1
|
de Kam PJ, Zielen S, Bernstein JA, Berger U, Berger M, Cuevas M, Cypcar D, Fuhr-Horst A, Greisner WA, Jandl M, Laßmann S, Worm M, Matz J, Sher E, Smith C, Steven GC, Mösges R, Shamji MH, DuBuske L, Borghese F, Oluwayi K, Zwingers T, Seybold M, Armfield O, Heath MD, Hewings SJ, Kramer MF, Skinner MA. Response to Correspondence to "Short-course subcutaneous treatment with PQ Grass strongly improves symptom and medication scores in grass allergy". Allergy 2024. [PMID: 38525846 DOI: 10.1111/all.16104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 03/08/2024] [Accepted: 03/12/2024] [Indexed: 03/26/2024]
Affiliation(s)
| | - S Zielen
- Children and Adolescents Deptartment, Allergology, Pulmonology & Cystic fibrosis, Goethe University, Frankfurt, Germany
| | - J A Bernstein
- Bernstein Clinical Research Center LLC, Cincinnati, Ohio, USA
| | - U Berger
- Department of Botany, University of Innsbruck, Innsbruck, Austria
| | - M Berger
- Department of Otorhinolaryngology, Wiener Gesundheitsverbund, Hospital Hietzing, Vienna, Austria
| | - M Cuevas
- Clinic and Polyclinic of Otorhinolaryngology, University Clinic Carl Gustav Carus, Dresden, Germany
| | - D Cypcar
- Allergy Partners of Western North Carolina, Asheville, North Carolina, USA
| | - A Fuhr-Horst
- ENT Research-Institut für klinische Studien, Essen, Germany
| | - W A Greisner
- Bluegrass Allergy Research, Lexington, Kentucky, USA
| | - M Jandl
- Hamburger Institut für Therapieforschung GmbH, Hamburg, Germany
| | - S Laßmann
- Studienzentrum Dr. Sabine Laßmann, Saalfeld, Germany
| | - M Worm
- Department of Dermatology and Allergy-Charite Campus Mitte, Universitätsmedizin Berlin, Berlin, Germany
| | - J Matz
- Chesapeake Clinical Research, Inc., White Marsh, Maryland, USA
| | - E Sher
- Allergy Partners of New Jersey, Ocean, New Jersey, USA
| | - C Smith
- Certified Research Associates, Cortland, New York, USA
| | - G C Steven
- Allergy Asthma & Sinus Center S.C., Greenfield, Wisconsin, USA
| | - R Mösges
- IMSB (Institute of Computational Biology and Medical Statistics), University at Cologne, Cologne, Germany
- ClinCompetence, Cologne, Germany
| | - M H Shamji
- Department of National Heart and Lung Institute, Immunomodulation and Tolerance Group, Allergy and Clinical Immunology, Imperial College London, London, UK
- Asthma UK Centre in Allergic Mechanisms of Asthma, Imperial College London, London, UK
| | - L DuBuske
- Division of Allergy and Immunology, Department of Internal Medicine, George Washington University Hospital, Washington, District of Columbia, USA
| | | | - K Oluwayi
- Allergy Therapeutics PLC, Worthing, UK
| | | | - M Seybold
- Allergy Therapeutics PLC, Worthing, UK
| | | | - M D Heath
- Allergy Therapeutics PLC, Worthing, UK
| | | | | | | |
Collapse
|
2
|
de Kam PJ, Zielen S, Bernstein JA, Berger U, Berger M, Cuevas M, Cypcar D, Fuhr-Horst A, Greisner WA, Jandl M, Laßmann S, Worm M, Matz J, Sher E, Smith C, Steven GC, Mösges R, Shamji MH, DuBuske L, Borghese F, Oluwayi K, Zwingers T, Seybold M, Armfield O, Heath MD, Hewings SJ, Kramer MF, Skinner MA. Short-course subcutaneous treatment with PQ Grass strongly improves symptom and medication scores in grass allergy. Allergy 2023; 78:2756-2766. [PMID: 37366581 DOI: 10.1111/all.15788] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/05/2023] [Accepted: 06/04/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND A modified grass allergen subcutaneous immunotherapy (SCIT) product with MicroCrystalline Tyrosine and monophosphoryl lipid-A as an adjuvant system (Grass MATA MPL [PQ Grass]) is being developed as short-course treatment of grass-pollen allergic rhinitis (SAR) and/or rhinoconjunctivitis. We sought to evaluate the combined symptom and medication score (CSMS) of the optimized cumulative dose of 27,600 standardized units (SU) PQ Grass in a field setting prior to embarking on a pivotal Phase III trial. METHODS In this exploratory, randomized, double-blind, placebo-controlled trial subjects were enrolled across 14 sites (Germany and the United States of America). Six pre-seasonal subcutaneous injections of PQ Grass (using conventional or extended regimens) or placebo were administered to 119 subjects (aged 18-65 years) with moderate-to-severe SAR with or without asthma that was well-controlled. The primary efficacy endpoint was CSMS during peak grass pollen season (GPS). Secondary endpoints included Rhinoconjunctivitis Quality of Life Questionnaire standardized (RQLQ-S) and allergen-specific IgG4 response. RESULTS The mean CSMS compared to placebo was 33.1% (p = .0325) and 39.5% (p = .0112) for the conventional and extended regimens, respectively. An increase in IgG4 was shown for both regimens (p < .01) as well as an improvement in total RQLQ-S for the extended regimen (mean change -0.72, p = .02). Both regimens were well-tolerated. CONCLUSIONS This trial demonstrated a clinically relevant and statistically significant efficacy response to PQ Grass. Unprecedented effect sizes were reached for grass allergy of up to ≈40% compared to placebo for CSMS after only six PQ Grass injections. Both PQ Grass regimens were considered equally safe and well-tolerated. Based on enhanced efficacy profile extended regime will be progressed to the pivotal Phase III trial.
Collapse
Affiliation(s)
| | - S Zielen
- Children and Adolescents Department, Allergology, Pulmonology & Cystic Fibrosis, Goethe University, Frankfurt, Germany
| | - J A Bernstein
- Bernstein Clinical Research Center, LLC, Cincinnati, Ohio, USA
| | - U Berger
- Aerobiology and Pollen Research Unit, Department of Oto-Rhino-Laryngology, Medical University Vienna, Vienna, Austria
| | - M Berger
- Department of Otorhinolaryngology, Wiener Gesundheitsverbund, Hospital Hietzing, Vienna, Austria
| | - M Cuevas
- Clinic and Polyclinic of Otorhinolaryngology, University Clinic Carl Gustav Carus, Dresden, Germany
| | - D Cypcar
- Allergy Partners of Western North Carolina, Asheville, North Carolina, USA
| | - A Fuhr-Horst
- ENT Research- Institut für klinische Studien, Essen, Germany
| | - W A Greisner
- Bluegrass Allergy Research, Lexington, Kentucky, USA
| | - M Jandl
- Hamburger Institut für Therapieforschung GmbH, Hamburg, Germany
| | - S Laßmann
- Studienzentrum Dr. Sabine Laßmann, Saalfeld, Germany
| | - M Worm
- Department of Dermatology and Allergy-Charite Campus Mitte, Universitätsmedizin Berlin, Berlin, Germany
| | - J Matz
- Chesapeake Clinical Research, Inc, White Marsh, Maryland, USA
| | - E Sher
- Allergy Partners of New Jersey, Ocean Township, New Jersey, USA
| | - C Smith
- Certified Research Associates, Cortland, New York, USA
| | - G C Steven
- Allergy Asthma & Sinus Center, S.C., Greenfield, Wisconsin, USA
| | - R Mösges
- IMSB (Institute of Computational Biology and Medical Statistics), University at Cologne, Cologne, Germany
- ClinCompetence, Cologne, Germany
| | - M H Shamji
- Immunomodulation and Tolerance Group, Allergy and Clinical Immunology, Department of National Heart and Lung Institute, Imperial College London, London, UK
- Asthma UK Centre in Allergic Mechanisms of Asthma, Imperial College London, London, UK
| | - L DuBuske
- Division of Allergy and Immunology, Department of Internal Medicine, George Washington University Hospital, Washington, DC, USA
| | | | - K Oluwayi
- Allergy Therapeutics PLC, Worthing, UK
| | | | - M Seybold
- Allergy Therapeutics PLC, Worthing, UK
| | | | - M D Heath
- Allergy Therapeutics PLC, Worthing, UK
| | | | | | | |
Collapse
|
3
|
Donath H, Wölke S, Knop V, Heß U, Duecker RP, Trischler J, Poynard T, Schubert R, Zielen S. Liver Assessment in Patients with Ataxia-Telangiectasia: Transient Elastography Detects Early Stages of Steatosis and Fibrosis. Can J Gastroenterol Hepatol 2023; 2023:2877350. [PMID: 36941982 PMCID: PMC10024628 DOI: 10.1155/2023/2877350] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 01/12/2023] [Accepted: 01/31/2023] [Indexed: 03/13/2023] Open
Abstract
Background Ataxia-telangiectasia (A-T) is a rare autosomal-recessive multisystem disorder characterized by pronounced cerebellar ataxia, telangiectasia, cancer predisposition, and altered body composition. Liver diseases with steatosis, fibrosis, and hepatocellular carcinoma are frequent findings in older patients but sensitive noninvasive diagnostic tools are lacking. Objectives To determine the sensitivity of transient elastography (TE) as a screening tool for early hepatic tissue changes and serum biomarkers for liver disease. Methods Thirty-one A-T patients aged 2 to 25 years were examined prospectively from 2016-2018 by TE. In addition, we evaluated the diagnostic performance of liver biomarkers for steatosis and necroinflammatory activity (SteatoTest and ActiTest, Biopredictive, Paris) compared to TE. For calculation and comparison, patients were divided into two groups (<12, >12 years of age). Results TE revealed steatosis in 2/21 (10%) younger patients compared to 9/10 (90%) older patients. Fibrosis was present in 3/10 (30%) older patients as assessed by TE. We found a significant correlation of steatosis with SteatoTest, alpha-fetoprotein (AFP), HbA1c, and triglycerides. Liver stiffness correlated significantly with SteatoTest, ActiTest, HbA1c, and triglycerides. Conclusion Liver disease is a common finding in older A-T patients. TE is an objective measure to detect early stages of steatosis and fibrosis. SteatoTest and ActiTest are a good diagnostic assessment for steatosis and necroinflammatory activity in patients with A-T and confirmed the TE results.
