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Madronich S, Bernhard GH, Neale PJ, Heikkilä A, Andersen MPS, Andrady AL, Aucamp PJ, Bais AF, Banaszak AT, Barnes PJ, Bornman JF, Bruckman LS, Busquets R, Chiodo G, Häder DP, Hanson ML, Hylander S, Jansen MAK, Lingham G, Lucas RM, Calderon RM, Olsen C, Ossola R, Pandey KK, Petropavlovskikh I, Revell LE, Rhodes LE, Robinson SA, Robson TM, Rose KC, Schikowski T, Solomon KR, Sulzberger B, Wallington TJ, Wang QW, Wängberg SÅ, White CC, Wilson SR, Zhu L, Neale RE. Continuing benefits of the Montreal Protocol and protection of the stratospheric ozone layer for human health and the environment. Photochem Photobiol Sci 2024:10.1007/s43630-024-00577-8. [PMID: 38763938 DOI: 10.1007/s43630-024-00577-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 04/09/2024] [Indexed: 05/21/2024]
Abstract
The protection of Earth's stratospheric ozone (O3) is an ongoing process under the auspices of the universally ratified Montreal Protocol and its Amendments and adjustments. A critical part of this process is the assessment of the environmental issues related to changes in O3. The United Nations Environment Programme's Environmental Effects Assessment Panel provides annual scientific evaluations of some of the key issues arising in the recent collective knowledge base. This current update includes a comprehensive assessment of the incidence rates of skin cancer, cataract and other skin and eye diseases observed worldwide; the effects of UV radiation on tropospheric oxidants, and air and water quality; trends in breakdown products of fluorinated chemicals and recent information of their toxicity; and recent technological innovations of building materials for greater resistance to UV radiation. These issues span a wide range of topics, including both harmful and beneficial effects of exposure to UV radiation, and complex interactions with climate change. While the Montreal Protocol has succeeded in preventing large reductions in stratospheric O3, future changes may occur due to a number of natural and anthropogenic factors. Thus, frequent assessments of potential environmental impacts are essential to ensure that policies remain based on the best available scientific knowledge.
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Affiliation(s)
- S Madronich
- National Center for Atmospheric Research, Boulder, CO, USA.
- Natural Resource Ecology Laboratory, USDA UV-B Monitoring and Research Program, Colorado State University, Fort Collins, CO, USA.
| | - G H Bernhard
- Biospherical Instruments Inc, San Diego, CA, USA
| | - P J Neale
- Smithsonian Environmental Research Center, Edgewater, MD, USA
| | - A Heikkilä
- Finnish Meteorological Institute, Helsinki, Finland
| | - M P Sulbæk Andersen
- Department of Chemistry and Biochemistry, California State University Northridge, Northridge, CA, USA
- Department of Chemistry, University of Copenhagen, Copenhagen, Denmark
| | - A L Andrady
- Department of Chemical and Biomolecular Engineering, North Carolina State University , Raleigh, NC, USA
| | - P J Aucamp
- Ptersa Environmental Consultants, Faerie Glen, South Africa
| | - A F Bais
- Laboratory of Atmospheric Physics, Department of Physics, Aristotle University, Thessaloniki, Greece
| | - A T Banaszak
- Unidad Académica de Sistemas Arrecifales, Instituto de Ciencias del Mar y Limnología, Universidad Nacional Autónoma de México, Puerto Morelos, Mexico
| | - P J Barnes
- Department of Biological Sciences and Environment Program, Loyola University New Orleans, New Orleans, LA, USA
| | - J F Bornman
- Food Futures Institute, Murdoch University, Perth, Australia
| | - L S Bruckman
- Department of Materials Science and Engineering, Reserve University, Cleveland, OH, USA
| | - R Busquets
- Chemical and Pharmaceutical Sciences, Kingston University London, Kingston Upon Thames, UK
| | - G Chiodo
- Institute for Atmospheric and Climate Science, ETH Zürich, Zurich, Switzerland
| | - D-P Häder
- Friedrich-Alexander University, Möhrendorf, Germany
| | - M L Hanson
- Department of Environment and Geography, University of Manitoba, Winnipeg, MB, Canada
| | - S Hylander
- Centre for Ecology and Evolution in Microbial Model Systems, Linnaeus University, Kalmar, Sweden
| | - M A K Jansen
- School of Biological, Earth and Environmental Sciences, University College, Cork, Ireland
| | - G Lingham
- Centre For Ophthalmology and Visual Science (Incorporating Lion's Eye Institute), University of Western Australia, Perth, Australia
- Centre for Eye Research Ireland, Environmental, Sustainability and Health Institute, Technological University Dublin, Dublin, Ireland
| | - R M Lucas
- National Centre for Epidemiology and Population Health, College of Health and Medicine, Australian National University, Canberra, Australia
| | - R Mackenzie Calderon
- Cape Horn International Center, Puerto Williams, Chile
- Millennium Institute Biodiversity of Antarctic and Subantarctic Ecosystems BASE, Santiago, Chile
- Centro Universitario Cabo de Hornos, Universidad de Magallanes, O'Higgins 310, Puerto Williams, Chile
| | - C Olsen
- Population Health Program, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - R Ossola
- Department of Chemistry, Colorado State University, Fort Collins, CO, USA
| | - K K Pandey
- Indian Academy of Wood Science, Bengaluru, India
| | - I Petropavlovskikh
- Cooperative Institute for Research in Environmental Sciences, University of Colorado , Boulder, CO, USA
- NOAA Global Monitoring Laboratory, Boulder, CO, USA
| | - L E Revell
- School of Physical and Chemical Sciences, University of Canterbury, Christchurch, New Zealand
| | - L E Rhodes
- Faculty of Biology Medicine and Health, School of Biological Sciences, The University of Manchester, Manchester, UK
- Dermatology Centre, Salford Royal Hospital, Greater Manchester, UK
| | - S A Robinson
- Securing Antarctica's Environmental Future, University of Wollongong, Wollongong, Australia
- School of Earth, Atmospheric and Life Sciences, University of Wollongong, Wollongong, Australia
| | - T M Robson
- UK National School of Forestry, University of Cumbria, Ambleside Campus, UK
- Viikki Plant Science Centre, Faculty of Biological and Environmental Sciences, University of Helsinki, Helsinki, Finland
| | - K C Rose
- Department of Biological Sciences, Rensselaer Polytechnic Institute, Troy, NY, USA
| | - T Schikowski
- IUF-Leibniz Research Institute for Environmental Medicine, Dusseldorf, Germany
| | - K R Solomon
- School of Environmental Sciences, University of Guelph, Guelph, Canada
| | - B Sulzberger
- Eawag, Swiss Federal Institute of Aquatic Science and Technology, Duebendorf, Switzerland
| | - T J Wallington
- Center for Sustainable Systems, School for Environment and Sustainability, University of Michigan, Ann Arbor, MI, USA
| | - Q-W Wang
- Institute of Applied Ecology, Chinese Academy of Sciences, Shenyang, China
| | - S-Å Wängberg
- Department of Marine Sciences, University of Gothenburg, Gothenburg, Sweden
| | | | - S R Wilson
- School of Earth, Atmospheric and Life Sciences, University of Wollongong, Wollongong, Australia
| | - L Zhu
- State Key Lab for Modification of Chemical Fibers and Polymer Materials, College of Materials Science and Engineering, Donghua University, Shanghai, China
| | - R E Neale
- Population Health Program, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.
- School of Public Health, University of Queensland, Brisbane, Australia.
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Singh R, Belchamber KBR, Fenwick PS, Chana K, Donaldson G, Wedzicha JA, Barnes PJ, Donnelly LE. Defective monocyte-derived macrophage phagocytosis is associated with exacerbation frequency in COPD. Respir Res 2021; 22:113. [PMID: 33879129 PMCID: PMC8059282 DOI: 10.1186/s12931-021-01718-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [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: 09/09/2020] [Accepted: 04/14/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Lower airway bacterial colonisation (LABC) in COPD patients is associated with increased exacerbation frequency and faster lung function decline. Defective macrophage phagocytosis in COPD drives inflammation, but how defective macrophage function contributes to exacerbations is not clear. This study investigated the association between macrophage phagocytosis and exacerbation frequency, LABC and clinical parameters. METHODS Monocyte-derived macrophages (MDM) were generated from 92 stable COPD patients, and at the onset of exacerbation in 39 patients. Macrophages were exposed to fluorescently labelled Haemophilus influenzae or Streptococcus pneumoniae for 4 h, then phagocytosis measured by fluorimetry and cytokine release by ELISA. Sputum bacterial colonisation was measured by PCR. RESULTS Phagocytosis of H. influenzae was negatively correlated with exacerbation frequency (r = 0.440, p < 0.01), and was significantly reduced in frequent vs. infrequent exacerbators (1.9 × 103 RFU vs. 2.5 × 103 RFU, p < 0.01). There was no correlation for S. pneumoniae. There was no association between phagocytosis of either bacteria with age, lung function, smoking history or treatment with inhaled corticosteroids, or long-acting bronchodilators. Phagocytosis was not altered during an exacerbation, or in the 2 weeks post-exacerbation. In response to phagocytosis, MDM from exacerbating patients showed increased release of CXCL-8 (p < 0.001) and TNFα (p < 0.01) compared to stable state. CONCLUSION Impaired COPD macrophage phagocytosis of H. influenzae, but not S. pneumoniae is associated with exacerbation frequency, resulting in pro-inflammatory macrophages that may contribute to disease progression. Targeting these frequent exacerbators with drugs that improve macrophage phagocytosis may prove beneficial.
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Affiliation(s)
- R Singh
- National Heart and Lung Institute, Imperial College London, London, UK
| | - K B R Belchamber
- National Heart and Lung Institute, Imperial College London, London, UK
| | - P S Fenwick
- National Heart and Lung Institute, Imperial College London, London, UK
| | - K Chana
- National Heart and Lung Institute, Imperial College London, London, UK
| | - G Donaldson
- National Heart and Lung Institute, Imperial College London, London, UK
| | - J A Wedzicha
- National Heart and Lung Institute, Imperial College London, London, UK
| | - P J Barnes
- National Heart and Lung Institute, Imperial College London, London, UK
| | - L E Donnelly
- National Heart and Lung Institute, Imperial College London, London, UK.
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Scichilone N, Barnes PJ, Battaglia S, Benfante A, Brown R, Canonica GW, Caramori G, Cazzola M, Centanni S, Cianferoni A, Corsico A, De Carlo G, Di Marco F, Gaga M, Hawrylowicz C, Heffler E, Matera MG, Matucci A, Paggiaro P, Papi A, Popov T, Rogliani P, Santus P, Solidoro P, Togias A, Boulet LP. The Hidden Burden of Severe Asthma: From Patient Perspective to New Opportunities for Clinicians. J Clin Med 2020; 9:jcm9082397. [PMID: 32727032 PMCID: PMC7463666 DOI: 10.3390/jcm9082397] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 07/15/2020] [Accepted: 07/20/2020] [Indexed: 12/17/2022] Open
Abstract
Severe asthma is an important topic in respiratory diseases, due to its high impact on morbidity and mortality as well as on health-care resources. The many challenges that still exist in the management of the most difficult-to-treat forms of the disease, and the acknowledgement of the existence of unexplored areas in the pathophysiological mechanisms and the therapeutic targets represent an opportunity to gather experts in the field with the immediate goals to summarize current understanding about the natural history of severe asthma and to identify gaps in knowledge and research opportunities, with the aim to contribute to improved medical care and health outcomes. This article is a consensus document from the “International Course on Severe Asthma” that took place in Palermo, Italy, on May 10–11, 2019. Emerging topics in severe asthma were addressed and discussed among experts, with special focus on patient’s needs and research opportunities, with the aim to highlight the unanswered questions in the diagnostic process and therapeutic approach.
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Affiliation(s)
- Nicola Scichilone
- Division of Respiratory Diseases, Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Piazza delle Cliniche 2, 90143 Palermo, Italy; (S.B.); (A.B.)
- Correspondence: ; Tel.: +39-091-655-2146
| | - Peter John Barnes
- Airway Disease Section, National Heart & Lung Institute, Imperial College London, Dovehouse Street, London SW3 6LY, UK;
| | - Salvatore Battaglia
- Division of Respiratory Diseases, Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Piazza delle Cliniche 2, 90143 Palermo, Italy; (S.B.); (A.B.)
| | - Alida Benfante
- Division of Respiratory Diseases, Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Piazza delle Cliniche 2, 90143 Palermo, Italy; (S.B.); (A.B.)
| | - Robert Brown
- Department of Anesthesiology and Critical Care Medicine, Medicine, Department of Medicine, Division of Pulmonary Medicine, Department of Environmental Health and Engineering, Johns Hopkins University, Baltimore, MD 21287, USA;
| | - Giorgio Walter Canonica
- Personalised Medicine Clinic Asthma & Allergy, Humanitas University, Department of Biomedical Sciences, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (G.W.C.); (E.H.)
| | - Gaetano Caramori
- Respiratory Medicine Unit, Department of Biomedical Sciences, Dentistry and Morphological and Functional Imaging (BIOMORF), University of Messina, 98122 Messina, Italy;
| | - Mario Cazzola
- Unit of Respiratory Medicine, Dept. Experimental Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; (M.C.); (P.R.)
| | - Stefano Centanni
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Health Sciences, University of Milan, 20142 Milan, Italy;
| | - Antonella Cianferoni
- Pediatrics Department, Perlman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Angelo Corsico
- Division of Respiratory Diseases, IRCCS Policlinico San Matteo Foundation and Department of Internal Medicine and Therapeutics – University of Pavia, 27100 Pavia, Italy;
| | - Giuseppe De Carlo
- The European Federation of Allergy and Airways Diseases Patients Associations (EFA), 1000 Brussels, Belgium;
| | - Fabiano Di Marco
- Respiratory Unit, ASST - Papa Giovanni XXIII Hospital, Bergamo, University of Milan, 24127 Milan, Italy;
| | - Mina Gaga
- 7th Respiratory Medicine Dept, Asthma Cen, Athens Chest Hospital, 11527 Athens, Greece;
| | - Catherine Hawrylowicz
- Division of Asthma, Allergy and Lung Biology, King’s College London, Guy’s Hospital, London SE1 9RT, UK;
| | - Enrico Heffler
- Personalised Medicine Clinic Asthma & Allergy, Humanitas University, Department of Biomedical Sciences, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (G.W.C.); (E.H.)
| | - Maria Gabriella Matera
- Unit of Pharmacology, Dept. Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy;
| | - Andrea Matucci
- Immunoallergology Unit, Careggi University Hospital, 50139 Florence, Italy;
| | - Pierluigi Paggiaro
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, 56126 Pisa, Italy;
| | - Alberto Papi
- Research Center on Asthma and COPD, Dept of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy;
| | - Todor Popov
- Clinic of Occupational Diseases, University Hospital Sv. Ivan Rilski, 1431 Sofia, Bulgaria;
| | - Paola Rogliani
- Unit of Respiratory Medicine, Dept. Experimental Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; (M.C.); (P.R.)
| | - Pierachille Santus
- Division of Respiratory Diseases, Department of Biomedical and Clinical Sciences (DIBIC), Università degli Studi di Milano, Ospedale L. Sacco, ASST Fatebenefratelli-Sacco, 20157 Milan, Italy;
| | - Paolo Solidoro
- Pneumology Unit U, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino, University of Turin, 10126 Turin, Italy;
| | - Alkis Togias
- National Institute of Allergy and Infectious Diseases, Bethesda, MD 20814, USA;
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Tambascio J, de Souza HCD, Martinez R, Baddini-Martinez JA, Barnes PJ, Gastaldi AC. Effects of an Airway Clearance Device on Inflammation, Bacteriology, and Mucus Transport in Bronchiectasis. Respir Care 2017; 62:1067-1074. [DOI: 10.4187/respcare.05214] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Baker JR, Vuppusetty C, Colley T, Papaioannou AI, Fenwick P, Donnelly L, Ito K, Barnes PJ. Oxidative stress dependent microRNA-34a activation via PI3Kα reduces the expression of sirtuin-1 and sirtuin-6 in epithelial cells. Sci Rep 2016; 6:35871. [PMID: 27767101 PMCID: PMC5073335 DOI: 10.1038/srep35871] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 10/07/2016] [Indexed: 12/18/2022] Open
Abstract
Sirtuin-1 (SIRT1) and SIRT6, NAD+-dependent Class III protein deacetylases, are putative anti-aging enzymes, down-regulated in patients with chronic obstructive pulmonary disease (COPD), which is characterized by the accelerated ageing of the lung and associated with increased oxidative stress. Here, we show that oxidative stress (hydrogen peroxide) selectively elevates microRNA-34a (miR-34a) but not the related miR-34b/c, with concomitant reduction of SIRT1/-6 in bronchial epithelial cells (BEAS2B), which was also observed in peripheral lung samples from patients with COPD. Over-expression of a miR-34a mimic caused a significant reduction in both mRNA and protein of SIRT1/-6, whereas inhibition of miR-34a (antagomir) increased these sirtuins. Induction of miR-34a expression with H2O2 was phosphoinositide-3-kinase (PI3K) dependent as it was associated with PI3Kα activation as well as phosphatase and tensin homolog (PTEN) reduction. Importantly, miR-34a antagomirs increased SIRT1/-6 mRNA levels, whilst decreasing markers of cellular senescence in airway epithelial cells from COPD patients, suggesting that this process is reversible. Other sirtuin isoforms were not affected by miR-34a. Our data indicate that miR-34a is induced by oxidative stress via PI3K signaling, and orchestrates ageing responses under oxidative stress, therefore highlighting miR-34a as a new therapeutic target and biomarker in COPD and other oxidative stress-driven aging diseases.
