific immunotherapy (AIT). METHODS We generated an allergome-wide microarray comprising 731 allergens in the form of more than 172,000 overlapping 16-mer peptides. Allergen recognition by IgE, IgG4, and IgG was examined in serum samples collected from subjects undergoing AIT against pollen allergy. RESULTS Extensive induction of linear peptide-specific Phl p 1- and Bet v 1-specific humoral immunity was demonstrated in subjects undergoing a 3-year-long AIT against grass and birch pollen allergy, respectively. Epitope profiles differed between subjects but were largely established already after 1 year of AIT, suggesting that dominant allergen-specific antibody clones remained as important contributors to humoral immunity following their initial establishment during the early phase of AIT. Complex, subject-specific patterns of allergen isoform and group cross-reactivities in the repertoires were observed, patterns that may indicate different levels of protection against different allergen sources. CONCLUSIONS The study highlights the complexity and subject-specific nature of allergen epitopes recognized following AIT. We envisage that epitope deconvolution will be an important aspect of future efforts to describe and analyze the outcomes of AIT in a personalized manner.
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Affiliation(s)
- Maria Mikus
- Division of Affinity Proteomics, Department of Protein Science, KTH Royal Institute of Technology & SciLifeLab, Stockholm, Sweden; Unit of Experimental Asthma and Allergy Research, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Arash Zandian
- Division of Affinity Proteomics, Department of Protein Science, KTH Royal Institute of Technology & SciLifeLab, Stockholm, Sweden
| | - Ronald Sjöberg
- Division of Affinity Proteomics, Department of Protein Science, KTH Royal Institute of Technology & SciLifeLab, Stockholm, Sweden
| | - Carl Hamsten
- Division of Immunology and Allergy, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Björn Forsström
- Division of Systems Biology, Department of Protein Science, KTH Royal Institute of Technology & SciLifeLab, Stockholm, Sweden
| | - Morgan Andersson
- Department of Otorhinolaryngology, Head & Neck Surgery, Skåne University Hospital, Lund, Sweden
| | - Lennart Greiff
- Department of Otorhinolaryngology, Head & Neck Surgery, Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Mathias Uhlén
- Division of Systems Biology, Department of Protein Science, KTH Royal Institute of Technology & SciLifeLab, Stockholm, Sweden
| | - Mattias Levin
- Department of Immunotechnology, Lund University, Lund, Sweden
| | - Peter Nilsson
- Division of Affinity Proteomics, Department of Protein Science, KTH Royal Institute of Technology & SciLifeLab, Stockholm, Sweden
| | - Marianne van Hage
- Division of Immunology and Allergy, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Mats Ohlin
- Department of Immunotechnology, Lund University, Lund, Sweden.
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9
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Patil SU, Steinbrecher J, Calatroni A, Smith N, Ma A, Ruiter B, Virkud Y, Schneider M, Shreffler WG. Early decrease in basophil sensitivity to Ara h 2 precedes sustained unresponsiveness after peanut oral immunotherapy. J Allergy Clin Immunol 2019; 144:1310-1319.e4. [PMID: 31377342 DOI: 10.1016/j.jaci.2019.07.028] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 07/05/2019] [Accepted: 07/17/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Only some patients with peanut allergy undergoing oral immunotherapy (OIT) achieve sustained clinical response. Basophil activation could provide a functional surrogate of efficacy. OBJECTIVE We hypothesized that changes in basophil sensitivity and area under the curve (AUC) to the immunodominant allergen Ara h 2 correlate with clinical responses to OIT. METHODS Children with peanut allergy aged 7 to 13 years were enrolled in a single-center, open-label peanut OIT trial. Levels of specific immunoglobulins were measured throughout OIT. Peripheral blood from multiple time points was stimulated in vitro with peanut allergens for flow cytometric assessment of the percentage of CD63hi activated basophils. RESULTS Twenty-two of 30 subjects were successfully treated with OIT; after avoidance, 9 achieved sustained unresponsiveness (SU), and 13 had transient desensitization (TD). Basophil sensitivity, measured by using the dose that induces 50% of the maximal basophil response, to Ara h 2 stimulation decreased from baseline in subjects with SU (after OIT, P = .0041; after avoidance, P = .0011). At 3 months of OIT, basophil sensitivity in subjects with SU decreased from baseline compared with that in subjects with TD (median, 18-fold vs 3-fold; P = .01), with a receiver operating characteristic of 0.84 and optimal fold change of 4.9. Basophil AUC to Ara h 2 was suppressed after OIT equally in subjects with SU and those with TD (P = .4). After avoidance, basophil AUC rebounded in subjects with TD but not those with SU (P < .001). Passively sensitized basophils suppressed with postavoidance SU plasma had a lower AUC than TD plasma (6.4% vs 38.9%, P = .03). CONCLUSIONS Early decreases in basophil sensitivity to Ara h 2 correlate with SU. Basophil AUC rebounds after avoidance in subjects with TD. Therefore, different aspects of basophil activation might be useful for monitoring of OIT efficacy.
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Affiliation(s)
- Sarita U Patil
- Food Allergy Center, Massachusetts General Hospital, Boston, Mass; Harvard Medical School, Boston, Mass; Center for Immunology & Inflammatory Diseases, Massachusetts General Hospital, Boston, Mass; Food Allergy Science Initiative at Broad Institute at Massachusetts Institute of Technology and Harvard, Boston, Mass.
