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Gates J, Hearn A, Mason T, Fernandes M, Green L, Thomson L, Roxas C, Lam J, d'Ancona G, Nanzer AM, Dhariwal J, Jackson DJ. Long-Term Effectiveness of Anti-IL-4R Therapy Following Suboptimal Response to Anti-IL-5/5R Therapy in Severe Eosinophilic Asthma. J Allergy Clin Immunol Pract 2024:S2213-2198(24)00343-X. [PMID: 38583517 DOI: 10.1016/j.jaip.2024.03.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 03/12/2024] [Accepted: 03/28/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Dupilumab is an anti-IL-4R monoclonal antibody (mAb) with proven efficacy in severe eosinophilic asthma (SEA). A suboptimal response to anti-IL-5/5R mAbs is seen in some patients with ongoing evidence of type 2 (T2) inflammation. OBJECTIVE To understand whether targeting IL-13 pathways with dupilumab in these patients may lead to better clinical outcomes. METHODS We performed a retrospective analysis of the extended clinical effectiveness of dupilumab up to 2 years of treatment in patients with SEA who had not responded adequately to anti-IL-5/5R biologics. The ability to achieve clinical remission and the change in the remission domains of exacerbation rate (AER), maintenance oral corticosteroid dose (mOCS), lung function (forced expiratory volume in 1 second), and asthma control (Asthma Control Questionnaire 6) were recorded. RESULTS Thirty-seven patients (mean age 41 years, 70% female) were included in the analysis. The mean (standard deviation) AER fell by almost 90% from 3.16 (1.28) at dupilumab initiation to 0.35 (0.72) after 1 year. The median (interquartile range) mOCS dose (n = 20) fell from 10 (5-25) mg to 0 (0-5) mg at 1 year, with 14 of 20 (70%) able to stop prednisolone altogether. Clinical remission was achieved in 16 of 37 (43%). Patients who achieved remission had a higher pre-IL-5/5R fractional exhaled nitric oxide (FeNO) level (85 [39-198] parts per billion [ppb] vs 75 [42-96] ppb, P = .03). CONCLUSIONS Significant improvements in clinical outcomes are possible after a switch to dupilumab in patients experiencing a suboptimal response to anti-IL-5/5R therapies. A higher FeNO in poor responders to anti-IL-5/5R who achieve remission with dupilumab is suggestive of an IL-13-driven subphenotype of T2-high asthma in which the eosinophil appears unlikely to play a key role in the disease pathogenesis.
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Affiliation(s)
- Jessica Gates
- Guy's Severe Asthma Centre, Guy's & St Thomas' NHS Trust, London, United Kingdom; School of Immunology & Microbial Sciences, King's College London, London, United Kingdom
| | - Andrew Hearn
- Guy's Severe Asthma Centre, Guy's & St Thomas' NHS Trust, London, United Kingdom; School of Immunology & Microbial Sciences, King's College London, London, United Kingdom
| | - Tom Mason
- Guy's Severe Asthma Centre, Guy's & St Thomas' NHS Trust, London, United Kingdom
| | - Mariana Fernandes
- Guy's Severe Asthma Centre, Guy's & St Thomas' NHS Trust, London, United Kingdom
| | - Linda Green
- Guy's Severe Asthma Centre, Guy's & St Thomas' NHS Trust, London, United Kingdom
| | - Louise Thomson
- Guy's Severe Asthma Centre, Guy's & St Thomas' NHS Trust, London, United Kingdom
| | - Cris Roxas
- Guy's Severe Asthma Centre, Guy's & St Thomas' NHS Trust, London, United Kingdom
| | - Jodie Lam
- Guy's Severe Asthma Centre, Guy's & St Thomas' NHS Trust, London, United Kingdom
| | - Grainne d'Ancona
- Guy's Severe Asthma Centre, Guy's & St Thomas' NHS Trust, London, United Kingdom
| | - Alexandra M Nanzer
- Guy's Severe Asthma Centre, Guy's & St Thomas' NHS Trust, London, United Kingdom; School of Immunology & Microbial Sciences, King's College London, London, United Kingdom
| | - Jaideep Dhariwal
- Guy's Severe Asthma Centre, Guy's & St Thomas' NHS Trust, London, United Kingdom
| | - David J Jackson
- Guy's Severe Asthma Centre, Guy's & St Thomas' NHS Trust, London, United Kingdom; School of Immunology & Microbial Sciences, King's College London, London, United Kingdom.
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Nanzer AM, Maynard-Paquette AC, Alam V, Green L, Thomson L, Lam J, Fernandes M, Roxas C, d'Ancona G, Hearn A, Gates J, Agarwal S, Kent BD, Fernando M, D'Cruz DP, Hopkins C, Ismail TF, Dhariwal J, Jackson DJ. Long-Term Effectiveness of Benralizumab in Eosinophilic Granulomatosis With Polyangiitis. J Allergy Clin Immunol Pract 2024; 12:724-732. [PMID: 38211889 DOI: 10.1016/j.jaip.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 12/19/2023] [Accepted: 01/03/2024] [Indexed: 01/13/2024]
Abstract
BACKGROUND Eosinophilic granulomatosis with polyangiitis (EGPA) is a multisystemic disease characterized by eosinophilic tissue inflammation. Benralizumab, an anti-IL-5 receptor (anti-IL-5R) monoclonal antibody, induces rapid depletion of eosinophils; its longer-term effect in EGPA is unknown. OBJECTIVE To assess the real-world effectiveness and clinical remission rates of anti-IL-5R therapy in EGPA. METHODS We performed a retrospective cohort analysis of patients with EGPA, who commenced treatment with benralizumab. Clinical remission, assessed at 1 year and 2 years after the initiation of benralizumab, was defined as an absence of active vasculitis (Birmingham Vasculitis Activity Score of 0) and an oral corticosteroid (OCS) dose of ≤4 mg/d of prednisolone. "Super-responders" were defined as patients in remission and free of any significant relapses (asthma or extrapulmonary) over the preceding 12 months. The corticosteroid-sparing capacity of benralizumab, patient-reported outcome measures, and characteristics associated with clinical remission and super-responder status were also analyzed. RESULTS A total of 70 patients completed at least 1 year of treatment with benralizumab, of whom 53 completed 2 years. Of 70 patients, 47 (67.1%) met the definition for clinical remission at 1 year, with a similar proportion in remission at 2 years. Excluding asthma-related relapses, 61 of 70 (87.1%) patients were relapse free at 1 year, and of the 53 who completed 2 years, 45 (84.9%) were relapse free. A total of 67.9% of patients no longer needed any OCS for disease control. No significant difference was seen between antineutrophilic cytoplasmic antibody (ANCA)-positive and ANCA-negative subgroups. CONCLUSIONS In this real-world setting of patients with EGPA, treatment with benralizumab was well tolerated and resulted in corticosteroid-free clinical remission for the majority of patients.
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Affiliation(s)
- Alexandra M Nanzer
- Guy's Severe Asthma Centre, Guy's and St Thomas' NHS Trust, London, United Kingdom; School of Immunology & Microbial Sciences, King's College London, London, United Kingdom
| | | | - Vardah Alam
- Guy's Severe Asthma Centre, Guy's and St Thomas' NHS Trust, London, United Kingdom; School of Immunology & Microbial Sciences, King's College London, London, United Kingdom
| | - Linda Green
- Guy's Severe Asthma Centre, Guy's and St Thomas' NHS Trust, London, United Kingdom
| | - Louise Thomson
- Guy's Severe Asthma Centre, Guy's and St Thomas' NHS Trust, London, United Kingdom
| | - Jodie Lam
- Guy's Severe Asthma Centre, Guy's and St Thomas' NHS Trust, London, United Kingdom
| | - Mariana Fernandes
- Guy's Severe Asthma Centre, Guy's and St Thomas' NHS Trust, London, United Kingdom
| | - Cris Roxas
- Guy's Severe Asthma Centre, Guy's and St Thomas' NHS Trust, London, United Kingdom
| | - Grainne d'Ancona
- Guy's Severe Asthma Centre, Guy's and St Thomas' NHS Trust, London, United Kingdom; School of Immunology & Microbial Sciences, King's College London, London, United Kingdom
| | - Andrew Hearn
- Guy's Severe Asthma Centre, Guy's and St Thomas' NHS Trust, London, United Kingdom; School of Immunology & Microbial Sciences, King's College London, London, United Kingdom
| | - Jessica Gates
- Guy's Severe Asthma Centre, Guy's and St Thomas' NHS Trust, London, United Kingdom; School of Immunology & Microbial Sciences, King's College London, London, United Kingdom
| | - Sangita Agarwal
- Rheumatology Department, Louise Coote Lupus Unit, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Brian D Kent
- Guy's Severe Asthma Centre, Guy's and St Thomas' NHS Trust, London, United Kingdom
| | - Michelle Fernando
- Rheumatology Department, Louise Coote Lupus Unit, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - David P D'Cruz
- Rheumatology Department, Louise Coote Lupus Unit, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Claire Hopkins
- Department of Ear, Nose and Throat Surgery, Guy's and St Thomas' NHS Trust, London, United Kingdom
| | - Tevfik F Ismail
- Department of Cardiology, Guy's and St Thomas' NHS Trust, London, United Kingdom; School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Jaideep Dhariwal
- Guy's Severe Asthma Centre, Guy's and St Thomas' NHS Trust, London, United Kingdom
| | - David J Jackson
- Guy's Severe Asthma Centre, Guy's and St Thomas' NHS Trust, London, United Kingdom; School of Immunology & Microbial Sciences, King's College London, London, United Kingdom.