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Affiliation(s)
- J R Baker
- Airway Disease Section, National Heart and Lung Institute, Imperial College, London SW3 6LY, U.K
| | - C Vuppusetty
- Airway Disease Section, National Heart and Lung Institute, Imperial College, London SW3 6LY, U.K
| | - T Colley
- Airway Disease Section, National Heart and Lung Institute, Imperial College, London SW3 6LY, U.K
| | | | - P Fenwick
- Airway Disease Section, National Heart and Lung Institute, Imperial College, London SW3 6LY, U.K
| | - Louise Donnelly
- Airway Disease Section, National Heart and Lung Institute, Imperial College, London SW3 6LY, U.K
| | - K Ito
- Airway Disease Section, National Heart and Lung Institute, Imperial College, London SW3 6LY, U.K
| | - P J Barnes
- Airway Disease Section, National Heart and Lung Institute, Imperial College, London SW3 6LY, U.K
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7
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Nicholson GC, Holloway RA, Leaker BR, Kilty I, Salganik M, Tan L, Barnes PJ, Donnelly LE. A novel flow cytometric-based method to measure kinase inhibition in sputum from COPD subjects. BMJ Open Respir Res 2016; 3:e000140. [PMID: 27403320 PMCID: PMC4932304 DOI: 10.1136/bmjresp-2016-000140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 04/04/2016] [Accepted: 06/03/2016] [Indexed: 12/05/2022] Open
Abstract
Introduction Janus kinases (JAKs) regulate inflammatory gene expression through phosphorylation of signal transducer and activator of transcription (STAT) proteins. Expression of STAT proteins is increased in chronic obstructive pulmonary disease (COPD), and may be involved in driving chronic inflammation. Oral JAK inhibitors are effective as anti-inflammatory therapy but exhibit dose-limiting adverse effects. Development of inhaled compounds would be enhanced by robust biomarkers that directly reflect the anti-inflammatory and pharmacological activity in the lung. Methods A novel flow cytometry assay was developed to measure STAT1 phosphorylation in sputum inflammatory cells. The standard sputum processing method was refined to improve sputum cell viability. The flow cytometric assay was used to assess the reproducibility of the measurement of STAT1 phosphorylation and the in vitro activity of a pan JAK-inhibitor on three separate visits in patients with COPD. Results Upregulation of STAT1 phosphorylation was measured following in vitro IFNγ stimulation of sputum macrophages (stimulated/unstimulated ratio 1.57; p<0.00001). Upregulation was inhibited following in vitro preincubation with a pan JAK-inhibitor (inhibited+stimulated/unstimulated ratio 0.97). STAT1 phosphorylation activity could only be measured in macrophages. Conclusions Sputum from patients with COPD can be used to reproducibly measure phospho-STAT expression in sputum macrophages. The flow cytometry-based method can be used to evaluate kinase inhibitors in vitro and subsequently in ex vivo studies. The assay is particularly useful for the assessment of inhaled compounds where whole blood assays may not be relevant.
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Affiliation(s)
| | - R A Holloway
- Airways Disease Section , National Heart & Lung Institute, Imperial College , London , UK
| | - B R Leaker
- Respiratory Clinical Trials Ltd , London , UK
| | - I Kilty
- Pfizer , Cambridge, Massachusetts , USA
| | | | - L Tan
- Pfizer , Cambridge, Massachusetts , USA
| | - P J Barnes
- Airways Disease Section , National Heart & Lung Institute, Imperial College , London , UK
| | - L E Donnelly
- Airways Disease Section , National Heart & Lung Institute, Imperial College , London , UK
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Singh D, Leaker B, Boyce M, Nandeuil MA, Collarini S, Mariotti F, Santoro D, Barnes PJ. A novel inhaled phosphodiesterase 4 inhibitor (CHF6001) reduces the allergen challenge response in asthmatic patients. Pulm Pharmacol Ther 2016; 40:1-6. [PMID: 27373438 DOI: 10.1016/j.pupt.2016.06.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Revised: 06/08/2016] [Accepted: 06/28/2016] [Indexed: 12/18/2022]
Abstract
CHF6001 is an inhaled phosphodiesterase 4 (PDE4) inhibitor in development for the treatment of obstructive lung diseases. The efficacy and safety of CHF6001 were investigated in a double blind, placebo controlled, 3-way cross-over study using the allergen challenge model. Thirty-six atopic asthmatics who were not taking inhaled corticosteroids and who demonstrated a late asthmatic response (LAR) to inhaled allergen at screening were randomised to receive CHF6001 400 μg or 1200 μg or placebo administered once a day using a dry powder inhaler. The three treatment periods were 9 days; allergen challenges were performed on day 9 and induced sputum was obtained after 10 h from challenge. Washout periods between treatments were up to 5 weeks. Both CHF6001 doses significantly attenuated the LAR; the primary endpoint analysis showed that CHF6001 400 μg and 1200 μg caused reductions of 19.7% (p = 0.015) and 28.2% (p < 0.001) respectively of the weighted FEV1 AUC4-10h compared with placebo. The difference between the CHF6001 doses was not statistically significant (p = 0.223). Compared with placebo, CHF6001 caused greater reduction in sputum eosinophil counts, although these changes were not statistically significant. CHF6001 was well tolerated, with similar numbers of adverse events in each treatment period. This inhaled PDE4 inhibitor has the potential to provide clinical benefits in patients with atopic asthma.
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Affiliation(s)
- D Singh
- University of Manchester, Medicines Evaluation Unit, University Hospital of South Manchester Foundation Trust, Southmoor Road, Manchester, M23 9QZ, United Kingdom.
| | - B Leaker
- Respiratory Clinical Trials Ltd, 18-22 Queen Anne St, London, W1G 8HU, United Kingdom
| | - M Boyce
- Hammersmith Medicines Research, Cumberland Avenue, London, NW10 7EW, United Kingdom
| | - M A Nandeuil
- Chiesi S.A., 11 Avenue Dubonnet, 92400, Courbevoie, France
| | - S Collarini
- Chiesi Farmaceutici S.p.A., Via Palermo 26/A, 43122, Parma, Italy
| | - F Mariotti
- Chiesi Farmaceutici S.p.A., Via Palermo 26/A, 43122, Parma, Italy
| | - D Santoro
- Chiesi Farmaceutici S.p.A., Via Palermo 26/A, 43122, Parma, Italy
| | - P J Barnes
- National Heart & Lung Institute, Imperial College, London, SW3 6LY, United Kingdom
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Levy ML, Dekhuijzen P, Barnes PJ, Broeders M, Corrigan CJ, Chawes BL, Corbetta L, Dubus JC, Hausen T, Lavorini F, Roche N, Sanchis J, Usmani OS, Viejo J, Vincken W, Voshaar T, Crompton GK, Pedersen S. Erratum: Inhaler technique: facts and fantasies. A view from the Aerosol Drug Management Improvement Team (ADMIT). NPJ Prim Care Respir Med 2016; 26:16028. [PMID: 31265706 PMCID: PMC4881806 DOI: 10.1038/npjpcrm.2016.28] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
[This corrects the article DOI: 10.1038/npjpcrm.2016.17.].
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Levy ML, Dekhuijzen PNR, Barnes PJ, Broeders M, Corrigan CJ, Chawes BL, Corbetta L, Dubus JC, Hausen T, Lavorini F, Roche N, Sanchis J, Usmani OS, Viejo J, Vincken W, Voshaar T, Crompton GK, Pedersen S. Inhaler technique: facts and fantasies. A view from the Aerosol Drug Management Improvement Team (ADMIT). NPJ Prim Care Respir Med 2016; 26:16017. [PMID: 27098045 PMCID: PMC4839029 DOI: 10.1038/npjpcrm.2016.17] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 01/23/2016] [Accepted: 02/09/2016] [Indexed: 01/04/2023] Open
Abstract
Health professionals tasked with advising patients with asthma and chronic obstructive pulmonary disease (COPD) how to use inhaler devices properly and what to do about unwanted effects will be aware of a variety of commonly held precepts. The evidence for many of these is, however, lacking or old and therefore in need of re-examination. Few would disagree that facilitating and encouraging regular and proper use of inhaler devices for the treatment of asthma and COPD is critical for successful outcomes. It seems logical that the abandonment of unnecessary or ill-founded practices forms an integral part of this process: the use of inhalers is bewildering enough, particularly with regular introduction of new drugs, devices and ancillary equipment, without unnecessary and pointless adages. We review the evidence, or lack thereof, underlying ten items of inhaler ‘lore’ commonly passed on by health professionals to each other and thence to patients. The exercise is intended as a pragmatic, evidence-informed review by a group of clinicians with appropriate experience. It is not intended to be an exhaustive review of the literature; rather, we aim to stimulate debate, and to encourage researchers to challenge some of these ideas and to provide new, updated evidence on which to base relevant, meaningful advice in the future. The discussion on each item is followed by a formal, expert opinion by members of the ADMIT Working Group.
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Affiliation(s)
- Mark L Levy
- General Practitioner and Respiratory Lead, Harrow, London, UK
| | - P N R Dekhuijzen
- Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - P J Barnes
- National Heart and Lung Institute, Imperial College London, London, UK
| | - M Broeders
- University Medical Centre Nijmegen, Nijmegen, The Netherlands
| | - C J Corrigan
- Department of Respiratory Medicine and Allergy, King's College London School of Medicine, London, UK
| | - B L Chawes
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - L Corbetta
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - J C Dubus
- Unité de Medicine Infantile, Marseille, France
| | | | - F Lavorini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - N Roche
- Service de Pneumologie et Soins Intensifs Respiratoires, Groupe Hospitalier Cochin, Université Paris-Descartes, Paris, France
| | - J Sanchis
- Departament de Pneumologia, Hospital de la Santa Creuide Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Omar S Usmani
- NIHR Career Development Fellow, National Heart and Lung Institute (NHLI), Imperial College London, UK.,Royal Brompton Hospital, London, UK
| | - J Viejo
- Hospital General Yagüe de Burgos, Spain
| | - W Vincken
- Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Dienst Pneumologie, Brussels, Belgium
| | | | | | - Soren Pedersen
- Pediatric Research Unit, University of Southern Denmark, Kolding Hospital, Kolding, Denmark
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11
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Leaker BR, Nicholson GC, Ali FY, Daudi N, O'Connor BJ, Barnes PJ. Bronchoabsorption; a novel bronchoscopic technique to improve biomarker sampling of the airway. Respir Res 2015; 16:102. [PMID: 26338015 PMCID: PMC4559920 DOI: 10.1186/s12931-015-0268-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 08/26/2015] [Indexed: 02/03/2023] Open
Abstract
Background Current techniques used to obtain lung samples have significant limitations and do not provide reproducible biomarkers of inflammation. We have developed a novel technique that allows multiple sampling methods from the same area (or multiple areas) of the lung under direct bronchoscopic vision. It allows collection of mucosal lining fluid and bronchial brushing from the same site; biopsy samples may also be taken. The novel technique takes the same time as standard procedures and can be conducted safely. Methods Eight healthy smokers aged 40–65 years were included in this study. An absorptive filter paper was applied to the bronchial mucosa under direct vision using standard bronchoscopic techniques. Further samples were obtained from the same site using bronchial brushings. Bronchoalveolar lavage (BAL) was obtained using standard techniques. Chemokine (C-C Motif) Ligand 20 (CCL20), CCL4, CCL5, Chemokine (C-X-C Motif) Ligand 1 (CXCL1), CXCL8, CXCL9, CXCL10, CXCL11, Interleukin 1 beta (IL-1β), IL-6, Vascular endothelial growth factor (VEGF), Matrix metalloproteinase 8 (MMP-8) and MMP-9 were measured in exudate and BAL. mRNA was collected from the bronchial brushings for gene expression analysis. Results A greater than 10 fold concentration of all the biomarkers was detected in lung exudate in comparison to BAL. High yield of good quality RNA with RNA integrity numbers (RIN) between 7.6 and 9.3 were extracted from the bronchial brushings. The subset of genes measured were reproducible across the samples and corresponded to the inflammatory markers measured in exudate and BAL. Conclusions The bronchoabsorption technique as described offers the ability to sample lung fluid direct from the site of interest without the dilution effects caused by BAL. Using this method we were able to successfully measure the concentrations of biomarkers present in the lungs as well as collect high yield mRNA samples for gene expression analysis from the same site. This technique demonstrates superior sensitivity to standard BAL for the measurement of biomarkers of inflammation. It could replace BAL as the method of choice for these measurements. This method provides a systems biology approach to studying the inflammatory markers of respiratory disease progression. Trial registration NHS Health Research Authority (13/LO/0256).
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Affiliation(s)
- B R Leaker
- Respiratory Clinical Trials Ltd., 18-22 Queen Anne Street, London, W1G 8HU, UK.
| | - G C Nicholson
- Respiratory Clinical Trials Ltd., 18-22 Queen Anne Street, London, W1G 8HU, UK.
| | - F Y Ali
- Respiratory Clinical Trials Ltd., 18-22 Queen Anne Street, London, W1G 8HU, UK.
| | - N Daudi
- Respiratory Clinical Trials Ltd., 18-22 Queen Anne Street, London, W1G 8HU, UK.
| | - B J O'Connor
- Respiratory Clinical Trials Ltd., 18-22 Queen Anne Street, London, W1G 8HU, UK.
| | - P J Barnes
- National Heart & Lung Institute, Imperial College London, London, UK.