| | | | | | - Neal Smith
- Food Allergy Center, Massachusetts General Hospital, Boston, Mass
| | - Alex Ma
- Food Allergy Center, Massachusetts General Hospital, Boston, Mass
| | - Bert Ruiter
- Food Allergy Center, Massachusetts General Hospital, Boston, Mass; Harvard Medical School, Boston, Mass; Center for Immunology & Inflammatory Diseases, Massachusetts General Hospital, Boston, Mass; Food Allergy Science Initiative at Broad Institute at Massachusetts Institute of Technology and Harvard, Boston, Mass
| | - Yamini Virkud
- Food Allergy Center, Massachusetts General Hospital, Boston, Mass; Harvard Medical School, Boston, Mass; Food Allergy Science Initiative at Broad Institute at Massachusetts Institute of Technology and Harvard, Boston, Mass
| | | | - Wayne G Shreffler
- Food Allergy Center, Massachusetts General Hospital, Boston, Mass; Harvard Medical School, Boston, Mass; Center for Immunology & Inflammatory Diseases, Massachusetts General Hospital, Boston, Mass; Food Allergy Science Initiative at Broad Institute at Massachusetts Institute of Technology and Harvard, Boston, Mass
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Della-Torre E, Rigamonti E, Perugino C, Baghai-Sain S, Sun N, Kaneko N, Maehara T, Rovati L, Ponzoni M, Milani R, Lanzillotta M, Mahajan V, Mattoo H, Molineris I, Deshpande V, Stone JH, Falconi M, Manfredi AA, Pillai S. B lymphocytes directly contribute to tissue fibrosis in patients with IgG 4-related disease. J Allergy Clin Immunol 2019; 145:968-981.e14. [PMID: 31319101 DOI: 10.1016/j.jaci.2019.07.004] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 05/31/2019] [Accepted: 07/09/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND IgG4-related disease (IgG4-RD) is a fibroinflammatory condition marked by rapid clinical improvement after selective depletion of B lymphocytes with rituximab. This feature suggests that B cells might participate in fibrogenesis and wound healing. OBJECTIVE In the present work we aimed to demonstrate that B lymphocytes contribute directly to tissue fibrosis in patients with IgG4-RD. METHODS Total circulating CD19+ B lymphocytes, naive B cells, memory B cells, or plasmablasts from patients with IgG4-RD were cultivated with human fibroblasts. Profibrotic soluble factors and collagen production in cocultures were assessed by using ELISAs and Luminex assays. RNA sequencing and quantitative RT-PCR were used to assess fibroblast activation in the presence of B cells, as well as induction of profibrotic pathways in B-cell subsets. Relevant profibrotic and inflammatory molecules were confirmed in vitro by using functional experiments and on IgG4-RD tissue sections by using multicolor immunofluorescence studies. RESULTS B cells from patients with IgG4-RD (1) produced the profibrotic molecule platelet-derived growth factor B and stimulated collagen production by fibroblasts; (2) expressed enzymes implicated in extracellular matrix remodeling, such as lysyl oxidase homolog 2; (3) produced the chemotactic factors CCL4, CCL5, and CCL11; and (4) induced production of these same chemokines by activated fibroblasts. Plasmablasts expressed sets of genes implicated in fibroblast activation and proliferation and therefore represent cells with intrinsic profibrotic properties. CONCLUSION We have demonstrated that B cells contribute directly to tissue fibrosis in patients with IgG4-RD. These unanticipated profibrotic properties of B lymphocytes, particularly plasmablasts, might be relevant for fibrogenesis in patients with other fibroinflammatory disorders and for wound-healing processes in physiologic conditions.
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Affiliation(s)
- Emanuel Della-Torre
- Università Vita-Salute San Raffaele, IRCCS San Raffaele Scientific Institute, Milan, Italy; Ragon Institute of MGH, MIT, and Harvard, Massachusetts General Hospital, Harvard Medical School, Boston, Mass; Unit of Immunology, Rheumatology, Allergy, and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Elena Rigamonti
- Università Vita-Salute San Raffaele, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Cory Perugino
- Ragon Institute of MGH, MIT, and Harvard, Massachusetts General Hospital, Harvard Medical School, Boston, Mass; Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Simona Baghai-Sain
- Center for Translational Genomics and Bioinformatics, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Na Sun
- Ragon Institute of MGH, MIT, and Harvard, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Naoki Kaneko
- Ragon Institute of MGH, MIT, and Harvard, Massachusetts General Hospital, Harvard Medical School, Boston, Mass; Section of Oral and Maxillofacial Oncology, Division of Maxillofacial Diagnostic and Surgical Sciences, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
| | - Takashi Maehara
- Ragon Institute of MGH, MIT, and Harvard, Massachusetts General Hospital, Harvard Medical School, Boston, Mass; Section of Oral and Maxillofacial Oncology, Division of Maxillofacial Diagnostic and Surgical Sciences, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
| | - Lucrezia Rovati
- Università Vita-Salute San Raffaele, IRCCS San Raffaele Scientific Institute, Milan, Italy; Ragon Institute of MGH, MIT, and Harvard, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Maurilio Ponzoni
- Università Vita-Salute San Raffaele, IRCCS San Raffaele Scientific Institute, Milan, Italy; Pathology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Raffaella Milani
- Immunohematology and Transfusion Medicine Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Lanzillotta
- Università Vita-Salute San Raffaele, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Vinay Mahajan
- Ragon Institute of MGH, MIT, and Harvard, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Hamid Mattoo
- Immunology and Inflammation Therapeutic Area, Sanofi, Cambridge, Mass
| | - Ivan Molineris
- Center for Translational Genomics and Bioinformatics, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Vikram Deshpande
- Department of Pathology, Massachusetts General Hospital, Boston, Mass
| | - John H Stone
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Massimo Falconi
- Università Vita-Salute San Raffaele, IRCCS San Raffaele Scientific Institute, Milan, Italy; Division of Pancreatic Surgery, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Angelo A Manfredi
- Università Vita-Salute San Raffaele, IRCCS San Raffaele Scientific Institute, Milan, Italy; Unit of Immunology, Rheumatology, Allergy, and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Shiv Pillai
- Ragon Institute of MGH, MIT, and Harvard, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
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11
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Heddle R, Smith A, Woodman R, Hissaria P, Petrovsky N. Randomized controlled trial demonstrating the benefits of delta inulin adjuvanted immunotherapy in patients with bee venom allergy. J Allergy Clin Immunol 2019; 144:504-513.e16. [PMID: 31300280 PMCID: PMC7112352 DOI: 10.1016/j.jaci.2019.03.035] [Citation(s) in RCA: 14] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 03/11/2019] [Accepted: 03/22/2019] [Indexed: 12/29/2022]
Abstract
Background Allergic reactions to Hymenoptera insect stings remain a major global clinical problem. Although effective, parenteral desensitization regimens require use of costly venom extracts and require frequent visits over extended periods of time. Objective Adjuvants are commonly used to enhance the efficacy of infectious disease vaccines, and this study asked whether Advax (Vaxine Pty Ltd, Adelaide, Australia), a novel noninflammatory polysaccharide adjuvant, might provide similar benefits for allergy desensitization. Methods A randomized, controlled phase 1/2 trial was undertaken in 27 adults with a history of rapid-onset systemic allergic reactions to honeybee stings and positive specific IgE levels to evaluate the safety and efficacy of honeybee venom immunotherapy (HBVIT) combined with Advax adjuvant. Venom immunotherapy (VIT) was administered monthly for 30 months after achievement of maintenance doses. Results Advax-adjuvanted HBVIT was well tolerated. Around week 14 of VIT, specific IgG4 responses peaked in both groups but increased earlier, peaked higher, and were better maintained through the end of the study in the Advax-adjuvanted arm. Several different patterns of serologic response to VIT were seen; some subjects had a dominant IgG4 response, some had a combined IgG4 and IgG1 response, and some had an exclusively IgG1 response. In some subjects specific IgE levels increased during the induction phase and then decreased, whereas in others specific IgE levels progressively decreased from the start of VIT. Conclusion Advax adjuvant favorably enhanced the immunogenicity of HBVIT, with an early and prolonged switch to specific IgG4 production. The ability of Advax adjuvant to enhance VIT efficacy warrants further study.