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Nanzer AM, Taylor V, Hearn AP, Kavanagh JE, Patrick T, Green L, Thomson L, Lam J, Fernandes M, Roxas C, d'Ancona G, Kent BD, Dhariwal J, Jackson DJ. The impact of steroid-sparing biologic therapies on weight loss in obese individuals with severe eosinophilic asthma. Eur Respir J 2023; 62:2300245. [PMID: 37474156 DOI: 10.1183/13993003.00245-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 06/25/2023] [Indexed: 07/22/2023]
Affiliation(s)
- Alexandra M Nanzer
- Guy's Severe Asthma Service, Guy's and St Thomas' NHS Foundation Trust, London, UK
- King's Centre for Lung Health, School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Victoria Taylor
- Guy's Severe Asthma Service, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Andrew P Hearn
- Guy's Severe Asthma Service, Guy's and St Thomas' NHS Foundation Trust, London, UK
- King's Centre for Lung Health, School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Joanne E Kavanagh
- Guy's Severe Asthma Service, Guy's and St Thomas' NHS Foundation Trust, London, UK
- King's Centre for Lung Health, School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Tanya Patrick
- Guy's Severe Asthma Service, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Linda Green
- Guy's Severe Asthma Service, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Louise Thomson
- Guy's Severe Asthma Service, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jodie Lam
- Guy's Severe Asthma Service, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Mariana Fernandes
- Guy's Severe Asthma Service, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Cris Roxas
- Guy's Severe Asthma Service, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Grainne d'Ancona
- Guy's Severe Asthma Service, Guy's and St Thomas' NHS Foundation Trust, London, UK
- King's Centre for Lung Health, School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Brian D Kent
- Guy's Severe Asthma Service, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Department of Respiratory Medicine, St James' Hospital, Dublin, Ireland
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Jaideep Dhariwal
- Guy's Severe Asthma Service, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - David J Jackson
- Guy's Severe Asthma Service, Guy's and St Thomas' NHS Foundation Trust, London, UK
- King's Centre for Lung Health, School of Immunology and Microbial Sciences, King's College London, London, UK
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4
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Francis CHR, Hearn AP, Ratnakumar S, Taylor A, Duckitt J, Ahmed U, Dhariwal J, Nanzer AM, Jackson DJ. Covid-19 in the absence of eosinophils: The outcome of confirmed SARS-COV-2 infection whilst on treatment with benralizumab. Allergy 2022; 77:2558-2560. [PMID: 35491441 PMCID: PMC9347634 DOI: 10.1111/all.15334] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 04/21/2022] [Accepted: 04/27/2022] [Indexed: 11/27/2022]
Affiliation(s)
| | - Andrew P. Hearn
- Guy’s Severe Asthma Centre Guy’s and St Thomas’ NHS Foundation Trust London UK
- School of Immunology & Microbial Sciences King’s College London London UK
| | - Sharenja Ratnakumar
- Guy’s Severe Asthma Centre Guy’s and St Thomas’ NHS Foundation Trust London UK
| | - Alexander Taylor
- Guy’s Severe Asthma Centre Guy’s and St Thomas’ NHS Foundation Trust London UK
| | - Jordan Duckitt
- Guy’s Severe Asthma Centre Guy’s and St Thomas’ NHS Foundation Trust London UK
| | - Usmaan Ahmed
- Guy’s Severe Asthma Centre Guy’s and St Thomas’ NHS Foundation Trust London UK
| | - Jaideep Dhariwal
- Guy’s Severe Asthma Centre Guy’s and St Thomas’ NHS Foundation Trust London UK
| | - Alexandra M. Nanzer
- Guy’s Severe Asthma Centre Guy’s and St Thomas’ NHS Foundation Trust London UK
| | - David J. Jackson
- Guy’s Severe Asthma Centre Guy’s and St Thomas’ NHS Foundation Trust London UK
- School of Immunology & Microbial Sciences King’s College London London UK
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5
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Cameron A, Dhariwal J, Upton N, Ranz Jimenez I, Paulsen M, Wong E, Trujillo‐Torralbo M, del Rosario A, Jackson DJ, Edwards MR, Johnston SL, Walton RP. Type I conventional dendritic cells relate to disease severity in virus-induced asthma exacerbations. Clin Exp Allergy 2022; 52:550-560. [PMID: 35212067 PMCID: PMC9310571 DOI: 10.1111/cea.14116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 01/31/2022] [Accepted: 02/10/2022] [Indexed: 01/07/2023]
Abstract
RATIONALE Rhinoviruses are the major precipitant of asthma exacerbations and individuals with asthma experience more severe/prolonged rhinovirus infections. Concurrent viral infection and allergen exposure synergistically increase exacerbation risk. Although dendritic cells orchestrate immune responses to both virus and allergen, little is known about their role in viral asthma exacerbations. OBJECTIVES To characterize dendritic cell populations present in the lower airways, and to assess whether their numbers are altered in asthma compared to healthy subjects prior to infection and during rhinovirus-16 infection. METHODS Moderately-severe atopic asthmatic patients and healthy controls were experimentally infected with rhinovirus-16. Bronchoalveolar lavage was collected at baseline, day 3 and day 8 post infection and dendritic cells isolated using fluorescence activated cell sorting. MEASUREMENTS AND MAIN RESULTS Numbers of type I conventional dendritic cells, which cross prime CD8+ T helper cells and produce innate interferons, were significantly reduced in the lower airways of asthma patients compared to healthy controls at baseline. This reduction was associated serum IgE at baseline and with reduced numbers of CD8+ T helper cells and with increased viral replication, airway eosinophils and reduced lung function during infection. IgE receptor expression on lower airway plasmacytoid dendritic cells was significantly increased in asthma, consistent with a reduced capacity to produce innate interferons. CONCLUSIONS Reduced numbers of anti-viral type I conventional dendritic cells in asthma are associated with adverse outcomes during rhinovirus infection. This, with increased FcεR1α expression on lower airway plasmacytoid DCs could mediate the more permissive respiratory viral infection observed in asthma patients.
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Affiliation(s)
- Aoife Cameron
- National Heart and Lung InstituteLondonUK,MRC Asthma UK Centre in Allergic Mechanisms of AsthmaLondonUK
| | - Jaideep Dhariwal
- National Heart and Lung InstituteLondonUK,MRC Asthma UK Centre in Allergic Mechanisms of AsthmaLondonUK
| | - Nadine Upton
- MRC Asthma UK Centre in Allergic Mechanisms of AsthmaLondonUK,School of Immunology & Microbial SciencesKing’s College LondonLondonUK
| | - Ismael Ranz Jimenez
- MRC Asthma UK Centre in Allergic Mechanisms of AsthmaLondonUK,School of Immunology & Microbial SciencesKing’s College LondonLondonUK
| | - Malte Paulsen
- St. Mary’s Flow Cytometry Core FacilityLondonUK,Novo Nordisk Foundation Center for Stem Cell MedicineFaculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
| | - Ernie Wong
- National Heart and Lung InstituteLondonUK,MRC Asthma UK Centre in Allergic Mechanisms of AsthmaLondonUK
| | | | - Ajerico del Rosario
- National Heart and Lung InstituteLondonUK,MRC Asthma UK Centre in Allergic Mechanisms of AsthmaLondonUK
| | - David J. Jackson
- MRC Asthma UK Centre in Allergic Mechanisms of AsthmaLondonUK,School of Immunology & Microbial SciencesKing’s College LondonLondonUK,Guy's and St Thomas’ NHS TrustLondonUK
| | - Michael R. Edwards
- National Heart and Lung InstituteLondonUK,MRC Asthma UK Centre in Allergic Mechanisms of AsthmaLondonUK
| | - Sebastian L. Johnston
- National Heart and Lung InstituteLondonUK,MRC Asthma UK Centre in Allergic Mechanisms of AsthmaLondonUK
| | - Ross P. Walton
- National Heart and Lung InstituteLondonUK,MRC Asthma UK Centre in Allergic Mechanisms of AsthmaLondonUK
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Dhariwal J, Cameron A, Wong E, Paulsen M, Trujillo-Torralbo B, Del Rosario A, Bakhsoliani E, Kebadze T, Almond M, Farne H, Gogsadze L, Aniscenko J, Rana B, Hansel TT, Jackson DJ, Kon OM, Edwards MR, Solari R, Cousins D, Walton RP, Johnston SL. Pulmonary Innate Lymphoid Cell Responses during Rhinovirus-induced Asthma Exacerbations In Vivo: A Clinical Trial. Am J Respir Crit Care Med 2021; 204:1259-1273. [PMID: 34469272 DOI: 10.1164/rccm.202010-3754oc] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Rationale Type 2 innate lymphoid cells (ILC2s) are significant sources of type 2 cytokines, which are implicated in the pathogenesis of asthma and asthma exacerbations. The role of ILC2s in virus-induced asthma exacerbations is not well-characterized. Objectives To characterize pulmonary ILC responses following experimental rhinovirus challenge in patients with moderate asthma and healthy subjects. Methods Patients with moderate asthma and healthy subjects were inoculated with rhinovirus-16, and underwent bronchoscopy at baseline, day 3 and day 8 post-inoculation. Pulmonary ILC1s and ILC2s were quantified in bronchoalveolar lavage (BAL) using flow cytometry. The ratio of BAL ILC2:ILC1 was assessed to determine their relative contributions to the clinical and immune response to rhinovirus challenge. Measurements and Main Results At baseline, ILC2s were significantly higher in patients with asthma than healthy subjects. At day 8, ILC2s significantly increased from baseline in both groups, which was significantly higher in asthma than in healthy subjects (all comparisons P<0.05). In healthy subjects, ILC1s increased from baseline at day 3 (P=0.001), while in patients with asthma, ILC1s increased from baseline at day 8 (P=0.042). Patients with asthma had significantly higher ILC2:ILC1 ratios at baseline (P=0.024) and day 8 (P=0.005). Increased ILC2:ILC1 ratio in asthma correlated with clinical exacerbation severity and type 2 cytokines in nasal mucosal lining fluid. Conclusions An ILC2-predominant inflammatory profile in asthma was associated with increased severity and duration of rhinovirus infection compared with healthy subjects, supporting the potential role of ILC2s in the pathogenesis of virus-induced asthma exacerbations. Clinical trial registration available at www.clinicaltrials.gov, ID: NCT01773590.
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Affiliation(s)
- Jaideep Dhariwal
- Guy's and St Thomas' Hospitals NHS Trust, 8945, London, United Kingdom of Great Britain and Northern Ireland;
| | - Aoife Cameron
- Imperial College London, NHLI, London, United Kingdom of Great Britain and Northern Ireland
| | - Ernie Wong
- Imperial College London, NHLI, London, United Kingdom of Great Britain and Northern Ireland
| | - Malte Paulsen
- St Mary's Flow Cytometry Core Facility, London, United Kingdom of Great Britain and Northern Ireland
| | - Belen Trujillo-Torralbo
- National Heart and Lung Institute, Respiratory Science, London, United Kingdom of Great Britain and Northern Ireland
| | - Ajerico Del Rosario
- Imperial College London, 4615, NHLI, London, United Kingdom of Great Britain and Northern Ireland
| | - Eteri Bakhsoliani
- National Heart and Lung Institute, Respiratory Science, London, United Kingdom of Great Britain and Northern Ireland
| | - Tatiana Kebadze
- Imperial College London, 4615, NHLI, London, United Kingdom of Great Britain and Northern Ireland
| | - Mark Almond
- Imperial College London, 4615, NHLI, London, United Kingdom of Great Britain and Northern Ireland
| | - Hugo Farne
- Imperial College, London, Airway Disease Infection Section, National Heart and Lung Institute, London, United Kingdom of Great Britain and Northern Ireland.,MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom of Great Britain and Northern Ireland
| | - Leila Gogsadze
- National Heart and Lung Institute, Respiratory Science, London, United Kingdom of Great Britain and Northern Ireland
| | - Julia Aniscenko
- Imperial College London, 4615, Airway Disease Infection, National Heart and Lung Institute, London, United Kingdom of Great Britain and Northern Ireland
| | - Batika Rana
- MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom of Great Britain and Northern Ireland
| | - Trevor T Hansel
- Imperial College London, 4615, ICRRU(Research Unit), London, United Kingdom of Great Britain and Northern Ireland
| | - David J Jackson
- Guy's and St Thomas' NHS Foundation Trust, 8945, National Heart and Lung Institute, London, United Kingdom of Great Britain and Northern Ireland
| | - Onn Min Kon
- Imperial College Healthcare NHS Trust, 8946, London, United Kingdom of Great Britain and Northern Ireland
| | - Michael R Edwards
- Imperial College London, Airway Disease Infection, London, United Kingdom of Great Britain and Northern Ireland