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12
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Leaker BR, Barnes PJ, O'Connor BJ, Ali FY, Tam P, Neville J, Mackenzie LF, MacRury T. The effects of the novel SHIP1 activator AQX-1125 on allergen-induced responses in mild-to-moderate asthma. Clin Exp Allergy 2015; 44:1146-53. [PMID: 25040039 DOI: 10.1111/cea.12370] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 06/02/2014] [Accepted: 07/01/2014] [Indexed: 01/01/2023]
Abstract
BACKGROUND SH2-containing inositol-5'-phosphatase 1 (SHIP1) is an endogenous inhibitor of the phosphoinositide-3-kinase pathway that is involved in the activation and chemotaxis of inflammatory cells. AQX-1125 is a first-in-class, oral SHIP1 activator with a novel anti-inflammatory mode of action. OBJECTIVE To evaluate the effects of AQX-1125 on airway responses to allergen challenge in mild-to-moderate asthmatic patients. METHODS A randomized, double-blind, placebo-controlled, two-way crossover study was performed in 22 steroid-naïve mild-to-moderate asthmatics with a documented late-phase response to inhaled allergen (LAR). AQX-1125 (450 mg daily) or placebo was administered orally for 7 days. Allergen challenge was performed on day 6 (2 h postdose), followed by methacholine challenge (day 7), and induced sputum collection and fractional exhaled nitric oxide (FeNO). RESULTS AQX-1125 significantly attenuated the late-phase response compared with placebo (FEV1 4-10 h: mean difference 150 mL, 20%; P = 0.027) and significantly increased the minimum FEV1 during LAR (mean difference 180 mL; P = 0.014). AQX-1125 had no effect on the early-phase response. AQX-1125 showed a trend in reduction of sputum eosinophils, neutrophils and macrophages although this did not achieve significance as there were only 11 paired samples for analysis. There was no effect on methacholine responsiveness or FeNO. Pharmacokinetic data showed AQX-1125 was rapidly absorbed with geometric mean Cmax and AUC0-24 h values of 1417 ng/mL and 16 727 h ng/mL, respectively. AQX-1125 was well tolerated, but mild GI side-effects (dyspepsia, nausea and abdominal pain) were described in 4/22 subjects on active treatment. These side-effects were mild self-limiting, required no further treatment and did not lead to discontinuation of therapy. CONCLUSION AND CLINICAL RELEVANCE AQX-1125, a novel oral SHIP1 activator, significantly reduces the late response to allergen challenge, with a trend to reduce airway inflammation. AQX-1125 was safe and well tolerated and merits further investigation in inflammatory disorders.
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Affiliation(s)
- B R Leaker
- Respiratory Clinical Trials Ltd., London, UK
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13
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Bousquet J, Addis A, Adcock I, Agache I, Agusti A, Alonso A, Annesi-Maesano I, Anto JM, Bachert C, Baena-Cagnani CE, Bai C, Baigenzhin A, Barbara C, Barnes PJ, Bateman ED, Beck L, Bedbrook A, Bel EH, Benezet O, Bennoor KS, Benson M, Bernabeu-Wittel M, Bewick M, Bindslev-Jensen C, Blain H, Blasi F, Bonini M, Bonini S, Boulet LP, Bourdin A, Bourret R, Bousquet PJ, Brightling CE, Briggs A, Brozek J, Buhl R, Bush A, Caimmi D, Calderon M, Calverley P, Camargos PA, Camuzat T, Canonica GW, Carlsen KH, Casale TB, Cazzola M, Cepeda Sarabia AM, Cesario A, Chen YZ, Chkhartishvili E, Chavannes NH, Chiron R, Chuchalin A, Chung KF, Cox L, Crooks G, Crooks MG, Cruz AA, Custovic A, Dahl R, Dahlen SE, De Blay F, Dedeu T, Deleanu D, Demoly P, Devillier P, Didier A, Dinh-Xuan AT, Djukanovic R, Dokic D, Douagui H, Dubakiene R, Eglin S, Elliot F, Emuzyte R, Fabbri L, Fink Wagner A, Fletcher M, Fokkens WJ, Fonseca J, Franco A, Frith P, Furber A, Gaga M, Garcés J, Garcia-Aymerich J, Gamkrelidze A, Gonzales-Diaz S, Gouzi F, Guzmán MA, Haahtela T, Harrison D, Hayot M, Heaney LG, Heinrich J, Hellings PW, Hooper J, Humbert M, Hyland M, Iaccarino G, Jakovenko D, Jardim JR, Jeandel C, Jenkins C, Johnston SL, Jonquet O, Joos G, Jung KS, Kalayci O, Karunanithi S, Keil T, Khaltaev N, Kolek V, Kowalski ML, Kull I, Kuna P, Kvedariene V, Le LT, Lodrup Carlsen KC, Louis R, MacNee W, Mair A, Majer I, Manning P, de Manuel Keenoy E, Masjedi MR, Melen E, Melo-Gomes E, Menzies-Gow A, Mercier G, Mercier J, Michel JP, Miculinic N, Mihaltan F, Milenkovic B, Molimard M, Momas I, Montilla-Santana A, Morais-Almeida M, Morgan M, N'Diaye M, Nafti S, Nekam K, Neou A, Nicod L, O'Hehir R, Ohta K, Paggiaro P, Palkonen S, Palmer S, Papadopoulos NG, Papi A, Passalacqua G, Pavord I, Pigearias B, Plavec D, Postma DS, Price D, Rabe KF, Radier Pontal F, Redon J, Rennard S, Roberts J, Robine JM, Roca J, Roche N, Rodenas F, Roggeri A, Rolland C, Rosado-Pinto J, Ryan D, Samolinski B, Sanchez-Borges M, Schünemann HJ, Sheikh A, Shields M, Siafakas N, Sibille Y, Similowski T, Small I, Sola-Morales O, Sooronbaev T, Stelmach R, Sterk PJ, Stiris T, Sud P, Tellier V, To T, Todo-Bom A, Triggiani M, Valenta R, Valero AL, Valiulis A, Valovirta E, Van Ganse E, Vandenplas O, Vasankari T, Vestbo J, Vezzani G, Viegi G, Visier L, Vogelmeier C, Vontetsianos T, Wagstaff R, Wahn U, Wallaert B, Whalley B, Wickman M, Williams DM, Wilson N, Yawn BP, Yiallouros PK, Yorgancioglu A, Yusuf OM, Zar HJ, Zhong N, Zidarn M, Zuberbier T. Integrated care pathways for airway diseases (AIRWAYS-ICPs). Eur Respir J 2014; 44:304-23. [PMID: 24925919 DOI: 10.1183/09031936.00014614] [Citation(s) in RCA: 128] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The objective of Integrated Care Pathways for Airway Diseases (AIRWAYS-ICPs) is to launch a collaboration to develop multi-sectoral care pathways for chronic respiratory diseases in European countries and regions. AIRWAYS-ICPs has strategic relevance to the European Union Health Strategy and will add value to existing public health knowledge by: 1) proposing a common framework of care pathways for chronic respiratory diseases, which will facilitate comparability and trans-national initiatives; 2) informing cost-effective policy development, strengthening in particular those on smoking and environmental exposure; 3) aiding risk stratification in chronic disease patients, using a common strategy; 4) having a significant impact on the health of citizens in the short term (reduction of morbidity, improvement of education in children and of work in adults) and in the long-term (healthy ageing); 5) proposing a common simulation tool to assist physicians; and 6) ultimately reducing the healthcare burden (emergency visits, avoidable hospitalisations, disability and costs) while improving quality of life. In the longer term, the incidence of disease may be reduced by innovative prevention strategies. AIRWAYSICPs was initiated by Area 5 of the Action Plan B3 of the European Innovation Partnership on Active and Healthy Ageing. All stakeholders are involved (health and social care, patients, and policy makers).
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Affiliation(s)
| | | | | | - J Bousquet
- University Hospital Montpellier, Montpellier, France MACVIA-LR, Fighting Chronic Diseases for Healthy Ageing, Région Languedoc Roussillon, France MeDALL, Mechanisms of the Development of Allergy ARIA, Allergic Rhinitis and Its Impact on Asthma EAACI, European Academy of Allergy and Clinical Immunology EIP on AHA, European Innovation Partnership on Active and Healthy Ageing, Reference Site EIP on AHA, European Innovation Partnership on Active and Healthy Ageing, B3 Commitment for Action UM1, University 1, Montpellier, France Fondation Partenariale, France
| | - A Addis
- EIP on AHA, European Innovation Partnership on Active and Healthy Ageing, B3 Commitment for Action EIP on AHA, European Innovation Partnership on Active and Healthy Ageing, Reference Site, Regione Emilia-Romagna, Italy
| | - I Adcock
- National Heart and Lung Institute, Imperial College London and Royal Brompton and Harefield NIHR Biomedical Research Unit, London, UK
| | - I Agache
- ARIA, Allergic Rhinitis and Its Impact on Asthma Romanian Alliance Against Chronic Respiratory Diseases Faculty of Medicine, Transylvania University, Brasov, Romania
| | - A Agusti
- Thorax Institute, Hospital Clinic, IDIBAPS, University of Barcelona and CIBER Enfermedades Respiratorias, Barcelona, Spain
| | - A Alonso
- Hospital Clínic/FCRB, Barcelona, Spain
| | | | - J M Anto
- MeDALL, Mechanisms of the Development of Allergy Centre for Research in Environmental Epidemiology (CREAL), IMIM (Hospital del Mar Medical Research Institute, Universitat Pompeu Fabra (UPF), CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - C Bachert
- MeDALL, Mechanisms of the Development of Allergy ARIA, Allergic Rhinitis and Its Impact on Asthma Dept Respiratory Medicine, Ghent University Hospital, Gent, Belgium ENT Dept, Ghent University Hospital, Gent, Belgium
| | - C E Baena-Cagnani
- ARIA, Allergic Rhinitis and Its Impact on Asthma Research Centre in Respiratory Medicine (CIMER), Faculty of Medicine, Catholic University, Cordoba, Argentina
| | - C Bai
- Shanghai Respiratory Research Institute, Chinese Medical Association, Shanghai, China Chinese Alliance against Lung Cancer
| | - A Baigenzhin
- EuroAsian Respiratory Society, Astana City, Kazakhstan
| | - C Barbara
- EIP on AHA, European Innovation Partnership on Active and Healthy Ageing, B3 Commitment for Action PNDR, Portuguese National Programme for Respiratory Diseases
| | - P J Barnes
- National Heart and Lung Institute, Imperial College London and Royal Brompton and Harefield NIHR Biomedical Research Unit, London, UK
| | - E D Bateman
- ARIA, Allergic Rhinitis and Its Impact on Asthma Division of Pulmonology, Dept of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
| | - L Beck
- Health Innovation Centre of Southern Denmark, Region of Southern Denmark, Denmark
| | - A Bedbrook
- MACVIA-LR, Fighting Chronic Diseases for Healthy Ageing, Région Languedoc Roussillon, France ARIA, Allergic Rhinitis and Its Impact on Asthma
| | - E H Bel
- Academic Medical Centre, University of Amsterdam, The Netherlands
| | - O Benezet
- MACVIA-LR, Fighting Chronic Diseases for Healthy Ageing, Région Languedoc Roussillon, France
| | - K S Bennoor
- ARIA, Allergic Rhinitis and Its Impact on Asthma Bangladesh Lung Foundation and National Institute of Diseases of Chest and Hospital, Dhaka, Bangladesh
| | - M Benson
- Centre for Individualised Medicine, Dept of Clinical and Experimental Sciences, Linköping University, Linköping, Sweden
| | - M Bernabeu-Wittel
- EIP on AHA, European Innovation Partnership on Active and Healthy Ageing, Reference Site, Aura Andalucia, Spain Andalusian Healthcare Service, Spain
| | - M Bewick
- Deputy National Medical Director, NHS England, UK
| | - C Bindslev-Jensen
- ARIA, Allergic Rhinitis and Its Impact on Asthma Dept of Dermatology and Allergy Center, Odense Research Center for Anaphylaxis, Odense University Hospital, Odense, Denmark
| | - H Blain
- University Hospital Montpellier, Montpellier, France MACVIA-LR, Fighting Chronic Diseases for Healthy Ageing, Région Languedoc Roussillon, France UM1, University 1, Montpellier, France
| | - F Blasi
- ERS, European Respiratory Society, University of Milan, IRCCS Cà Granda, Milan, Italy
| | - M Bonini
- ARIA, Allergic Rhinitis and Its Impact on Asthma Dept of Public Health and Infectious Diseases "Sapienza" University of Rome, Rome, Italy
| | - S Bonini
- ARIA, Allergic Rhinitis and Its Impact on Asthma Second University of Naples and Institute of Translational Medicine, Italian National Research Council, Naples, Italy
| | - L P Boulet
- ARIA, Allergic Rhinitis and Its Impact on Asthma Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec City, QC, Canada
| | - A Bourdin
- University Hospital Montpellier, Montpellier, France MACVIA-LR, Fighting Chronic Diseases for Healthy Ageing, Région Languedoc Roussillon, France UM1, University 1, Montpellier, France INSERM, U1046, Montpellier, France
| | - R Bourret
- University Hospital Montpellier, Montpellier, France MACVIA-LR, Fighting Chronic Diseases for Healthy Ageing, Région Languedoc Roussillon, France
| | - P J Bousquet
- ARIA, Allergic Rhinitis and Its Impact on Asthma
| | - C E Brightling
- National Institute for Health Research, Leicester Respiratory Biomedical Research Unit, Glenfield Hospital, Leicester, UK
| | - A Briggs
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - J Brozek
- ARIA, Allergic Rhinitis and Its Impact on Asthma Depts of Clinical Epidemiology, and Biostatistics and Medicine, McMaster University, Hamilton, ON, Canada
| | - R Buhl
- Pulmonary Dept, III, Medical Centre, Mainz University Hospital, Mainz, Germany
| | - A Bush
- ARIA, Allergic Rhinitis and Its Impact on Asthma Dept of Paediatric Respiratory Medicine, Royal Brompton Hospital and National Heart and Lung Institute, Imperial College, London, UK
| | - D Caimmi
- University Hospital Montpellier, Montpellier, France MACVIA-LR, Fighting Chronic Diseases for Healthy Ageing, Région Languedoc Roussillon, France ARIA, Allergic Rhinitis and Its Impact on Asthma
| | - M Calderon
- University of Costa Rica, San Jose, Costa Rica Section of Allergy and Clinical Immunology, Imperial College London, Royal Brompton Hospital, London, UK
| | - P Calverley
- Institute of Ageing and Chronic Disease, University of Liverpool and University Hospital Aintree, Liverpool, UK
| | - P A Camargos
- ARIA, Allergic Rhinitis and Its Impact on Asthma Dept of Pediatrics, Medical School, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - T Camuzat
- MACVIA-LR, Fighting Chronic Diseases for Healthy Ageing, Région Languedoc Roussillon, France
| | - G W Canonica
- ARIA, Allergic Rhinitis and Its Impact on Asthma Allergy and Respiratory Diseases, IRCCS San Martino - IST- University of Genoa, Dept of Internal Medicine, Genoa, Italy
| | - K H Carlsen
- MeDALL, Mechanisms of the Development of Allergy ARIA, Allergic Rhinitis and Its Impact on Asthma NAH, National Allergy Health Programme, Norway University of Oslo and Oslo University Hospital, Dept of Paediatrics, Oslo, Norway
| | - T B Casale
- ARIA, Allergic Rhinitis and Its Impact on Asthma
| | - M Cazzola
- University of Rome "Tor Vergata" Dept of System Medicine, Rome, Italy
| | - A M Cepeda Sarabia
- ARIA, Allergic Rhinitis and Its Impact on Asthma Allergy and Immunology Laboratory, Metropolitan University, Simon Bolivar University, Barranquilla, Colombia SLaai, Sociedad Latinoamericana de Allergia, Asma e Immunologia
| | - A Cesario
- IRCCS, San Raffaele Pisana, Rome, Italy
| | - Y Z Chen
- National Cooperative Group of Paediatric Research on Asthma, Asthma Clinic and Education Center of the Capital Institute of Pediatrics, Peking and Center for Asthma Research and Education, Beijing, PR China
| | - E Chkhartishvili
- Chachava Clinic, David Tvildiani Medical University-AIETI Medical School, Grigol Robakidze University, Tbilisi, Georgia
| | - N H Chavannes
- ARIA, Allergic Rhinitis and Its Impact on Asthma IPCRG, International Primary Care Respiratory Group Dept of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - R Chiron
- University Hospital Montpellier, Montpellier, France MACVIA-LR, Fighting Chronic Diseases for Healthy Ageing, Région Languedoc Roussillon, France ARIA, Allergic Rhinitis and Its Impact on Asthma
| | - A Chuchalin