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Affiliation(s)
- Robert Heddle
- University of Adelaide, North Terrace, Adelaide, Australia; Royal Adelaide Hospital, North Terrace, Adelaide, Australia; Flinders University, Bedford Park, Australia
| | - Anthony Smith
- Allergy and Clinical Immunology Department, Flinders Medical Centre, Bedford Park, Australia
| | - Richard Woodman
- Flinders Centre for Epidemiology and Biostatistics, Flinders University, Bedford Park, Australia
| | | | - Nikolai Petrovsky
- Flinders University, Bedford Park, Australia; Vaxine, Bedford Park, Australia.
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12
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Zhao J, Chen X, Long X, Rafaels N, Campbell M, Liang H, Zhang B, Barnes KC, Hamilton RG, Chen Q. The soluble worm antigens-specific antibodies used as biomarkers of Schistosoma japonicum in a low prevalence and intensity endemic area of Hubei, China. Acta Trop 2019; 195:28-34. [PMID: 30986379 PMCID: PMC8547602 DOI: 10.1016/j.actatropica.2019.04.011] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 03/18/2019] [Accepted: 04/10/2019] [Indexed: 01/20/2023]
Abstract
The precise diagnosis of Schistosoma japonicum (S. japonicum) infection plays a critical role in achieving the ultimate goal of eliminating schistosomiasis in endemic regions. We evaluated the S. japonicum soluble worm antigen protein (SWAP) specific-IgG, IgG4 and IgE levels, and evaluated the association between S. japonicum infection and these antibodies in a sample of 837 residents from a S. japonicum-endemic area in Hubei province, China. The anticipants were divided into the Training Set (TS) and Validation Set (VS) based on the chronological order. Enzyme-linked immunosorbent assays were performed to detect the SWAP-specific antibodies. Three algorithms for identifying S. japonicum infection were generated in the TS and subsequently validated in the VS. The findings were further replicated in an independent cohort from an endemic area for Schistosoma mansoni (S. mansoni) in Brazil. Our results indicated for the first time that S. japonicum-infected individuals had higher levels of SWAP-specific IgG, IgG4 and IgE, and lower value of the IgE/IgG4 ratio than uninfected individuals in both the two sets (p < 0.01). Both the infected and uninfected individuals had a high prevalence of seropositivity for IgG. We further showed that the predictive model EGR (IgE/IgG4 ratio) score performed best in Chinese population (area under the receiver operating characteristic (AUROC) 0.905, sensitivity 82.7%, specificity 84.0% in the TS; AUROC 0.933, sensitivity 87.7%, specificity 89.1% in the VS). Nevertheless, the predictive model IgG4 score performed best in Brazilian cohort (AUROC 0.788, sensitivity 73.2%, specificity 73.3%). In summary, SWAP-specific IgG could be used as a biomarker for identifying individuals who have been previously exposed to S. japonicum, and furthermore the SWAP-specific IgE/IgG4 could be used as an immune biomarker for S. japonicum infection in particular in the endemic areas with low prevalence and intensity.
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Affiliation(s)
- Jianping Zhao
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China
| | - Xiaoping Chen
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China
| | - Xin Long
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China
| | - Nicholas Rafaels
- Division of Biomedical Informatics and Personalized Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Monica Campbell
- Division of Biomedical Informatics and Personalized Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Huifang Liang
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China
| | - Bixiang Zhang
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China
| | - Kathleen C Barnes
- Division of Biomedical Informatics and Personalized Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Robert G Hamilton
- Johns Hopkins Asthmas and Allergy Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Qian Chen
- Division of Gastroenterology, Tongji Hospital, Tongji Medical College, HUST, Wuhan, China.
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13
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Boonpiyathad T, van de Veen W, Wirz O, Sokolowska M, Rückert B, Tan G, Sangasapaviliya A, Pradubpongsa P, Fuengthong R, Thantiworasit P, Sirivichayakul S, Ruxrungtham K, Akdis CA, Akdis M. Role of Der p 1-specific B cells in immune tolerance during 2 years of house dust mite-specific immunotherapy. J Allergy Clin Immunol 2018; 143:1077-1086.e10. [PMID: 30529452 DOI: 10.1016/j.jaci.2018.10.061] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 08/20/2018] [Accepted: 10/01/2018] [Indexed: 01/23/2023]
Abstract
BACKGROUND Long-term follow-up of allergen-specific B cells in terms of immunoglobulin isotype expression, plasmablast differentiation, and regulatory B (Breg) cell development during allergen-specific immunotherapy (AIT) has not been reported. OBJECTIVE Allergen-specific B-cell responses during 2 years of house dust mite AIT were compared between responder and nonresponder patients. METHODS B cells specific for Der p 1 were detected by using the fluorochrome-labeled allergen method. The frequency of IgA-, IgG1- and IgG4-switched Der p 1-specific B cells, plasmablasts, and IL-10- and IL-1 receptor antagonist (IL-1RA)-producing Breg cells were investigated and correlated to clinical response to AIT. RESULTS Sixteen of 25 patients completed the 2-year study. Eleven responder patients showed a successful response to AIT, as measured by a decrease in symptom-medication scores from 13.23 ± 0.28 to 2.45 ± 0.24 (P = .001) and a decrease in skin prick test reactivity to house dust mite from 7.0 ± 1.3 to 2.7 ± 0.5 mm (P = .001). IgG4+ and IgA+ Der p 1-specific B cells showed a significant increase after AIT, with a significantly greater frequency in responders compared with nonresponders in the IgG4+ but not the IgA+ fraction. The frequency of plasmablasts and IL-10- and/or IL-1RA-producing Breg cells was greater among responders compared with nonresponders after 2 years. The increased frequency of Der p 1-specific IgG4+ B cells, plasmablasts, and IL-10+ and dual-positive IL-10+IL-1RA+ Breg cells significantly correlated with improved clinical symptoms over the course of AIT. CONCLUSION Allergen-specific B cells in patients responding to AIT are characterized by increased numbers of IgA- and IgG4-expressing Der p 1-specific B cells, plasmablasts, and IL-10+ and/or IL-1RA+ Breg cells.
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Affiliation(s)
- Tadech Boonpiyathad
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland; Christine Kühne-Center for Allergy Research and Education, Davos, Switzerland; Department of Medicine, Phramongkutklao Hospital, Bangkok, Thailand; Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Willem van de Veen
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Oliver Wirz
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Milena Sokolowska
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Beate Rückert
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Ge Tan
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | | | | | | | | | | | - Kiat Ruxrungtham
- Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Cezmi A Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland; Christine Kühne-Center for Allergy Research and Education, Davos, Switzerland
| | - Mübeccel Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland.