| | - Roberto Solari
- National Heart and Lung Institute, Respiratory Science, London, United Kingdom of Great Britain and Northern Ireland
| | - David Cousins
- University of Leicester, Department of Infection, Immunity and Inflammation, Leicester, United Kingdom of Great Britain and Northern Ireland
| | - Ross P Walton
- Imperial College, National Heart and Lung Institute, London, United Kingdom of Great Britain and Northern Ireland
| | - Sebastian L Johnston
- National Heart & Lung and Wright Felming Institute of Infection & Immunity, Respiratory Medicine, London, United Kingdom of Great Britain and Northern Ireland
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7
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d'Ancona G, Kavanagh JE, Dhariwal J, Hearn AP, Roxas C, Fernandes M, Green L, Thomson L, Nanzer AM, Jackson DJ, Kent BD. Adherence to inhaled corticosteroids and clinical outcomes following a year of benralizumab therapy for severe eosinophilic asthma. Allergy 2021; 76:2238-2241. [PMID: 33432682 DOI: 10.1111/all.14737] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 01/05/2021] [Accepted: 01/07/2021] [Indexed: 01/13/2023]
Affiliation(s)
- Grainne d'Ancona
- Guy's Severe Asthma Centre Guy's and St Thomas' Hospitals London UK
| | - Joanne E. Kavanagh
- Guy's Severe Asthma Centre Guy's and St Thomas' Hospitals London UK
- Asthma UK Centre King's College London London UK
| | - Jaideep Dhariwal
- Guy's Severe Asthma Centre Guy's and St Thomas' Hospitals London UK
- Asthma UK Centre King's College London London UK
| | - Andrew P. Hearn
- Guy's Severe Asthma Centre Guy's and St Thomas' Hospitals London UK
- Asthma UK Centre King's College London London UK
| | - Cris Roxas
- Guy's Severe Asthma Centre Guy's and St Thomas' Hospitals London UK
| | | | - Linda Green
- Guy's Severe Asthma Centre Guy's and St Thomas' Hospitals London UK
| | - Louise Thomson
- Guy's Severe Asthma Centre Guy's and St Thomas' Hospitals London UK
| | - Alexandra M. Nanzer
- Guy's Severe Asthma Centre Guy's and St Thomas' Hospitals London UK
- Asthma UK Centre King's College London London UK
| | - David J. Jackson
- Guy's Severe Asthma Centre Guy's and St Thomas' Hospitals London UK
- Asthma UK Centre King's College London London UK
| | - Brian D. Kent
- Guy's Severe Asthma Centre Guy's and St Thomas' Hospitals London UK
- Department of Respiratory Medicine St James' Hospital Dublin Ireland
- School of Medicine Trinity College Dublin Dublin Ireland
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8
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Hearn AP, Hug OD, Somani ZA, Kavanagh J, d'Ancona G, Roxas C, Green L, Thomson L, Fernandes M, Kent BD, Dhariwal J, Nanzer AM, Jackson DJ. Real world effectiveness of anti-IL-5/5R therapies is independent of co-eligibility for anti-IgE therapy. Eur Respir J 2021; 57:13993003.00166-2021. [PMID: 33632798 DOI: 10.1183/13993003.00166-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 02/04/2021] [Indexed: 11/05/2022]
Affiliation(s)
- Andrew P Hearn
- Guy's Severe Asthma Centre, Guy's Hospital, Guy's and St Thomas' NHS Trust, London, UK.,School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Oliver D Hug
- School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Ziana A Somani
- School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Joanne Kavanagh
- Guy's Severe Asthma Centre, Guy's Hospital, Guy's and St Thomas' NHS Trust, London, UK.,School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Grainne d'Ancona
- Guy's Severe Asthma Centre, Guy's Hospital, Guy's and St Thomas' NHS Trust, London, UK
| | - Cris Roxas
- Guy's Severe Asthma Centre, Guy's Hospital, Guy's and St Thomas' NHS Trust, London, UK
| | - Linda Green
- Guy's Severe Asthma Centre, Guy's Hospital, Guy's and St Thomas' NHS Trust, London, UK
| | - Louise Thomson
- Guy's Severe Asthma Centre, Guy's Hospital, Guy's and St Thomas' NHS Trust, London, UK
| | - Mariana Fernandes
- Guy's Severe Asthma Centre, Guy's Hospital, Guy's and St Thomas' NHS Trust, London, UK
| | - Brian D Kent
- Guy's Severe Asthma Centre, Guy's Hospital, Guy's and St Thomas' NHS Trust, London, UK.,Dept of Respiratory Medicine, St James' Hospital, Dublin, Ireland.,School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Jaideep Dhariwal
- Guy's Severe Asthma Centre, Guy's Hospital, Guy's and St Thomas' NHS Trust, London, UK
| | - Alexandra M Nanzer
- Guy's Severe Asthma Centre, Guy's Hospital, Guy's and St Thomas' NHS Trust, London, UK
| | - David J Jackson
- Guy's Severe Asthma Centre, Guy's Hospital, Guy's and St Thomas' NHS Trust, London, UK .,School of Immunology and Microbial Sciences, King's College London, London, UK
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9
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Kavanagh JE, Hearn AP, d'Ancona G, Dhariwal J, Roxas C, Green L, Thomson L, Fernandes M, Kent BD, Nanzer AM, Jackson DJ. Benralizumab after sub-optimal response to mepolizumab in severe eosinophilic asthma. Allergy 2021; 76:1890-1893. [PMID: 33300186 DOI: 10.1111/all.14693] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 11/12/2020] [Accepted: 12/02/2020] [Indexed: 01/04/2023]
Affiliation(s)
- Joanne E Kavanagh
- Guy's Severe Asthma Centre, Guy's Hospital, Guy's & St Thomas' NHS Trust, London, UK
- School of Immunology & Microbial Sciences, King's College London, London, UK
| | - Andrew P Hearn
- Guy's Severe Asthma Centre, Guy's Hospital, Guy's & St Thomas' NHS Trust, London, UK
- School of Immunology & Microbial Sciences, King's College London, London, UK
| | - Grainne d'Ancona
- Guy's Severe Asthma Centre, Guy's Hospital, Guy's & St Thomas' NHS Trust, London, UK
| | - Jaideep Dhariwal
- Guy's Severe Asthma Centre, Guy's Hospital, Guy's & St Thomas' NHS Trust, London, UK
| | - Cris Roxas
- Guy's Severe Asthma Centre, Guy's Hospital, Guy's & St Thomas' NHS Trust, London, UK
| | - Linda Green
- Guy's Severe Asthma Centre, Guy's Hospital, Guy's & St Thomas' NHS Trust, London, UK
| | - Louise Thomson
- Guy's Severe Asthma Centre, Guy's Hospital, Guy's & St Thomas' NHS Trust, London, UK
| | - Mariana Fernandes
- Guy's Severe Asthma Centre, Guy's Hospital, Guy's & St Thomas' NHS Trust, London, UK
| | - Brian D Kent
- Department of Respiratory Medicine, St James' Hospital, Dublin, Ireland
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Alexandra M Nanzer
- Guy's Severe Asthma Centre, Guy's Hospital, Guy's & St Thomas' NHS Trust, London, UK
| | - David J Jackson
- Guy's Severe Asthma Centre, Guy's Hospital, Guy's & St Thomas' NHS Trust, London, UK
- School of Immunology & Microbial Sciences, King's College London, London, UK
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10
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Dhariwal J, Hearn AP, Kavanagh JE, d'Ancona G, Green L, Fernandes M, Thomson L, Roxas C, Kent BD, Nanzer AM, Jackson DJ. Real-World Effectiveness of Anti-IL-5/5R Therapy in Severe Atopic Eosinophilic Asthma with Fungal Sensitization. J Allergy Clin Immunol Pract 2021; 9:2315-2320.e1. [PMID: 33689868 DOI: 10.1016/j.jaip.2021.02.048] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 02/22/2021] [Accepted: 02/22/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Severe asthma with fungal sensitization (SAFS) is a complex clinical phenotype associated with poorly controlled type 2 inflammation and significant morbidity from both the disease itself and a high steroid burden. OBJECTIVE To assess the effectiveness of biologic therapies targeting eosinophilic inflammation in SAFS. METHODS We assessed the effectiveness of treatment with mepolizumab or benralizumab in patients with SAFS, and compared outcomes with patients with severe atopic asthma without fungal sensitization and patients with severe nonatopic asthma. Baseline clinical characteristics and clinical outcomes at 48 weeks were evaluated. A subgroup analysis was performed of patients who met the criteria for allergic bronchopulmonary aspergillosis (ABPA) rather than SAFS. RESULTS A total of 193 patients treated with mepolizumab (n = 63) or benralizumab (n = 130) were included. Patients with SAFS had higher baseline IgE level compared with patients with severe atopic asthma without fungal sensitization and severe nonatopic asthma (733 ± 837 IU/mL vs 338 ± 494 and 142 ± 171, respectively; both P < .001). There were no other significant baseline differences in clinical characteristics between groups. At 48 weeks, there were significant improvements in 6-item asthma control questionnaire score and exacerbation frequency, and reduction in maintenance oral corticosteroid dose across all groups (all P < .05). No significant between-group differences in outcomes were observed at 48 weeks. Patients with ABPA (n = 9) had a significant reduction in exacerbation frequency (P = .013) with treatment. CONCLUSIONS Treatment with eosinophil-targeting biologics led to improvements in exacerbation frequency, oral corticosteroid requirements, and patient-reported outcomes in patients with SAFS, with a reduction in exacerbations in the subgroup of patients with ABPA. These data highlight the potential clinical utility of targeting eosinophilic inflammation in SAFS and ABPA.
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Affiliation(s)
- Jaideep Dhariwal
- Guy's Severe Asthma Service, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Andrew P Hearn
- Guy's Severe Asthma Service, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Joanne E Kavanagh
- Guy's Severe Asthma Service, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Gráinne d'Ancona
- Guy's Severe Asthma Service, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Linda Green
- Guy's Severe Asthma Service, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Mariana Fernandes
- Guy's Severe Asthma Service, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Louise Thomson
- Guy's Severe Asthma Service, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Cris Roxas
- Guy's Severe Asthma Service, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Brian D Kent
- Guy's Severe Asthma Service, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Department of Respiratory Medicine, St James' Hospital, Dublin, Ireland; School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Alexandra M Nanzer
- Guy's Severe Asthma Service, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - David J Jackson
- Guy's Severe Asthma Service, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Asthma UK Centre, School of Immunology & Microbial Sciences, King's College London, London, United Kingdom.
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11
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Hearn AP, Kavanagh J, d'Ancona G, Roxas C, Green L, Thomson L, Fernandes M, Kent BD, Dhariwal J, Nanzer AM, Jackson DJ. The relationship between Feno and effectiveness of mepolizumab and benralizumab in severe eosinophilic asthma. J Allergy Clin Immunol Pract 2021; 9:2093-2096.e1. [PMID: 33486140 DOI: 10.1016/j.jaip.2021.01.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 12/30/2020] [Accepted: 01/05/2021] [Indexed: 12/21/2022]
Affiliation(s)
- Andrew P Hearn
- Guy's Severe Asthma Centre, Guy's Hospital, Guy's & St Thomas' NHS Trust, London, United Kingdom; School of Immunology & Microbial Sciences, King's College London, United Kingdom
| | - Joanne Kavanagh
- Guy's Severe Asthma Centre, Guy's Hospital, Guy's & St Thomas' NHS Trust, London, United Kingdom; School of Immunology & Microbial Sciences, King's College London, United Kingdom
| | - Grainne d'Ancona
- Guy's Severe Asthma Centre, Guy's Hospital, Guy's & St Thomas' NHS Trust, London, United Kingdom
| | - Cris Roxas
- Guy's Severe Asthma Centre, Guy's Hospital, Guy's & St Thomas' NHS Trust, London, United Kingdom
| | - Linda Green
- Guy's Severe Asthma Centre, Guy's Hospital, Guy's & St Thomas' NHS Trust, London, United Kingdom
| | - Louise Thomson
- Guy's Severe Asthma Centre, Guy's Hospital, Guy's & St Thomas' NHS Trust, London, United Kingdom
| | - Marianna Fernandes
- Guy's Severe Asthma Centre, Guy's Hospital, Guy's & St Thomas' NHS Trust, London, United Kingdom
| | - Brian D Kent
- Guy's Severe Asthma Centre, Guy's Hospital, Guy's & St Thomas' NHS Trust, London, United Kingdom; Department of Respiratory Medicine, St James' Hospital, Dublin, Ireland; School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Jaideep Dhariwal
- Guy's Severe Asthma Centre, Guy's Hospital, Guy's & St Thomas' NHS Trust, London, United Kingdom
| | - Alexanda M Nanzer
- Guy's Severe Asthma Centre, Guy's Hospital, Guy's & St Thomas' NHS Trust, London, United Kingdom
| | - David J Jackson
- Guy's Severe Asthma Centre, Guy's Hospital, Guy's & St Thomas' NHS Trust, London, United Kingdom; School of Immunology & Microbial Sciences, King's College London, United Kingdom.