- ARIA, Allergic Rhinitis and Its Impact on Asthma GARD, Global Alliance against Chronic Respiratory Diseases (WHO) Pulmonology Research Institute and Russian Respiratory Society, Moscow, Russia
| | - K F Chung
- National Heart and Lung Institute, Imperial College London and Royal Brompton and Harefield NIHR Biomedical Research Unit, London, UK
| | - L Cox
- ARIA, Allergic Rhinitis and Its Impact on Asthma Nova Southeastern University Osteopathic College of Medicine, Davie, FL, USA
| | - G Crooks
- EIP on AHA, European Innovation Partnership on Active and Healthy Ageing, Reference Site, NHS Scotland, Glasgow, UK
| | - M G Crooks
- Centre for Cardiovascular and Metabolic Research, Hull York Medical School, Hull, UK
| | - A A Cruz
- ARIA, Allergic Rhinitis and Its Impact on Asthma GARD, Global Alliance against Chronic Respiratory Diseases (WHO) ProAR, Nucleo de Excelencia em Asma, Federal University of Bahia and CNPq, Salvador, Brazil
| | - A Custovic
- ARIA, Allergic Rhinitis and Its Impact on Asthma EAACI, European Academy of Allergy and Clinical Immunology University of Manchester, Manchester, UK
| | - R Dahl
- ARIA, Allergic Rhinitis and Its Impact on Asthma Dept of Dermatology and Allergy Center, Odense Research Center for Anaphylaxis, Odense University Hospital, Odense, Denmark
| | - S E Dahlen
- CfA, The Centre for Allergy Research, The Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - F De Blay
- ARIA, Allergic Rhinitis and Its Impact on Asthma SFA, Société française d'Allergologie Strasbourg University, Strasbourg, France
| | - T Dedeu
- EUREGHA, European Regions and Health Authorities, Brussels, Belgium
| | - D Deleanu
- ARIA, Allergic Rhinitis and Its Impact on Asthma Romanian Alliance Against Chronic Respiratory Diseases University of Medicine and Pharmacy Iuliu Hatieganu, Cluj-Napoca, Romania
| | - P Demoly
- University Hospital Montpellier, Montpellier, France MACVIA-LR, Fighting Chronic Diseases for Healthy Ageing, Région Languedoc Roussillon, France ARIA, Allergic Rhinitis and Its Impact on Asthma EAACI, European Academy of Allergy and Clinical Immunology EIP on AHA, European Innovation Partnership on Active and Healthy Ageing, B3 Commitment for Action UM1, University 1, Montpellier, France
| | - P Devillier
- ARIA, Allergic Rhinitis and Its Impact on Asthma UPRES, EA 220, Université Versailles Saint Quentin, Hôpital Foch, Suresnes, France
| | - A Didier
- SPLF, Société de Pneumologie de Langue Française Dept of Respiratory Medicine, University of Toulouse, Toulouse, France
| | - A T Dinh-Xuan
- Service de Physiologie, Paris Descartes University EA 2511, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France
| | - R Djukanovic
- University Southampton Faculty of Medicine and NIHR Southampton Respiratory Biomedical Research Unit, Southampton, UK
| | - D Dokic
- ARIA, Allergic Rhinitis and Its Impact on Asthma University Clinic of Pulmology and Allergy, University "Ss. Cyril and Methodius", Skopje, Macedonia
| | - H Douagui
- ARIA, Allergic Rhinitis and Its Impact on Asthma Service de pneumo-allergologie, Centre Hospitalo-Universitaire de Béni-Messous, Algiers, Algeria
| | - R Dubakiene
- ARIA, Allergic Rhinitis and Its Impact on Asthma LSACI, Lithuanian Society of Allergology and Clinical Immunology Vilnius University Faculty of Medicine, Vilnius, Lithuania
| | - S Eglin
- NHS R&D North West, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - F Elliot
- EIP on AHA, European Innovation Partnership on Active and Healthy Ageing, Reference Site, NHS Scotland, Edinburgh, UK
| | - R Emuzyte
- ARIA, Allergic Rhinitis and Its Impact on Asthma LSACI, Lithuanian Society of Allergology and Clinical Immunology Vilnius University Faculty of Medicine, Vilnius, Lithuania
| | - L Fabbri
- Dept of Oncology, Haematology and Respiratory Diseases, Policlinic of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - A Fink Wagner
- GAAPP, Global Allergy and Asthma Patient Platform, Vienna, Austria
| | - M Fletcher
- GARD, Global Alliance against Chronic Respiratory Diseases (WHO) Education for Health, Warwick, UK
| | - W J Fokkens
- ARIA, Allergic Rhinitis and Its Impact on Asthma Academic Medical Centre, University of Amsterdam, The Netherlands European Rhinology Society
| | - J Fonseca
- ARIA, Allergic Rhinitis and Its Impact on Asthma PNDR, Portuguese National Programme for Respiratory Diseases Porto Age-Up Consortium, Porto, Portugal Dept of Health Information and Decision Sciences and CINTESIS, Porto University Medical School, Allergy, Hospital S. Joao and Instituto and Hospital CUF Porto, Porto, Portugal
| | - A Franco
- Internal and Geriatric Medicine, University of Nice - Sophia Antipolis, Nice, France
| | - P Frith
- Repatriation General Hospital, Adelaide, Australia
| | - A Furber
- Director of Public Health, Wakefield Council, Wakefield, UK
| | - M Gaga
- 7th Respiratory Medicine Dept and Asthma Centre, Athens Chest Hospital, Athens, Greece
| | - J Garcés
- EIP on AHA, European Innovation Partnership on Active and Healthy Ageing, Reference Site, Valencia, Spain Polibienestar Research Institute, University of Valencia, Valencia, Spain
| | - J Garcia-Aymerich
- MeDALL, Mechanisms of the Development of Allergy Centre for Research in Environmental Epidemiology (CREAL), IMIM (Hospital del Mar Medical Research Institute, Universitat Pompeu Fabra (UPF), CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - A Gamkrelidze
- ARIA, Allergic Rhinitis and Its Impact on Asthma National Center for Disease Control and Public Health of Georgia, Tbilisi, Georgia
| | - S Gonzales-Diaz
- ARIA, Allergic Rhinitis and Its Impact on Asthma SLaai, Sociedad Latinoamericana de Allergia, Asma e Immunologia
| | - F Gouzi
- University Hospital Montpellier, Montpellier, France INSERM, U1046, Montpellier, France
| | - M A Guzmán
- ARIA, Allergic Rhinitis and Its Impact on Asthma Immunology and Allergology Division, Dept of Medicine, Clinical Hospital University of Chile, Santiago, Chile
| | - T Haahtela
- MeDALL, Mechanisms of the Development of Allergy ARIA, Allergic Rhinitis and Its Impact on Asthma Dept of Allergy, Skin and Allergy Hospital, Helsinki University Hospital, Helsinki, Finland
| | - D Harrison
- Director of Public Health for Blackburn with Darwen, Blackburn, UK
| | - M Hayot
- University Hospital Montpellier, Montpellier, France MACVIA-LR, Fighting Chronic Diseases for Healthy Ageing, Région Languedoc Roussillon, France UM1, University 1, Montpellier, France
| | - L G Heaney
- Centre for Infection and Immunity, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - J Heinrich
- MeDALL, Mechanisms of the Development of Allergy
| | - P W Hellings
- ARIA, Allergic Rhinitis and Its Impact on Asthma EAACI, European Academy of Allergy and Clinical Immunology Dept of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
| | - J Hooper
- Director of Public Health for Kirklees, Huddersfield, UK
| | - M Humbert
- SPLF, Société de Pneumologie de Langue Française
| | - M Hyland
- School of Psychology, University of Plymouth, Plymouth, UK
| | - G Iaccarino
- EIP on AHA Reference Site, Regione-Campania, Italy Dept of Medicine and Surgery, University of Salerno, Salerno, Italy IRCCS Multimedica, Milan, Italy
| | - D Jakovenko
- MACVIA-LR, Fighting Chronic Diseases for Healthy Ageing, Région Languedoc Roussillon, France
| | - J R Jardim
- Respiratory Diseases, Escola Paulista de Medicina of Federal University of Sao Paulo, Sao Paulo, Brazil
| | - C Jeandel
- University Hospital Montpellier, Montpellier, France MACVIA-LR, Fighting Chronic Diseases for Healthy Ageing, Région Languedoc Roussillon, France UM1, University 1, Montpellier, France
| | - C Jenkins
- The George Institute for Global Health and The University of Sydney, Sydney, Australia
| | - S L Johnston
- ARIA, Allergic Rhinitis and Its Impact on Asthma Airway Disease Infection Section, National Heart and Lung Institute, Imperial College London, London, UK
| | - O Jonquet
- University Hospital Montpellier, Montpellier, France MACVIA-LR, Fighting Chronic Diseases for Healthy Ageing, Région Languedoc Roussillon, France UM1, University 1, Montpellier, France
| | - G Joos
- Dept Respiratory Medicine, Ghent University Hospital, Gent, Belgium
| | - K S Jung
- Hallym University College of Medicine, Hallym University Sacred Heart Hospital, Gyeonggi-do, South Korea
| | - O Kalayci
- ARIA, Allergic Rhinitis and Its Impact on Asthma EAACI, European Academy of Allergy and Clinical Immunology GARD-Turkey, Global Alliance against Chronic Respiratory Diseases (GARD), Turkey Hacettepe University School of Medicine, Paediatric Allergy and Asthma Unit, Hacettepe, Ankara, Turkey
| | | | - T Keil
- MeDALL, Mechanisms of the Development of Allergy Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - N Khaltaev
- ARIA, Allergic Rhinitis and Its Impact on Asthma GARD, Global Alliance against Chronic Respiratory Diseases (WHO)
| | - V Kolek
- CARO, Czech Alliance against Chronic Respiratory Diseases
| | - M L Kowalski
- Dept Immunology, Rheumatology and Allergy, Faculty of Medicine, Medical University of Lodz, Lodz, Poland
| | - I Kull
- MeDALL, Mechanisms of the Development of Allergy Karolinska Institutet, Dept of Clinical Science and Education, Institute of Environmental Medicine, Stockholm, Sweden
| | - P Kuna
- ARIA, Allergic Rhinitis and Its Impact on Asthma EIP on AHA, European Innovation Partnership on Active and Healthy Ageing, B3 Commitment for Action GARD, Global Alliance against Chronic Respiratory Diseases (WHO) Polastma, Poland Dept of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Lodz, Poland
| | - V Kvedariene
- ARIA, Allergic Rhinitis and Its Impact on Asthma EAACI, European Academy of Allergy and Clinical Immunology LSACI, Lithuanian Society of Allergology and Clinical Immunology Pulmonology and Allergology Center, Vilnius University, Vilnius, Lithuania
| | - L T Le
- ARIA, Allergic Rhinitis and Its Impact on Asthma GARD, Global Alliance against Chronic Respiratory Diseases (WHO) University of Medicine and Pharmacy, Hochiminh City, Vietnam
| | - K C Lodrup Carlsen
- MeDALL, Mechanisms of the Development of Allergy ARIA, Allergic Rhinitis and Its Impact on Asthma NAH, National Allergy Health Programme, Norway University of Oslo and Oslo University Hospital, Dept of Paediatrics, Oslo, Norway
| | - R Louis
- CHU Liege, GIGA I Research Center, University of Liege, Liege, Belgium
| | - W MacNee
- Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - A Mair
- Directorate of Finance, eHealth and Pharmaceuticals, Scottish Government Health Dept, Edinburgh, UK
| | - I Majer
- University of Bratislava, Bratislava, Slovakia
| | - P Manning
- Dept of Medicine, Royal College of Surgeons in Ireland (Medical School) Bon Secours Hospital, Dublin, Ireland
| | - E de Manuel Keenoy
- EIP on AHA, European Innovation Partnership on Active and Healthy Ageing, Reference Site Kronikgune, Basque Region, Spain
| | - M R Masjedi
- Chronic Respiratory Diseases Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Science, Tehran, Iran
| | - E Melen
- MeDALL, Mechanisms of the Development of Allergy ARIA, Allergic Rhinitis and Its Impact on Asthma Karolinska Institutet, Dept of Clinical Science and Education, Institute of Environmental Medicine, Stockholm, Sweden
| | - E Melo-Gomes
- EIP on AHA, European Innovation Partnership on Active and Healthy Ageing, B3 Commitment for Action PNDR, Portuguese National Programme for Respiratory Diseases
| | | | - G Mercier
- University Hospital Montpellier, Montpellier, France MACVIA-LR, Fighting Chronic Diseases for Healthy Ageing, Région Languedoc Roussillon, France UM1, University 1, Montpellier, France
| | - J Mercier
- University Hospital Montpellier, Montpellier, France MACVIA-LR, Fighting Chronic Diseases for Healthy Ageing, Région Languedoc Roussillon, France EIP on AHA, European Innovation Partnership on Active and Healthy Ageing, B3 Commitment for Action UM1, University 1, Montpellier, France
| | - J P Michel
- Geneva Medical School and University Hospitals, Geneva, Switzerland
| | - N Miculinic
- University Hospital for Pulmonary Diseases, Jordanovac, Zagreb, Croatia
| | - F Mihaltan
- ARIA, Allergic Rhinitis and Its Impact on Asthma Romanian Alliance Against Chronic Respiratory Diseases Institute of Pneumology Marius Nasta, Bucharest, Romania
| | - B Milenkovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia Serbian Alliance against Chronic Respiratory Diseases Association for Asthma and COPD in Serbia
| | | | - I Momas
- Paris Descartes University, Dept of Public Health and Biostatistics, EA 4064 and Paris Municipal, Dept of Social Action, Childhood and Health, Paris, France
| | - A Montilla-Santana
- EIP on AHA, European Innovation Partnership on Active and Healthy Ageing, Reference Site, Aura Andalucia, Spain
| | - M Morais-Almeida
- Immunoallergy Dept, Hospital CUF-Descobertas, Lisbon, Portugal SPAIC, Sociedade Portuguesa de Alergologia e Imunologia Clínica, Portugal
| | - M Morgan
- Respiratory National Clinical Director, NHS England, UK
| | - M N'Diaye
- Service de Médecine Interne et Pathologies Professionnelles, Hôpital Polyclinique de Dakar (IHS), Dakar, Sénégal
| | - S Nafti
- ARIA, Allergic Rhinitis and Its Impact on Asthma Mustapha Hospital, Algiers, Algeria
| | - K Nekam
- ARIA, Allergic Rhinitis and Its Impact on Asthma Hospital of the Hospitaller Brothers in Buda, Budapest, Hungary
| | - A Neou
- GALEN, Global Allergy and Asthma European Network Charité University Hospital, Allergy Centre Charité, Berlin, Germany
| | - L Nicod
- Service de Pneumologie, 1011 CHUV-Lausanne, Lausanne, Switerland
| | - R O'Hehir
- ARIA, Allergic Rhinitis and Its Impact on Asthma Dept of Allergy, Immunology and Respiratory Medicine, Alfred Hospital and Monash University, Melbourne, Australia
| | - K Ohta
- ARIA, Allergic Rhinitis and Its Impact on Asthma National Hospital Organization, Tokyo National Hospital and Teikyo University School of Medicine, Tokyo, Japan
| | - P Paggiaro
- Cardio-Thoracic and Vascular Dept, University Hospital of Pisa, Pisa, Italy
| | - S Palkonen
- MeDALL, Mechanisms of the Development of Allergy ARIA, Allergic Rhinitis and Its Impact on Asthma EFA, European Federation of Allergy and Airways Diseases patients' association
| | - S Palmer
- Centre for Reviews and Dissemination (CRD), University of York, York, UK
| | - N G Papadopoulos
- ARIA, Allergic Rhinitis and Its Impact on Asthma EAACI, European Academy of Allergy and Clinical Immunology University of Manchester, Manchester, UK Allergy Dept, 2nd Paediatric Clinic, University of Athens, Athens, Greece
| | - A Papi
- Ferrara University, Ferrara, Italy
| | - G Passalacqua
- ARIA, Allergic Rhinitis and Its Impact on Asthma Allergy and Respiratory Diseases, IRCCS San Martino - IST- University of Genoa, Dept of Internal Medicine, Genoa, Italy
| | - I Pavord
- NDM Research Building, University of Oxford, Oxford, UK
| | | | - D Plavec
- Children's Hospital Srebrnjak, Zagreb, School of Medicine, University J.J. Strossmayer, Osijek, Croatia
| | - D S Postma
- MeDALL, Mechanisms of the Development of Allergy University of Groningen, Dept of Pulmonology, GRIAC Research Institute University Medical Center Groningen, Groningen, The Netherlands
| | - D Price
- ARIA, Allergic Rhinitis and Its Impact on Asthma IPCRG, International Primary Care Respiratory Group Academic Primary Care, University of Aberdeen, Aberdeen, UK