Collapse
Affiliation(s)
- H. Donath
- 1Department for Children and Adolescents, Division of Allergology, Pulmonology and Cystic Fibrosis, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - S. Wölke
- 1Department for Children and Adolescents, Division of Allergology, Pulmonology and Cystic Fibrosis, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - V. Knop
- 2Department of Internal Medicine 1, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - U. Heß
- 1Department for Children and Adolescents, Division of Allergology, Pulmonology and Cystic Fibrosis, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - R. P. Duecker
- 1Department for Children and Adolescents, Division of Allergology, Pulmonology and Cystic Fibrosis, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - J. Trischler
- 1Department for Children and Adolescents, Division of Allergology, Pulmonology and Cystic Fibrosis, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - T. Poynard
- 3Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Hepatology Department, Frankfurt, Germany
| | - R. Schubert
- 1Department for Children and Adolescents, Division of Allergology, Pulmonology and Cystic Fibrosis, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - S. Zielen
- 1Department for Children and Adolescents, Division of Allergology, Pulmonology and Cystic Fibrosis, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| |
Collapse
|
4
|
De Bernardi N, Duecker RP, Zielen S, Schubert R, Eickmeier O. Epigenetische Regulation der Resolution der Inflammation bei
Cystischer Fibrose. Klinische Pädiatrie 2022. [DOI: 10.1055/s-0042-1754511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- N De Bernardi
- Universitätsklinikum Frankfurt, Klinik für Kinder- und
Jugendmedizin, Abteilung für Allergologie, Pneumologie und Cystische
Fibrose, Frankfurt am Main, Germany
| | - RP Duecker
- Universitätsklinikum Frankfurt, Klinik für Kinder- und
Jugendmedizin, Abteilung für Allergologie, Pneumologie und Cystische
Fibrose, Frankfurt am Main, Germany
| | - S Zielen
- Universitätsklinikum Frankfurt, Klinik für Kinder- und
Jugendmedizin, Abteilung für Allergologie, Pneumologie und Cystische
Fibrose, Frankfurt am Main, Germany
| | - R Schubert
- Universitätsklinikum Frankfurt, Klinik für Kinder- und
Jugendmedizin, Abteilung für Allergologie, Pneumologie und Cystische
Fibrose, Frankfurt am Main, Germany
| | - O Eickmeier
- Universitätsklinikum Frankfurt, Klinik für Kinder- und
Jugendmedizin, Abteilung für Allergologie, Pneumologie und Cystische
Fibrose, Frankfurt am Main, Germany
| |
Collapse
|
5
|
Trischler J, Laschinski J, Dreßler M, Schulze J, Zielen S. Non-asthmatic, chronic cough in school-aged children: does an
extended diagnostic work-up help? Klinische Pädiatrie 2022. [DOI: 10.1055/s-0042-1754473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- J Trischler
- University Hospital Frankfurt, Department for Children and Adolescents,
Division for Allergy, Pulmonology and Cystic Fibrosis, Frankfurt,
Germany
| | - J Laschinski
- University Hospital Frankfurt, Department for Children and Adolescents,
Division for Allergy, Pulmonology and Cystic Fibrosis, Frankfurt,
Germany
| | - M Dreßler
- University Hospital Frankfurt, Department for Children and Adolescents,
Division for Allergy, Pulmonology and Cystic Fibrosis, Frankfurt,
Germany
| | - J Schulze
- University Hospital Frankfurt, Department for Children and Adolescents,
Division for Allergy, Pulmonology and Cystic Fibrosis, Frankfurt,
Germany
| | - S Zielen
- University Hospital Frankfurt, Department for Children and Adolescents,
Division for Allergy, Pulmonology and Cystic Fibrosis, Frankfurt,
Germany
| |
Collapse
|
6
|
Dreßler M, Eichhorn C, Gerhardt H, Trischler J, Zielen S, Schulze J. Diagnostik und Prädiktoren bei belastungsinduzierter
bronchialer Obstruktion (EIB) und belastungsinduzierter laryngealer Obstruktion
(EILO). Klinische Pädiatrie 2022. [DOI: 10.1055/s-0042-1754467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- M Dreßler
- Universitätsklinikum Frankfurt, Allergologie, Pneumologie und
Mukoviszidose, Klinik für Kinder- und Jugendmedizin, Frankfurt am Main,
Germany
| | - C Eichhorn
- Universitätsklinikum Frankfurt, Allergologie, Pneumologie und
Mukoviszidose, Klinik für Kinder- und Jugendmedizin, Frankfurt am Main,
Germany
| | - H Gerhardt
- Universitätsklinikum Frankfurt, Allergologie, Pneumologie und
Mukoviszidose, Klinik für Kinder- und Jugendmedizin, Frankfurt am Main,
Germany
| | - J Trischler
- Universitätsklinikum Frankfurt, Allergologie, Pneumologie und
Mukoviszidose, Klinik für Kinder- und Jugendmedizin, Frankfurt am Main,
Germany
| | - S Zielen
- Universitätsklinikum Frankfurt, Allergologie, Pneumologie und
Mukoviszidose, Klinik für Kinder- und Jugendmedizin, Frankfurt am Main,
Germany
| | - J Schulze
- Universitätsklinikum Frankfurt, Allergologie, Pneumologie und
Mukoviszidose, Klinik für Kinder- und Jugendmedizin, Frankfurt am Main,
Germany
| |
Collapse
|
7
|
Jerkic SP, Bächle L, Trischler J, Schubert R, Zielen S. Fettsäureprofil und bronchiale Entzündung bei
Patienten mit Bronchiolitis obliterans. Klinische Pädiatrie 2022. [DOI: 10.1055/s-0042-1754499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- SP Jerkic
- Klinik für Kinder- und Jugendmedizin,
Universitätsklinikum Frankfurt, Allergologie, Pneumologie und
Mukoviszidose, Frankfurt am Main, Germany
| | - L Bächle
- Klinik für Kinder- und Jugendmedizin,
Universitätsklinikum Frankfurt, Allergologie, Pneumologie und
Mukoviszidose, Frankfurt am Main, Germany
| | - J Trischler
- Klinik für Kinder- und Jugendmedizin,
Universitätsklinikum Frankfurt, Allergologie, Pneumologie und
Mukoviszidose, Frankfurt am Main, Germany
| | - R Schubert
- Klinik für Kinder- und Jugendmedizin,
Universitätsklinikum Frankfurt, Allergologie, Pneumologie und
Mukoviszidose, Frankfurt am Main, Germany
| | - S Zielen
- Klinik für Kinder- und Jugendmedizin,
Universitätsklinikum Frankfurt, Allergologie, Pneumologie und
Mukoviszidose, Frankfurt am Main, Germany
| |
Collapse
|
8
|
Donath H, Woelke S, Schubert R, Kieslich M, Theis M, Auburger G, Duecker RP, Zielen S. Neurofilament Light Chain Is a Biomarker of Neurodegeneration in Ataxia Telangiectasia. Cerebellum 2021; 21:39-47. [PMID: 33893614 PMCID: PMC8885493 DOI: 10.1007/s12311-021-01257-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/10/2021] [Indexed: 12/12/2022]
Abstract
Ataxia telangiectasia (A-T) is a progressive and life-limiting disease associated with cerebellar ataxia due to progressive cerebellar degeneration. In addition to ataxia, which is described in detail, the presence of chorea, dystonia, oculomotor apraxia, athetosis, parkinsonism, and myoclonia are typical manifestations of the disease. The study aimed to evaluate the specificity and sensitivity of neurofilament light chain (NfL) as a biomarker of neurodegeneration in relation to SARA score. In this prospective trial, one visit of 42 A-T patients aged 1.3–25.6 years (mean 11.6 ± 7.3 years) was performed, in which NfL was determined from serum by ELISA. Additionally, a neurological examination of the patients was performed. Blood was collected from 19 healthy volunteers ≥ 12 years of age. We found significantly increased levels of NfL in patients with A-T compared to healthy controls (21.5 ± 3.6 pg/mL vs. 9.3 ± 0.49 pg/mL, p ≤ 0.01). There was a significant correlation of NfL with age, AFP, and SARA. NfL is a new potential progression biomarker in blood for neurodegeneration in A-T which increases with age.
Collapse
Affiliation(s)
- H Donath
- Division of Allergology, Pulmonology and Cystic Fibrosis, Department for Children and Adolescents, Goethe University, Frankfurt, Germany.
| | - S Woelke
- Division of Allergology, Pulmonology and Cystic Fibrosis, Department for Children and Adolescents, Goethe University, Frankfurt, Germany
| | - R Schubert
- Division of Allergology, Pulmonology and Cystic Fibrosis, Department for Children and Adolescents, Goethe University, Frankfurt, Germany
| | - M Kieslich
- Division of Pediatric Neurology, Department for Children and Adolescents, Goethe University, Frankfurt, Germany
| | - M Theis
- Division of Pediatric Neurology, Department for Children and Adolescents, Goethe University, Frankfurt, Germany
| | - G Auburger
- Experimental Neurology, Medical School, Goethe University, Frankfurt, Germany
| | - R P Duecker
- Division of Allergology, Pulmonology and Cystic Fibrosis, Department for Children and Adolescents, Goethe University, Frankfurt, Germany
| | - S Zielen
- Division of Allergology, Pulmonology and Cystic Fibrosis, Department for Children and Adolescents, Goethe University, Frankfurt, Germany
| |
Collapse
|
9
|
Dreßler M, Fussbroich D, Böhler L, Herrmann E, Benker N, Tytyk M, Schulze J, Schubert R, Beermann C, Zielen S. Oil supplementation with a special combination of n-3 and n-6 long-chain polyunsaturated fatty acids does not protect for exercise induced asthma: a double-blind placebo-controlled trial. Lipids Health Dis 2020; 19:167. [PMID: 32660564 PMCID: PMC7359229 DOI: 10.1186/s12944-020-01343-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 01/03/2020] [Accepted: 07/03/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many patients suffering from exercise-induced asthma (EIA) have normal lung function at rest and show symptoms and a decline in FEV1 when they do sports or during exercise-challenge. It has been described that long-chain polyunsaturated fatty acids (LCPUFA) could exert a protective effect on EIA. METHODS In this study the protective effect of supplementation with a special combination of n-3 and n-6 LCPUFA (sc-LCPUFA) (total 1.19 g/ day) were investigated in an EIA cold air provocation model. PRIMARY OUTCOME MEASURE Decrease in FEV1 after exercise challenge and secondary outcome measure: anti-inflammatory effects monitored by exhaled NO (eNO) before and after sc-LCPUFA supplementation versus placebo. RESULTS Ninety-nine patients with exercise-induced symptoms aged 10 to 45 were screened by a standardized exercise challenge in a cold air chamber at 4 °C. Seventy-three patients fulfilled the inclusion criteria of a FEV1 decrease > 15% and were treated double-blind placebo-controlled for 4 weeks either with sc-LCPUFA or placebo. Thirty-two patients in each group completed the study. Mean FEV1 decrease after cold air exercise challenge and eNO were unchanged after 4 weeks sc-LCPUFA supplementation. CONCLUSION Supplementation with sc-LCPUFA at a dose of 1.19 g/d did not have any broncho-protective and anti-inflammatory effects on EIA. TRIAL REGISTRATION Clinical trial registration number: NCT02410096. Registered 7 February 2015 at Clinicaltrial.gov.