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12
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McErlean P, Kelly A, Dhariwal J, Kirtland M, Watson J, Ranz I, Smith J, Saxena A, Cousins DJ, Van Oosterhout A, Solari R, Edwards MR, Johnston SL, Lavender P. Profiling of H3K27Ac Reveals the Influence of Asthma on the Epigenome of the Airway Epithelium. Front Genet 2020; 11:585746. [PMID: 33362848 PMCID: PMC7758344 DOI: 10.3389/fgene.2020.585746] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 07/21/2020] [Accepted: 11/03/2020] [Indexed: 12/17/2022] Open
Abstract
Background Asthma is a chronic airway disease driven by complex genetic–environmental interactions. The role of epigenetic modifications in bronchial epithelial cells (BECs) in asthma is poorly understood. Methods We piloted genome-wide profiling of the enhancer-associated histone modification H3K27ac in BECs from people with asthma (n = 4) and healthy controls (n = 3). Results We identified n = 4,321 (FDR < 0.05) regions exhibiting differential H3K27ac enrichment between asthma and health, clustering at genes associated predominately with epithelial processes (EMT). We identified initial evidence of asthma-associated Super-Enhancers encompassing genes encoding transcription factors (TP63) and enzymes regulating lipid metabolism (PTGS1). We integrated published datasets to identify epithelium-specific transcription factors associated with H3K27ac in asthma (TP73) and identify initial relationships between asthma-associated changes in H3K27ac and transcriptional profiles. Finally, we investigated the potential of CRISPR-based approaches to functionally evaluate H3K27ac-asthma landscape in vitro by identifying guide-RNAs capable of targeting acetylation to asthma DERs and inducing gene expression (TLR3). Conclusion Our small pilot study validates genome-wide approaches for deciphering epigenetic mechanisms underlying asthma pathogenesis in the airways.
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Affiliation(s)
- Peter McErlean
- Peter Gorer Department of Immunobiology, King's College London, London, United Kingdom.,Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom
| | - Audrey Kelly
- Peter Gorer Department of Immunobiology, King's College London, London, United Kingdom.,Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom
| | - Jaideep Dhariwal
- Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom.,Airway Disease Infection Section, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Max Kirtland
- Peter Gorer Department of Immunobiology, King's College London, London, United Kingdom.,Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom
| | - Julie Watson
- Peter Gorer Department of Immunobiology, King's College London, London, United Kingdom.,Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom
| | - Ismael Ranz
- Peter Gorer Department of Immunobiology, King's College London, London, United Kingdom.,Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom
| | - Janet Smith
- GlaxoSmithKline Allergic Inflammation Discovery Performance Unit, Respiratory Therapy Area, Stevenage, United Kingdom
| | - Alka Saxena
- Genomics Platform, Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - David J Cousins
- Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom.,National Institute for Health Research (NIHR) Respiratory Biomedical Research Unit, Department of Infection, Immunity & Inflammation, Leicester Institute for Lung Health, University of Leicester, Leicester, United Kingdom
| | - Antoon Van Oosterhout
- GlaxoSmithKline Allergic Inflammation Discovery Performance Unit, Respiratory Therapy Area, Stevenage, United Kingdom
| | - Roberto Solari
- Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom.,Airway Disease Infection Section, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Michael R Edwards
- Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom.,Airway Disease Infection Section, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Sebastian L Johnston
- Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom.,Airway Disease Infection Section, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Paul Lavender
- Peter Gorer Department of Immunobiology, King's College London, London, United Kingdom.,Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom
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13
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Nanzer AM, Dhariwal J, Kavanagh J, Hearn A, Fernandes M, Thomson L, Roxas C, Green L, D'Ancona G, Agarwal S, Kent BD, Jackson DJ. Steroid-sparing effects of benralizumab in patients with eosinophilic granulomatosis with polyangiitis. ERJ Open Res 2020; 6:00451-2020. [PMID: 33263051 PMCID: PMC7682702 DOI: 10.1183/23120541.00451-2020] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 08/17/2020] [Indexed: 12/12/2022] Open
Abstract
Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare, anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis characterised by asthma, chronic rhinosinusitis and blood eosinophilia, which may be accompanied by neurological, cardiac, cutaneous and renal involvement [1]. Oral corticosteroids (OCS) are the most frequently used drugs to control eosinophilic inflammation and symptoms. Persistent symptoms or relapses are common, however, and many patients are at risk of developing long-term complications from systemic steroid therapy [2]. The ability of other immunosuppressant agents to achieve consistent disease control or to reduce maintenance OCS (mOCS) requirements appears to be limited [3]. Benralizumab reduces oral corticosteroid requirements in patients with EGPA and leads to improved patient-reported outcome measureshttps://bit.ly/2GI0vhf
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Affiliation(s)
- Alexandra M Nanzer
- Guy's and St Thomas' NHS Foundation Trust, Thoracic Medicine, Guy's Severe Asthma Service, London, UK.,School of Immunology & Microbial Sciences, King's College London, London, UK
| | - Jaideep Dhariwal
- Guy's and St Thomas' NHS Foundation Trust, Thoracic Medicine, Guy's Severe Asthma Service, London, UK
| | - Joanne Kavanagh
- Guy's and St Thomas' NHS Foundation Trust, Thoracic Medicine, Guy's Severe Asthma Service, London, UK.,School of Immunology & Microbial Sciences, King's College London, London, UK
| | - Andrew Hearn
- Guy's and St Thomas' NHS Foundation Trust, Thoracic Medicine, Guy's Severe Asthma Service, London, UK.,School of Immunology & Microbial Sciences, King's College London, London, UK
| | - Mariana Fernandes
- Guy's and St Thomas' NHS Foundation Trust, Thoracic Medicine, Guy's Severe Asthma Service, London, UK
| | - Louise Thomson
- Guy's and St Thomas' NHS Foundation Trust, Thoracic Medicine, Guy's Severe Asthma Service, London, UK
| | - Cris Roxas
- Guy's and St Thomas' NHS Foundation Trust, Thoracic Medicine, Guy's Severe Asthma Service, London, UK
| | - Linda Green
- Guy's and St Thomas' NHS Foundation Trust, Thoracic Medicine, Guy's Severe Asthma Service, London, UK
| | - Grainne D'Ancona
- Guy's and St Thomas' NHS Foundation Trust, Thoracic Medicine, Guy's Severe Asthma Service, London, UK
| | - Sangita Agarwal
- Dept of Rheumatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Brian D Kent
- Guy's and St Thomas' NHS Foundation Trust, Thoracic Medicine, Guy's Severe Asthma Service, London, UK
| | - David J Jackson
- Guy's and St Thomas' NHS Foundation Trust, Thoracic Medicine, Guy's Severe Asthma Service, London, UK.,School of Immunology & Microbial Sciences, King's College London, London, UK
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14
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Kavanagh JE, Hearn AP, Dhariwal J, d'Ancona G, Douiri A, Roxas C, Fernandes M, Green L, Thomson L, Nanzer AM, Kent BD, Jackson DJ. Real-World Effectiveness of Benralizumab in Severe Eosinophilic Asthma. Chest 2020; 159:496-506. [PMID: 32882249 DOI: 10.1016/j.chest.2020.08.2083] [Citation(s) in RCA: 137] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/08/2020] [Accepted: 08/19/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Benralizumab is an IL5-receptor monoclonal antibody licensed for the treatment of severe eosinophilic asthma (SEA). It has demonstrated efficacy in clinical trials in reducing asthma exacerbation rates and maintenance oral corticosteroids (mOCSs). RESEARCH QUESTION What is the real-world effectiveness of benralizumab and what baseline characteristics are associated with response to therapy? STUDY DESIGN AND METHODS We assessed outcomes in all SEA patients who began benralizumab treatment at our specialist center. At each dosing visit, exacerbation history, mOCS dose, spirometry, and Asthma Control Questionnaire (ACQ6) and Mini-Asthma Quality of Life Questionnaire (mAQLQ) scores were recorded. Response to treatment was defined as a reduction of ≥ 50% in annualized exacerbation rate (AER) or in mOCS dose after 48 weeks of treatment. Super response was defined as zero exacerbations and no mOCSs for asthma. RESULTS One hundred thirty patients were included in the analysis. At 48 weeks, a 72.8% reduction in AER was noted, from 4.92 ± 3.35 per year in the year preceding biologic treatment to 1.34 ± 1.71 per year (P < .001), including 57 patients (43.8%) who were exacerbation-free with benralizumab. In those receiving mOCSs (n = 74 [56.9%]), the median daily prednisolone dose fell from 10 mg (interquartile range, 5-20 mg) to 0 mg (interquartile range, 0-5 mg; P < .001), and 38 of 74 patients (51.4%) were able to discontinue mOCS therapy. Clinically and statistically significant improvements were found in ACQ6 scores, mAQLQ scores, and FEV1. Overall, 51 patients (39%) met the super responder definition and 112 patients (86%) met the responder definition. The optimal regression model of super responders vs other responders included baseline characteristics associated with a strongly eosinophilic phenotype and less severe disease. Eighteen patients (13.8%) were nonresponders to benralizumab. Evidence of chronic airway infection was observed in 6 of 18 patients, and an increase in the blood eosinophil count consistent with the development of anti-drug antibodies was observed in 5 of 18 patients. INTERPRETATION In a large real-world SEA cohort, benralizumab led to significant improvements in all clinical outcome measures. A lack of response was seen in a minority of patients and should be a focus for future investigation.
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Affiliation(s)
- Joanne E Kavanagh
- Guy's Severe Asthma Centre, Guy's and St Thomas' Hospitals, London, England; Asthma UK Centre, King's College London, London, England
| | - Andrew P Hearn
- Guy's Severe Asthma Centre, Guy's and St Thomas' Hospitals, London, England; Asthma UK Centre, King's College London, London, England
| | - Jaideep Dhariwal
- Guy's Severe Asthma Centre, Guy's and St Thomas' Hospitals, London, England
| | - Gráinne d'Ancona
- Guy's Severe Asthma Centre, Guy's and St Thomas' Hospitals, London, England
| | - Abdel Douiri
- Department of Medical Statistics, King's College London, London, England
| | - Cris Roxas
- Guy's Severe Asthma Centre, Guy's and St Thomas' Hospitals, London, England
| | - Mariana Fernandes
- Guy's Severe Asthma Centre, Guy's and St Thomas' Hospitals, London, England
| | - Linda Green
- Guy's Severe Asthma Centre, Guy's and St Thomas' Hospitals, London, England
| | - Louise Thomson
- Guy's Severe Asthma Centre, Guy's and St Thomas' Hospitals, London, England
| | - Alexandra M Nanzer
- Guy's Severe Asthma Centre, Guy's and St Thomas' Hospitals, London, England
| | - Brian D Kent
- Department of Respiratory Medicine, St. James' Hospital, Dublin, Ireland; School of Medicine, Trinity College, Dublin, Ireland
| | - David J Jackson
- Guy's Severe Asthma Centre, Guy's and St Thomas' Hospitals, London, England; Asthma UK Centre, King's College London, London, England.