| | - K F Rabe
- Christian Albrechts University Kiel, LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Germany
| | - F Radier Pontal
- MACVIA-LR, Fighting Chronic Diseases for Healthy Ageing, Région Languedoc Roussillon, France
| | - J Redon
- EIP on AHA, European Innovation Partnership on Active and Healthy Ageing, Reference Site Research Institute INCLIVA, University of Valencia, CIBERObn, Health Institute Carlos III, Madrid, Spain
| | - S Rennard
- University of Nebraska Medical Center, Division of Pulmonary, Critical Care, Sleep and Allergy, Nebraska Medical Center, Omaha, NE, USA
| | - J Roberts
- Respiratory Nurse Consultant, Salford Royal NHS Foundation Trust, Salford, UK
| | - J M Robine
- MACVIA-LR, Fighting Chronic Diseases for Healthy Ageing, Région Languedoc Roussillon, France INSERM, U710 and 988, Montpellier, France
| | - J Roca
- Thorax Institute, Hospital Clinic, IDIBAPS, University of Barcelona and CIBER Enfermedades Respiratorias, Barcelona, Spain
| | - N Roche
- Pneumologie, AP-HP, Hôpital Cochin - Site Val de Grâce, Université Paris Descartes and SPLF, Société de Pneumologie de Langue Française, Paris, France
| | - F Rodenas
- EIP on AHA, European Innovation Partnership on Active and Healthy Ageing, Reference Site, Valencia, Spain Polibienestar Research Institute, University of Valencia, Valencia, Spain
| | - A Roggeri
- Arcispedale, S.Maria Nuova Hospital, Reggio Emilia, Italy
| | - C Rolland
- Association Asthme et Allergies, Boulogne-Billancourt, France
| | - J Rosado-Pinto
- ARIA, Allergic Rhinitis and Its Impact on Asthma EIP on AHA, European Innovation Partnership on Active and Healthy Ageing, B3 Commitment for Action PNDR, Portuguese National Programme for Respiratory Diseases GARD, Global Alliance against Chronic Respiratory Diseases (WHO)
| | - D Ryan
- ARIA, Allergic Rhinitis and Its Impact on Asthma IPCRG, International Primary Care Respiratory Group Woodbrook Medical Centre, Loughborough, UK Allergy and Respiratory Research Group, Centre for Population Health Sciences, The University of Edinburgh, Medical School, Edinburgh, UK
| | - B Samolinski
- EIP on AHA, European Innovation Partnership on Active and Healthy Ageing, B3 Commitment for Action Dept of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Lodz, Poland Dept of Prevention of Environmental Hazards and Allergology, Medical University of Warsaw, Warsaw, Poland
| | - M Sanchez-Borges
- Dept of Allergy and Clinical Immunology, Centro Medico-Docente La Trinidad, Caracas, Venezuela
| | - H J Schünemann
- Depts of Clinical Epidemiology, and Biostatistics and Medicine, McMaster University, Hamilton, ON, Canada
| | - A Sheikh
- Allergy and Respiratory Research Group, Centre for Population Health Sciences, The University of Edinburgh, Medical School, Edinburgh, UK Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA
| | - M Shields
- Child Health, Queen's University Belfast and Royal Belfast Hospital for Sick Children, Belfast, UK
| | - N Siafakas
- Dept of Thoracic Medicine, University Hospital of Heraklion, Heraklion, Greece
| | - Y Sibille
- University Hospital of Mont-Godinne, Catholic University of Louvain, Yvoir, Belgium
| | - T Similowski
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1158 "Neurophysiologie Respiratoire Expérimentale et Clinique", Paris, France INSERM, UMR_S 1158 "Neurophysiologie Respiratoire Expérimentale et Clinique", Paris, France AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (Département "R3S"), Paris, France Fonds de Dotation Recherche en Santé Respiratoire - Fondation du Souffle, Paris, France
| | - I Small
- National Advisory Group, Respiratory Managed Clinical Networks in Scotland
| | - O Sola-Morales
- HITT, Health Institute for Technology Transfer, Barcelona, Spain
| | - T Sooronbaev
- ARIA, Allergic Rhinitis and Its Impact on Asthma GARD, Global Alliance against Chronic Respiratory Diseases (WHO) EuroAsian Respiratory Society, Bishkek, Kyrgyzstan National Centre Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
| | - R Stelmach
- Pulmonary Division, InCor (Heart Institute), Hospital da Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - P J Sterk
- Academic Medical Centre, University of Amsterdam, The Netherlands
| | - T Stiris
- Dept of Neonatal Intensive Care, Oslo University Hospital, Ulleval, Faculty of Medicine, University of Oslo, Oslo, Norway European Academy of Paediatrics (EAP-UEMS)
| | - P Sud
- Regional Medical Manager (North), NHS England, UK
| | - V Tellier
- Observatoire wallon de la santé, Direction générale opérationnelle Pouvoirs locaux, action sociale et Santé, Service public de Wallonie, Belgium
| | - T To
- GARD, Global Alliance against Chronic Respiratory Diseases (WHO)
| | - A Todo-Bom
- Immunoallergy Dept, Coimbra University Hospital, Coimbra, Portugal
| | - M Triggiani
- Dept of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - R Valenta
- ARIA, Allergic Rhinitis and Its Impact on Asthma Dept of Pathophysiology and Allergy Research, Centre of Pathophysiology, Infectology and Immunology, Medical University of Vienna, Vienna, Austria
| | - A L Valero
- Thorax Institute, Hospital Clinic, IDIBAPS, University of Barcelona and CIBER Enfermedades Respiratorias, Barcelona, Spain
| | - A Valiulis
- ARIA, Allergic Rhinitis and Its Impact on Asthma LSACI, Lithuanian Society of Allergology and Clinical Immunology Vilnius University Faculty of Medicine, Vilnius, Lithuania European Academy of Paediatrics (EAP-UEMS) LACRD, Lithuanian National Alliance Against Chronic Respiratory Diseases
| | - E Valovirta
- Dept of Lung Diseases and Clinical Allergology, University of Turku, Finland
| | - E Van Ganse
- Pharmacoepidemiology Unit and Respiratory Medicine, CHU-Lyon and UMR CNRS 5558, Claude-Bernard University Lyon, Lyon, France
| | - O Vandenplas
- ARIA, Allergic Rhinitis and Its Impact on Asthma INSERM, UMR_S 1158 "Neurophysiologie Respiratoire Expérimentale et Clinique", Paris, France
| | | | - J Vestbo
- Respiratory and Allergy Research Group, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK Dept of Respiratory Medicine J, Odense University Hospital, Odense, Denmark
| | - G Vezzani
- EIP on AHA B3 Action Group (Delivering Integrated Care Models), Regional Agency for Health and Social Care, Arcispedale S.Maria Nuova/IRCCS, Research Hospital, Reggio Emilia, Italy
| | - G Viegi
- CNR, Institutes of Biomedicine and Molecular Immunology (IBIM), Palermo, and of Clinical Physiology (IFC), Pisa, Italy
| | - L Visier
- University Hospital Montpellier, Montpellier, France MACVIA-LR, Fighting Chronic Diseases for Healthy Ageing, Région Languedoc Roussillon, France UM1, University 1, Montpellier, France
| | - C Vogelmeier
- German Center for Lung Research (DZL), Dept of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University Marburg, Germany
| | | | - R Wagstaff
- Acting Director of Public Health, Cumbria County Council, Carlisle, UK
| | - U Wahn
- Charité University Hospital, Allergy Centre Charité, Berlin, Germany
| | - B Wallaert
- SFA, Société française d'Allergologie Hôpital Albert Calmette, CHRU, Lille, France
| | - B Whalley
- School of Psychology, University of Plymouth, Plymouth, UK
| | - M Wickman
- MeDALL, Mechanisms of the Development of Allergy ARIA, Allergic Rhinitis and Its Impact on Asthma Karolinska Institutet, Dept of Clinical Science and Education, Institute of Environmental Medicine, Stockholm, Sweden
| | - D M Williams
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - N Wilson
- North of England EU Health Partnership, UK
| | - B P Yawn
- ARIA, Allergic Rhinitis and Its Impact on Asthma Olmsted Medical Center, Dept of Research and University of Minnesota, Dept of Family and Community Health, Rochester, MN, USA
| | - P K Yiallouros
- ARIA, Allergic Rhinitis and Its Impact on Asthma Cyprus International Institute for Environmental and Public Health in Association with Harvard School of Public Health, Cyprus University of Technology, Limassol, Cyprus
| | - A Yorgancioglu
- ARIA, Allergic Rhinitis and Its Impact on Asthma GARD-Turkey, Global Alliance against Chronic Respiratory Diseases (GARD), Turkey
| | - O M Yusuf
- GARD, Global Alliance against Chronic Respiratory Diseases (WHO) The Allergy and Asthma Institute, Pakistan
| | - H J Zar
- Dept of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - N Zhong
- Guangzhou Institute of Respiratory Diseases and State Key Laboratory of Respiratory Diseases, Guangzhou Medical College, Guangzhou, China
| | - M Zidarn
- ARIA, Allergic Rhinitis and Its Impact on Asthma University Clinic of Respiratory and Allergic Diseases, Golnik, Slovenia
| | - T Zuberbier
- GALEN, Global Allergy and Asthma European Network Charité University Hospital, Allergy Centre Charité, Berlin, Germany
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Paredi P, Barnes PJ. A breath of hot air? Int J Tuberc Lung Dis 2014; 17:855. [PMID: 23743305 DOI: 10.5588/ijtld.13.0355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Azam AA, Barnes PJ, Mercado NM. S66 Targeting anti-ageing molecule AMPK restores corticosteroid sensitivity in COPD. Thorax 2013. [DOI: 10.1136/thoraxjnl-2013-204457.73] [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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Footitt J, Mallia P, Durham A, Trujillo-Torralbo MB, Telcian A, Kebadze T, Aniscenko J, Essilfie-Quaye S, Ito K, Barnes PJ, Elkin S, Kon OM, Adcock I, Johnston SL. S112 HDAC activity in macrophages in experimental rhinovirus infection in COPD. Thorax 2013. [DOI: 10.1136/thoraxjnl-2013-204457.119] [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: 11/03/2022]
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Singh R, Such K, Kowlessar BS, Patel ARC, Mackay AJ, Brill SE, Allinson JP, Donaldson GC, Barnes PJ, Wedzicha JA, Donnelly LE. P184 Macrophage phagocytosis in COPD patients at exacerbation compared to stable state. Thorax 2013. [DOI: 10.1136/thoraxjnl-2013-204457.336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Paschalaki K, Starke RD, Hu Y, Mercado N, Margariti A, Gorgoulis VG, Randi AM, Barnes PJ. T5 Circulating endothelial progenitor cells in smokers and patients with COPD are dysfunctional due to increased DNA damage and senescence. Thorax 2013. [DOI: 10.1136/thoraxjnl-2013-204457.5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Kobayashi Y, Wada H, Rossios C, Takagi D, Charron C, Barnes PJ, Ito K. A novel macrolide/fluoroketolide, solithromycin (CEM-101), reverses corticosteroid insensitivity via phosphoinositide 3-kinase pathway inhibition. Br J Pharmacol 2013; 169:1024-34. [PMID: 23758162 PMCID: PMC3696326 DOI: 10.1111/bph.12187] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2012] [Revised: 01/24/2013] [Accepted: 03/03/2013] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND AND PURPOSE Corticosteroid insensitivity is a major therapeutic problem for some inflammatory diseases including chronic obstructive pulmonary disease (COPD), and it is known to be induced by reduced histone deacetylase (HDAC)-2 activities via activation of the phosphoinositide 3-kinase (PI3K) pathway. The aim of this study is to evaluate effects of a novel macrolide/fluoroketolide, solithromycin (SOL, CEM-101), on corticosteroid sensitivity induced by oxidative stress. EXPERIMENTAL APPROACH Corticosteroid sensitivity was determined by IC50/EC50 of dexamethasone (Dex) on TNF-α-induced CXCL8 production in U937 monocytic cell line and peripheral blood mononuclear cells (PBMC) from COPD patients. Activities of HDAC and protein phosphatase 2A (PP2A) were measured by fluorescence-based assay in cells exposed to hydrogen peroxide (H2O2). We also investigated steroid insensitive airway neutrophilia in cigarette smoke exposed mice in vivo. KEY RESULTS SOL (10 μM) restored Dex sensitivity in PBMC from COPD patients, H2O2-treated U937 cells and phorbol 12-myristate 13-acetate-differentiated U937 cells. In addition, SOL restored HDAC activity with concomitant inhibition of Akt phosphorylation as surrogate marker of PI3K activation. The inhibition of Akt phosphorylation by SOL was due to increased PP2A phosphatase activity, which was reduced in COPD and oxidative stress model. Other known macrolides, such as eryhthromycin, clarithromycin and azithromycin, were significantly less effective in these responses. In cigarette smoke-exposed mice, SOL (100 mg kg(-1), po) showed significant but weak inhibition of neutrophilia, whereas Dex (10 mg kg(-1), p.o.) showed no such effect. However, a combination of SOL and Dex inhibited neutrophilia by over 50%. CONCLUSIONS AND IMPLICATIONS SOL has potential as novel therapy for corticosteroid-insensitive diseases such as COPD.
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Affiliation(s)
- Y Kobayashi
- Airway Disease Section, National Heart and Lung Institute, Imperial College London, London, UK
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Paschalaki KE, Starke RD, Hu Y, Mercado N, Margariti A, Gorgoulis VG, Barnes PJ, Randi AM. 168 CIRCULATING ENDOTHELIAL PROGENITOR CELLS IN SMOKERS ARE DYSFUNCTIONAL DUE TO INCREASED DNA DAMAGE AND SENESCENCE. Heart 2013. [DOI: 10.1136/heartjnl-2013-304019.168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Rossios C, To Y, Osoata G, Ito M, Barnes PJ, Ito K. Corticosteroid insensitivity is reversed by formoterol via phosphoinositide-3-kinase inhibition. Br J Pharmacol 2013; 167:775-86. [PMID: 22251095 DOI: 10.1111/j.1476-5381.2012.01864.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND AND PURPOSE Patients with chronic obstructive pulmonary disease (COPD) show a poor response to corticosteroids, which has been linked to oxidative stress. Here we show that the long-acting β(2) -agonist formoterol (FM) reversed corticosteroid insensitivity under oxidative stress via inhibition of phosphoinositide-3-kinase (PI3K) signalling. EXPERIMENTAL APPROACH Responsiveness to corticosteroids dexamethasone (Dex), budesonide (Bud) and fluticasone propionate (FP) was determined, as IC(50) values on TNF-α-induced interleukin 8 release, in U937 monocytic cell line treated with hydrogen peroxide (H(2) O(2) ) or peripheral blood mononuclear cells (PBMCs) from patients with COPD or severe asthma. KEY RESULTS PBMCs from severe asthma and COPD were less sensitive to Dex compared with those from healthy subjects. Both FM (10(-9) M) and salmeterol (SM, 10(-8) M) reversed Dex insensitivity in severe asthma, but only FM restored Dex sensitivity in COPD. Although H(2) O(2) exposure decreased steroid sensitivity in U937 cells, FM restored responsiveness to Bud and FP while the effects of SM were weaker. Additionally, FM, but not SM, partially inhibited H(2) O(2) -induced PI3Kδ-dependent (PKB) phosphorylation. H(2) O(2) decreased SM-induced cAMP production in U937 cells, but did not significantly affect the response to FM. The reduction of SM effects by H(2) O(2) was reversed by pretreatment with LY294002, a PI3K inhibitor, or IC87114, a PI3Kδ inhibitor. CONCLUSION AND IMPLICATIONS FM reversed oxidative stress-induced corticosteroid insensitivity and decreased β(2) adrenoceptor-dependent cAMP production via inhibition of PI3Kδ signalling. FM will be more effective than SM, when combined with corticosteroids, for the treatment of respiratory diseases under conditions of high oxidative stress, such as in COPD.