Collapse
Affiliation(s)
- M Dreßler
- Department for Children and Adolescents, Division of Allergology, Pulmonology and Cystic fibrosis, Goethe-University, Frankfurt/Main, Germany
| | - D Fussbroich
- Department for Children and Adolescents, Division of Allergology, Pulmonology and Cystic fibrosis, Goethe-University, Frankfurt/Main, Germany.,Department of Food Technology, University of Applied Science, Fulda, Germany.,Faculty of Biological Sciences, Goethe-University, Frankfurt/Main, Germany
| | - L Böhler
- Department for Children and Adolescents, Division of Allergology, Pulmonology and Cystic fibrosis, Goethe-University, Frankfurt/Main, Germany
| | - E Herrmann
- Institute of Biostatistics and Mathematical Modelling, Goethe-University, Frankfurt/Main, Germany
| | - N Benker
- Department for Children and Adolescents, Division of Allergology, Pulmonology and Cystic fibrosis, Goethe-University, Frankfurt/Main, Germany
| | - M Tytyk
- Department of Food Technology, University of Applied Science, Fulda, Germany
| | - J Schulze
- Department for Children and Adolescents, Division of Allergology, Pulmonology and Cystic fibrosis, Goethe-University, Frankfurt/Main, Germany
| | - R Schubert
- Department for Children and Adolescents, Division of Allergology, Pulmonology and Cystic fibrosis, Goethe-University, Frankfurt/Main, Germany
| | - C Beermann
- Department of Food Technology, University of Applied Science, Fulda, Germany
| | - S Zielen
- Department for Children and Adolescents, Division of Allergology, Pulmonology and Cystic fibrosis, Goethe-University, Frankfurt/Main, Germany.
| |
Collapse
|
10
|
Fussbroich D, Colas RA, Eickmeier O, Trischler J, Jerkic SP, Zimmermann K, Göpel A, Schwenger T, Schaible A, Henrich D, Baer P, Zielen S, Dalli J, Beermann C, Schubert R. A combination of LCPUFA ameliorates airway inflammation in asthmatic mice by promoting pro-resolving effects and reducing adverse effects of EPA. Mucosal Immunol 2020; 13:481-492. [PMID: 31907365 PMCID: PMC7181394 DOI: 10.1038/s41385-019-0245-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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: 09/28/2018] [Revised: 11/24/2019] [Accepted: 12/02/2019] [Indexed: 02/04/2023]
Abstract
Lipid mediators derived from omega (n)-3 and n-6 long-chain polyunsaturated fatty acids (LCPUFA) play key roles in bronchoconstriction, airway inflammation, and resolution processes in asthma. This study compared the effects of dietary supplementation with either a combination of LCPUFAs or eicosapentaenoic acid (EPA) alone to investigate whether the combination has superior beneficial effects on the outcome of asthmatic mice. Mice were sensitized with house dust mite (HDM) extract, and subsequently supplemented with either a combination of LCPUFAs or EPA alone in a recall asthma model. After the final HDM and LCPUFA administration, airway hyperresponsiveness (AHR), bronchoalveolar lavages, and lung histochemistry were examined. Lipid mediator profiles were determined by liquid chromatography coupled with tandem mass spectrometry (LC-MS-MS). The LCPUFA combination reduced AHR, eosinophilic inflammation, and inflammatory cytokines (IL-5, IFN-γ, and IL-6) in asthmatic mice, whereas EPA enhanced inflammation. The combination of LCPUFAs was more potent in downregulating EPA-derived LTB5 and LTC5 and in supporting DHA-derived RvD1 and RvD4 (2.22-fold and 2.58-fold higher levels) than EPA alone. Ex vivo experiments showed that LTB5 contributes to granulocytes' migration and M1-polarization in monocytes. Consequently, the LCPUFA combination ameliorated airway inflammation by inhibiting adverse effects of EPA and promoting pro-resolving effects supporting the lipid mediator-dependent resolution program.
Collapse
Affiliation(s)
- D. Fussbroich
- grid.430588.2Department of Food Technology, University of Applied Sciences Fulda, Fulda, Germany ,0000 0004 1936 9721grid.7839.5Division for Allergy, Pneumology and Cystic Fibrosis, Department for Children and Adolescence, Goethe-University, Frankfurt/Main, Germany ,0000 0004 1936 9721grid.7839.5Faculty of Biological Sciences, Goethe University Frankfurt/Main, Frankfurt/Main, Germany
| | - R. A. Colas
- 0000 0001 2171 1133grid.4868.2Lipid Mediator Unit, William Harvey Research Institute, Bart’s and the London School of Medicine, Queen Mary University of London, London, UK
| | - O. Eickmeier
- 0000 0004 1936 9721grid.7839.5Division for Allergy, Pneumology and Cystic Fibrosis, Department for Children and Adolescence, Goethe-University, Frankfurt/Main, Germany
| | - J. Trischler
- 0000 0004 1936 9721grid.7839.5Division for Allergy, Pneumology and Cystic Fibrosis, Department for Children and Adolescence, Goethe-University, Frankfurt/Main, Germany
| | - S. P. Jerkic
- 0000 0004 1936 9721grid.7839.5Division for Allergy, Pneumology and Cystic Fibrosis, Department for Children and Adolescence, Goethe-University, Frankfurt/Main, Germany
| | - K. Zimmermann
- grid.430588.2Department of Food Technology, University of Applied Sciences Fulda, Fulda, Germany
| | - A. Göpel
- grid.430588.2Department of Food Technology, University of Applied Sciences Fulda, Fulda, Germany
| | - T. Schwenger
- grid.430588.2Department of Food Technology, University of Applied Sciences Fulda, Fulda, Germany
| | - A. Schaible
- 0000 0004 1936 9721grid.7839.5Department of Trauma, Hand & Reconstructive Surgery, Goethe-University, Frankfurt/Main, Germany
| | - D. Henrich
- 0000 0004 1936 9721grid.7839.5Department of Trauma, Hand & Reconstructive Surgery, Goethe-University, Frankfurt/Main, Germany
| | - P. Baer
- 0000 0004 1936 9721grid.7839.5Division of Nephrology, Department of Internal Medicine III, Goethe-University, Frankfurt/Main, Germany
| | - S. Zielen
- 0000 0004 1936 9721grid.7839.5Division for Allergy, Pneumology and Cystic Fibrosis, Department for Children and Adolescence, Goethe-University, Frankfurt/Main, Germany
| | - J. Dalli
- 0000 0001 2171 1133grid.4868.2Lipid Mediator Unit, William Harvey Research Institute, Bart’s and the London School of Medicine, Queen Mary University of London, London, UK ,0000 0001 2171 1133grid.4868.2Centre for inflammation and Therapeutic Innovation, Queen Mary University of London, London, UK
| | - C. Beermann
- grid.430588.2Department of Food Technology, University of Applied Sciences Fulda, Fulda, Germany
| | - R. Schubert
- 0000 0004 1936 9721grid.7839.5Division for Allergy, Pneumology and Cystic Fibrosis, Department for Children and Adolescence, Goethe-University, Frankfurt/Main, Germany
| |
Collapse
|
11
|
Fussbroich D, Kohnle C, Schwenger T, Driessler C, Dücker RP, Eickmeier O, Gottwald G, Jerkic SP, Zielen S, Kreyenberg H, Beermann C, Chiocchetti AG, Schubert R. A combination of LCPUFAs regulates the expression of miRNA-146a-5p in a murine asthma model and human alveolar cells. Prostaglandins Other Lipid Mediat 2019; 147:106378. [PMID: 31698144 DOI: 10.1016/j.prostaglandins.2019.106378] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 08/14/2019] [Accepted: 09/09/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND LCPUFAs are suggestive of having beneficial effects on inflammatory diseases such as asthma. However, little is known about the modulative capacity of omega-(n)-3 and n-6 LCPUFAs within the epigenetic regulation of inflammatory processes. OBJECTIVE The aim of this study was to investigate whether a specific combined LCPUFA supplementation restores disease-dysregulated miRNA-profiles in asthmatic mice. In addition, we determined the effect of the LCPUFA supplementation on the interaction of the most regulated miRNA expression and oxygenase activity in vitro. METHODS Sequencing of miRNA was performed by NGS from lung tissue of asthmatic and control mice with normal diet, as well as of LCPUFA supplemented asthmatic mice. Network analysis and evaluation of the biological targets of the miRNAs were performed by DIANA- miRPath v.3 webserver software, TargetScanMouse 7.2, and tool String v.10, respectively. Expression of hsa-miRNA-146a-5p and activity of COX-2 and 5-LO in LCPUFA-treated A549 cells were assessed by qPCR and flow cytometry, respectively. RESULTS In total, 62 miRNAs were dysregulated significantly in murine allergic asthma. The LCPUFA combination restored 21 of these dysregulated miRNAs, of which eight (mmu-miR-146a-5p, -30a-3p, -139-5p, -669p-5p, -145a-5p, -669a-5p, -342-3p and -15b-5p) were even normalized compared to the control levels. Interestingly, six of the eight rescued miRNAs are functionally implicated in TGF-β signaling, ECM-receptor interaction and fatty acid biosynthesis. Furthermore, in vitro experiments demonstrated that upregulation of hsa-miRNA-146a-5p is accompanied by a reduction of COX-2 and 5-LO activity. Moreover, transfection experiments revealed that LCPUFAs inhibit 5-LO activity in the presence and absence of anti-miR-146a-5p. CONCLUSION Our results demonstrate the modulative capacity of LCPUFAs on dysregulated miRNA expression in asthma. In addition, we pointed out the high regulative potential of LCPUFAs on 5-LO regulation and provided evidence that miR-146a partly controls the regulation of 5-LO.