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15
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Nanzer AM, Chowdhury A, Raheem A, Roxas C, Fernandes M, Thomson L, Green L, Dhariwal J, D'Ancona G, Kent BD, Kelly PA, Jackson DJ. Prevalence and recovery of adrenal insufficiency in steroid-dependent asthma patients receiving biologic therapy. Eur Respir J 2020; 56:13993003.02273-2019. [PMID: 32217655 DOI: 10.1183/13993003.02273-2019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 03/11/2020] [Indexed: 11/05/2022]
Affiliation(s)
- Alexandra M Nanzer
- Guy's and St Thomas' NHS Foundation Trust, Thoracic Medicine, Guy's Severe Asthma Service, London, UK
| | | | | | - Cris Roxas
- Guy's and St Thomas' NHS Foundation Trust, Thoracic Medicine, Guy's Severe Asthma Service, London, UK
| | - Mariana Fernandes
- Guy's and St Thomas' NHS Foundation Trust, Thoracic Medicine, Guy's Severe Asthma Service, London, UK
| | - Louise Thomson
- Guy's and St Thomas' NHS Foundation Trust, Thoracic Medicine, Guy's Severe Asthma Service, London, UK
| | - Linda Green
- Guy's and St Thomas' NHS Foundation Trust, Thoracic Medicine, Guy's Severe Asthma Service, London, UK
| | - Jaideep Dhariwal
- Guy's and St Thomas' NHS Foundation Trust, Thoracic Medicine, Guy's Severe Asthma Service, London, UK
| | - Grainne D'Ancona
- Guy's and St Thomas' NHS Foundation Trust, Thoracic Medicine, Guy's Severe Asthma Service, London, UK
| | - Brian D Kent
- Guy's and St Thomas' NHS Foundation Trust, Thoracic Medicine, Guy's Severe Asthma Service, London, UK
| | - Philip A Kelly
- King's College Hospital NHS Foundation Trust, Dept of Acute Medicine, London, UK
| | - David J Jackson
- Guy's and St Thomas' NHS Foundation Trust, Thoracic Medicine, Guy's Severe Asthma Service, London, UK.,King's College London, London, UK
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16
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d'Ancona G, Kavanagh J, Roxas C, Green L, Fernandes M, Thomson L, Dhariwal J, Nanzer AM, Jackson DJ, Kent BD. Adherence to corticosteroids and clinical outcomes in mepolizumab therapy for severe asthma. Eur Respir J 2020; 55:13993003.02259-2019. [PMID: 32060061 DOI: 10.1183/13993003.02259-2019] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 02/03/2020] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Inhaled corticosteroids (ICS) achieve disease control in the majority of asthmatic patients, although adherence to prescribed ICS is often poor. Patients with severe eosinophilic asthma may require treatment with oral corticosteroids (OCS) and/or biologic agents such as mepolizumab. It is unknown if ICS adherence changes on, or alters clinical response to, biologic therapy. METHODS We examined ICS adherence and clinical outcomes in OCS-dependent severe eosinophilic asthma patients who completed 1 year of mepolizumab therapy. The ICS medicines possession ratio (MPR) was calculated (the number of doses of ICS issued on prescription/expected number) for the year before and the year after biologic initiation. Good adherence was defined as MPR >0.75, intermediate 0.74-0.51 and poor <0.5. We examined outcomes after 12 months of biologic therapy, including OCS reduction and annualised exacerbation rate (AER), stratified by adherence to ICS on mepolizumab. RESULTS Out of 109 patients commencing mepolizumab, 91 who had completed 12 months of treatment were included in the final analysis. While receiving mepolizumab, 68% had good ICS adherence, with 16 (18%) having poor ICS adherence. ICS use within the cohort remained similar before (MPR 0.81±0.32) and during mepolizumab treatment (0.82±0.32; p=0.78). Patients with good adherence had greater reductions in OCS dose (median (interquartile range) OCS reduction 100 (74-100)% versus 60 (27-100)%; p=0.031) and exacerbations (AER change -2.1±3.1 versus 0.3±2.5; p=0.011) than those with poor adherence. Good ICS adherence predicted the likelihood of stopping maintenance OCS (adjusted OR 3.19, 95% CI 1.02-9.94; p=0.045). CONCLUSION ICS nonadherence is common in severe eosinophilic asthma patients receiving mepolizumab, and is associated with a lesser reduction in OCS requirements and AER.
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Affiliation(s)
- Gráinne d'Ancona
- Guy's Severe Asthma Centre, Guy's and St Thomas' Hospitals, London, UK
| | - Joanne Kavanagh
- Guy's Severe Asthma Centre, Guy's and St Thomas' Hospitals, London, UK
| | - Cris Roxas
- Guy's Severe Asthma Centre, Guy's and St Thomas' Hospitals, London, UK
| | - Linda Green
- Guy's Severe Asthma Centre, Guy's and St Thomas' Hospitals, London, UK
| | - Mariana Fernandes
- Guy's Severe Asthma Centre, Guy's and St Thomas' Hospitals, London, UK
| | - Louise Thomson
- Guy's Severe Asthma Centre, Guy's and St Thomas' Hospitals, London, UK
| | - Jaideep Dhariwal
- Guy's Severe Asthma Centre, Guy's and St Thomas' Hospitals, London, UK.,Asthma UK Centre, King's College London, London, UK
| | - Alexandra M Nanzer
- Guy's Severe Asthma Centre, Guy's and St Thomas' Hospitals, London, UK.,Asthma UK Centre, King's College London, London, UK
| | - David J Jackson
- Guy's Severe Asthma Centre, Guy's and St Thomas' Hospitals, London, UK.,Asthma UK Centre, King's College London, London, UK.,Both authors contributed equally
| | - Brian D Kent
- Guy's Severe Asthma Centre, Guy's and St Thomas' Hospitals, London, UK .,Asthma UK Centre, King's College London, London, UK.,Dept of Respiratory Medicine, St James' Hospital, Dublin, Ireland.,Both authors contributed equally
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17
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Kavanagh JE, d'Ancona G, Elstad M, Green L, Fernandes M, Thomson L, Roxas C, Dhariwal J, Nanzer AM, Kent BD, Jackson DJ. Real-World Effectiveness and the Characteristics of a "Super-Responder" to Mepolizumab in Severe Eosinophilic Asthma. Chest 2020; 158:491-500. [PMID: 32275980 DOI: 10.1016/j.chest.2020.03.042] [Citation(s) in RCA: 120] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 03/06/2020] [Accepted: 03/19/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Mepolizumab was the first licensed anti-IL5 monoclonal antibody for severe eosinophilic asthma (SEA). To date there are few data to confirm its efficacy in the real-world setting or assessment of baseline characteristics associated with response. RESEARCH QUESTION How do patients with severe eosinophilic asthma respond to mepolizumab in the real world setting and which characteristics are associated with a super-response to this therapy? STUDY DESIGN AND METHODS We conducted a retrospective review of all patients who received at least 16 weeks of treatment with mepolizumab (100 mg subcutaneously) for SEA at our regional asthma center in the United Kingdom. Clinical data were collected at each 4-week visit. At 16, 24, and 52 weeks, patients were classified as "responders" or "nonresponders." A response was defined as ≥50% reduction in exacerbations; for patients whose condition requires maintenance oral corticosteroids (mOCS), a response was defined as ≥50% reduction in prednisolone dose. Super responders were defined as exacerbation-free and off mOCS at one year. RESULTS Ninety-nine patients were included in the analysis. Asthma exacerbations decreased from a baseline of 4.04 ± 2.57 to 1.86 ± 2.17 per year at one year (54% reduction; P < .001). Sixty-eight patients were receiving mOCS at the time of commencing mepolizumab. By one year, the daily median dose fell from 10 mg (interquartile range, 10 to 15) to 0 mg (interquartile range, 0 to 10; P < .001). Fifty-seven percent of them were able to discontinue mOCS; 72.7% (95% CI, 63.0 to 80.7) of the patients were classified as responders, and 28.3% (95% CI, 20.2 to 38.0) of the patients were classified as super responders. Baseline characteristics associated with responder and super responder status included the presence of nasal polyposis (P = .012), lower baseline Asthma Control Questionnaire 6 (P = .006), a lower BMI (P = .014), and, in those patients receiving mOCS, a significantly lower prednisolone dose at baseline (P = .005). At 16 weeks, the one-year responder status was correctly identified in 80.8% patients; by 24 weeks, this status rose to 92.9%. INTERPRETATION In a real-world SEA cohort, treatment with mepolizumab reduced exacerbation frequency and mOCS requirements. Nasal polyposis, a lower BMI, and a lower maintenance prednisolone requirement at baseline were associated with better outcomes. Twelve-month response was identifiable in >90% of patients by week 24.
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Affiliation(s)
| | - Grainne d'Ancona
- Guy's Severe Asthma Centre, Guy's Hospital, Guy's & St Thomas' NHS Trust, London, UK
| | | | - Linda Green
- Guy's Severe Asthma Centre, Guy's Hospital, Guy's & St Thomas' NHS Trust, London, UK
| | - Mariana Fernandes
- Guy's Severe Asthma Centre, Guy's Hospital, Guy's & St Thomas' NHS Trust, London, UK
| | - Louise Thomson
- Guy's Severe Asthma Centre, Guy's Hospital, Guy's & St Thomas' NHS Trust, London, UK
| | - Cris Roxas
- Guy's Severe Asthma Centre, Guy's Hospital, Guy's & St Thomas' NHS Trust, London, UK
| | - Jaideep Dhariwal
- Guy's Severe Asthma Centre, Guy's Hospital, Guy's & St Thomas' NHS Trust, London, UK
| | - Alexandra M Nanzer
- Guy's Severe Asthma Centre, Guy's Hospital, Guy's & St Thomas' NHS Trust, London, UK
| | | | - David J Jackson
- King's College London, London, UK; Guy's Severe Asthma Centre, Guy's Hospital, Guy's & St Thomas' NHS Trust, London, UK.
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18
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Guvenel A, Jozwik A, Ascough S, Ung SK, Paterson S, Kalyan M, Gardener Z, Bergstrom E, Kar S, Habibi MS, Paras A, Zhu J, Park M, Dhariwal J, Almond M, Wong EH, Sykes A, Del Rosario J, Trujillo-Torralbo MB, Mallia P, Sidney J, Peters B, Kon OM, Sette A, Johnston SL, Openshaw PJ, Chiu C. Epitope-specific airway-resident CD4+ T cell dynamics during experimental human RSV infection. J Clin Invest 2020; 130:523-538. [PMID: 31815739 PMCID: PMC6934186 DOI: 10.1172/jci131696] [Citation(s) in RCA: 39] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 10/08/2019] [Indexed: 01/27/2023] Open
Abstract
BACKGROUNDRespiratory syncytial virus (RSV) is an important cause of acute pulmonary disease and one of the last remaining major infections of childhood for which there is no vaccine. CD4+ T cells play a key role in antiviral immunity, but they have been little studied in the human lung.METHODSHealthy adult volunteers were inoculated i.n. with RSV A Memphis 37. CD4+ T cells in blood and the lower airway were analyzed by flow cytometry and immunohistochemistry. Bronchial soluble mediators were measured using quantitative PCR and MesoScale Discovery. Epitope mapping was performed by IFN-γ ELISpot screening, confirmed by in vitro MHC binding.RESULTSActivated CD4+ T cell frequencies in bronchoalveolar lavage correlated strongly with local C-X-C motif chemokine 10 levels. Thirty-nine epitopes were identified, predominantly toward the 3' end of the viral genome. Five novel MHC II tetramers were made using an immunodominant EFYQSTCSAVSKGYL (F-EFY) epitope restricted to HLA-DR4, -DR9, and -DR11 (combined allelic frequency: 15% in Europeans) and G-DDF restricted to HLA-DPA1*01:03/DPB1*02:01 and -DPA1*01:03/DPB1*04:01 (allelic frequency: 55%). Tetramer labeling revealed enrichment of resident memory CD4+ T (Trm) cells in the lower airway; these Trm cells displayed progressive differentiation, downregulation of costimulatory molecules, and elevated CXCR3 expression as infection evolved.CONCLUSIONSHuman infection challenge provides a unique opportunity to study the breadth of specificity and dynamics of RSV-specific T-cell responses in the target organ, allowing the precise investigation of Trm recognizing novel viral antigens over time. The new tools that we describe enable precise tracking of RSV-specific CD4+ cells, potentially accelerating the development of effective vaccines.TRIAL REGISTRATIONClinicalTrials.gov NCT02755948.FUNDINGMedical Research Council, Wellcome Trust, National Institute for Health Research.