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Affiliation(s)
- C Rossios
- Airway Disease Section, NHLI, Imperial College, London, UK
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Maneechotesuwan K, Kasetsinsombat K, Wamanuttajinda V, Wongkajornsilp A, Barnes PJ. Statins enhance the effects of corticosteroids on the balance between regulatory T cells and Th17 cells. Clin Exp Allergy 2013; 43:212-22. [PMID: 23331562 DOI: 10.1111/cea.12067] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [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: 06/08/2012] [Revised: 10/09/2012] [Accepted: 11/01/2012] [Indexed: 12/24/2022]
Abstract
BACKGROUND Plasticity of CD4(+) lymphocyte Th17/regulatory T cell (Treg) subsets is involved in the pathogenesis of chronic airway inflammatory diseases, such as asthma. Reversal of Th17/Treg cell balance towards Treg cells may be beneficial for the suppression of chronic Th2 cell-mediated inflammatory diseases, such as asthma. However, the effect of the combination of corticosteroids and a statin on the ratio of Treg/Th17 cells is unknown. OBJECTIVE We investigated the in vitro effects of the combination of simvastatin and fluticasone propionate (FP) on the numbers of Treg and Th17 cells in asthmatic patients after co-incubation with monocyte-derived DCs (mDCs), and explored the underlying signalling pathways involved. METHODS Using flow cytometry, we determined the effects of FP and simvastatin on Treg/Th17 balance after co-incubation of asthmatic CD4(+) T cells with mDCs. We also measured the relevant Treg and Th17-polarizing cytokines released from mDCs and also investigated the role of indoleamine 2, 3-dioxygenase (IDO) in this response. RESULTS The combination of simvastatin and FP significantly increased Treg and concomitantly reduced Th17 cell numbers to a greater extent than FP or statin treatment alone. The enhancing effects of simvastatin on FP effects were mediated through the up-regulation of indoleamine 2, 3-dioxygenase and interleukin (IL)-10, together with down-regulation of IL-6 and IL-23 expression in mDCs. CONCLUSION On the basis of this in vitro model of asthma, we suggest that the combination of a statin and a corticosteroid could augment the Treg/Th17 cell ratio and thus more effectively suppress airway inflammation in asthma patients. This may be particularly relevant in the treatment of severe asthma where Th17 cells are activated and linked to neutrophilic inflammation.
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Affiliation(s)
- K Maneechotesuwan
- Division of Respiratory Disease and Tuberculosis, Department of Internal Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
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Hanna W, Barnes PJ, Chang MC, Gilks B, Magliocco A, Rees H, Robertson S, SenGupta SK, Nofech-Mozes S. Abstract P2-10-09: The incidence of false negative of HER2/Neu status in primary breast cancer in the era of standardized testing: a Canadian prospective study. Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-p2-10-09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
The efficacy of trastuzumab in the treatment of primary breast cancer has mandated accurate and timely testing of all patients with a new diagnosis of breast cancer. Testing is centralized in designated laboratories across Canada with adherence to guidelines and mandatory participation in quality assurance programs. The Canadian testing algorithm recommends starting with immunohistochemistry (IHC) followed by in situ hybridization (ISH) for equivocal cases. Early HER2 testing showed that approximately 25–30% of invasive breast cancer is HER2 positive. Recent data shows that the HER2/neu positive rate in breast cancer in Canada is 17.6%.
Design: The study was designed to assess the rate of false-negative HER2 tests based on the IHC-first algorithm used in 8 pathology centres across Canada. Surgical excisions with invasive carcinoma were tested using the standardized local methodology for both IHC and ISH. The cases were scored by the local breast pathologist and in 2 of 8 centers image analysis was used in the evaluation of ISH. We compared consecutive HER2-negative IHC results (score 0/1+) to the corresponding ISH (either silver or fluorescence) result. False negative cases were defined as a negative IHC with an ISH ratio of≥ 2, since these patients are eligible for trastuzumab therapy.
Results: 715 cases were analyzed by IHC using Ventana 4B5 (287), HercepTest (253), or SP3 (175), and by ISH kits: Vysis FISH (303), Ventana SISH (412). The HER2 and CEP17 counts were available in all cases.
There were 4 cases with an ISH score ≥2 (4B5: 2/4, HercepTest 1/4, SP3 1/4). In 3 additional cases the absolute HER2 copy number was ≥6 but the HER2/CEP17 amplification ratio was <2 due to an increased number of CEP 17 signal (“polysomy 17”) or amplification of the pericentromeric region. The overall rate of false negative cases was 0.98% (7/715). These cases had a low level of amplification (ratio 2 to 2.45) or an absolute HER2 count of 6–8.
Conclusion: Our observation confirms that IHC is an adequate test to predict negative HER2 status in primary breast cancer in surgical excision specimens, even when different antibodies and IHC platforms are used. The study supports and justifies the Canadian algorithm of IHC followed by ISH in equivocal cases in view of the extremely low percentage of false negative cases observed. This reflects the strict adherence to internal protocols and mandatory participation in quality assurance programs. These results provide further confirmation that the vast majority of patients eligible for trastuzumab are not deprived from an effective treatment by using this algorithm.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P2-10-09.
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Affiliation(s)
- W Hanna
- Sunnybrook Health Sciences Centre; Capital Health District Authority; Mount Sinai Hospital; Vancouver General Hospital; Tom Baker Cancer Centre; Saskatoon City Hospital; Ottawa General Hospital; Kingston General Hospital
| | - PJ Barnes
- Sunnybrook Health Sciences Centre; Capital Health District Authority; Mount Sinai Hospital; Vancouver General Hospital; Tom Baker Cancer Centre; Saskatoon City Hospital; Ottawa General Hospital; Kingston General Hospital
| | - MC Chang
- Sunnybrook Health Sciences Centre; Capital Health District Authority; Mount Sinai Hospital; Vancouver General Hospital; Tom Baker Cancer Centre; Saskatoon City Hospital; Ottawa General Hospital; Kingston General Hospital
| | - B Gilks
- Sunnybrook Health Sciences Centre; Capital Health District Authority; Mount Sinai Hospital; Vancouver General Hospital; Tom Baker Cancer Centre; Saskatoon City Hospital; Ottawa General Hospital; Kingston General Hospital
| | - A Magliocco
- Sunnybrook Health Sciences Centre; Capital Health District Authority; Mount Sinai Hospital; Vancouver General Hospital; Tom Baker Cancer Centre; Saskatoon City Hospital; Ottawa General Hospital; Kingston General Hospital
| | - H Rees
- Sunnybrook Health Sciences Centre; Capital Health District Authority; Mount Sinai Hospital; Vancouver General Hospital; Tom Baker Cancer Centre; Saskatoon City Hospital; Ottawa General Hospital; Kingston General Hospital
| | - S Robertson
- Sunnybrook Health Sciences Centre; Capital Health District Authority; Mount Sinai Hospital; Vancouver General Hospital; Tom Baker Cancer Centre; Saskatoon City Hospital; Ottawa General Hospital; Kingston General Hospital
| | - SK SenGupta
- Sunnybrook Health Sciences Centre; Capital Health District Authority; Mount Sinai Hospital; Vancouver General Hospital; Tom Baker Cancer Centre; Saskatoon City Hospital; Ottawa General Hospital; Kingston General Hospital
| | - S Nofech-Mozes
- Sunnybrook Health Sciences Centre; Capital Health District Authority; Mount Sinai Hospital; Vancouver General Hospital; Tom Baker Cancer Centre; Saskatoon City Hospital; Ottawa General Hospital; Kingston General Hospital
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Singh R, Chana KK, Wright LL, Garcha DS, Kowlessar BS, Patel ARC, Mackay AJ, Fenwick PS, Donaldson GC, Barnes PJ, Wedzicha JA, Donnelly LE. P253 Association of Defective Monocyte-Derived Macrophage Phagocytosis with Clinical Phenotypes in Stable COPD. Thorax 2012. [DOI: 10.1136/thoraxjnl-2012-202678.345] [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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25
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Bryan SA, Leckie MJ, Jenkins G, Barnes PJ, Williams TJ, Sabroe I, Hansel TT. Measurement of granulocyte pharmacodynamics in whole blood by flow cytometry. Methods Mol Med 2012; 56:345-55. [PMID: 21336912 DOI: 10.1385/1-59259-151-5:345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
During the Phase I/II assessment of new therapies with the potential to suppress eosinophil and neutrophil inflammation, there is a need to assess the peripheral blood pharmacokinetic (PK) and pharmacodynamic (PD) profiles of the drug. This has relevance in respiratory disease since drugs that target eosinophillic inflammation are in development for asthma; whereas neutrophil-directed therapies are being introduced for treatment of chronic obstructive airways disease (COPD). Pharmacokinetic evaluation is required to determine the concentration of drug substance (and possibly metabolites) in peripheral blood at intervals following single or repeated dosing. Pharmacodynamic assessment is also required since many drug substances have a duration of action which is prolonged beyond the time when drug substance is detectable in the blood (see Fig. 1). Fig. 1. Whole blood pharmacodynamics. In preclinical studies, animal or human blood is treated with test agents. In clinical studies, human subjects are treated with drug and blood removed for analysis. GAFS, gated autofluorescence forward scatter; PK, pharmacokinetics; PD, pharmacoldynamics.
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Affiliation(s)
- S A Bryan
- Royal Brompton Clinical Studies Unit, National Heart and Lung Institute, Imperial College School of Science, Technology and Medicine, London, UK
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Paredi P, Kharitonov SA, Barnes PJ. Measurement of exhaled hydrocarbons. Methods Mol Med 2012; 56:109-18. [PMID: 21336894 DOI: 10.1385/1-59259-151-5:109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Oxidative stress is implicated in the pathogenesis and progression of asthma (1,2), chronic obstructive respiratory disease (COPD) (3), and cystic fibrosis (4). Reactive oxygen species (ROS) are unstable compounds with unpaired electrons, capable of initiating oxidation. Several of the inflammatory cells which participate in the inflammatory response, such as macrophages, neutrophils, and eosinophils release increased amounts of ROS (1,5) exceeding the already reduced tissue antioxidant defences of asthmatic and COPD patients (2).
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Affiliation(s)
- P Paredi
- Department of Thoracic Medicine, National Heart and Lung Institute, Imperial College School of Science, Technology and Medicine, London, UK
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Koarai A, Traves SL, Fenwick PS, Brown SM, Chana KK, Russell REK, Nicholson AG, Barnes PJ, Donnelly LE. Expression of muscarinic receptors by human macrophages. Eur Respir J 2011; 39:698-704. [PMID: 21885397 DOI: 10.1183/09031936.00136710] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Macrophages increase in number and are highly activated in chronic obstructive pulmonary disease (COPD). Muscarinic receptor antagonists inhibit acetylcholine-stimulated release of neutrophilic chemoattractants, suggesting that acetylcholine may regulate macrophage responses. Therefore, expression and function of components of the non-neuronal cholinergic system in monocyte-macrophage cells was investigated. RNA was isolated from monocytes, monocyte-derived macrophages (MDMs), lung and alveolar macrophages from nonsmokers, smokers and COPD patients, and expression of the high-affinity choline transporter, choline acetyltransferase, vesicular acetylcholine transporter and muscarinic receptors (M(1)-M(5)) ascertained using real-time PCR. M(2) and M(3) receptor expression was confirmed using immunocytochemistry. Release of interleukin (IL)-8, IL-6 and leukotriene (LT)B(4) were measured by ELISA or EIA. All monocyte-macrophage cells expressed mRNA for components of the non-neuronal cholinergic system. Lung macrophages expressed significantly more M(1) mRNA compared with monocytes, and both lung macrophages and alveolar macrophages expressed the highest levels of M(3) mRNA. Expression of M(2) and M(3) protein was confirmed in MDMs and lung macrophages. Carbachol stimulated release of LTB(4) from lung macrophages (buffer 222.3 ± 75.1 versus carbachol 1,118 ± 622.4 pg · mL(-1); n = 15, p<0.05) but not IL-6 or IL-8. LTB(4) release was attenuated by the M(3) antagonist, 1,1-dimethyl-4-diphenylacetoxypiperidinium iodide (4-DAMP; half maximal effective concentration 5.2 ± 2.2 nM; n = 9). Stimulation of macrophage M(3) receptors promotes release of LTB(4), suggesting that anti-muscarinic agents may be anti-inflammatory.
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Affiliation(s)
- A Koarai
- Airways Disease, National Heart and Lung Institute, Imperial College London, Dovehouse St, London SW3 6LY, UK
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Price JA, Grunfeld E, Barnes PJ, Rheaume DE, Rayson D. Inter-institutional pathology consultations for breast cancer: impact on clinical oncology therapy recommendations. ACTA ACUST UNITED AC 2011; 17:25-32. [PMID: 20179800 PMCID: PMC2826773 DOI: 10.3747/co.v17i1.461] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [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] [Indexed: 12/16/2022]
Abstract
Background Despite recommendations favouring review of cancer pathology specimens for patients being treated at an institution other than the one that produced the initial pathology report, data regarding discordance rates and their potential clinical impact remain limited, particularly for breast cancer. At the QEII Health Sciences Centre in Halifax, Nova Scotia, it was routine practice to review histopathology when patients referred for adjuvant therapy had undergone their breast cancer surgery and pathology reporting at another institution. The aim of the present study was to determine the rate and clinical impact of discordance in inter-institutional pathology consultations for breast cancer in Nova Scotia. Methods We conducted a retrospective review of 100 randomly selected inter-institutional pathology consultations for breast cancer patients referred to the QEII in 2004. Cases were categorized as having either no discordance, discordance with no clinical impact, or discordance with potential for clinical impact. Cases with potential clinical impact were independently reviewed by 2 medical oncologists and 2 radiation oncologists, and the discordances were rated as having high, medium, or no clinical impact. Results The study cohort consisted of 93 cases that met the inclusion criteria. Of these 93 cases, 6 had no discordance, 7 had discordance with no clinical impact, and 80 had discordance with potential for clinical impact. Overall, 10 cases (11%) were rated as having either high or medium clinical impact, with agreement on the clinical impact ratings by oncologist reviewers in the same specialty. The remaining cases had either no clinical impact or disagreement on the clinical impact rating. Conclusions Inter-institutional pathology consultations for breast cancer in Nova Scotia identified discordant findings with potential clinical impact as determined by oncologist reviewers. Further evaluation of inter-institutional pathology consultations and the impact on clinical decision-making is warranted.
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Affiliation(s)
- J A Price
- Division of Medical Oncology, Department of Oncology, Cross Cancer Institute, Edmonton, AB
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29
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Lavorini F, Corrigan CJ, Barnes PJ, Dekhuijzen PRN, Levy ML, Pedersen S, Roche N, Vincken W, Crompton GK. Retail sales of inhalation devices in European countries: so much for a global policy. Respir Med 2011; 105:1099-103. [PMID: 21489771 DOI: 10.1016/j.rmed.2011.03.012] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2010] [Revised: 03/07/2011] [Accepted: 03/11/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate the retail sales of pressurised metered-dose inhalers (pMDIs), dry-powder inhalers (DPIs) and liquids for nebulisation in 16 European countries. METHODS Retail sales data relating to pMDIs, DPIs and liquids for nebulisation delivering short- and long-acting bronchodilators, corticosteroids and combinations between 2002 and 2008 were obtained from the IMS sales database. The IMS database ensured that wholesalers' stock sales accurately matched that of retail pharmacies and included purchases by panel pharmacies directly from pharmaceutical manufacturers, specialist wholesalers and distribution cooperatives. RESULTS Mean inhaler retail sales (expressed as percentages of total sales) were 47.5% for pMDIs, 39.5% for DPIs and 13% for nebulisers. The distribution of inhaler sales differed significantly between the countries with pMDI sales greatest in the United Kingdom and Hungary compared to other countries, where DPI sales prevailed. Sales of nebulisation liquids were high in Italy. The pMDI was the most frequently prescribed inhaler for bronchodilators. In contrast, retail sales of DPIs were similar to those of pMDIs for inhaled corticosteroids, and higher in the case of inhalers with combined long-acting β(2)-agonist and corticosteroid. CONCLUSION We found a high degree of variability in inhaler prescription between European countries. Differing health policies, costs, health insurance issues, pharmaceutical/commercial aspects and prescribers' and patients' preferences may explain this variation. We suggest a need for more uniform, outcome-led inhaler prescribing practice across Europe to improve the efficacy and cost effectiveness of the treatment of obstructive airways diseases.