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14
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Shamji MH, Kappen J, Abubakar-Waziri H, Zhang J, Steveling E, Watchman S, Kouser L, Eifan A, Switzer A, Varricchi G, Marone G, Couto-Francisco NC, Calderon M, Durham SR. Nasal allergen-neutralizing IgG 4 antibodies block IgE-mediated responses: Novel biomarker of subcutaneous grass pollen immunotherapy. J Allergy Clin Immunol 2018; 143:1067-1076. [PMID: 30445057 DOI: 10.1016/j.jaci.2018.09.039] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 09/19/2018] [Accepted: 09/28/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND Grass pollen subcutaneous immunotherapy (SCIT) is associated with induction of serum IgG4-associated inhibitory antibodies that prevent IgE-facilitated allergen binding to B cells. OBJECTIVE We sought to determine whether SCIT induces nasal allergen-specific IgG4 antibodies with inhibitory activity that correlates closely with clinical response. METHODS In a cross-sectional controlled study, nasal fluid and sera were collected during the grass pollen season from 10 SCIT-treated patients, 13 untreated allergic patients (with seasonal allergic rhinitis [SAR]), and 12 nonatopic control subjects. Nasal and serum IgE and IgG4 levels to Phleum pratense components were measured by using the Immuno Solid Allergen Chip microarray. Inhibitory activity was measured by IgE-facilitated allergen binding assay. IL-10+ regulatory B cells were quantified in peripheral blood by using flow cytometry. RESULTS Nasal and serum Phl p 1- and Phl p 5-specific IgE levels were increased in patients with SAR compared to nonatopic control subjects (all, P < .001) and SCIT-treated patients (nasal, P < .001; serum Phl p 5, P = .073). Nasal IgG4 levels were increased in the SCIT group compared to those in the SAR group (P < .001) during the pollen season compared to out of season. IgG-associated inhibitory activity in nasal fluid and serum was significantly increased in the SCIT group compared to that in the SAR (both, P < .01). The magnitude of the inhibitory activity was 93% (P < .001) in nasal fluid compared to 66% (P < .001) in serum and was reversed after depletion of IgG. Both nasal fluid (r = -0.69, P = .0005) and serum (r = -0.552, P = .0095) blocking activity correlated with global symptom improvement. IL-10+ regulatory B cells were increased in season compared to out of season in the SCIT group (P < .01). CONCLUSION For the first time, we show that nasal IgG4-associated inhibitory activity correlates closely with the clinical response to allergen immunotherapy in patients with allergic rhinitis with or without asthma.
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Affiliation(s)
- Mohamed H Shamji
- Allergy and Clinical Immunology, Immunomodulation and Tolerance Group, National Heart and Lung Institute, Inflammation Repair and Development, Imperial College, London, United Kingdom.
| | - Jasper Kappen
- Allergy and Clinical Immunology, Immunomodulation and Tolerance Group, National Heart and Lung Institute, Inflammation Repair and Development, Imperial College, London, United Kingdom; Department of Pulmonology, STZ Centre of Excellence for Asthma & COPD, Franciscus group, Rotterdam, United Kingdom
| | - Hisham Abubakar-Waziri
- Allergy and Clinical Immunology, Immunomodulation and Tolerance Group, National Heart and Lung Institute, Inflammation Repair and Development, Imperial College, London, United Kingdom
| | - Jinjin Zhang
- Allergy and Clinical Immunology, Immunomodulation and Tolerance Group, National Heart and Lung Institute, Inflammation Repair and Development, Imperial College, London, United Kingdom
| | - Esther Steveling
- Allergy and Clinical Immunology, Immunomodulation and Tolerance Group, National Heart and Lung Institute, Inflammation Repair and Development, Imperial College, London, United Kingdom
| | - Shelley Watchman
- Allergy and Clinical Immunology, Immunomodulation and Tolerance Group, National Heart and Lung Institute, Inflammation Repair and Development, Imperial College, London, United Kingdom
| | - Lubna Kouser
- Allergy and Clinical Immunology, Immunomodulation and Tolerance Group, National Heart and Lung Institute, Inflammation Repair and Development, Imperial College, London, United Kingdom
| | - Aarif Eifan
- Allergy and Clinical Immunology, Immunomodulation and Tolerance Group, National Heart and Lung Institute, Inflammation Repair and Development, Imperial College, London, United Kingdom
| | - Amy Switzer
- Allergy and Clinical Immunology, Immunomodulation and Tolerance Group, National Heart and Lung Institute, Inflammation Repair and Development, Imperial College, London, United Kingdom
| | - Gilda Varricchi
- Allergy and Clinical Immunology, Immunomodulation and Tolerance Group, National Heart and Lung Institute, Inflammation Repair and Development, Imperial College, London, United Kingdom
| | - Gianni Marone
- Allergy and Clinical Immunology, Immunomodulation and Tolerance Group, National Heart and Lung Institute, Inflammation Repair and Development, Imperial College, London, United Kingdom
| | - Natália C Couto-Francisco
- Allergy and Clinical Immunology, Immunomodulation and Tolerance Group, National Heart and Lung Institute, Inflammation Repair and Development, Imperial College, London, United Kingdom
| | - Moises Calderon
- Allergy and Clinical Immunology, Immunomodulation and Tolerance Group, National Heart and Lung Institute, Inflammation Repair and Development, Imperial College, London, United Kingdom
| | - Stephen R Durham
- Allergy and Clinical Immunology, Immunomodulation and Tolerance Group, National Heart and Lung Institute, Inflammation Repair and Development, Imperial College, London, United Kingdom
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15
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Berin MC, Grishin A, Masilamani M, Leung DYM, Sicherer SH, Jones SM, Burks AW, Henning AK, Dawson P, Grabowska J, Agashe C, Davidson WF, Wood RA, Sampson HA. Egg-specific IgE and basophil activation but not egg-specific T-cell counts correlate with phenotypes of clinical egg allergy. J Allergy Clin Immunol 2018. [PMID: 29518422 DOI: 10.1016/j.jaci.2018.01.044] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [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: 12/01/2022]
Abstract
BACKGROUND Egg allergy is phenotypically heterogeneous. A subset of patients with egg allergy can tolerate egg in an extensively heated form. Inclusion of baked egg (BE) into the diet accelerates resolution of egg allergy. Conversely, BE reactivity is associated with persistent disease. The immune basis of this clinical heterogeneity is unknown. OBJECTIVES We sought to study egg-specific antibody, basophil, and T-cell responses in children with reactivity or tolerance to BE. METHODS All participants underwent double-blind, placebo-controlled challenges to BE, and those who tolerated BE were challenged with unheated egg white protein to confirm clinical egg reactivity. Laboratory studies included serum antibody measurements, basophil activation tests, and CD154-based detection of egg-responsive T cells by using flow cytometry. RESULTS Of the 129 children studied, BE-reactive participants had significantly greater levels of egg-, ovalbumin-, and ovomucoid-specific IgE; lower ratios of egg-specific IgG4/IgE; and increased basophil activation in response to egg. Among all participants, CD154-based profiling revealed egg-responsive T cells producing IL-4 and IL-13 but little IL-10 or IFN-γ, as well as the presence of egg-responsive Foxp3+CD25+CD127low regulatory T cells. Egg-responsive T cells expressed CCR4, CCR6, and CXCR5, indicating capacity for homing to the skin, mucosa, and B-cell follicles. However, neither the frequency nor phenotype of egg-responsive T cells was different in those with tolerance or reactivity to BE. CONCLUSIONS Egg-specific antibody and basophil responses, but not T-cell responses, are greater in those with reactivity versus tolerance to BE. Egg-specific antibody and T-cell responses were highly heterogeneous in this cohort. The clinical implications of this immune heterogeneity will need to be studied longitudinally.