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Affiliation(s)
| | | | - Stephanie Ascough
- Department of Infectious Disease, Imperial College London, London, United Kingdom
| | - Seng Kuong Ung
- Department of Infectious Disease, Imperial College London, London, United Kingdom
| | - Suzanna Paterson
- Department of Infectious Disease, Imperial College London, London, United Kingdom
| | - Mohini Kalyan
- Department of Infectious Disease, Imperial College London, London, United Kingdom
| | - Zoe Gardener
- Department of Infectious Disease, Imperial College London, London, United Kingdom
| | - Emma Bergstrom
- Department of Infectious Disease, Imperial College London, London, United Kingdom
| | - Satwik Kar
- Department of Infectious Disease, Imperial College London, London, United Kingdom
| | | | | | - Jie Zhu
- National Heart and Lung Institute and
| | | | | | | | | | | | | | | | | | - John Sidney
- Centre for Infectious Disease, Division of Vaccine Discovery, La Jolla Institute for Allergy and Immunology, La Jolla, California, USA
| | - Bjoern Peters
- Centre for Infectious Disease, Division of Vaccine Discovery, La Jolla Institute for Allergy and Immunology, La Jolla, California, USA
| | | | - Alessandro Sette
- Centre for Infectious Disease, Division of Vaccine Discovery, La Jolla Institute for Allergy and Immunology, La Jolla, California, USA
- Department of Medicine, UCSD, La Jolla, California, USA
| | | | | | - Christopher Chiu
- Department of Infectious Disease, Imperial College London, London, United Kingdom
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19
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Dhariwal J, Cameron A, Trujillo-Torralbo MB, Del Rosario A, Bakhsoliani E, Paulsen M, Jackson DJ, Edwards MR, Rana BMJ, Cousins DJ, Hansel TT, Johnston SL, Walton RP. Mucosal Type 2 Innate Lymphoid Cells Are a Key Component of the Allergic Response to Aeroallergens. Am J Respir Crit Care Med 2017; 195:1586-1596. [PMID: 28085492 DOI: 10.1164/rccm.201609-1846oc] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Newly characterized type 2 innate lymphoid cells (ILC2s) display potent type 2 effector functionality; however, their contribution to allergic airways inflammation and asthma is poorly understood. Mucosal biopsy used to characterize the airway mucosa is invasive, poorly tolerated, and does not allow for sequential sampling. OBJECTIVES To assess the role of ILC2s during nasal allergen challenge in subjects with allergic rhinitis using novel noninvasive methodology. METHODS We used a human experimental allergen challenge model, with flow cytometric analysis of nasal curettage samples, to assess the recruitment of ILC2s and granulocytes to the upper airways of subjects with atopy and healthy subjects after allergen provocation. Soluble mediators in the nasal lining fluid were measured using nasosorption. MEASUREMENTS AND MAIN RESULTS After an allergen challenge, subjects with atopy displayed rapid induction of upper airway symptoms, an enrichment of ILC2s, eosinophils, and neutrophils, along with increased production of IL-5, prostaglandin D2, and eosinophil and T-helper type 2 cell chemokines compared with healthy subjects. The most pronounced ILC2 recruitment was observed in subjects with elevated serum IgE and airway eosinophilia. CONCLUSIONS The rapid recruitment of ILC2s to the upper airways of allergic patients with rhinitis, and their association with key type 2 mediators, highlights their likely important role in the early allergic response to aeroallergens in the airways. The novel methodology described herein enables the analysis of rare cell populations from noninvasive serial tissue sampling.
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Affiliation(s)
- Jaideep Dhariwal
- 1 Airway Disease Infection Section, National Heart and Lung Institute, London, United Kingdom.,2 Medical Research Council Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom
| | - Aoife Cameron
- 1 Airway Disease Infection Section, National Heart and Lung Institute, London, United Kingdom.,2 Medical Research Council Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom
| | - Maria-Belen Trujillo-Torralbo
- 1 Airway Disease Infection Section, National Heart and Lung Institute, London, United Kingdom.,2 Medical Research Council Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom
| | - Ajerico Del Rosario
- 1 Airway Disease Infection Section, National Heart and Lung Institute, London, United Kingdom.,2 Medical Research Council Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom
| | - Eteri Bakhsoliani
- 1 Airway Disease Infection Section, National Heart and Lung Institute, London, United Kingdom.,2 Medical Research Council Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom
| | - Malte Paulsen
- 3 St. Mary's Flow Cytometry Core Facility, London, United Kingdom
| | - David J Jackson
- 1 Airway Disease Infection Section, National Heart and Lung Institute, London, United Kingdom.,2 Medical Research Council Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom.,4 Guy's and St. Thomas' National Health Service Trust, London, United Kingdom
| | - Michael R Edwards
- 1 Airway Disease Infection Section, National Heart and Lung Institute, London, United Kingdom.,2 Medical Research Council Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom
| | - Batika M J Rana
- 5 Department of Respiratory Medicine & Allergy, King's College London, London, United Kingdom; and
| | - David J Cousins
- 2 Medical Research Council Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom.,5 Department of Respiratory Medicine & Allergy, King's College London, London, United Kingdom; and.,6 National Institute for Health Research Respiratory Biomedical Research Unit, Department of Infection, Immunity & Inflammation, Leicester Institute for Lung Health, University of Leicester, Leicester, United Kingdom
| | - Trevor T Hansel
- 1 Airway Disease Infection Section, National Heart and Lung Institute, London, United Kingdom.,2 Medical Research Council Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom
| | - Sebastian L Johnston
- 1 Airway Disease Infection Section, National Heart and Lung Institute, London, United Kingdom.,2 Medical Research Council Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom
| | - Ross P Walton
- 1 Airway Disease Infection Section, National Heart and Lung Institute, London, United Kingdom.,2 Medical Research Council Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom
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20
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Hansel TT, Tunstall T, Trujillo-Torralbo MB, Shamji B, Del-Rosario A, Dhariwal J, Kirk PDW, Stumpf MPH, Koopmann J, Telcian A, Aniscenko J, Gogsadze L, Bakhsoliani E, Stanciu L, Bartlett N, Edwards M, Walton R, Mallia P, Hunt TM, Hunt TL, Hunt DG, Westwick J, Edwards M, Kon OM, Jackson DJ, Johnston SL. A Comprehensive Evaluation of Nasal and Bronchial Cytokines and Chemokines Following Experimental Rhinovirus Infection in Allergic Asthma: Increased Interferons (IFN-γ and IFN-λ) and Type 2 Inflammation (IL-5 and IL-13). EBioMedicine 2017; 19:128-138. [PMID: 28373098 PMCID: PMC5440599 DOI: 10.1016/j.ebiom.2017.03.033] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 03/09/2017] [Accepted: 03/24/2017] [Indexed: 01/04/2023] Open
Abstract
Background Rhinovirus infection is a major cause of asthma exacerbations. Objectives We studied nasal and bronchial mucosal inflammatory responses during experimental rhinovirus-induced asthma exacerbations. Methods We used nasosorption on days 0, 2–5 and 7 and bronchosorption at baseline and day 4 to sample mucosal lining fluid to investigate airway mucosal responses to rhinovirus infection in patients with allergic asthma (n = 28) and healthy non-atopic controls (n = 11), by using a synthetic absorptive matrix and measuring levels of 34 cytokines and chemokines using a sensitive multiplex assay. Results Following rhinovirus infection asthmatics developed more upper and lower respiratory symptoms and lower peak expiratory flows compared to controls (all P < 0.05). Asthmatics also developed higher nasal lining fluid levels of an anti-viral pathway (including IFN-γ, IFN-λ/IL-29, CXCL11/ITAC, CXCL10/IP10 and IL-15) and a type 2 inflammatory pathway (IL-4, IL-5, IL-13, CCL17/TARC, CCL11/eotaxin, CCL26/eotaxin-3) (area under curve day 0–7, all P < 0.05). Nasal IL-5 and IL-13 were higher in asthmatics at day 0 (P < 0.01) and levels increased by days 3 and 4 (P < 0.01). A hierarchical correlation matrix of 24 nasal lining fluid cytokine and chemokine levels over 7 days demonstrated expression of distinct interferon-related and type 2 pathways in asthmatics. In asthmatics IFN-γ, CXCL10/IP10, CXCL11/ITAC, IL-15 and IL-5 increased in bronchial lining fluid following viral infection (all P < 0.05). Conclusions Precision sampling of mucosal lining fluid identifies robust interferon and type 2 responses in the upper and lower airways of asthmatics during an asthma exacerbation. Nasosorption and bronchosorption have potential to define asthma endotypes in stable disease and at exacerbation. Following rhinovirus infection asthmatics have increased interferons and type 2 inflammation in airway mucosal lining fluid. Nasosorption cytokines and chemokines showed distinct pathways of interferon and type 2 inflammation in asthma. Precision mucosal sampling has potential for stratifying molecular endotypes of asthma. Validation of nasosorption and bronchosorption will be required for selection of asthmatics for therapy with biologics.
Experimental human rhinovirus (HRV) infection causes more severe upper and lower respiratory tract symptoms in allergic asthmatics than in healthy controls. There is greater induction of cytokines and chemokines in nasal and bronchial mucosal lining fluid (MLF) of asthmatics: with distinct pathways of type 2 and anti-viral/regulatory inflammation. Subject to further validation, analysis of MLF may prove useful in stratification of patients with asthma, and the definition of molecular endotypes. Interpretation Nasosorption and bronchosorption are precision sampling methods with potential for widespread application in respiratory and other mucosal diseases (e.g. gastrointestinal diseases). Biomarkers identified in nasosorption and bronchosorption samples will need to be validated compared to established airway sampling methods, in a range of asthma phenotypes, and with current and novel therapies.
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Affiliation(s)
- Trevor T Hansel
- Airway Disease Infection Section, National Heart and Lung Institute (NHLI), Imperial College (IC), London, UK; MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, UK; Imperial College Healthcare NHS Trust, UK; Imperial Clinical Respiratory Research Unit (ICRRU), UK.