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Affiliation(s)
- F Lavorini
- Department of Internal Medicine, Section of Immunoallergology, Respiratory Diseases and Cell Therapy, University of Florence, Florence, Italy.
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Joos GF, Barnes PJ. Inflammatory airway diseases and clinical allergy: inflammatory airways diseases and clinical allergy assembly contribution to the celebration of 20 years of the ERS. Eur Respir J 2010; 35:1197-9. [PMID: 20513906 DOI: 10.1183/09031936.00051510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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32
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Donnelly LE, Tudhope SJ, Fenwick PS, Barnes PJ. Effects of formoterol and salmeterol on cytokine release from monocyte-derived macrophages. Eur Respir J 2009; 36:178-86. [PMID: 19926732 DOI: 10.1183/09031936.00158008] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Pulmonary macrophages are a target for inhaled therapies. Combinations of long-acting beta(2)-agonists (LABA) and glucocorticosteroids have been developed for asthma and chronic obstructive pulmonary disease (COPD). This study examined two LABA, salmeterol and formoterol, and the glucocorticosteroid, budesonide, on cytokine release from monocyte-derived macrophages (MDM) to determine whether anti-inflammatory effects observed in patients are due to inhibition of macrophages. MDM were incubated in the absence or presence of LABA or budesonide prior to stimulation with lipopolysaccharide (LPS). Tumour necrosis factor (TNF)-alpha, granulocyte macrophage-colony stimulating factor (GM-CSF) and CXC chemokine ligand (CXCL)8 were measured by ELISA. Formoterol and salmeterol inhibited LPS-stimulated release of TNF-alpha (mean effective concentration (EC(50)) 2.4+/-1.8 and 3.5+/-2.7 nM, respectively; n = 11-16), GM-CSF (EC(50) 24.6+/-2.1 and 52.4+/-40.8 nM, respectively, n = 11-12) but not CXCL8 from LPS-stimulated MDM. Budesonide inhibited release of all three cytokines (EC(50) TNF-alpha: 1.2+/-0.4 nM; GM-CSF: 0.4+/-0.2 nM; CXCL8: 0.4+/-0.1 nM; n = 3-4). Formoterol but not salmeterol elevated cAMP in these cells. These effects were attenuated by beta-adrenoceptor antagonists, propranolol and ICI118551. Salmeterol (10(-7) M) also inhibited formoterol-induced cAMP and formoterol-mediated attenuation of cytokine release. Combining budesonide (0.3 nM) with formoterol, inhibited TNF-alpha release additively. LABA may inhibit inflammatory cytokine release from macrophages in a cAMP-independent manner and act additively with budesonide.
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Affiliation(s)
- L E Donnelly
- Airway Disease, National Heart and Lung Institute, Imperial College London, Dovehouse Street, London, SW3 6LY, UK.
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Taylor AE, Finney-Hayward TK, Quint JK, Thomas CMR, Tudhope SJ, Wedzicha JA, Barnes PJ, Donnelly LE. Defective macrophage phagocytosis of bacteria in COPD. Eur Respir J 2009; 35:1039-47. [PMID: 19897561 DOI: 10.1183/09031936.00036709] [Citation(s) in RCA: 244] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Exacerbations of chronic obstructive pulmonary disease (COPD) are an increasing cause of hospitalisations and are associated with accelerated progression of airflow obstruction. Approximately half of COPD exacerbations are associated with bacteria and many patients have lower airways colonisation. This suggests that bacterial infection in COPD could be due to reduced pathogen removal. This study investigated whether bacterial clearance by macrophages is defective in COPD. Phagocytosis of fluorescently labelled polystyrene beads and Haemophillus influenzae and Streptococcus pneumoniae by alveolar macrophages and monocyte-derived macrophages (MDM) was assessed by fluorimetry and flow cytometry. Receptor expression was measured by flow cytometry. Alveolar macrophages and MDM phagocytosed polystyrene beads similarly. There was no difference in phagocytosis of beads by MDM from COPD patients compared with cells from smokers and nonsmokers. MDM from COPD patients showed reduced phagocytic responses to S. pneumoniae and H. influenzae compared with nonsmokers and smokers. This was not associated with alterations in cell surface receptor expression of toll-like receptor (TLR)2, TLR4, macrophage receptor with collagenous structure, cluster of differentiation (CD)163, CD36 or mannose receptor. Budesonide, formoterol or azithromycin did not suppress phagocytosis suggesting that reduced responses in COPD MDM were not due to medications. COPD macrophage innate responses are suppressed and may lead to bacterial colonisation and increased exacerbation frequency.
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Affiliation(s)
- A E Taylor
- Airways Disease Section, National Heart and Lung Institute, Dovehouse Street, London, UK
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35
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Di Stefano A, Caramori G, Gnemmi I, Contoli M, Bristot L, Capelli A, Ricciardolo FLM, Magno F, D'Anna SE, Zanini A, Carbone M, Sabatini F, Usai C, Brun P, Chung KF, Barnes PJ, Papi A, Adcock IM, Balbi B. Association of increased CCL5 and CXCL7 chemokine expression with neutrophil activation in severe stable COPD. Thorax 2009; 64:968-75. [PMID: 19703829 DOI: 10.1136/thx.2009.113647] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Increased numbers of activated neutrophils have been reported in the bronchial mucosa of patients with stable chronic obstructive pulmonary disease (COPD), particularly in severe disease. OBJECTIVES To investigate the expression of neutrophilic chemokines and adhesion molecules in bronchial biopsies from patients with stable COPD of different severity (GOLD stages I-IV) compared with age-matched control subjects, smokers with normal lung function and never smokers. METHODS The expression of CCL5, CXCL1, 5, 6, 7 and 8, CXCR1, CXCR2, CD11b and CD44 was measured in the bronchial mucosa using immunohistochemistry, confocal immunofluorescence, real-time quantitative polymerase chain reaction (RT-QPCR) and Western blotting (WB). RESULTS The numbers of CCL5+ epithelial cells and CCL5+ and CXCL7+ immunostained cells were increased in the bronchial submucosa of patients with stable severe COPD compared with control never smokers and smokers with normal lung function. This was also confirmed at the level of mRNA expression. The numbers of CCL5+ cells in the submucosa of patients with COPD were 2-15 times higher than any other chemokines. There was no correlation between the number of these cells and the number of neutrophils in the bronchial submucosa. Compared with control smokers, the percentage of neutrophils co-expressing CD11b and CD44 receptors was significantly increased in the submucosa of patients with COPD. CONCLUSION The increased expression of CCL5 and CXCL7 in the bronchial mucosa of patients with stable COPD, together with an increased expression of extracellular matrix-binding receptors on neutrophils, may be involved in the pathogenesis of COPD.
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Affiliation(s)
- A Di Stefano
- Division of Pulmonary Disease and Laboratory of Cytoimmunopathology of Heart and Lung, Salvatore Maugeri Foundation, IRCCS, Veruno, Italy.
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36
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Di Stefano A, Caramori G, Gnemmi I, Contoli M, Vicari C, Capelli A, Magno F, D'Anna SE, Zanini A, Brun P, Casolari P, Chung KF, Barnes PJ, Papi A, Adcock I, Balbi B. T helper type 17-related cytokine expression is increased in the bronchial mucosa of stable chronic obstructive pulmonary disease patients. Clin Exp Immunol 2009; 157:316-24. [PMID: 19604272 PMCID: PMC2730858 DOI: 10.1111/j.1365-2249.2009.03965.x] [Citation(s) in RCA: 242] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2009] [Indexed: 01/12/2023] Open
Abstract
There are increased numbers of activated T lymphocytes in the bronchial mucosa of stable chronic obstructive pulmonary disease (COPD) patients. T helper type 17 (Th17) cells release interleukin (IL)-17 as their effector cytokine under the control of IL-22 and IL-23. Furthermore, Th17 numbers are increased in some chronic inflammatory conditions. To investigate the expression of interleukin (IL)-17A, IL-17F, IL-21, IL-22 and IL-23 and of retinoic orphan receptor RORC2, a marker of Th17 cells, in bronchial biopsies from patients with stable COPD of different severity compared with age-matched control subjects. The expression of IL-17A, IL-17F, IL-21, IL-22, IL-23 and RORC2 was measured in the bronchial mucosa using immunohistochemistry and/or quantitative polymerase chain reaction. The number of IL-22(+) and IL-23(+) immunoreactive cells is increased in the bronchial epithelium of stable COPD compared with control groups. In addition, the number of IL-17A(+) and IL-22(+) immunoreactive cells is increased in the bronchial submucosa of stable COPD compared with control non-smokers. In all smokers, with and without disease, and in patients with COPD alone, the number of IL-22(+) cells correlated significantly with the number of both CD4(+) and CD8(+) cells in the bronchial mucosa. RORC2 mRNA expression in the bronchial mucosa was not significantly different between smokers with normal lung function and COPD. Further, we report that endothelial cells express high levels of IL-17A and IL-22. Increased expression of the Th17-related cytokines IL-17A, IL-22 and IL-23 in COPD patients may reflect their involvement, and that of specific IL-17-producing cells, in driving the chronic inflammation seen in COPD.
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MESH Headings
- Aged
- Analysis of Variance
- Bronchi/immunology
- Case-Control Studies
- DNA Primers/genetics
- Female
- Humans
- Immunohistochemistry
- Interleukin-17/immunology
- Interleukin-23/genetics
- Interleukin-23/immunology
- Interleukins/genetics
- Interleukins/immunology
- Male
- Middle Aged
- Mucous Membrane/immunology
- Nuclear Receptor Subfamily 1, Group F, Member 3
- Polymerase Chain Reaction
- Pulmonary Disease, Chronic Obstructive/immunology
- RNA, Messenger/analysis
- Receptors, Retinoic Acid/genetics
- Receptors, Retinoic Acid/immunology
- Receptors, Thyroid Hormone/genetics
- Receptors, Thyroid Hormone/immunology
- Respiratory Function Tests
- Smoking/adverse effects
- Statistics, Nonparametric
- T-Lymphocytes, Helper-Inducer/immunology
- Interleukin-22
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Affiliation(s)
- A Di Stefano
- Division of Pulmonary Disease, Salvatore Maugeri Foundation, IRCCS, Veruno (NO), Italy.
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Abstract
It is increasingly recognised that the airway circulation plays an important role in airway diseases, either through a change in blood flow or through microvascular leakage. Most of the information available regarding the anatomy and physiology of bronchial blood flow and its regulation has necessarily derived from animal studies. However, there have recently been important advances in understanding airway blood flow in airway disease in humans through the development of non-invasive methods and in the quantification of microvascular leakage using plasma markers. These studies have shown that bronchial blood flow is increased in patients with asthma but not in those with chronic obstructive pulmonary disease, confirming previous pathology investigations. Changes in bronchial blood flow may in part reflect the generation of new vascular vessels, a process known as "angiogenesis" which is caused by airway inflammation. Angiogenesis and the resulting plasma leak affect airway physiology, drug clearance and its bioavailability. This review discusses the anatomy, physiology and regulation of bronchial blood flow in the normal and diseased lung, In addition, it analyses the effect of current medical treatment and discusses the potential use of new anti-angiogenesis medications. The development of non-invasive assessment of bronchial blood flow and the study of angiogenesis have provided a tool to investigate airway physiology in vivo; these advances will contribute to a better understanding of inflammatory airway diseases as well as the implication of these findings to management.
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Affiliation(s)
- P Paredi
- National Heart and Lung Institute, London, UK.
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Abstract
The mechanisms of intrinsic or non-allergic asthma remain uncertain as allergens have no obvious role in driving the inflammatory process in the airways. However, IgE synthesis occurs in the airways, despite negative skin prick tests and serum-specific IgE. Furthermore, the inflammatory process in the airways is very similar between allergic and non-allergic asthma, with increased T-helper type 2 (Th2) cells, mast cell activation and infiltration of eosinophils. This pattern of inflammation is associated with a similar expression of inflammatory mediators, including Th2 cytokines and eosinophilotactic chemokines. There is increasing evidence that microbial superantigens, particularly Staphylococcal enterotoxins are important in amplifying inflammation in atopic dermatitis and chronic rhinosinusitis, in atopic and non-atopic patients. Superantigens may also be important in intrinsic asthma as airway epithelial cells may be colonized by Staphylococci and other superantigen-producing microbes. Superantigens produced locally in the airways may lead to class switching of local B cells, resulting in polyclonal IgE production in the airways and also specific IgE against the superantigen (which functions as a 'superallergen'). This leads to sensitization of mast cells, which can be activated by the usual asthma triggers, such as exercise. Superantigens also cause clonal expansion of T cells, resulting in increased Th2 cells and CD8(+) cells, while suppressing regulatory T cells. Superantigens may also reduce responsiveness to corticosteroids, resulting in more severe asthma. Finally, cytotoxic autoantibodies may also be implicated as IgG antibodies directed against epithelial proteins, such as cytokeratin-18, have been detected in intrinsic asthma, possibly as a result of epithelial damage and this may make epithelial cells more susceptible to microbial colonization. The therapeutic implications are that antibodies against local IgE and microbial superantigens or antibiotic therapy to eradicate the relevant superantigen-producing microorganisms may improve the efficacy of conventional therapy with corticosteroids.
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Affiliation(s)
- P J Barnes
- National Heart & Lung Institute, Imperial College London, London, UK.
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Abstract
This review will highlight recent advances in understanding the physiological role of calcium and effects of calcium channel blockers on pathogenetic factors in asthma, including airway smooth muscle contraction, mast cell degranulation and mucus secretion. A review of clinical studies with calcium channel blockers in asthma will also be presented.
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Spears M, Donnelly I, Jolly L, Brannigan M, Ito K, McSharry C, Lafferty J, Chaudhuri R, Braganza G, Adcock IM, Barnes PJ, Wood S, Thomson NC. Effect of low-dose theophylline plus beclometasone on lung function in smokers with asthma: a pilot study. Eur Respir J 2009; 33:1010-7. [PMID: 19196814 DOI: 10.1183/09031936.00158208] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Smoking is common in asthma and is associated with worse asthma control and a reduced therapeutic response to corticosteroids. The present authors hypothesised that treating smokers with asthma with low-dose theophylline added to inhaled corticosteroids would enhance steroid sensitivity and thereby improve lung function and symptoms. In a double-blind, parallel group exploratory trial, 68 asthmatic smokers were randomised to one of three treatments for 4 weeks: inhaled beclometasone (200 microg day(-1)), theophylline (400 mg day(-1)) or both treatments combined. Outcome measures included change in lung function and Asthma Control Questionnaire (ACQ) scores. At 4 weeks, theophylline added to inhaled beclometasone produced an improvement in peak expiratory flow (39.9 L min(-1), 95% confidence intervals (CI) 10.9-68.8) and ACQ score (-0.47, 95% CI -0.91- -0.04) and a borderline improvement in pre-bronchodilator forced expiratory volume in one second (mean difference 165 mL, 95% CI -13-342) relative to inhaled corticosteroid alone. Theophylline alone improved the ACQ score (-0.55, 95% CI -0.99- -0.11), but not lung function. In the present pilot study, the combination of low-dose theophylline and inhaled beclometasone produced improvements in both lung function and symptoms in a group of smokers with asthma. Larger trials are required to extend and confirm these findings.