Collapse
Affiliation(s)
- D Fussbroich
- Department of Food Technology, University of Applied Sciences, Leipziger Str. 123, Fulda, Germany; Division for Allergy, Pneumology and Cystic Fibrosis, Department for Children and Adolescents, Goethe University, Theodor-Stern-Kai 7, Frankfurt/Main, Germany; Faculty of Biological Sciences, Goethe University Frankfurt/Main, Max-von-Laue-Straße 9, Frankfurt/Main, Germany.
| | - C Kohnle
- Division for Allergy, Pneumology and Cystic Fibrosis, Department for Children and Adolescents, Goethe University, Theodor-Stern-Kai 7, Frankfurt/Main, Germany
| | - T Schwenger
- Department of Food Technology, University of Applied Sciences, Leipziger Str. 123, Fulda, Germany
| | - C Driessler
- Division for Allergy, Pneumology and Cystic Fibrosis, Department for Children and Adolescents, Goethe University, Theodor-Stern-Kai 7, Frankfurt/Main, Germany
| | - R P Dücker
- Division for Allergy, Pneumology and Cystic Fibrosis, Department for Children and Adolescents, Goethe University, Theodor-Stern-Kai 7, Frankfurt/Main, Germany
| | - O Eickmeier
- Division for Allergy, Pneumology and Cystic Fibrosis, Department for Children and Adolescents, Goethe University, Theodor-Stern-Kai 7, Frankfurt/Main, Germany
| | - G Gottwald
- Division for Allergy, Pneumology and Cystic Fibrosis, Department for Children and Adolescents, Goethe University, Theodor-Stern-Kai 7, Frankfurt/Main, Germany
| | - S P Jerkic
- Division for Allergy, Pneumology and Cystic Fibrosis, Department for Children and Adolescents, Goethe University, Theodor-Stern-Kai 7, Frankfurt/Main, Germany
| | - S Zielen
- Division for Allergy, Pneumology and Cystic Fibrosis, Department for Children and Adolescents, Goethe University, Theodor-Stern-Kai 7, Frankfurt/Main, Germany
| | - H Kreyenberg
- Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital, Goethe University, Theodor-Stern-Kai 7, Frankfurt/Main, Germany
| | - C Beermann
- Department of Food Technology, University of Applied Sciences, Leipziger Str. 123, Fulda, Germany
| | - A G Chiocchetti
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Goethe University, Theodor-Stern-Kai 7, Frankfurt/Main, Germany
| | - R Schubert
- Division for Allergy, Pneumology and Cystic Fibrosis, Department for Children and Adolescents, Goethe University, Theodor-Stern-Kai 7, Frankfurt/Main, Germany
| |
Collapse
|
12
|
Zielen S, Kuna P, Aberer W, Lassmann S, Pfaar O, Klimek L, Wade A, Kluehr K, Raab J, Wessiepe D, Lee D, Kramer M, Gunawardena K, Higenbottam T, Heath M, Skinner M, de Kam P. Strong dose response after immunotherapy with PQ grass using conjunctival provocation testing. World Allergy Organ J 2019; 12:100075. [PMID: 31709029 PMCID: PMC6831906 DOI: 10.1016/j.waojou.2019.100075] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 09/19/2019] [Accepted: 09/24/2019] [Indexed: 12/24/2022] Open
Abstract
Background Pollinex Quattro Grass (PQ Grass) is an effective, well-tolerated, short pre-seasonal subcutaneous immunotherapy to treat seasonal allergic rhinoconjunctivitis (SAR) due to grass pollen. In this Phase II study, 4 cumulative doses of PQ Grass and placebo were evaluated to determine its optimal cumulative dose. Methods Patients with grass pollen-induced SAR were randomised to either a cumulative dose of PQ Grass (5100, 14400, 27600 and 35600 SU) or placebo, administered as 6 weekly subcutaneous injections over 31-41 days (EudraCT number 2017-000333-31). Standardized conjunctival provocation tests (CPT) using grass pollen allergen extract were performed at screening, baseline and post-treatment to determine the total symptom score (TSS) assessed approximately 4 weeks after dosing. Three models were pre-defined (Emax, logistic, and linear in log-dose model) to evaluate a dose response relationship. Results In total, 95.5% of the 447 randomized patients received all 6 injections. A highly statistically significant (p < 0.0001), monotonic dose response was observed for all three pre-specified models. All treatment groups showed a statistically significant decrease from baseline in TSS compared to placebo, with the largest decrease observed after 27600 SU (p < 0.0001). The full course of 6 injections was completed by 95.5% of patients. Treatment-emergent adverse events were similar across PQ Grass groups, and mostly mild and transient in nature. Conclusions PQ Grass demonstrated a strong curvilinear dose response in TSS following CPT without compromising its safety profile.
Collapse
Key Words
- ADRs, adverse drug reactions
- AE, adverse events
- AIT, allergen immunotherapy
- ANCOVA, analysis of covariance
- ARC, adverse reaction complexes
- Allergen immunotherapy
- Allergoid
- CIA-CPT, Culture – Independent Assessment of the Conjunctival Provocation Test
- CPT, conjunctival provocation test
- Cumulative dose
- Curvilinear dose response
- EAACI, European Academy of Allergy and Clinical Immunology
- EMA, European Medicine Agency
- FAS, Full Analysis Set
- FEV, forced expiratory volume
- FVC, forced vital capacity
- Grass pollen
- HEP, Histamine Equivalent Potency
- LPS, lipopolysaccharide
- MCP-Mod, Multiple Comparison Procedure and Modelling
- MCT, microcrystalline tyrosine
- MPL, Monophosphoryl Lipid A
- MedDRA, Medical Dictionary for Regulatory Activities
- PPS, Per Protocol Set
- SAEs, serious adverse events
- SAF, safety set
- SAR, seasonal allergic rhinoconjunctivitis
- SD, standard deviation
- SU, standardized units
- TEAEs, treatment-emergent adverse events
- TLR, Toll-like receptor
- TSS, Total Symptom Score
- mFAS, Modified Full Analysis Set
Collapse
Affiliation(s)
- S. Zielen
- Department for Children and Adolescents, Division of Allergology, Pulmonology and Cystic fibrosis, Goethe University, Frankfurt, Germany
| | - P. Kuna
- Poradnia Alergologii i Chorób Płuc Lodz, Poland
| | - W. Aberer
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - S. Lassmann
- Specialist in Otolaryngology, Saalfeld, Germany
| | - O. Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, Germany
| | - L. Klimek
- Centre for Rhinology and Allergology, Wiesbaden, Germany
| | - A. Wade
- Allergy Therapeutics Ltd., Worthing, UK
| | - K. Kluehr
- Allergy Therapeutics Ltd., Worthing, UK
| | - J. Raab
- Allergy Therapeutics Ltd., Worthing, UK
| | - D. Wessiepe
- Metronomia Clinical Research GmbH, Munich, Germany
| | - D. Lee
- Allergy Therapeutics Ltd., Worthing, UK
| | | | | | | | | | | | - P.J. de Kam
- Allergy Therapeutics Ltd., Worthing, UK
- Corresponding author. Allergy Therapeutics (UK) Ltd, Dominion Way Worthing, West Sussex BN14 8SA, UK
| |
Collapse
|
13
|
Belachew N, Jerkic S, Michel F, Schubert R, Zielen S, Rosewich M. Lungenfunktion, Lung Clearance Index und bronchiale Entzündung bei Kindern und Jugendlichen mit Bronchiolitis obliterans. Pneumologie 2019; 73:399-406. [DOI: 10.1055/a-0853-0253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Zusammenfassung
Einleitung Die Bronchiolitis obliterans (BO) ist eine sehr seltene, chronische Lungenerkrankung, die vereinzelt nach schweren Atemwegsinfektionen oder als Folge von Stammzell- und Lungentransplantation auftritt. Ziel der Arbeit war es, die Lungenfunktion und die bronchiale Entzündung bei BO-Patienten im Jugend- und Kindesalter zu untersuchen. Zudem sollte das Potenzial des LCI in der Diagnostik dieser Patienten untersucht werden.
Methoden Es wurden 16 BO-Patienten (Alter: Median 16,7; 9,6 – 25,3 Jahre) und 17 gesunde Probanden (Alter: Median 16,6; 7,6 – 25,0 Jahre) untersucht. Neben der Untersuchung der Lungenfunktion (FVC, FEV1, MEF25, RV und RV/TLC) mittels Bodyplethysmografie erfolgte eine Reversibilitätstestung nach Gabe von 400 µg Salbutamol. Die Bestimmung des LCI erfolgte mittels Multiple Breath Washout (MBW)-Methode. Zusätzlich wurde die Zellverteilung und das Zytokinprofil (IL-1ß, IL-6, IL-8, TNF-α) mittels Cytometric Bead Array (CBA) im induzierten Sputum analysiert.
Ergebnisse FVC, FEV1 und MEF25 der BO-Patienten waren signifikant niedriger, das RV und die RV/TLC jedoch signifikant erhöht im Vergleich zur Kontrollgruppe. Eine bronchiale Reversibilität zeigte sich bei 3 Patienten. Der LCI war bei den BO-Patienten gegenüber der Kontrollgruppe signifikant erhöht (Median 10,24 vs. 7,1) und korrelierte signifikant mit dem MEF25 (p < 0,0001). Im induzierten Sputum fand sich eine signifikante Erhöhung der Gesamtzellzahl, der neutrophilen Granulozyten sowie von IL-6 und IL-8 (p < 0.01).
Schlussfolgerung Die Lungenfunktion ist bei Kindern und Jugendlichen mit BO stark eingeschränkt. Zudem erwies sich der LCI als sensitiver und reproduzierbarer Marker zur Beurteilung der obstruktiven Beeinträchtigung der kleinen Atemwege. Im induzierten Sputum ist eine von Neutrophilen dominierte bronchiale Entzündung nachweisbar.
Collapse
Affiliation(s)
- N. Belachew
- Klinik für Kinder- und Jugendmedizin, Allergologie, Pneumologie und Mukoviszidose
| | - S. Jerkic
- Klinik für Kinder- und Jugendmedizin, Allergologie, Pneumologie und Mukoviszidose
| | - F. Michel
- Klinik für Kinder- und Jugendmedizin, Allergologie, Pneumologie und Mukoviszidose
| | - R. Schubert
- Klinik für Kinder- und Jugendmedizin, Allergologie, Pneumologie und Mukoviszidose
| | - S. Zielen
- Klinik für Kinder- und Jugendmedizin, Allergologie, Pneumologie und Mukoviszidose
| | - M. Rosewich
- Klinik für Kinder- und Jugendmedizin, Allergologie, Pneumologie und Mukoviszidose
| |
Collapse
|
14
|
Fussbroich D, Zimmermann K, Göpel A, Eickmeier O, Trischler J, Zielen S, Schubert R, Beermann C. A specific combined long-chain polyunsaturated fatty acid supplementation reverses fatty acid profile alterations in a mouse model of chronic asthma. Lipids Health Dis 2019; 18:16. [PMID: 30658644 PMCID: PMC6339374 DOI: 10.1186/s12944-018-0947-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 04/27/2018] [Accepted: 12/17/2018] [Indexed: 12/31/2022] Open
Abstract
Background The immune-modulating potential of long-chain polyunsaturated fatty acids (LCPUFAs) based on their conversion into lipid mediators in inflammatory situations has been proven by several studies. Respecting the immune-modulative role of lipid mediators in bronchoconstriction, airway inflammation and resolution of inflammatory processes, LCPUFAs play an important role in asthma. To design a disease-specific and most beneficial LCPUFA supplementation strategy, it is essential to understand how asthma alters LCPUFA profiles. Therefore, this study characterizes the alterations of LCPUFA profiles induced by allergic asthma. In addition, this study explores whether a simple eicosapentaenoic acid (EPA) alone or a specific combined LCPUFA supplementation could restore imbalanced LCPUFA profiles. Methods Mice were sensitized with a daily dose of 40 μg house dust mite (HDM)-extract in a recall model and fed with either normal diet, EPA or a specific combined (sc)-LCPUFA supplementation containing EPA, docosahexaenoic acid (DHA), γ -linolenic acid (GLA) and stearidonic acid (SDA) for 24 days. After recall with HDM, mice were sacrificed and blood and lung tissue were collected. Fatty acid profiles were determined in plasma, blood cells and lung cells of asthmatic mice by capillary gas-chromatography. Results In lung cells of asthmatic mice, arachidonic acid (AA, p < 0.001) and DHA (p < 0.01) were increased while dihomo-γ-linolenic acid (DGLA, p < 0.05) was decreased. EPA supplementation increased only EPA (p < 0.001) and docosapentaenoic acid (DPA, p < 0.001), but neither DGLA nor DHA in lung cells of asthmatic mice. In contrast, a specific combined dietary supplementation containing n-3 and n-6 LCPUFAs could decrease AA (p < 0.001), increase EPA (p < 0.001), DPA (p < 0.001) and DHA (p < 0.01) and could reverse the lack of DGLA (p < 0.05). Conclusions In summary, allergic asthma alters LCPUFA profiles in blood and lung tissue. In contrast to the EPA supplementation, the distinct combination of n-3 and n-6 LCPUFAs restored the LCPUFA profiles in lung tissue of asthmatic mice completely. Subsequently, sc-LCPUFA supplementation is likely to be highly supportive in limiting and resolving the inflammatory process in asthma. Electronic supplementary material The online version of this article (10.1186/s12944-018-0947-6) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- D Fussbroich
- Department of Food Technology, University of Applied Science Fulda, Leipziger Str. 123, 36039, Fulda, Germany. .,Division for Allergy, Pneumology and Cystic Fibrosis, Department for Children and Adolescence, Goethe University, Theodor-Stern-Kai 7, Frankfurt/Main, Germany. .,Faculty of Biological Sciences, Goethe University, Max-von-Laue-Straße 13, Frankfurt/Main, Germany.