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Affiliation(s)
- M Cecilia Berin
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Alexander Grishin
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Madhan Masilamani
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Scott H Sicherer
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Stacie M Jones
- Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, Ark
| | - A Wesley Burks
- Department of Pediatrics, University of North Carolina, Chapel Hill, NC
| | | | | | - Joanna Grabowska
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Charuta Agashe
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Wendy F Davidson
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Robert A Wood
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Hugh A Sampson
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY
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16
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Kaur A, Skoner D, Ibrahim J, Li Q, Lockey RF, Blaiss M, Bufe A, Andersen JS, Canonica GW, Nolte H. Effect of grass sublingual tablet immunotherapy is similar in children and adults: A Bayesian approach to design pediatric sublingual immunotherapy trials. J Allergy Clin Immunol 2017; 141:1744-1749. [PMID: 29221713 DOI: 10.1016/j.jaci.2017.09.051] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 09/19/2017] [Accepted: 09/29/2017] [Indexed: 01/02/2023]
Abstract
BACKGROUND Large sample sizes are needed for sublingual immunotherapy (SLIT) trials because of inherent data variability secondary to inconsistent allergen exposure. Obtaining large sample sizes for pediatric SLIT trials is challenging, but a Bayesian approach using prior adult data can reduce the necessary sample size. OBJECTIVE We sought to describe how a Bayesian framework using prior information from adult trials can be used to improve pediatric SLIT clinical development. METHODS Data were compiled by using a frequentist approach (conventional clinical trial approach independent of prior data) from trials conducted during the clinical development of timothy grass SLIT-tablets. RESULTS The treatment effect of timothy grass SLIT-tablets was considered similar between pediatric (n = 795) and adult (n = 2299) data pools, with relative total combined symptom plus medication score improvement versus placebo of 21% (95% CI, 11.0% to 30.4%) and 20% (95% CI, 14.6% to 24.4%), respectively. Phleum pratense-specific IgG4 and IgE-blocking factor increased from baseline in both children and adults treated with timothy grass SLIT-tablets. Given the reasonable assumption in similarity of treatment response between adults and children, a Bayesian approach is described to demonstrate rigorous efficacy criteria for pediatric trials incorporating information from prior adult trials and thereby reduce the sample size. CONCLUSIONS Data support the similarity of efficacy and immunologic changes between children and adults treated with SLIT for allergic rhinoconjunctivitis. Therefore it is appropriate to use data from adult trials to design feasible trials in children, which might reduce unsafe off-label use by promoting more quickly proper labeling of approved products.
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Affiliation(s)
| | - David Skoner
- Department of Pediatrics, West Virginia University School of Medicine, Morgantown, WV
| | - Joseph Ibrahim
- Department of Biostatistics, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC
| | | | - Richard F Lockey
- Division of Allergy and Immunology, University of South Florida Morsani College of Medicine, Tampa, Fla
| | - Michael Blaiss
- Department of Pediatrics, Medical College of Georgia, Augusta, Ga
| | - Albrecht Bufe
- Department of Experimental Pneumology, Ruhr-University Bochum, Bochum, Germany
| | | | - Giorgio Walter Canonica
- Personalized Medicine Clinic Asthma & Allergy, Humanitas University & Research Hospital, Milan, Italy
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17
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Heeringa JJ, Karim AF, van Laar JAM, Verdijk RM, Paridaens D, van Hagen PM, van Zelm MC. Expansion of blood IgG 4+ B, T H2, and regulatory T cells in patients with IgG 4-related disease. J Allergy Clin Immunol 2017; 141:1831-1843.e10. [PMID: 28830675 DOI: 10.1016/j.jaci.2017.07.024] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Revised: 07/26/2017] [Accepted: 07/31/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND IgG4-related disease (IgG4-RD) is a systemic fibroinflammatory condition affecting various organs and has a diverse clinical presentation. Fibrosis and accumulation of IgG4+ plasma cells in tissue are hallmarks of the disease, and IgG4-RD is associated with increased IgG4 serum levels. However, disease pathogenesis is still unclear, and these cellular and molecular parameters are neither sensitive nor specific for the diagnosis of IgG4-RD. OBJECTIVE Here we sought to develop a flow cytometric gating strategy to reliably identify blood IgG4+ B cells to study their cellular and molecular characteristics and investigate their contribution in disease pathogenesis. METHODS Sixteen patients with histologically confirmed IgG4-RD, 11 patients with sarcoidosis, and 30 healthy subjects were included for 11-color flow cytometric analysis of peripheral blood for IgG4-expressing B cells and TH subsets. In addition, detailed analysis of activation markers and chemokine receptors was performed on IgG4-expressing B cells, and IgG4 transcripts were analyzed for somatic hypermutations. RESULTS Cellular and molecular analyses revealed increased numbers of blood IgG4+ memory B cells in patients with IgG4-RD. These cells showed reduced expression of CD27 and CXCR5 and increased signs of antibody maturation. Furthermore, patients with IgG4-RD, but not patients with sarcoidosis, had increased numbers of circulating plasmablasts and CD21low B cells, as well as TH2 and regulatory T cells, indicating a common disease pathogenesis in patients with IgG4-RD. CONCLUSION These results provide new insights into the dysregulated IgG4 response in patients with IgG4-RD. A specific "peripheral lymphocyte signature" observed in patients with IgG4-RD, could support diagnosis and treatment monitoring.
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Affiliation(s)
- Jorn J Heeringa
- Department of Immunology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - A Faiz Karim
- Department of Immunology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Jan A M van Laar
- Department of Immunology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Robert M Verdijk
- Department of Pathology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Dion Paridaens
- Department of Oculoplastic & Orbital Surgery, The Rotterdam Eye Hospital, Rotterdam, The Netherlands
| | - P Martin van Hagen
- Department of Immunology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Menno C van Zelm
- Department of Immunology and Pathology, Central Clinical School, Monash University and Alfred Hospital, Melbourne, Australia.
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van de Veen W, Akdis M. Role of IgG 4 in IgE-mediated allergic responses. J Allergy Clin Immunol 2016; 138:1434-1435. [PMID: 27566454 DOI: 10.1016/j.jaci.2016.07.022] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 07/05/2016] [Accepted: 07/20/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Willem van de Veen
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zürich, and the Christine Kühne-Center for Allergy Research and Education, Davos, Switzerland
| | - Mübeccel Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zürich, and the Christine Kühne-Center for Allergy Research and Education, Davos, Switzerland.