| | - Tanushree Tunstall
- Imperial College Healthcare NHS Trust, UK; Imperial Clinical Respiratory Research Unit (ICRRU), UK
| | - Maria-Belen Trujillo-Torralbo
- Airway Disease Infection Section, National Heart and Lung Institute (NHLI), Imperial College (IC), London, UK; MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, UK; Imperial College Healthcare NHS Trust, UK
| | - Betty Shamji
- Novartis Institute for Biomedical Research, Horsham, UK
| | - Ajerico Del-Rosario
- Airway Disease Infection Section, National Heart and Lung Institute (NHLI), Imperial College (IC), London, UK; MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, UK; Imperial College Healthcare NHS Trust, UK
| | - Jaideep Dhariwal
- Airway Disease Infection Section, National Heart and Lung Institute (NHLI), Imperial College (IC), London, UK; MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, UK; Imperial College Healthcare NHS Trust, UK
| | - Paul D W Kirk
- MRC Biostatistics Unit, Cambridge Institute of Public Health, Cambridge, UK
| | | | - Jens Koopmann
- Airway Disease Infection Section, National Heart and Lung Institute (NHLI), Imperial College (IC), London, UK; Medimmune, Cambridge, UK
| | - Aurica Telcian
- Airway Disease Infection Section, National Heart and Lung Institute (NHLI), Imperial College (IC), London, UK; MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, UK
| | - Julia Aniscenko
- Airway Disease Infection Section, National Heart and Lung Institute (NHLI), Imperial College (IC), London, UK; MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, UK
| | - Leila Gogsadze
- Airway Disease Infection Section, National Heart and Lung Institute (NHLI), Imperial College (IC), London, UK; MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, UK
| | - Eteri Bakhsoliani
- Airway Disease Infection Section, National Heart and Lung Institute (NHLI), Imperial College (IC), London, UK; MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, UK
| | - Luminita Stanciu
- Airway Disease Infection Section, National Heart and Lung Institute (NHLI), Imperial College (IC), London, UK; MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, UK
| | - Nathan Bartlett
- Airway Disease Infection Section, National Heart and Lung Institute (NHLI), Imperial College (IC), London, UK; MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, UK
| | - Michael Edwards
- Airway Disease Infection Section, National Heart and Lung Institute (NHLI), Imperial College (IC), London, UK; MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, UK
| | - Ross Walton
- Airway Disease Infection Section, National Heart and Lung Institute (NHLI), Imperial College (IC), London, UK; MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, UK
| | - Patrick Mallia
- Airway Disease Infection Section, National Heart and Lung Institute (NHLI), Imperial College (IC), London, UK; MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, UK; Imperial College Healthcare NHS Trust, UK
| | - Toby M Hunt
- Hunt Developments (UK) Ltd, Midhurst, West Sussex, UK
| | - Trevor L Hunt
- Hunt Developments (UK) Ltd, Midhurst, West Sussex, UK
| | - Duncan G Hunt
- Hunt Developments (UK) Ltd, Midhurst, West Sussex, UK
| | - John Westwick
- Novartis Institute for Biomedical Research, Horsham, UK
| | | | - Onn Min Kon
- Imperial College Healthcare NHS Trust, UK; Imperial Clinical Respiratory Research Unit (ICRRU), UK
| | - David J Jackson
- Airway Disease Infection Section, National Heart and Lung Institute (NHLI), Imperial College (IC), London, UK; MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, UK; Guy's and St Thomas' NHS Trust
| | - Sebastian L Johnston
- Airway Disease Infection Section, National Heart and Lung Institute (NHLI), Imperial College (IC), London, UK; MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, UK; Imperial College Healthcare NHS Trust, UK
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21
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Bryan Wu YC, Rosenfeld AM, Upton N, Dhariwal J, Hershberg U, Kipling D, Johnston SL, Gould HJ. Insight into Rhinovirus-Induced Asthma Exacerbation Using High-Throughput Immunosequencing of B-Cell Repertoires. J Allergy Clin Immunol 2017. [DOI: 10.1016/j.jaci.2016.12.213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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22
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McErlean P, Kelly A, Dhariwal J, Watson J, Jurdzinski N, Smith J, Solari R, Edwards MR, Oosterhout AV, Johnston SL, Lavender P. P235 Epigenetic landscape of the asthmatic airways. Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.378] [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: 11/04/2022]
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23
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Wong EHC, Dhariwal J, Cuthbertson L, James P, Cox M, Moffatt M, Cookson W, Johnston S. P242 The airway microbiota in human rhinovirus induced asthma exacerbation. Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.385] [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: 11/04/2022]
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24
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Porter JD, Watson J, Roberts LR, Gill SK, Groves H, Dhariwal J, Almond MH, Wong E, Walton RP, Jones LH, Tregoning J, Kilty I, Johnston SL, Edwards MR. Identification of novel macrolides with antibacterial, anti-inflammatory and type I and III IFN-augmenting activity in airway epithelium. J Antimicrob Chemother 2016; 71:2767-81. [PMID: 27494903 PMCID: PMC5031920 DOI: 10.1093/jac/dkw222] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 05/09/2016] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Exacerbations of asthma and COPD are triggered by rhinoviruses. Uncontrolled inflammatory pathways, pathogenic bacterial burden and impaired antiviral immunity are thought to be important factors in disease severity and duration. Macrolides including azithromycin are often used to treat the above diseases, but exhibit variable levels of efficacy. Inhaled corticosteroids are also readily used in treatment, but may lack specificity. Ideally, new treatment alternatives should suppress unwanted inflammation, but spare beneficial antiviral immunity. METHODS In the present study, we screened 225 novel macrolides and tested them for enhanced antiviral activity against rhinovirus, as well as anti-inflammatory activity and activity against Gram-positive and Gram-negative bacteria. Primary bronchial epithelial cells were grown from 10 asthmatic individuals and the effects of macrolides on rhinovirus replication were also examined. Another 30 structurally similar macrolides were also examined. RESULTS The oleandomycin derivative Mac5, compared with azithromycin, showed superior induction (up to 5-fold, EC50 = 5-11 μM) of rhinovirus-induced type I IFNβ, type III IFNλ1 and type III IFNλ2/3 mRNA and the IFN-stimulated genes viperin and MxA, yet had no effect on IL-6 and IL-8 mRNA. Mac5 also suppressed rhinovirus replication at 48 h, proving antiviral activity. Mac5 showed antibacterial activity against Gram-positive Streptococcus pneumoniae; however, it did not have any antibacterial properties compared with azithromycin when used against Gram-negative Escherichia coli (as a model organism) and also the respiratory pathogens Pseudomonas aeruginosa and non-typeable Haemophilus influenzae. Further non-toxic Mac5 derivatives were identified with various anti-inflammatory, antiviral and antibacterial activities. CONCLUSIONS The data support the idea that macrolides have antiviral properties through a mechanism that is yet to be ascertained. We also provide evidence that macrolides can be developed with anti-inflammatory, antibacterial and antiviral activity and show surprising versatility depending on the clinical need.
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Affiliation(s)
- James D Porter
- Airway Disease Infection Section, National Heart Lung Institute, Imperial College London, London, UK MRC & Asthma UK Centre for Allergic Mechanisms of Asthma, London, UK
| | - Jennifer Watson
- Airway Disease Infection Section, National Heart Lung Institute, Imperial College London, London, UK
| | | | - Simren K Gill
- Mucosal Infection and Immunity Group, Section of Virology, Imperial College London, London, UK
| | - Helen Groves
- Mucosal Infection and Immunity Group, Section of Virology, Imperial College London, London, UK
| | - Jaideep Dhariwal
- Airway Disease Infection Section, National Heart Lung Institute, Imperial College London, London, UK MRC & Asthma UK Centre for Allergic Mechanisms of Asthma, London, UK
| | - Mark H Almond
- Airway Disease Infection Section, National Heart Lung Institute, Imperial College London, London, UK MRC & Asthma UK Centre for Allergic Mechanisms of Asthma, London, UK
| | - Ernie Wong
- Airway Disease Infection Section, National Heart Lung Institute, Imperial College London, London, UK MRC & Asthma UK Centre for Allergic Mechanisms of Asthma, London, UK
| | - Ross P Walton
- Airway Disease Infection Section, National Heart Lung Institute, Imperial College London, London, UK MRC & Asthma UK Centre for Allergic Mechanisms of Asthma, London, UK
| | | | - John Tregoning
- Mucosal Infection and Immunity Group, Section of Virology, Imperial College London, London, UK
| | | | - Sebastian L Johnston
- Airway Disease Infection Section, National Heart Lung Institute, Imperial College London, London, UK MRC & Asthma UK Centre for Allergic Mechanisms of Asthma, London, UK
| | - Michael R Edwards
- Airway Disease Infection Section, National Heart Lung Institute, Imperial College London, London, UK MRC & Asthma UK Centre for Allergic Mechanisms of Asthma, London, UK
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Jozwik A, Habibi MS, Paras A, Zhu J, Guvenel A, Dhariwal J, Almond M, Wong EHC, Sykes A, Maybeno M, Del Rosario J, Trujillo-Torralbo MB, Mallia P, Sidney J, Peters B, Kon OM, Sette A, Johnston SL, Openshaw PJ, Chiu C. RSV-specific airway resident memory CD8+ T cells and differential disease severity after experimental human infection. Nat Commun 2015; 6:10224. [PMID: 26687547 PMCID: PMC4703893 DOI: 10.1038/ncomms10224] [Citation(s) in RCA: 207] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 11/16/2015] [Indexed: 12/30/2022] Open
Abstract
In animal models, resident memory CD8+ T (Trm) cells assist in respiratory virus elimination but their importance in man has not been determined. Here, using experimental human respiratory syncytial virus (RSV) infection, we investigate systemic and local virus-specific CD8+ T-cell responses in adult volunteers. Having defined the immunodominance hierarchy, we analyse phenotype and function longitudinally in blood and by serial bronchoscopy. Despite rapid clinical recovery, we note surprisingly extensive lower airway inflammation with persistent viral antigen and cellular infiltrates. Pulmonary virus-specific CD8+ T cells display a CD69+CD103+ Trm phenotype and accumulate to strikingly high frequencies into convalescence without continued proliferation. While these have a more highly differentiated phenotype, they express fewer cytotoxicity markers than in blood. Nevertheless, their abundance before infection correlates with reduced symptoms and viral load, implying that CD8+ Trm cells in the human lung can confer protection against severe respiratory viral disease when humoral immunity is overcome. Respiratory syncytial virus (RSV) is a common cause of respiratory tract infections. Here the authors analyse cellular immune responses of individuals experimentally infected with RSV and reveal the presence of high frequencies of virus- specific resident memory CD8+ T cells in the airway, which correlate with improved viral control.
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Affiliation(s)
- Agnieszka Jozwik
- National Heart and Lung Institute, Imperial College London, London W2 1PG, UK
| | | | - Allan Paras
- National Heart and Lung Institute, Imperial College London, London W2 1PG, UK
| | - Jie Zhu
- National Heart and Lung Institute, Imperial College London, London W2 1PG, UK
| | - Aleks Guvenel
- National Heart and Lung Institute, Imperial College London, London W2 1PG, UK
| | - Jaideep Dhariwal
- National Heart and Lung Institute, Imperial College London, London W2 1PG, UK
| | - Mark Almond
- National Heart and Lung Institute, Imperial College London, London W2 1PG, UK
| | - Ernie H C Wong
- National Heart and Lung Institute, Imperial College London, London W2 1PG, UK
| | - Annemarie Sykes
- National Heart and Lung Institute, Imperial College London, London W2 1PG, UK
| | - Matthew Maybeno
- Centre for Infectious Disease, Division of Vaccine Discovery, La Jolla Institute of Allergy and Immunology, 9420 Athena Circle, La Jolla, California 92037, USA
| | - Jerico Del Rosario
- National Heart and Lung Institute, Imperial College London, London W2 1PG, UK
| | | | - Patrick Mallia
- National Heart and Lung Institute, Imperial College London, London W2 1PG, UK
| | - John Sidney
- Centre for Infectious Disease, Division of Vaccine Discovery, La Jolla Institute of Allergy and Immunology, 9420 Athena Circle, La Jolla, California 92037, USA
| | - Bjoern Peters
- Centre for Infectious Disease, Division of Vaccine Discovery, La Jolla Institute of Allergy and Immunology, 9420 Athena Circle, La Jolla, California 92037, USA
| | - Onn Min Kon
- National Heart and Lung Institute, Imperial College London, London W2 1PG, UK
| | - Alessandro Sette
- Centre for Infectious Disease, Division of Vaccine Discovery, La Jolla Institute of Allergy and Immunology, 9420 Athena Circle, La Jolla, California 92037, USA
| | | | - Peter J Openshaw
- National Heart and Lung Institute, Imperial College London, London W2 1PG, UK
| | - Christopher Chiu
- National Heart and Lung Institute, Imperial College London, London W2 1PG, UK
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26
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Jackson DJ, Makrinioti H, Rana BMJ, Shamji BWH, Trujillo-Torralbo MB, Footitt J, Jerico Del-Rosario, Telcian AG, Nikonova A, Zhu J, Aniscenko J, Gogsadze L, Bakhsoliani E, Traub S, Dhariwal J, Porter J, Hunt D, Hunt T, Hunt T, Stanciu LA, Khaitov M, Bartlett NW, Edwards MR, Kon OM, Mallia P, Papadopoulos NG, Akdis CA, Westwick J, Edwards MJ, Cousins DJ, Walton RP, Johnston SL. IL-33-dependent type 2 inflammation during rhinovirus-induced asthma exacerbations in vivo. Am J Respir Crit Care Med 2015; 190:1373-82. [PMID: 25350863 DOI: 10.1164/rccm.201406-1039oc] [Citation(s) in RCA: 440] [Impact Index Per Article: 48.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Rhinoviruses are the major cause of asthma exacerbations; however, its underlying mechanisms are poorly understood. We hypothesized that the epithelial cell-derived cytokine IL-33 plays a central role in exacerbation pathogenesis through augmentation of type 2 inflammation. OBJECTIVES To assess whether rhinovirus induces a type 2 inflammatory response in asthma in vivo and to define a role for IL-33 in this pathway. METHODS We used a human experimental model of rhinovirus infection and novel airway sampling techniques to measure IL-4, IL-5, IL-13, and IL-33 levels in the asthmatic and healthy airways during a rhinovirus infection. Additionally, we cultured human T cells and type 2 innate lymphoid cells (ILC2s) with the supernatants of rhinovirus-infected bronchial epithelial cells (BECs) to assess type 2 cytokine production in the presence or absence of IL-33 receptor blockade. MEASUREMENTS AND MAIN RESULTS IL-4, IL-5, IL-13, and IL-33 are all induced by rhinovirus in the asthmatic airway in vivo and relate to exacerbation severity. Further, induction of IL-33 correlates with viral load and IL-5 and IL-13 levels. Rhinovirus infection of human primary BECs induced IL-33, and culture of human T cells and ILC2s with supernatants of rhinovirus-infected BECs strongly induced type 2 cytokines. This induction was entirely dependent on IL-33. CONCLUSIONS IL-33 and type 2 cytokines are induced during a rhinovirus-induced asthma exacerbation in vivo. Virus-induced IL-33 and IL-33-responsive T cells and ILC2s are key mechanistic links between viral infection and exacerbation of asthma. IL-33 inhibition is a novel therapeutic approach for asthma exacerbations.