| | - K Zimmermann
- Department of Food Technology, University of Applied Science Fulda, Leipziger Str. 123, 36039, Fulda, Germany
| | - A Göpel
- Department of Food Technology, University of Applied Science Fulda, Leipziger Str. 123, 36039, Fulda, Germany
| | - O Eickmeier
- Division for Allergy, Pneumology and Cystic Fibrosis, Department for Children and Adolescence, Goethe University, Theodor-Stern-Kai 7, Frankfurt/Main, Germany
| | - J Trischler
- Division for Allergy, Pneumology and Cystic Fibrosis, Department for Children and Adolescence, Goethe University, Theodor-Stern-Kai 7, Frankfurt/Main, Germany
| | - S Zielen
- Division for Allergy, Pneumology and Cystic Fibrosis, Department for Children and Adolescence, Goethe University, Theodor-Stern-Kai 7, Frankfurt/Main, Germany
| | - R Schubert
- Division for Allergy, Pneumology and Cystic Fibrosis, Department for Children and Adolescence, Goethe University, Theodor-Stern-Kai 7, Frankfurt/Main, Germany
| | - C Beermann
- Department of Food Technology, University of Applied Science Fulda, Leipziger Str. 123, 36039, Fulda, Germany
| |
Collapse
|
15
|
Zielen S, Devillier P, Wahn U. Impact d’un traitement d’immunothérapie sublinguale aux pollens de bouleau sur l’évolution à long terme de l’asthme : une sous-analyse à long terme des prescriptions en vie réelle en Allemagne. Rev Mal Respir 2019. [DOI: 10.1016/j.rmr.2018.10.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
16
|
Ballard R, Lee D, Zielen S, Bullimore A, Skinner M. CONJUNCTIVAL PROVOCATION TESTING IN A DOSE FINDING STUDY WITH SUBCUTANEOUS IMMUNOTHERAPY WITH GRASS + MPL. Ann Allergy Asthma Immunol 2018. [DOI: 10.1016/j.anai.2018.09.090] [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: 11/16/2022]
|
17
|
Worm M, Higenbottam T, Pfaar O, Mösges R, Aberer W, Gunawardena K, Wessiepe D, Lee D, Kramer MF, Skinner M, Lees B, Zielen S. Randomized controlled trials define shape of dose response for Pollinex Quattro Birch allergoid immunotherapy. Allergy 2018; 73:1812-1822. [PMID: 29779247 PMCID: PMC6175210 DOI: 10.1111/all.13478] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND The Birch Allergoid, Tyrosine Adsorbate, Monophosphoryl Lipid A (POLLINEX® Quattro Plus 1.0 ml Birch 100%) is an effective, well-tolerated short course subcutaneous immunotherapy. We performed 2 phase II studies to determine its optimal cumulative dose. METHODS The studies were conducted in Germany, Austria and Poland (EudraCT numbers: 2012-004336-28 PQBirch203 and 2015-000984-15 PQBirch204) using a wide range of cumulative doses. In both studies, subjects were administered 6 therapy injections weekly outside the pollen season. Conjunctival Provocation Tests were performed at screening, baseline and 3-4 weeks after completing treatment, to quantify the reduction in Total Symptom Scores (as the primary endpoint) with each cumulative dose. Multiple Comparison Procedure and Modeling analysis was used to test for the dose response, shape of the curve and estimation of the median effective dose (ED50 ), a measure of potency. RESULTS Statistically significant dose responses (P < .01 & .001) were seen, respectively. The highest cumulative dose in PQBirch204 (27 300 standardized units [SU]) approached a plateau. Potency of the PQBirch was demonstrated by an ED50 2723 SU, just over half the current dose. Prevalence of treatment-emergent adverse events was similar for active doses, most being short-lived and mild. Compliance was over 85% in all groups. CONCLUSION Increasing the cumulative dose of PQBirch 5.5-fold from 5100 to 27 300 SU achieved an absolute point difference from placebo of 1.91, a relative difference 32.3% and an increase in efficacy of 50%, without compromising safety. The cumulative dose response was confirmed to be curvilinear in shape.
Collapse
Affiliation(s)
- M. Worm
- Department Campus Charité Mitte; Universitätsmedizin Berlin; Berlin Germany
| | | | - O. Pfaar
- Department of Otorhinolaryngology Head and Neck Surgery; University of Medicine, Mannheim, Germany; Medical Faculty Mannheim; Heidelberg University; Mannheim Germany
- Centre for Rhinology and Allergology; Wiesbaden Germany
| | - R. Mösges
- Hospital of the University of Cologne; Cologne Germany
| | - W. Aberer
- University Hospital Clinic; Graz Austria
| | | | - D. Wessiepe
- Metronomia Clinical Research GmbH; Muenchen Germany
| | - D. Lee
- Bencard Allergie; München Germany
| | | | | | - B. Lees
- Allergy Therapeutics; Worthing UK
| | - S. Zielen
- Clinic for Child and Adolescent Medicine, Allergology, Pneumonology and Cystic Fibrosis; Goethe University Frankfurt am Main; Frankfurt Germany
| |
Collapse
|
18
|
Zielen S, Devillier P, Heinrich J, Richter H, Wahn U. Sublingual immunotherapy provides long-term relief in allergic rhinitis and reduces the risk of asthma: A retrospective, real-world database analysis. Allergy 2018; 73:165-177. [PMID: 28561266 PMCID: PMC5763412 DOI: 10.1111/all.13213] [Citation(s) in RCA: 105] [Impact Index Per Article: 17.5] [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] [Accepted: 05/27/2017] [Indexed: 01/27/2023]
Abstract
BACKGROUND Allergy immunotherapy (AIT) is the only treatment for allergic rhinitis (AR) and/or allergic asthma (AA) with long-term efficacy. However, there are few real-life data on the progression of AR and/or AA in patients receiving AIT. OBJECTIVES To assess the real-world, long-term efficacy of grass pollen sublingual immunotherapy (SLIT) tablets in AR and their impact on asthma onset and progression. METHODS In a retrospective analysis of a German longitudinal prescription database, AR patients treated with grass pollen SLIT tablets were compared with a control group not having received AIT. Multiple regression analysis was used to compare changes over time in rescue symptomatic AR medication use after treatment cessation, asthma medication use, and the time to asthma onset in the two groups. RESULTS After applying all selection criteria, 2851 SLIT and 71 275 control patients were selected for the study. After treatment cessation, AR medication use was 18.8 percentage points lower (after adjustment for covariates, and relative to the pretreatment period) in SLIT tablet group than in the non-AIT group (P<.001). Asthma onset was less frequent in SLIT tablet group than in non-AIT group (odds ratio: 0.696, P=.002), and time to asthma was significantly longer (hazard ratio: 0.523; P=.003). After SLIT cessation, asthma medication use fell by an additional 16.7 percentage points (relative to the pretreatment period) in the SLIT tablet group vs the non-AIT group (P=.004). CONCLUSIONS Real-world treatment of AR patients with grass pollen SLIT tablets was associated with slower AR progression, less frequent asthma onset, and slower asthma progression.
Collapse
Affiliation(s)
- S. Zielen
- Division of Allergology, Pulmonology and Cystic Fibrosis Department for Children and Adolescents Goethe University Hospital Frankfurt Germany
| | - P. Devillier
- UPRES EA 220 Hospital Foch University Versailles Saint Quentin Suresnes France
| | - J. Heinrich
- Helmholtz Zentrum Munich German Research Centre for Environmental Health GmbH Institute of Epidemiology Neuherberg Germany
| | - H. Richter
- QuintilesIMS GmbH & Co. oHG Frankfurt am Main Germany
| | - U. Wahn
- Department for Paediatric Pneumology and Immunology Charité Medical University Berlin Germany
| |
Collapse
|
19
|
Trischler J, Lieb A, Arnold M, Schulze J, Rosewich M, Schubert R, Bottoli I, Zielen S. Omalizumab effectively protects against early and late allergic responses in asthma after 4 weeks. Allergy 2017; 72:1912-1915. [PMID: 28581121 DOI: 10.1111/all.13217] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Omalizumab is licensed for therapy in severe allergic asthma with an effect demonstrated after 8 weeks or longer treatment. As new applications for omalizumab demand precise knowledge of the onset of effects, the objective of this study was to determine the time course of the early (EAR) and late allergic reaction (LAR). MATERIALS AND METHODS Ten patients (IgE>300 IU/mL and <700 IU/mL) with a significant response to allergen challenge were treated with omalizumab according to the approved dosing table. Bronchial allergen provocations (BAP) were repeated at weeks 1, 2, 4, and 8. RESULTS EAR was significantly reduced after 4 weeks (ΔFEV1 28% vs 11%; P<.001), eNO (86 vs 53 ppb; P<.05) and basophil activation after 2 weeks (CD63 expression 79% vs 32%, P<.05) and LAR already after 1 week (ΔFEV1 26% vs 13%, P<.05). CONCLUSION These results demonstrate the onset of protective effects earlier than previously determined, potentially improving seasonal utilization and combination with immunotherapy.