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Woodfolk JA. Benign TH2 immunity in children: A fresh perspective on control of the allergic response. J Allergy Clin Immunol 2016; 137:388-9. [PMID: 26853130 DOI: 10.1016/j.jaci.2015.12.1153] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 12/04/2015] [Accepted: 12/11/2015] [Indexed: 02/06/2023]
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20
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Spertini F, DellaCorte G, Kettner A, de Blay F, Jacobsen L, Jutel M, Worm M, Charlon V, Reymond C. Efficacy of 2 months of allergen-specific immunotherapy with Bet v 1-derived contiguous overlapping peptides in patients with allergic rhinoconjunctivitis: Results of a phase IIb study. J Allergy Clin Immunol 2016; 138:162-8. [PMID: 27373329 DOI: 10.1016/j.jaci.2016.02.044] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Revised: 02/08/2016] [Accepted: 02/19/2016] [Indexed: 01/13/2023]
Abstract
BACKGROUND An immunotherapy formulation consisting of 3 contiguous overlapping peptides (COPs) derived from Bet v 1, the major birch pollen allergen, showed good clinical tolerability in a previous phase I/IIa clinical trial. OBJECTIVES We sought to evaluate the efficacy and safety of allergen-specific immunotherapy using 2 dose regimens of Bet v 1 COPs versus placebo in subjects with birch pollen-induced allergic rhinoconjunctivitis. METHODS A randomized, double-blind, placebo-controlled phase IIb clinical trial was performed to assess the efficacy of Bet v 1 COP immunotherapy during the 2013 birch pollen season. Before the season, Bet v 1 COPs (50 and 100 μg in aluminum hydroxide) or placebo (saline and aluminum hydroxide) were administered as 5 subcutaneous injections to 239 adults with allergic rhinoconjunctivitis to birch pollen. Bet v 1 COPs at 25 or 50 μg were administered on day 1, and 50 or 100 μg was administered on days 8, 15, 29, and 57, respectively. Patients were monitored for adverse events during the treatment period and assessed for combined rhinoconjunctivitis symptom and medication scores, as well as quality of life. RESULTS Rhinoconjunctivitis symptom and medication scores improved in both Bet v 1 COP-treated groups, reaching statistical significance over placebo in the 50-μg group (least squares mean, -0.23; 26% improvement; P = .015). Both active groups showed significant improvement in quality of life and nighttime nasal symptom scores, supporting the primary end point findings. Bet v 1 COP injections were well tolerated, with a higher frequency of systemic adverse events in the 100-μg group. CONCLUSION Two months of preseasonal immunotherapy with 3 COPs derived from Bet v 1 at a 50-μg dose showed promising efficacy, small risk for systemic reactions, and immunomodulatory changes in this single-season, dose-finding, phase IIb trial in patients allergic to birch pollen.
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Affiliation(s)
- François Spertini
- Division of Immunology and Allergy, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
| | | | | | - Frédéric de Blay
- Chest Diseases Department, Strasbourg University Hospital, Federation of Translational medicine, Strasbourg University, Strasbourg, France
| | - Lars Jacobsen
- Allergy Learning and Consulting, Copenhagen, Denmark
| | - Marek Jutel
- "ALL-MED" Medical Research Institute, Department of Clinical Immunology, Silesian Piasts University of Medicine, Wroclaw, Poland
| | - Margitta Worm
- Allergie-Centrum-Charité, Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Berlin, Berlin, Germany
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Platts-Mills TAE, Schuyler AJ, Erwin EA, Commins SP, Woodfolk JA. IgE in the diagnosis and treatment of allergic disease. J Allergy Clin Immunol 2016; 137:1662-1670. [PMID: 27264001 PMCID: PMC5406226 DOI: 10.1016/j.jaci.2016.04.010] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 04/22/2016] [Accepted: 04/22/2016] [Indexed: 10/21/2022]
Abstract
Traditionally, the concept of allergy implied an abnormal response to an otherwise benign agent (eg, pollen or food), with an easily identifiable relationship between exposure and disease. However, there are syndromes in which the relationship between exposure to the relevant allergen and the "allergic" disease is not clear. In these cases the presence of specific IgE antibodies can play an important role in identifying the relevant allergen and provide a guide to therapy. Good examples include chronic asthma and exposure to perennial indoor allergens and asthma related to fungal infection. Finally, we are increasingly aware of forms of food allergy in which the relationship between exposure and the disease is delayed by 3 to 6 hours or longer. Three forms of food allergy with distinct clinical features are now well recognized. These are (1) anaphylactic sensitivity to peanut, (2) eosinophilic esophagitis related to cow's milk, and (3) delayed anaphylaxis to red meat. In these syndromes the immunology of the response is dramatically different. Peanut and galactose α-1,3-galactose (alpha-gal) are characterized by high- or very high-titer IgE antibodies for Ara h 2 and alpha-gal, respectively. By contrast, eosinophilic esophagitis is characterized by low levels of IgE specific for milk proteins with high- or very high-titer IgG4 to the same proteins. The recent finding is that patients with alpha-gal syndrome do not have detectable IgG4 to the oligosaccharide. Thus the serum results not only identify relevant antigens but also provide a guide to the nature of the immune response.
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Affiliation(s)
| | | | - Elizabeth A Erwin
- Nationwide Children's Hospital, Center for Innovation in Pediatric Practice, Columbus, Ohio
| | - Scott P Commins
- Division of Rheumatology, Allergy, and Immunology, University of North Carolina, Chapel Hill, NC
| | - Judith A Woodfolk
- University of Virginia, Asthma and Allergy Disease Center, Charlottesville, Va
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Mattoo H, Mahajan VS, Maehara T, Deshpande V, Della-Torre E, Wallace ZS, Kulikova M, Drijvers JM, Daccache J, Carruthers MN, Castelino FV, Stone JR, Stone JH, Pillai S. Clonal expansion of CD4(+) cytotoxic T lymphocytes in patients with IgG4-related disease. J Allergy Clin Immunol 2016; 138:825-838. [PMID: 26971690 DOI: 10.1016/j.jaci.2015.12.1330] [Citation(s) in RCA: 240] [Impact Index Per Article: 30.0] [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: 09/11/2015] [Revised: 11/30/2015] [Accepted: 12/14/2015] [Indexed: 12/24/2022]
Abstract
BACKGROUND IgG4-related disease (IgG4-RD) is a systemic condition of unknown cause characterized by highly fibrotic lesions with dense lymphoplasmacytic infiltrates. CD4(+) T cells constitute the major inflammatory cell population in IgG4-RD lesions. OBJECTIVE We used an unbiased approach to characterize CD4(+) T-cell subsets in patients with IgG4-RD based on their clonal expansion and ability to infiltrate affected tissue sites. METHODS We used flow cytometry to identify CD4(+) effector/memory T cells in a cohort of 101 patients with IgG4-RD. These expanded cells were characterized by means of gene expression analysis and flow cytometry. Next-generation sequencing of the T-cell receptor β chain gene was performed on CD4(+)SLAMF7(+) cytotoxic T lymphocytes (CTLs) and CD4(+)GATA3(+) TH2 cells in a subset of patients to identify their clonality. Tissue infiltration by specific T cells was examined by using quantitative multicolor imaging. RESULTS CD4(+) effector/memory T cells with a cytolytic phenotype were expanded in patients with IgG4-RD. Next-generation sequencing revealed prominent clonal expansions of these CD4(+) CTLs but not CD4(+)GATA3(+) memory TH2 cells in patients with IgG4-RD. The dominant T cells infiltrating a range of inflamed IgG4-RD tissue sites were clonally expanded CD4(+) CTLs that expressed SLAMF7, granzyme A, IL-1β, and TGF-β1. Clinical remission induced by rituximab-mediated B-cell depletion was associated with a reduction in numbers of disease-associated CD4(+) CTLs. CONCLUSIONS IgG4-RD is prominently linked to clonally expanded IL-1β- and TGF-β1-secreting CD4(+) CTLs in both peripheral blood and inflammatory tissue lesions. These active, terminally differentiated, cytokine-secreting effector CD4(+) T cells are now linked to a human disease characterized by chronic inflammation and fibrosis.