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Affiliation(s)
- David J Jackson
- 1 Airway Disease Infection Section, National Heart & Lung Institute, Imperial College London, London, United Kingdom
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Dhariwal J, Tennant RC, Hansell DM, Westwick J, Walker C, Ward SP, Pride N, Barnes PJ, Kon OM, Hansel TT. Smoking cessation in COPD causes a transient improvement in spirometry and decreases micronodules on high-resolution CT imaging. Chest 2014; 145:1006-1015. [PMID: 24522562 PMCID: PMC4011651 DOI: 10.1378/chest.13-2220] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Accepted: 12/02/2013] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Smoking cessation is of major importance for all smokers; however, in patients with COPD, little information exists on how smoking cessation influences lung function and high-resolution CT (HRCT) scan appearances. METHODS In this single-center study, we performed screening spirometry in a group of heavy smokers aged 40 to 80 years (N = 358). We then studied the effects of smoking cessation in two groups of selected subjects: smokers with COPD (n = 38) and smokers with normal spirometry (n = 55). In parallel to subjects undergoing smoking cessation, we studied a control group of nonsmokers (n = 19). RESULTS Subjects with COPD who quit smoking had a marked, but transient improvement in FEV1 at 6 weeks (184 mL, n = 17, P < .01) that was still present at 12 weeks (81 mL, n = 17, P < .05) and only partially maintained at 1 year. In contrast, we saw improvement in the transfer factor of lung for carbon monoxide at 6 weeks in both subjects with COPD who quit smoking (0.47 mmol/min/kPa, n = 17, P < .01) and subjects who quit smoking with normal spirometry (0.40 mmol/min/kPa, n = 35, P < .01). An upper-zone single HRCT image slice reliably identified emphysema at baseline in 74% of smokers with COPD (28 of 38) and 29% of healthy smokers (16 of 55). Smoking cessation had no significant effect on the appearances of emphysema but decreased the presence of micronodules on HRCT imaging. CONCLUSIONS Cigarette smoking causes extensive lung function and HRCT image abnormalities, even in patients with normal spirometry. Smoking cessation has differential effects on lung function (FEV1 and gas transfer) and features on HRCT images (emphysema and micronodules). Cessation of smoking in patients with COPD causes a transient improvement in FEV1 and decreases the presence of micronodules, offering an opportunity for concomitant therapy during smoking cessation to augment these effects. Smoking cessation at the earliest possible opportunity is vital to minimize permanent damage to the lungs.
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Affiliation(s)
- Jaideep Dhariwal
- Chest and Allergy Department, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London
| | - Rachel C Tennant
- Departments of Thoracic Medicine, Radiology, and Lung Function and Clinical Studies Unit, National Heart and Lung Institute at the Royal Brompton Hospital, Imperial College, London
| | - David M Hansell
- Departments of Thoracic Medicine, Radiology, and Lung Function and Clinical Studies Unit, National Heart and Lung Institute at the Royal Brompton Hospital, Imperial College, London
| | | | | | - Simon P Ward
- Departments of Thoracic Medicine, Radiology, and Lung Function and Clinical Studies Unit, National Heart and Lung Institute at the Royal Brompton Hospital, Imperial College, London
| | - Neil Pride
- Departments of Thoracic Medicine, Radiology, and Lung Function and Clinical Studies Unit, National Heart and Lung Institute at the Royal Brompton Hospital, Imperial College, London
| | - Peter J Barnes
- Departments of Thoracic Medicine, Radiology, and Lung Function and Clinical Studies Unit, National Heart and Lung Institute at the Royal Brompton Hospital, Imperial College, London
| | - Onn Min Kon
- Chest and Allergy Department, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London
| | - Trevor T Hansel
- Departments of Thoracic Medicine, Radiology, and Lung Function and Clinical Studies Unit, National Heart and Lung Institute at the Royal Brompton Hospital, Imperial College, London.
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Dhariwal J, Edwards MR, Johnston SL. Anti-viral agents: potential utility in exacerbations of asthma. Curr Opin Pharmacol 2013; 13:331-6. [PMID: 23664758 PMCID: PMC7172264 DOI: 10.1016/j.coph.2013.04.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Revised: 04/15/2013] [Accepted: 04/16/2013] [Indexed: 01/30/2023]
Abstract
Respiratory virus infections are the single greatest precipitants of asthma exacerbations. Current treatment options for AE are limited and have developed little in recent years. Development of effective anti-viral treatments remains a key target for therapeutic intervention. Approaches include therapies that either target the virus or boost host response to the virus. New clinical studies are needed to further our understanding of the mechanisms of virus induced asthma exacerbation.
Asthma is the most common chronic respiratory disease and its prevalence is on the increase. Respiratory viral infections in early life have been suggested to increase the risk of development of asthma in later life and virus infection remains the single greatest precipitant of asthma exacerbations. The development of effective anti-viral treatments remains a key target for therapeutic intervention. Here we discuss the role of respiratory viral infection in asthma exacerbation and highlight current and potential anti-viral agents and their mechanisms of action.
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Affiliation(s)
- Jaideep Dhariwal
- Airway Disease Infection Section, National Heart Lung Institute, Imperial College London, UK
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Singanayagam A, Sridhar S, Dhariwal J, Abdel-Aziz D, Munro K, Connell DW, George PM, Molyneaux PL, Cooke GS, Burroughs AK, Lalvani A, Wickremasinghe M, Kon OM. A comparison between two strategies for monitoring hepatic function during antituberculous therapy. Am J Respir Crit Care Med 2011; 185:653-9. [PMID: 22198973 DOI: 10.1164/rccm.201105-0850oc] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
RATIONALE The optimum strategy for monitoring liver function during antituberculous therapy is unclear. OBJECTIVES To assess the value of the American Thoracic Society risk-factor approach for predicting drug-induced liver injury and to compare with a uniform policy of liver function testing in all patients at 2 weeks. METHODS We conducted an observational study of adult patients undergoing therapy for active tuberculosis at a tertiary center. All patients had alanine transferase measurement at baseline and 2 weeks following commencement of therapy. Sensitivity, specificity, and positive and negative predictive values were used to assess strategies. MEASUREMENTS AND MAIN RESULTS There were 288 patients included, and 21 (7.3%) developed drug-induced liver injury (57.1% "early" at 2 wk and 42.9% "late," after 2 wk). There were increased rates of individuals with HIV infection in the early drug-induced liver injury group compared with no drug-induced liver injury and late drug-induced liver injury groups (33% vs. 7.1% vs. 0%; P = 0.004). The American Thoracic Society algorithm had a sensitivity and specificity of 66.7 and 65.6%, respectively, for prediction of early and 22.2% and 63.7% for late drug-induced liver injury. The uniform monitoring policy had poor sensitivity but better specificity (22.2 and 82.1%) for prediction of late drug-induced liver injury. CONCLUSIONS In our urban, ethnically diverse population, a risk-factor approach is neither sensitive nor specific for prediction of drug-induced liver injury. A uniform policy of liver function testing at 2 weeks is useful for prompt identification of a subgroup who develop early drug-induced liver injury and may offer better specificity in ruling out late drug-induced liver injury.
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Affiliation(s)
- Aran Singanayagam
- Department of Respiratory Medicine, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
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George PM, Mehta M, Dhariwal J, Singanayagam A, Raphael CE, Salmasi M, Connell DW, Molyneaux P, Wickremasinghe M, Jepson A, Kon OM. Post-bronchoscopy sputum: improving the diagnostic yield in smear negative pulmonary TB. Respir Med 2011; 105:1726-31. [PMID: 21840695 DOI: 10.1016/j.rmed.2011.07.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2011] [Revised: 07/21/2011] [Accepted: 07/23/2011] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Patients with suspected active Pulmonary Tuberculosis (PTB) who are Acid-Fast Bacilli (AFB) smear negative or non-productive of sputum may undergo bronchoalveolar lavage. However, post-bronchoscopy sputum (PBS) sampling is not routine. The aim of this study was to establish the potential diagnostic value of PBS sampling. METHODS A retrospective study of patients attending a London University hospital with microbiologically confirmed PTB between January 2004 and December 2010. Patients who were AFB smear negative or non-productive of sputum were eligible if sputum sampling was performed within 7 days of bronchoscopy. RESULTS Over the study period, 236 patients had microbiologically confirmed smear negative PTB of which 57 patients were eligible for the study. 15 patients (26.3%) were infected with HIV. 19 patients (33.3%) converted to AFB sputum smear positivity post-bronchoscopy and 5 patients (8.8%) were exclusively AFB sputum smear positive on PBS microscopy. Mycobacterium tuberculosis was cultured from the PBS of 43 patients (75.4%) and of these, 4 (7.0%) were exclusively PBS culture positive. CONCLUSION PBS analysis can provide a simple method of rapidly diagnosing pulmonary tuberculosis. In this cohort, M. tuberculosis culture yield was increased by 7% through PBS sampling. This study has important infection control implications with nearly one third of patients becoming more infectious after bronchoscopy.
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Affiliation(s)
- Peter M George
- Chest and Allergy Department, St Mary's Hospital, Imperial College Healthcare NHS Trust, Praed Street, London W2 1NY, UK.
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George PM, Mehta M, Dhariwal J, Singanayagam A, Raphael CE, Salmasi M, Connell DW, Molyneaux P, Wickremasinghe M, Jepson A, Kon OM. P55 Post-bronchoscopy sputum: increasing the diagnostic yield in smear negative pulmonary tuberculosis. Thorax 2010. [DOI: 10.1136/thx.2010.150979.6] [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: 11/04/2022]
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