Collapse
Affiliation(s)
- J. Trischler
- Children's Hospital; Division of Allergology, Pulmonology and Cystic fibrosis; University Hospital Frankfurt; Frankfurt am Main Germany
| | - A. Lieb
- Children's Hospital; Division of Allergology, Pulmonology and Cystic fibrosis; University Hospital Frankfurt; Frankfurt am Main Germany
| | - M. Arnold
- Children's Hospital; Division of Allergology, Pulmonology and Cystic fibrosis; University Hospital Frankfurt; Frankfurt am Main Germany
| | - J. Schulze
- Children's Hospital; Division of Allergology, Pulmonology and Cystic fibrosis; University Hospital Frankfurt; Frankfurt am Main Germany
| | - M. Rosewich
- Children's Hospital; Division of Allergology, Pulmonology and Cystic fibrosis; University Hospital Frankfurt; Frankfurt am Main Germany
| | - R. Schubert
- Children's Hospital; Division of Allergology, Pulmonology and Cystic fibrosis; University Hospital Frankfurt; Frankfurt am Main Germany
| | | | - S. Zielen
- Children's Hospital; Division of Allergology, Pulmonology and Cystic fibrosis; University Hospital Frankfurt; Frankfurt am Main Germany
| |
Collapse
|
20
|
Ratnaparkhe M, Hlevnjak M, Kolb T, Jauch A, Maass KK, Devens F, Rode A, Hovestadt V, Korshunov A, Pastorczak A, Mlynarski W, Sungalee S, Korbel J, Hoell J, Fischer U, Milde T, Kramm C, Nathrath M, Chrzanowska K, Tausch E, Takagi M, Taga T, Constantini S, Loeffen J, Meijerink J, Zielen S, Gohring G, Schlegelberger B, Maass E, Siebert R, Kunz J, Kulozik AE, Worst B, Jones DT, Pfister SM, Zapatka M, Lichter P, Ernst A. Genomic profiling of Acute lymphoblastic leukemia in ataxia telangiectasia patients reveals tight link between ATM mutations and chromothripsis. Leukemia 2017; 31:2048-2056. [PMID: 28196983 DOI: 10.1038/leu.2017.55] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Revised: 01/17/2017] [Accepted: 02/02/2017] [Indexed: 12/28/2022]
Abstract
Recent developments in sequencing technologies led to the discovery of a novel form of genomic instability, termed chromothripsis. This catastrophic genomic event, involved in tumorigenesis, is characterized by tens to hundreds of simultaneously acquired locally clustered rearrangements on one chromosome. We hypothesized that leukemias developing in individuals with Ataxia Telangiectasia, who are born with two mutated copies of the ATM gene, an essential guardian of genome stability, would show a higher prevalence of chromothripsis due to the associated defect in DNA double-strand break repair. Using whole-genome sequencing, fluorescence in situ hybridization and RNA sequencing, we characterized the genomic landscape of Acute Lymphoblastic Leukemia (ALL) arising in patients with Ataxia Telangiectasia. We detected a high frequency of chromothriptic events in these tumors, specifically on acrocentric chromosomes, as compared with tumors from individuals with other types of DNA repair syndromes (27 cases total, 10 with Ataxia Telangiectasia). Our data suggest that the genomic landscape of Ataxia Telangiectasia ALL is clearly distinct from that of sporadic ALL. Mechanistically, short telomeres and compromised DNA damage response in cells of Ataxia Telangiectasia patients may be linked with frequent chromothripsis. Furthermore, we show that ATM loss is associated with increased chromothripsis prevalence in additional tumor entities.
Collapse
Affiliation(s)
- M Ratnaparkhe
- Division of Molecular Genetics, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - M Hlevnjak
- Division of Molecular Genetics, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - T Kolb
- Division of Molecular Genetics, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - A Jauch
- Institute of Human Genetics, University Heidelberg, Heidelberg, Germany
| | - K K Maass
- Division of Molecular Genetics, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - F Devens
- Division of Molecular Genetics, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - A Rode
- Division of Molecular Genetics, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - V Hovestadt
- Division of Molecular Genetics, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - A Korshunov
- Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), and Department of Neuropathology University Hospital, Heidelberg, Germany
| | - A Pastorczak
- Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, Lodz, Poland
| | - W Mlynarski
- Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, Lodz, Poland
| | - S Sungalee
- EMBL Heidelberg, Genome Biology, Heidelberg, Germany
| | - J Korbel
- EMBL Heidelberg, Genome Biology, Heidelberg, Germany
| | - J Hoell
- Department of Pediatric Oncology, Hematology and Clinical Immunology, Heinrich-Heine-University, Medical Faculty, Düsseldorf, Germany
| | - U Fischer
- Department of Pediatric Oncology, Hematology and Clinical Immunology, Heinrich-Heine-University, Medical Faculty, Düsseldorf, Germany
| | - T Milde
- Clinical Cooperation Unit Pediatric Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Pediatric Oncology, Hematology and Immunology, University of Heidelberg, Germany
| | - C Kramm
- Department of Pediatric Oncology, University of Halle, Halle, Germany.,Division of Pediatric Hematology and Oncology, Goettingen, Germany
| | - M Nathrath
- Clinical Cooperation Group Osteosarcoma, Pediatric Oncology Center, Department of Pediatrics, Technical University Munich, Munich, Germany.,Department of Pediatric Oncology, Klinikum Kassel, Kassel, Germany
| | - K Chrzanowska
- Department of Medical Genetics, The Children's Memorial Health Institute, Warsaw, Poland
| | - E Tausch
- Department of Internal Medicine III, University of Ulm, Germany
| | - M Takagi
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University, Tokyo, Japan
| | - T Taga
- Department of Pediatrics, Shiga University of Medical Science, Otsu, Japan
| | - S Constantini
- Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel-Aviv Medical Center, Tel-Aviv University, Tel Aviv, Israel
| | - J Loeffen
- Erasmus Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - J Meijerink
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - S Zielen
- Department of Paediatric Pulmonology, Allergy and Cystic Fibrosis, Children's Hospital, Goethe-University, Frankfurt, Germany
| | - G Gohring
- Institute of Human Genetics, Hannover Medical School, Hannover, Germany
| | - B Schlegelberger
- Institute of Human Genetics, Hannover Medical School, Hannover, Germany
| | - E Maass
- Olgahospital Stuttgart, Children's Hospital, Klinikum Stuttgart, Stuttgart, Germany
| | - R Siebert
- Institute of Human Genetics, University Hospital Schleswig-Holstein Campus Kiel/Christian-Albrechts University Kiel, Germany
| | - J Kunz
- Department of Pediatric Oncology, Hematology and Immunology, University of Heidelberg, Germany
| | - A E Kulozik
- Department of Pediatric Oncology, Hematology and Immunology, University of Heidelberg, Germany
| | - B Worst
- Department of Pediatric Oncology, Hematology and Immunology, University of Heidelberg, Germany.,Division of Pediatric Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - D T Jones
- Department of Pediatric Oncology, Hematology and Immunology, University of Heidelberg, Germany.,Division of Pediatric Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - S M Pfister
- Department of Pediatric Oncology, Hematology and Immunology, University of Heidelberg, Germany.,Division of Pediatric Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - M Zapatka
- Division of Molecular Genetics, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - P Lichter
- Division of Molecular Genetics, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - A Ernst
- Division of Molecular Genetics, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| |
Collapse
|
21
|
Pietzner J, Merscher BM, Baer PC, Duecker RP, Eickmeier O, Fußbroich D, Bader P, Del Turco D, Henschler R, Zielen S, Schubert R. Low-dose irradiation prior to bone marrow transplantation results in ATM activation and increased lethality in Atm-deficient mice. Bone Marrow Transplant 2016; 51:619. [PMID: 27050750 DOI: 10.1038/bmt.2016.22] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
22
|
Koc Günel S, Grünewaldt A, Rosewich M, Schubert R, Zielen S. Zellverteilung im induzierten Sputum bei Gesunden und Patienten mit allergischem Asthma bronchiale nach unterschiedlicher Sputuminduktion. Pneumologie 2016. [DOI: 10.1055/s-0036-1572297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
23
|
Pommerening H, van Dullemen S, Kieslich M, Schubert R, Zielen S, Voss S. Body composition, muscle strength and hormonal status in patients with ataxia telangiectasia: a cohort study. Orphanet J Rare Dis 2015; 10:155. [PMID: 26645295 PMCID: PMC4673730 DOI: 10.1186/s13023-015-0373-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [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: 09/14/2015] [Accepted: 12/02/2015] [Indexed: 12/29/2022] Open
Abstract
Background Ataxia-telangiectasia (A-T) is a devastating human autosomal recessive disorder that causes progressive cerebellar ataxia, immunodeficiency, premature aging, chromosomal instability and increased cancer risk. Affected patients show growth failure, poor weight gain, low body mass index (BMI), myopenia and increased fatigue during adolescence. The prevalence of alterations in body composition, muscle strength and hormonal status has not been well described in classical A-T patients. Additionally, no current guidelines are available for the assessment and management of these changes. Methods We analyzed body composition, manual muscle strength and hormonal status in 25 A-T patients and 26 age-matched, healthy controls. Bioelectrical impedance analysis (BIA) was performed to evaluate the body composition, fat-free mass (FFM), body cell mass (BCM), extracellular matrix (ECM), phase angle (PhA), fat mass (FM) and ECM to BCM ratio. Manual muscle strength was measured using a hydraulic hand dynamometer. Results The BMI, FFM and PhA were significantly lower in A-T patients than in controls (BMI 16.56 ± 3.52 kg/m2 vs. 19.86 ± 3.54 kg/m2; Z-Score: -1.24 ± 1.29 vs. 0.05 ± 0.92, p <0.001; FFM 25.4 ± 10.03 kg vs. 41.77 ± 18.25 kg, p < 0.001; PhA: 4.6 ± 0.58° vs. 6.15 ± 0.88°, p < 0.001). Manual muscle strength was significantly impaired in A-T patients compared with controls (10.65 ± 10.97 kg vs. 26.8 ± 30.39 kg, p < 0.0001). In addition, cortisol and dehydroepiandrosterone sulfate (DHEAS) levels were significantly lower in A-T patients than in controls. Conclusion Altered body composition, characterized by depleted BMI, PhA and BCM; by the need to sit in a wheelchair; by altered hormone levels; and by poor muscle strength, is a major factor underlying disease progression and increased fatigue in A-T patients. Trial registration ClinicalTrials.gov NCT02345200
Collapse
Affiliation(s)
- H Pommerening
- Children's Hospital, Allergology, Pneumology and Cystic Fibrosis, Goethe-University Theodor-Stern Kai, Frankfurt/Main, Germany.
| | - S van Dullemen
- Children's Hospital, Allergology, Pneumology and Cystic Fibrosis, Goethe-University Theodor-Stern Kai, Frankfurt/Main, Germany.
| | - M Kieslich
- Children's Hospital, Allergology, Pneumology and Cystic Fibrosis, Goethe-University Theodor-Stern Kai, Frankfurt/Main, Germany.
| | - R Schubert
- Children's Hospital, Allergology, Pneumology and Cystic Fibrosis, Goethe-University Theodor-Stern Kai, Frankfurt/Main, Germany.
| | - S Zielen
- Children's Hospital, Allergology, Pneumology and Cystic Fibrosis, Goethe-University Theodor-Stern Kai, Frankfurt/Main, Germany.
| | - S Voss
- Children's Hospital, Allergology, Pneumology and Cystic Fibrosis, Goethe-University Theodor-Stern Kai, Frankfurt/Main, Germany.