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Affiliation(s)
- Hamid Mattoo
- Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Vinay S Mahajan
- Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Takashi Maehara
- Massachusetts General Hospital, Harvard Medical School, Boston, Mass; Section of Oral and Maxillofacial Oncology, Division of Maxillofacial Diagnostic and Surgical Sciences, Fukuoka, Japan
| | - Vikram Deshpande
- Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | | | - Zachary S Wallace
- Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Maria Kulikova
- Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Jefte M Drijvers
- Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Joe Daccache
- Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | | | | | - James R Stone
- Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - John H Stone
- Massachusetts General Hospital, Harvard Medical School, Boston, Mass.
| | - Shiv Pillai
- Massachusetts General Hospital, Harvard Medical School, Boston, Mass.
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Renand A, Archila LD, McGinty J, Wambre E, Robinson D, Hales BJ, Thomas WR, Kwok WW. Chronic cat allergen exposure induces a TH2 cell-dependent IgG4 response related to low sensitization. J Allergy Clin Immunol 2015; 136:1627-1635.e13. [PMID: 26371841 DOI: 10.1016/j.jaci.2015.07.031] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 06/15/2015] [Accepted: 07/17/2015] [Indexed: 01/13/2023]
Abstract
BACKGROUND In human subjects, allergen tolerance has been observed after high-dose allergen exposure or after completed allergen immunotherapy, which is related to the accumulation of anti-inflammatory IgG4. However, the specific T-cell response that leads to IgG4 induction during chronic allergen exposure remains poorly understood. OBJECTIVE We sought to evaluate the relationship between cat allergen-specific T-cell frequency, cat allergen-specific IgE and IgG4 titers, and clinical status in adults with cat allergy with and without cat ownership and the cellular mechanism by which IgG4 is produced. METHODS Fel d 1-, Fel d 4-, Fel d 7-, and Fel d 8-specific T-cell responses were characterized by CD154 expression after antigen stimulation. RESULTS In allergic subjects without cat ownership, the frequency of cat allergen (Fel d 1 and Fel d 4)-specific TH2 (sTH2) cells correlates with higher IgE levels and is linked to asthma. Paradoxically, we observed that subjects with cat allergy and chronic cat exposure maintain a high frequency of sTH2 cells, which correlates with higher IgG4 levels and low sensitization. B cells from allergic, but not nonallergic subjects, are able to produce IgG4 after cognate interactions with sTH2 clones and Fel d 1 peptide or the Fel d 1 recombinant protein. CONCLUSION These experiments suggest that (1) allergen-experienced B cells with the capacity to produce IgG4 are present in allergic subjects and (2) cat allergen exposure induces an IgG4 response in a TH2 cell-dependent manner. Thus IgG4 accumulation could be mediated by chronic activation of the TH2 response, which in turn drives desensitization.
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Affiliation(s)
- Amedee Renand
- Benaroya Research Institute at Virginia Mason, Seattle, Wash
| | - Luis D Archila
- Benaroya Research Institute at Virginia Mason, Seattle, Wash
| | - John McGinty
- Benaroya Research Institute at Virginia Mason, Seattle, Wash
| | - Erik Wambre
- Benaroya Research Institute at Virginia Mason, Seattle, Wash
| | - David Robinson
- the Asthma and Allergy Department, Virginia Mason Medical Center, Seattle, Wash
| | - Belinda J Hales
- Telethon Kids Institute, University of Western Australia, Subiaco, Australia
| | - Wayne R Thomas
- Telethon Kids Institute, University of Western Australia, Subiaco, Australia
| | - William W Kwok
- Benaroya Research Institute at Virginia Mason, Seattle, Wash; Department of Medicine, University of Washington, Seattle, Wash.
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Hoh RA, Joshi SA, Liu Y, Wang C, Roskin KM, Lee JY, Pham T, Looney TJ, Jackson KJL, Dixit VP, King J, Lyu SC, Jenks J, Hamilton RG, Nadeau KC, Boyd SD. Single B-cell deconvolution of peanut-specific antibody responses in allergic patients. J Allergy Clin Immunol 2015; 137:157-167. [PMID: 26152318 DOI: 10.1016/j.jaci.2015.05.029] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2014] [Revised: 05/09/2015] [Accepted: 05/15/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND The frequencies, cellular phenotypes, epitope specificity, and clonal diversity of allergen-specific B cells in patients with food allergy are not fully understood but are of major pathogenic and therapeutic significance. OBJECTIVE We sought to characterize peanut allergen-specific B-cell populations and the sequences and binding activities of their antibodies before and during immunotherapy. METHODS B cells binding fluorescently labeled Ara h 1 or Ara h 2 were phenotyped and isolated by means of flow cytometric sorting from 18 patients at baseline and 13 patients during therapy. Fifty-seven mAbs derived from allergen-binding single B cells were evaluated by using ELISA, Western blotting, and peptide epitope mapping. Deep sequencing of the B-cell repertoires identified additional members of the allergen-specific B-cell clones. RESULTS Median allergen-binding B-cell frequencies were 0.0097% (Ara h 1) or 0.029% (Ara h 2) of B cells in baseline blood from allergic patients and approximately 3-fold higher during immunotherapy. Five of 57 allergen-specific cells belonged to clones containing IgE-expressing members. Almost all allergen-specific antibodies were mutated, and binding to both conformational and linear allergen epitopes was detected. Increasing somatic mutation of IgG4 members of a clone was seen in immunotherapy, whereas IgE mutation levels in the clone did not increase. CONCLUSION Most peanut allergen-binding B cells isolated by means of antigen-specific flow sorting express mutated and isotype-switched antibodies. Immunotherapy increases their frequency in the blood, and even narrowly defined allergen epitopes are recognized by numerous distinct B-cell clones in a patient. The results also suggest that oral immunotherapy can stimulate somatic mutation of allergen-specific IgG4.