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Affiliation(s)
- M Spears
- Faculty of Medicine, University of Glasgow, Glasgow, UK
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Cosio BG, Iglesias A, Rios A, Noguera A, Sala E, Ito K, Barnes PJ, Agusti A. Low-dose theophylline enhances the anti-inflammatory effects of steroids during exacerbations of COPD. Thorax 2009; 64:424-9. [PMID: 19158122 DOI: 10.1136/thx.2008.103432] [Citation(s) in RCA: 110] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is characterised by an abnormal inflammatory response mainly to cigarette smoke that flares up during exacerbations of the disease (ECOPD). Reduced activity of histone deacetylases (HDAC) contributes to enhanced inflammation in stable COPD. It was hypothesised that HDAC activity is further reduced during ECOPD and that theophylline, an HDAC activator, potentiates the anti-inflammatory effect of steroids in these patients. A study was performed to investigate HDAC activity during ECOPD and the effects of theophylline on the anti-inflammatory effects of steroids in a randomised single-blind controlled study. METHODS 35 patients hospitalised with ECOPD and treated according to international guidelines (including systemic steroids) were randomised to receive or not to receive low-dose oral theophylline (100 mg twice daily). Before treatment and 3 months after discharge, HDAC and nuclear factor-kappaB (NF-kappaB) activity in sputum macrophages, the concentration of nitric oxide in exhaled air (eNO) and total antioxidant status (TAS), tumour necrosis factor alpha (TNFalpha), interleukin (IL)-6 and IL8 levels in sputum supernatants were measured. RESULTS Patients receiving standard therapy showed decreased NF-kappaB activity, eNO concentration and sputum levels of TNFalpha, IL6 and IL8, as well as increased TAS during recovery of ECOPD, but HDAC activity did not change. The addition of low-dose theophylline increased HDAC activity and further reduced IL8 and TNFalpha concentrations. CONCLUSIONS During ECOPD, low-dose theophylline increases HDAC activity and improves the anti-inflammatory effects of steroids. TRIAL REGISTRATION NUMBER NCT00671151.
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Affiliation(s)
- B G Cosio
- Department of Respiratory Medicine, Hospital Universitario Son Dureta, Palma de Mallorca, Spain.
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42
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Abstract
Air pollution and cigarette smoke are recognized health risks. A method was developed for the measurement of the deposition fraction (DF) of polydisperse particulate matter (PM) in human airways. Ten normal volunteers [three females, age range 18-67 years, mean age (SD) 43.9 (14)] made single breath exhalations after inhalation to total lung capacity. The exhaled breath was diverted to a multichannel laser diffraction chamber where the particulate profiler measured 0.3 - 1.0-microm particles. DF was inversely related to expiration flow-rate, 0.69 (0.02) at 4 l min-1 and 0.5 (0.01) at 13 l min-1, respectively (p<0.05), and was influenced by the inhalation flow-rate [0.70 (0.02) at 3 l min-1 and 0.59 (0.02) at 13 l min-1, respectively (p<0.05)], while no differences were found between nasal and oral inhalation (0.68 (0.05) versus 0.67 (0.06), p>0.05). Higher breath holding times were associated with elevated DF [0.74 (0.02) at 20 s, and 0.62 (0.05) without breath holding (p<0.01)]. When the expiratory flow was controlled and the breath hold time standardized, DF was reproducible (CV = 4.85%). PM can be measured in the exhaled breath and its DF can be quantified using a portable device. These methods may be useful in studies investigating the health effects of air pollution and tobacco smoke.
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Affiliation(s)
- G Invernizzi
- Tobacco Control Unit, National Cancer Institute and SIMG-Italian College GPs, Milan, Italy
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43
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Torre O, Olivieri D, Barnes PJ, Kharitonov SA. Feasibility and interpretation of FE(NO) measurements in asthma patients in general practice. Respir Med 2008; 102:1417-24. [PMID: 18619827 DOI: 10.1016/j.rmed.2008.04.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2007] [Revised: 04/06/2008] [Accepted: 04/18/2008] [Indexed: 11/30/2022]
Abstract
BACKGROUND Exhaled NO (FE(NO)) is a useful biomarker for the monitoring of asthma control and response to therapy. However, there is a lack of data on FE(NO) levels and their interpretation in Primary Care asthma population depending on their treatment and smoking habit. Besides, the majority of current FE(NO) tests have been done by stationary chemiluminescence analysers whose use is limited to research laboratories. METHODS FE(NO) measurements by the novel hand-held NO monitoring device (NIOX MINO) were made in 96 asthma patients (32 males, mean age 53+/-12) at five local General Practices during their scheduled 15-20 min visits for lung function assessment. RESULTS Success rate was 78% and the intra-subject coefficient of variation was 8.7%. Inhaled corticosteroid treatment had an overall reducing effect on the FE(NO) value (30.5 [19.8-49.8]) vs. patients not on the ICS (26.5 [19-94]) (p<0.044). FE(NO) levels in the ICS treated current or ex-smokers group of patients were still significantly above the normal values (p<0.0001). FE(NO) levels were similar in patients receiving ICS whether there were current, ex-smokers or non-smokers. The highest FE(NO) levels (94 [15.8-151]) were found in asthmatic current smokers and not receiving treatment with ICS. The most "normalised" FE(NO) levels (35.3 [13.5-35.3]) were seen in ex-smokers. CONCLUSIONS FE(NO) measurements performed with a new hand-held monitoring device are reproducible and feasible in General Practice in the majority of patients of different ages and asthma severities. A high percentage of patients with different severities of asthma and regardless of their treatment with ICS and current smoking habit (current and/or ex-smokers) had highly elevated FE(NO) values, suggesting that their current therapy was possibly insufficient to control the underlying degree of airway inflammation and asthma symptoms.
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Affiliation(s)
- O Torre
- Section of Airway Diseases, National Heart and Lung Institute, Imperial College, London, United Kingdom
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Bateman ED, Hurd SS, Barnes PJ, Bousquet J, Drazen JM, FitzGerald JM, Gibson P, Ohta K, O'Byrne P, Pedersen SE, Pizzichini E, Sullivan SD, Wenzel SE, Zar HJ. Global strategy for asthma management and prevention: GINA executive summary. Eur Respir J 2008; 31:143-78. [PMID: 18166595 DOI: 10.1183/09031936.00138707] [Citation(s) in RCA: 1960] [Impact Index Per Article: 122.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Asthma is a serious health problem throughout the world. During the past two decades, many scientific advances have improved our understanding of asthma and ability to manage and control it effectively. However, recommendations for asthma care need to be adapted to local conditions, resources and services. Since it was formed in 1993, the Global Initiative for Asthma, a network of individuals, organisations and public health officials, has played a leading role in disseminating information about the care of patients with asthma based on a process of continuous review of published scientific investigations. A comprehensive workshop report entitled "A Global Strategy for Asthma Management and Prevention", first published in 1995, has been widely adopted, translated and reproduced, and forms the basis for many national guidelines. The 2006 report contains important new themes. First, it asserts that "it is reasonable to expect that in most patients with asthma, control of the disease can and should be achieved and maintained," and recommends a change in approach to asthma management, with asthma control, rather than asthma severity, being the focus of treatment decisions. The importance of the patient-care giver partnership and guided self-management, along with setting goals for treatment, are also emphasised.
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Affiliation(s)
- E D Bateman
- University of Cape Town Lung Institute, PO Box 34560, Groote School, 7700 Mowbray, Cape Town, South Africa.
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45
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Bhavsar P, Hew M, Khorasani N, Torrego A, Barnes PJ, Adcock I, Chung KF. Relative corticosteroid insensitivity of alveolar macrophages in severe asthma compared with non-severe asthma. Thorax 2008; 63:784-90. [PMID: 18492738 DOI: 10.1136/thx.2007.090027] [Citation(s) in RCA: 197] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND About 5-10% of patients with asthma suffer from poorly controlled disease despite corticosteroid (CS) treatment, which may indicate the presence of CS insensitivity. A study was undertaken to determine whether relative CS insensitivity is present in alveolar macrophages from patients with severe asthma and its association with p38 mitogen-activated protein kinase (MAPK) activation and MAPK phosphatase-1 (MKP-1). METHODS Fibreoptic bronchoscopy and bronchoalveolar lavage (BAL) were performed in 20 patients with severe asthma and 19 with non-severe asthma and, for comparison, in 14 normal volunteers. Alveolar macrophages were exposed to lipopolysaccharide (LPS, 10 mug/ml) and dexamethasone (10(-8) and 10(-6) M). Supernatants were assayed for cytokines using an ELISA-based method. p38 MAPK activity and MKP-1 messenger RNA expression were assayed in cell extracts. RESULTS The inhibition of LPS-induced interleukin (IL)1beta, IL6, IL8, monocyte chemotactic protein (MCP)-1 and macrophage inflammatory protein (MIP)-1alpha release by dexamethasone (10(-6) M) was significantly less in macrophages from patients with severe asthma than in macrophages from patients with non-severe asthma. There was increased p38 MAPK activation in macrophages from patients with severe asthma. MKP-1 expression induced by dexamethasone and LPS, expressed as a ratio of LPS-induced expression, was reduced in severe asthma. CONCLUSION Alveolar macrophages from patients with severe asthma demonstrate CS insensitivity associated with increased p38 MAPK activation that may result from impaired inducibility of MKP-1.
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Affiliation(s)
- P Bhavsar
- National Heart & Lung Institute, Imperial College, Dovehouse Street, London SW3 6LY, UK
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46
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Cazzola M, MacNee W, Martinez FJ, Rabe KF, Franciosi LG, Barnes PJ, Brusasco V, Burge PS, Calverley PMA, Celli BR, Jones PW, Mahler DA, Make B, Miravitlles M, Page CP, Palange P, Parr D, Pistolesi M, Rennard SI, Rutten-van Mölken MP, Stockley R, Sullivan SD, Wedzicha JA, Wouters EF. Outcomes for COPD pharmacological trials: from lung function to biomarkers. Eur Respir J 2008; 31:416-69. [PMID: 18238951 DOI: 10.1183/09031936.00099306] [Citation(s) in RCA: 554] [Impact Index Per Article: 34.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The American Thoracic Society/European Respiratory Society jointly created a Task Force on "Outcomes for COPD pharmacological trials: from lung function to biomarkers" to inform the chronic obstructive pulmonary disease research community about the possible use and limitations of current outcomes and markers when evaluating the impact of a pharmacological therapy. Based on their review of the published literature, the following document has been prepared with individual sections that address specific outcomes and markers, and a final section that summarises their recommendations.
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Affiliation(s)
- M Cazzola
- Unit of Respiratory Diseases, Dept of Internal Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy.
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47
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Virchow JC, Crompton GK, Dal Negro R, Pedersen S, Magnan A, Seidenberg J, Barnes PJ. Importance of inhaler devices in the management of airway disease. Respir Med 2007; 102:10-9. [PMID: 17923402 DOI: 10.1016/j.rmed.2007.07.031] [Citation(s) in RCA: 165] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2007] [Revised: 07/24/2007] [Accepted: 07/25/2007] [Indexed: 10/22/2022]
Abstract
The delivery of drugs by inhalation is an integral component of asthma and chronic obstructive pulmonary disease (COPD) management. However, even with effective inhaled pharmacological therapies, asthma, particularly, remains poorly controlled around the world. The reasons for this are manifold, but limitations of treatment guidelines in terms of content, implementation and relevance to everyday clinical life, including insufficient patient education, access to health care and cost of medication as well as poor inhaler technique are likely to contribute. Considering that inhalation therapy is a cornerstone in asthma and COPD management, little advice is provided in the guidelines regarding inhaler selection. The pressurised metered dose inhaler (pMDI) is still the most frequently prescribed device worldwide, but even after repeated tuition many patients fail to use it correctly. In addition, the correct technique can be lost over time. Although several improvements in pMDIs such as a change in the propellant and actuation have resulted in improvements in lung deposition, many dry powder inhalers (DPIs) are easier to use. However, these devices also have limitations such as dependency of drug particle size on flow rate and loss of the metered dose if the patient exhales through the device before inhaling. Improvements in using inhalation devices more efficiently, in inhaler design for supporting patient compliance, and advances in inhaler technology to assure drug delivery to the lungs, have the potential to improve asthma and COPD management and control. New and advanced devices are considered being helpful to minimise the most important problems patients have with current DPIs.
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Affiliation(s)
- J C Virchow
- Department of Pneumology, University Medical Clinic, University of Rostock, Rostock, Germany.
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Moschos SA, Jones SW, Perry MM, Williams AE, Erjefalt JS, Turner JJ, Barnes PJ, Sproat BS, Gait MJ, Lindsay MA. Lung delivery studies using siRNA conjugated to TAT(48-60) and penetratin reveal peptide induced reduction in gene expression and induction of innate immunity. Bioconjug Chem 2007; 18:1450-9. [PMID: 17711319 PMCID: PMC2621305 DOI: 10.1021/bc070077d] [Citation(s) in RCA: 249] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The therapeutic application of siRNA shows promise as an alternative approach to small-molecule inhibitors for the treatment of human disease. However, the major obstacle to its use has been the difficulty in delivering these large anionic molecules in vivo. In this study, we have investigated whether siRNA-mediated knockdown of p38 MAP kinase mRNA in mouse lung is influenced by conjugation to the nonviral delivery vector cholesterol and the cell penetrating peptides (CPP) TAT(48-60) and penetratin. Initial studies in the mouse fibroblast L929 cell line showed that siRNA conjugated to cholesterol, TAT(48-60), and penetratin, but not siRNA alone, achieved a limited reduction of p38 MAP kinase mRNA expression. Intratracheal administration of siRNA resulted in localization within macrophages and scattered epithelial cells and produced a 30-45% knockdown of p38 MAP kinase mRNA at 6 h. As with increasing doses of siRNA, conjugation to cholesterol improved upon the duration but not the magnitude of mRNA knockdown, while penetratin and TAT(48-60) had no effect. Importantly, administration of the penetratin or TAT(48-60) peptides alone caused significant reduction in p38 MAP kinase mRNA expression, while the penetratin-siRNA conjugate activated the innate immune response. Overall, these studies suggest that conjugation to cholesterol may extend but not increase siRNA-mediated p38 MAP kinase mRNA knockdown in the lung. Furthermore, the use of CPP may be limited due to as yet uncharacterized effects upon gene expression and a potential for immune activation.
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Affiliation(s)
- Sterghios Athanasios Moschos
- Biopharmaceutics Research Group, Airways Disease, National Heart and Lung Institute, Imperial College, London, UK.
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Abstract
Clinical trials have recently demonstrated that using a budesonide/formoterol combination inhaler as regular maintenance treatment twice daily but also as a rescue therapy for breakthrough symptoms can provide more effective control of asthma, particularly in reducing exacerbations, than using a short-acting beta2-agonist or formoterol as rescue therapy. This suggests that the corticosteroid component of the combination therapy plays an important role in rescue therapy. Formoterol as a rescue therapy is effective in relieving symptoms by relaxing airway smooth muscle but is also likely to have important inhibitory effects on mast cells, plasma exudation and neutrophilic inflammation. Inhaled corticosteroids have much more rapid suppressing effects on airway inflammation than previously recognised and the increased dose used as rescue therapy may prevent the increase in airway inflammation that occurs during the evolution of an exacerbation, thus preventing its development. It is likely that the molecular interactions between beta2-agonists and corticosteroids also enhance the effect of the combination therapy as rescue therapy. There is now a strong scientific rationale for single inhaler therapy in asthma, but more research is now needed to better understand the mechanisms involved.
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Affiliation(s)
- P J Barnes
- Section of Airway Disease, National Heart & Lung Institute, Imperial College, Dovehouse St, London SW3 6LY, UK.
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50
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Abstract
Exacerbations of chronic obstructive pulmonary disease are of major importance in terms of their prolonged detrimental effects on patients, the acceleration in disease progression and high healthcare costs. There is still debate about how exacerbations should be defined and graded, and their mechanisms are poorly understood. The major causal agents are either bacteria or viral infections, or a combination of the two. Noninfective causes include air pollution and pulmonary embolus but, in some patients, no cause is identified. Exacerbations represent an increase in the inflammation that is present in the stable state, with increased numbers of inflammatory cells (particularly neutrophils), cytokines, chemokines and proteases in the airways, and increased concentrations of certain cytokines and C-reactive protein in the blood. There are presently no reliable biomarkers with which to predict exacerbations. Exacerbations have a long-lasting adverse influence on health status. High doses of bronchodilators are the mainstay of treatment and systemic corticosteroids have some benefit. The routine use of antibiotics remains controversial but they are of benefit with exacerbations of a bacterial origin. Noninvasive ventilation is beneficial in preventing the need for intubation and its important complications but it is not certain whether its use in stable patients prevents exacerbations. Although important advances have been made, more effective treatments are needed in the future for prevention and treatment of exacerbations.
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Affiliation(s)
- B R Celli
- Caritas St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA, USA
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