| |
Collapse
|
24
|
Buslau A, Voss S, Herrmann E, Schubert R, Zielen S, Schulze J. Can we predict allergen-induced asthma in patients with allergic rhinitis? Clin Exp Allergy 2015; 44:1494-502. [PMID: 25270425 DOI: 10.1111/cea.12427] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 09/16/2014] [Accepted: 09/22/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND A high percentage of patients with allergic rhinitis (AR) exhibit signs of bronchial hyperreactivity (BHR), and approximately 30% may develop asthma later in life. OBJECTIVE The aim of this study was to identify predictors for allergen-induced asthma in patients with AR. METHODS Hundred patients with AR selected by public posting and 20 healthy controls were enrolled. Twenty-three patients with concomitant physician-diagnosed asthma and four with a negative allergy test were excluded from further analysis. The remaining 73 subjects with AR underwent bronchial allergen provocation (BAP), which is considered the gold standard for the diagnosis of clinically relevant allergen-specific asthma. The following parameters were measured to explore predictors for an early and late asthmatic response (EAR and LAR): standardised questionnaire, skin prick test (SPT), total IgE, specific IgE to grass pollen, FEV1, PD20FEV1 methacholine, exhaled nitric oxide (eNO) and eosinophils. RESULTS Early asthmatic reaction was equally distributed between patients with and without signs of possible asthma by questionnaire (56.8% vs. 48.3%). The following cut-off values showed the best combination of sensitivity and specificity for an EAR: specific IgE grass pollen 18.5 kU/L (AUC 0.83), SPT 8.5 mm (AUC 0.76), total IgE 95.5 kU/L (AUC 0.73), FEV1 102.4% (AUC 0.69), PD20FEV1 methacholine 1.67 mg (AUC 0.74), eNO 18.05 ppB (AUC 0.64) and eosinophils 115/mm(3) (AUC 0.58). CONCLUSIONS AND CLINICAL RELEVANCE There is a considerable discordance between reported asthma signs and diagnosed disease by BAP. Simple measurement of allergen-specific IgE for grass pollen was the best predictor of allergen-induced asthma in patients with AR.
Collapse
Affiliation(s)
- A Buslau
- Department of Pediatric Pulmonology, Allergy and Cystic fibrosis, Children's Hospital, Goethe-University, Frankfurt, Germany
| | | | | | | | | | | |
Collapse
|
25
|
Ludwig M, Eickmeier O, Smaczny C, Schreiner F, Dubois W, NGampolo D, Schubert R, Zielen S, Ganschow R, Schmitt-Grohé S. Connexin 37 and Connexin 43 genotypes in correlation to cytokines in induced sputum and blood in cystic fibrosis (CF). Mol Cell Pediatr 2014. [PMCID: PMC4715121 DOI: 10.1186/2194-7791-1-s1-a11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
26
|
Kent L, Reix P, Innes JA, Zielen S, Le Bourgeois M, Braggion C, Lever S, Arets HGM, Brownlee K, Bradley JM, Bayfield K, O'Neill K, Savi D, Bilton D, Lindblad A, Davies JC, Sermet I, De Boeck K. Lung clearance index: evidence for use in clinical trials in cystic fibrosis. J Cyst Fibros 2013; 13:123-38. [PMID: 24315208 DOI: 10.1016/j.jcf.2013.09.005] [Citation(s) in RCA: 148] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 09/10/2013] [Accepted: 09/23/2013] [Indexed: 02/09/2023]
Abstract
The ECFS-CTN Standardisation Committee has undertaken this review of lung clearance index as part of the group's work on evaluation of clinical endpoints with regard to their use in multicentre clinical trials in CF. The aims were 1) to review the literature on reliability, validity and responsiveness of LCI in patients with CF, 2) to gain consensus of the group on feasibility of LCI and 3) to gain consensus on answers to key questions regarding the promotion of LCI to surrogate endpoint status. It was concluded that LCI has an attractive feasibility and clinimetric properties profile and is particularly indicated for multicentre trials in young children with CF and patients with early or mild CF lung disease. This is the first article to collate the literature in this manner and support the use of LCI in clinical trials in CF.
Collapse
Affiliation(s)
- L Kent
- Centre for Health and Rehabilitation Technologies (CHaRT), Institute for Nursing and Health Research, University of Ulster, Newtownabbey, UK; Regional Cystic Fibrosis Centre, Belfast Health and Social Care Trust, Belfast, UK
| | - P Reix
- Centre de Référence de la Mucoviscidose, Hospices Civils de Lyon, Lyon, France
| | - J A Innes
- Scottish Adult Cystic Fibrosis Service, Western General Hospital, Edinburgh, UK; Molecular and Clinical Medicine, University of Edinburgh, UK
| | - S Zielen
- Department of Paediatrics, J.W. Goethe-Universität Frankfurt, Germany
| | - M Le Bourgeois
- Centre de Référence de la Mucoviscidose, Hôpital Necker-Enfants Malades, Paris, France
| | - C Braggion
- Cystic Fibrosis Center, Pediatric Department, Meyer Children's Hospital, Florence, Italy
| | - S Lever
- Erasmus MC, Rotterdam, The Netherlands
| | - H G M Arets
- Department of Pediatric Pulmonology, Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands
| | - K Brownlee
- Children's Cystic Fibrosis Centre, Leeds Teaching Hospitals, Leeds, UK
| | - J M Bradley
- Centre for Health and Rehabilitation Technologies (CHaRT), Institute for Nursing and Health Research, University of Ulster, Newtownabbey, UK; Regional Cystic Fibrosis Centre, Belfast Health and Social Care Trust, Belfast, UK
| | - K Bayfield
- Department of Gene Therapy, Imperial College London, UK
| | - K O'Neill
- Centre for Infection and Immunity, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, UK
| | - D Savi
- Department of Pediatrics and Pediatric Neurology, Cystic Fibrosis Center, Sapienza University of Rome, Italy
| | - D Bilton
- Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - A Lindblad
- Gothenburg CF Centre, Queen Silvia Children's Hospital, Göteborg, Sweden
| | - J C Davies
- Department of Gene Therapy, Imperial College London, UK; Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - I Sermet
- Centre de Référence de la Mucoviscidose, Hôpital Necker-Enfants Malades, Paris, France; Université Paris Descartes, Paris, France
| | - K De Boeck
- Pediatric Pulmonology, University Hospitals Leuven and KU Leuven, Leuven, Belgium.
| | | |
Collapse
|
27
|
Rose MA, Buess J, Ventur Y, Zielen S, Herrmann E, Schulze J, Schubert R. Reference ranges and cutoff levels of pneumococcal antibody global serum assays (IgG and IgG2) and specific antibodies in healthy children and adults. Med Microbiol Immunol 2013; 202:285-94. [PMID: 23529214 DOI: 10.1007/s00430-013-0292-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 03/08/2013] [Indexed: 10/27/2022]
Abstract
Pneumococcal antibodies represent the acquisition of natural immunity. Determination of pneumococcal antibodies is an important screening tool for immunodeficiencies. Our study generated reference ranges and cutoff levels for pneumococcal antibody global serum assays correlated to a specific pneumococcal antibody ELISA. Specific pneumococcal antibody levels were measured from 457 children undergoing elective surgery and 46 healthy adult volunteers (88 with previous pneumococcal immunization from both groups), 22 severe immunodeficient subjects with ataxia telangiectasia (A-T, negative controls), and age-matched 36 healthy allergic asthmatics. We determined a representative panel of serotype-specific pneumococcal antibodies (serotype 4, 5, 6B, 7F, 14, 18C, 19F, 23F) by ELISA and global pneumococcal IgG and IgG2 antibodies by EIA. In vaccine-naïve healthy subjects, initial pneumococcal IgG geometric mean concentrations of 13.1 μg/ml were low in the first year of life and increased over the time, reaching adult levels (70.5 μg/ml) at age 8-12 years. In parallel, IgG2 antibodies increased from 20.7 % (0.5-1 year old) to adult proportions (>30 %) in preschoolers. Correlation between the pneumococcal IgG screening assay and specific pneumococcal antibody levels was acceptable (Pearson's coefficient r = 0.4455; p = 0.001). Cutoff levels showed high sensitivity, whereas specificity was high to moderate calculated from correlations with the specific ELISA. We provide reference ranges and cutoff levels for the interpretation of specific antibody determinations in the clinical setting. The global pneumococcal IgG/IgG2 assay is a suitable screening tool and correlates with the ELISA serotype-specific pneumococcal antibodies. However, results below our cutoff values should be re-evaluated by serotype-specific ELISA testing.
Collapse
Affiliation(s)
- M A Rose
- Department of Pulmonology, Children`S Hospital, Allergy, and Cystic Fibrosis, Goethe-University, Theodor Stern Kai 7, 60590 Frankfurt, Germany.
| | | | | | | | | | | | | |
Collapse
|
28
|
Zielen S, Thron A, Hammer E, Linde R, Zissler U, Rosewich M, Schubert R. Bronchiale Inflammation bei Patienten mit schweren humoralen Immundefekten. Pneumologie 2013. [DOI: 10.1055/s-0033-1334764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
29
|
Rosewich M, Kheiri T, Eickmeier O, Zissler U, Schubert R, Zielen S. Bronchiolitis obliterans bei Kindern und Jugendlichen. Pneumologie 2013. [DOI: 10.1055/s-0033-1334766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
30
|
Pietzner J, Baer PC, Duecker RP, Merscher MB, Satzger-Prodinger C, Bechmann I, Wietelmann A, Del Turco D, Doering C, Kuci S, Bader P, Schirmer S, Zielen S, Schubert R. Bone marrow transplantation improves the outcome of Atm-deficient mice through the migration of ATM-competent cells. Hum Mol Genet 2012; 22:493-507. [DOI: 10.1093/hmg/dds448] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
|
31
|
Schulze J, Weber S, Oddo S, Rosewich M, Rose MA, Zielen S. [Quality of life for adolescents with vocal cord dysfunction]. Pneumologie 2012; 66:596-601. [PMID: 22872594 DOI: 10.1055/s-0032-1310105] [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: 10/28/2022]
Abstract
BACKGROUND Vocal cord dysfunction (VCD) is a functional breathing disorder. A psychosomatic aetiology has been discussed and associations with depression, anxiety disorders, and social stress have been reported. We have undertaken a screening of behavioural and emotional problems in adolescent patients using standardised questionnaires. METHODS Thirty-one patients (8 - 16 years) with the clinical suspicion of VCD were investigated using the Youth-Self-Report (YSR/11 - 18) and for the assessment of the parents we used the analoguous Child-Behaviour-Checklist (CBCL/6 - 18). YSR and CBCL contain two sub-areas: (a) competence scales that measure the child's participation in activities, social skills and school achievements and (b) items that contain subscales for emotional problems such as depressive and anxiety symptoms, conduct problems such as oppositional defiant problems and aggressive behaviour, social problems and physical complaints. RESULTS On average, the features of VCD patients were not significantly different from those of the reference population. But we did observe tendencies of psychological problems (YSR 16.7 %, CBCL 20 %) compared with the standard (2 %) in the syndrome scales of both questionnaires Adolescents reported particularly more internalising disorders such as social retreat, physical complaint and anxiety and depressive symptoms. The parents reported more often "physical complaints" (13.3 %) and "aggressive behaviour" (10 %). CONCLUSIONS We found tendencies of psychological strain, mainly social retreat, physical complaints and anxiety and depressive symptoms. Further investigations should focus on those emotional problems as well as on psychosomatically caused physical problems. Personality and psychological stress of the parents should be included in the investigation in order to evaluate the reports of the parents on higher aggressive behaviour and enhanced physical problems of their children in relation to their own psychological strain. We suggest family therapies, family counselling, or parental coaching as a therapeutic approach.