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Affiliation(s)
- Ramona A Hoh
- Department of Pathology, Stanford University, Stanford, Calif
| | - Shilpa A Joshi
- Department of Pathology, Stanford University, Stanford, Calif
| | - Yi Liu
- Department of Pathology, Stanford University, Stanford, Calif; Biomedical Informatics Training Program, Stanford University, Stanford, Calif
| | - Chen Wang
- Department of Pathology, Stanford University, Stanford, Calif
| | | | - Ji-Yeun Lee
- Department of Pathology, Stanford University, Stanford, Calif
| | - Tho Pham
- Department of Pathology, Stanford University, Stanford, Calif
| | - Tim J Looney
- Department of Pathology, Stanford University, Stanford, Calif
| | | | | | - Jasmine King
- Department of Pathology, Stanford University, Stanford, Calif
| | - Shu-Chen Lyu
- Department of Pediatrics, Stanford University, Stanford, Calif
| | - Jennifer Jenks
- Department of Pediatrics, Stanford University, Stanford, Calif
| | - Robert G Hamilton
- Division of Allergy and Clinical Immunology, School of Medicine, Johns Hopkins University, Baltimore, Md
| | - Kari C Nadeau
- Department of Pediatrics, Stanford University, Stanford, Calif
| | - Scott D Boyd
- Department of Pathology, Stanford University, Stanford, Calif.
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Santos AF, James LK, Bahnson HT, Shamji MH, Couto-Francisco NC, Islam S, Houghton S, Clark AT, Stephens A, Turcanu V, Durham SR, Gould HJ, Lack G. IgG4 inhibits peanut-induced basophil and mast cell activation in peanut-tolerant children sensitized to peanut major allergens. J Allergy Clin Immunol 2015; 135:1249-56. [PMID: 25670011 DOI: 10.1016/j.jaci.2015.01.012] [Citation(s) in RCA: 182] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 01/26/2015] [Accepted: 01/26/2015] [Indexed: 12/24/2022]
Abstract
Background Most children with detectable peanut-specific IgE (P-sIgE) are not allergic to peanut. We addressed 2 non–mutually exclusive hypotheses for the discrepancy between allergy and sensitization: (1) differences in P-sIgE levels between children with peanut allergy (PA) and peanut-sensitized but tolerant (PS) children and (2) the presence of an IgE inhibitor, such as peanut-specific IgG4 (P-sIgG4), in PS patients. Methods Two hundred twenty-eight children (108 patients with PA, 77 PS patients, and 43 nonsensitized nonallergic subjects) were studied. Levels of specific IgE and IgG4 to peanut and its components were determined. IgE-stripped basophils or a mast cell line were used in passive sensitization activation and inhibition assays. Plasma of PS subjects and patients submitted to peanut oral immunotherapy (POIT) were depleted of IgG4 and retested in inhibition assays. Results Basophils and mast cells sensitized with plasma from patients with PA but not PS patients showed dose-dependent activation in response to peanut. Levels of sIgE to peanut and its components could only partially explain differences in clinical reactivity between patients with PA and PS patients. P-sIgG4 levels (P = .023) and P-sIgG4/P-sIgE (P < .001), Ara h 1–sIgG4/Ara h 1–sIgE (P = .050), Ara h 2–sIgG4/Ara h 2–sIgE (P = .004), and Ara h 3–sIgG4/Ara h 3–sIgE (P = .016) ratios were greater in PS children compared with those in children with PA. Peanut-induced activation was inhibited in the presence of plasma from PS children with detectable P-sIgG4 levels and POIT but not from nonsensitized nonallergic children. Depletion of IgG4 from plasma of children with PS (and POIT) sensitized to Ara h 1 to Ara h 3 partially restored peanut-induced mast cell activation (P = .007). Conclusions Differences in sIgE levels and allergen specificity could not justify the clinical phenotype in all children with PA and PS children. Blocking IgG4 antibodies provide an additional explanation for the absence of clinical reactivity in PS patients sensitized to major peanut allergens.
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Suárez-Fueyo A, Ramos T, Galán A, Jimeno L, Wurtzen PA, Marin A, de Frutos C, Blanco C, Carrera AC, Barber D, Varona R. Grass tablet sublingual immunotherapy downregulates the TH2 cytokine response followed by regulatory T-cell generation. J Allergy Clin Immunol 2013; 133:130-8.e1-2. [PMID: 24290282 DOI: 10.1016/j.jaci.2013.09.043] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 09/12/2013] [Accepted: 09/26/2013] [Indexed: 01/08/2023]
Abstract
BACKGROUND Sublingual administration of Phleum pratense allergen immunotherapy (SLIT) tablets is a clinically efficient treatment for grass pollen-induced rhinoconjunctivitis. This immunotherapy downregulates TH2 immune responses, induces tolerogenic pathways, and increases regulatory T cells. However, associated immune response markers of allergen desensitization remain undefined. OBJECTIVE We sought to characterize the kinetics of individual changes in the immunologic response to grass tablet SLIT. METHODS We evaluated the systemic effects of SLIT in a longitudinal analysis of humoral and cellular immune parameters in peripheral blood samples. RESULTS Grass tablet SLIT administration induced a 2-phase systemic humoral and cellular response. The TH2 response was initially exacerbated and detected as increased allergen-specific IgE (sIgE) and IgG4 (sIgG4) levels and an increase in IL-4-producing cells, followed by downregulation of the TH2 response with a shift toward a TH1 cytokine profile. T cells with a regulatory phenotype were also elicited. Statistical correlations between immunologic measurements for each patient throughout therapy indicated that TH2 response downregulation and reduction of the immediate SLIT-induced IgE response were associated with increased allergen-specific IgG4 synthesis early in therapy. TH2 response downregulation by month 4 correlated with increased frequency of CD4(+) T cells with a regulatory phenotype by 12 months. CONCLUSION Changes in sIgE levels after therapy were linked to a specific IgG4 response, and production of blocking antibodies correlated with TH2 response downregulation. Reduced IL-4(+) cell frequency was linked to an increase in the frequency of CD4(+) T cells with a regulatory phenotype. Changes in sIgE levels and reduced IL-4 and blocking antibody levels could thus be used as indicators of a patient's immune response to therapy.
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Affiliation(s)
- Abel Suárez-Fueyo
- Department of Immunology and Oncology, Centro Nacional de Biotecnología (CNB-CSIC), Madrid, Spain
| | - Tania Ramos
- Servicio de Alergia, Hospital Universitario de La Princesa (IP), Instituto de Investigación Sanitaria Princesa, Madrid, Spain
| | | | | | | | | | - Consolación de Frutos
- Servicio de Alergia, Hospital Universitario de La Princesa (IP), Instituto de Investigación Sanitaria Princesa, Madrid, Spain
| | - Carlos Blanco
- Servicio de Alergia, Hospital Universitario de La Princesa (IP), Instituto de Investigación Sanitaria Princesa, Madrid, Spain
| | - Ana C Carrera
- Department of Immunology and Oncology, Centro Nacional de Biotecnología (CNB-CSIC), Madrid, Spain
| | | | - Rosa Varona
- Department of Immunology and Oncology, Centro Nacional de Biotecnología (CNB-CSIC), Madrid, Spain.
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