Collapse
Affiliation(s)
- J Schulze
- Pädiatrische Pneumologie, Allergologie und Mukoviszidose, Zentrum für Kinder- und Jugendmedizin, Klinikum der J. W. Goethe-Universität, Frankfurt am Main.
| | | | | | | | | | | |
Collapse
|
32
|
Rose MA, Schubert R, Schulze J, Zielen S. Follow-up of probiotic Lactobacillus GG effects on allergic sensitization and asthma in infants at risk. Clin Exp Allergy 2012; 41:1819-21. [PMID: 22107145 DOI: 10.1111/j.1365-2222.2011.03876.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
33
|
Rosewich M, Eickmeier O, Zissler U, Serve F, Leutz P, Schubert R, Zielen S. 162 Airway inflammation in mild cystic fibrosis patients with small airway disease. J Cyst Fibros 2012. [DOI: 10.1016/s1569-1993(12)60332-4] [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: 11/24/2022]
|
34
|
Serve F, Eickmeier O, Rosewich M, Leutz P, Zissler U, Zielen S, Kirkamm R. 245 Fatty acids and bronchial inflammation in mild cystic fibrosis. J Cyst Fibros 2012. [DOI: 10.1016/s1569-1993(12)60414-7] [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: 11/17/2022]
|
35
|
Eickmeier O, Zissler U, Unger F, Rosewich M, Schubert R, Zielen S. 229* Clinical relevance of Aspergillus in cystic fibrosis patients sensitized to Aspergillus. J Cyst Fibros 2011. [DOI: 10.1016/s1569-1993(11)60245-2] [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: 11/15/2022]
|
36
|
Wollin P, Christmann M, Kroker A, Zielen S. [Lung function testing in children before and after an age-adapted SCUBA dive in a swimming pool]. Pneumologie 2011; 65:308-13. [PMID: 21294078 DOI: 10.1055/s-0030-1256152] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The number of children that SCUBA dive is increasing. Airway narrowing while SCUBA diving can cause dangerous complications like pulmonary barotrauma and arterial gas embolism. Statistics show that children are at an increased risk. Since data are scarce, the goal of this study was to gain new knowledge about acute lung function changes in children while SCUBA diving. MATERIAL AND METHODS 41 children aged 8 - 14 years underwent lung function testing (spirometry and residual volume measurement) before and after a single age-adapted SCUBA dive in a swimming pool. RESULTS A significant reduction of the dynamic expiratory lung function parameters FEV (1) (p < 0.01), FEV (1)/VC (p < 0.05), MEF 75 % (p < 0.05), MEF 50 % (p < 0.01) und MEF 25 % (p < 0.05) was measured. No statistically significant change of the residual volume was found. A decrease of FEV (1) > 10 % (12 % - 21 %) was found in 5 children (12.2 %). CONCLUSION The majority of the children (87.8 %) did not show any relevant lung function changes. Five children had a considerable reduction of FEV (1). Signs indicate the importance of bronchial hyperreactivity (BHR) as a key factor. Children with asthma or BHR should not SCUBA dive. A detailed medical examination is recommended (including an unspecific bronchial provocation test) before starting to dive.
Collapse
Affiliation(s)
- P Wollin
- Allergologie, Pneumologie und Mukoviszidose, Zentrum für Kinder- und Jugendmedizin, J. W. Goethe-Universität Frankfurt am Main
| | | | | | | |
Collapse
|
37
|
Abstract
Uncontrolled inflammation of the lung contributes to the major medical and economic burden on healthcare, and the need for therapeutics to dampen pathological inflammation is largely unmet. Recently, a new genus of anti-inflammatory/ pro-resolving lipid mediators has been identified: Lipoxins, resolvins, protectins and maresins. These compounds are enzymatically derived from the polyunsaturated fatty acids (PUFAs) arachidonic acid (AA), docosahexaenoic acid (DHA), and eicosapentaenoic acid (EPA) that have long been known to have beneficial health properties. These mediators have potent anti-inflammatory effects IN VITRO and IN VIVO in murine models of lung inflammation. Therefore, this group of compounds carries considerable therapeutic potential for the treatment of many inflammatory lung diseases including asthma, cystic fibrosis and acute lung injury.
Collapse
Affiliation(s)
- O Eickmeier
- Zentrum für Kinder- und Jugendmedizin, Allergologie, Pneumologie und Mukoviszidose, Klinikum der Johann Wolfgang Goethe- Universität Frankfurt a.M.
| | | | | | | |
Collapse
|
38
|
Christmann M, Erffa SV, Rosewich M, Rose MA, Schulze J, Zielen S. [The repeatability of forced expiratory manoeuvres in 4- to 6-year-old children with intermittent bronchial asthma in healthy and in exacerbated status]. Pneumologie 2010; 64:745-51. [PMID: 20734282 DOI: 10.1055/s-0030-1255625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The question about the repeatability of forced expiratory manoeuvres in childhood lung function testing is of scientific and clinical interest. The following study investigated to what extent children ≥ 4 to < 7 years of age with intermittent bronchial asthma are able to produce reproducible lung function measurements on the one hand in the healthy status and on the other hand in an exacerbated status. METHOD 64 children at the age of ≥ 4 to < 7 years with intermittent preschool bronchial asthma performed lung function measurements in the healthy status and again in an exacerbated status. FEV (1) values from the measurements were analysed according to ATS/ERS guidelines concerning repeatability. RESULTS According to the new ATS/ERS guidelines 74.6 % of the children could perform at least 2, and 59.3 % could perform 3 repeatable measurements in the healthy status. In the exacerbated status this was 87.5 % and 68.8 %, respectively. There were no significant differences between the healthy and the exacerbated status and between the age groups. Compared to former repeatability criteria, children of this age group can perform significantly more reproducible measurements (p < 0.0001). CONCLUSION The ATS/ERS guidelines from 2007 simplify the repeatability of forced expiratory manoeuvres in children at ≥ 4 to < 7 years of age compared to the former criteria. Repeatability is not reduced in the exacerbated status. 74.6 % of children in this age group can produce repeatable lung function measurements.
Collapse
Affiliation(s)
- M Christmann
- Allergologie, Pneumologie und Mukoviszidose, Zentrum für Kinder- und Jugendmedizin, Theodor-Stern-Kai 7, Frankfurt am Main.
| | | | | | | | | | | |
Collapse
|
39
|
Rose MA, Stieglitz F, Köksal A, Schubert R, Schulze J, Zielen S. Efficacy of probiotic Lactobacillus GG on allergic sensitization and asthma in infants at risk. Clin Exp Allergy 2010; 40:1398-405. [PMID: 20604800 DOI: 10.1111/j.1365-2222.2010.03560.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Probiotics are perceived to exert beneficial effects in the prevention and treatment of allergic diseases. OBJECTIVE There are conflicting data from studies as to an impact on allergic sensitization and asthma. METHODS Our prospective double-blind study randomly assigned 131 children (6-24 months old) with at least two wheezing episodes and a first-degree family history of atopic disease to 6 months of Lactobacillus rhamnosus (LGG, 10(10) colony forming units) or placebo. Atopic dermatitis and asthma-related events (e.g. need of inhalation, symptom-free days) were documented throughout the intervention and 6-month follow-up. We determined IgE, a representative panel of specific IgE, eosinophils, eosinophilic cationic protein, and TGF-beta before, at the end of intervention, and after 6 months of follow-up. RESULTS There were no significant differences as to atopic dermatitis or asthma-related events. In a subgroup with antecedent allergic sensitizations, asthmatic complaints were even slightly worse. We found fewer sensitizations towards aeroallergens after 6 months of LGG (P=0.027) and after 6 months of follow-up (P=0.03). Supplementation was well-tolerated and no severe adverse events occurred. CONCLUSIONS In young children with recurrent wheeze and an atopic family history, oral LGG had no clinical effect on atopic dermatitis or asthma-related events, and only mild effects on allergic sensitization. This effect persisted 6 months after the cessation of the supplementation.
Collapse
Affiliation(s)
- M A Rose
- Children's Hospital, Goethe University, Theodor Stern Kai 7, Frankfurt, Germany.
| | | | | | | | | | | |
Collapse
|
40
|
Rosewich M, Schulze J, Eickmeier O, Telles T, Rose MA, Schubert R, Zielen S. Tolerance induction after specific immunotherapy with pollen allergoids adjuvanted by monophosphoryl lipid A in children. Clin Exp Immunol 2010; 160:403-10. [PMID: 20345983 DOI: 10.1111/j.1365-2249.2010.04106.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Specific immunotherapy (SIT) is a well-established and clinically effective treatment for allergic diseases. A pollen allergoid formulated with the T helper type 1 (Th1)-inducing adjuvant monophosphoryl lipid A (MPL) facilitates short-term SIT. Little is known about mechanisms of tolerance induction in this setting. In a prospective study, 34 patients allergic to grass pollen (25 male, nine female, median age 10.2 years) received a total of 44 SIT courses (20 in the first, 24 in the second) with MPL-adjuvanted pollen allergoids. Immunogenicity was measured by levels of specific immunoglobulin G (IgG(grass)) and IgG4(grass) by antibody blocking properties on basophil activation, and by induction of CD4(+), CD25(+) and forkhead box P3 (FoxP3(+)) regulatory T cells (T(reg)). Specific IgG and IgG4 levels increased only slightly in the first year of SIT. In the second year these changes reached significance (P < 0.0001). In keeping with these findings, we were able to show an increase of T(reg) cells and a decreased release of leukotrienes after the second year of treatment. In the first year of treatment we found little evidence for immunological changes. A significant antibody induction was seen only after the second course of SIT. Short-course immunotherapy with pollen allergoids formulated with the Th1-inducing adjuvant MPL needs at least two courses to establish tolerance.
Collapse
Affiliation(s)
- M Rosewich
- Paediatric Pulmonology and Allergology, Goethe University, Frankfurt/Main, Germany.
| | | | | | | | | | | | | |
Collapse
|
41
|
Lieb A, Christmann M, Rosewich M, Schulze J, Schubert R, Jaffe J, Rose M, Zielen S. Einfluss von Omalizumab auf die allergische Frühreaktion und die allergische Spätreaktion bei allergischen Asthmatikern. Pneumologie 2010. [DOI: 10.1055/s-0030-1251136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
42
|
Christmann M, Erffa SV, Rosewich M, Lieb A, Rose M, Schulze J, Zielen S. Reproduzierbarkeit der FEV1 bei Kindern von 4 bis 6 Jahren im gesunden sowie im kranken Intervall. Pneumologie 2010. [DOI: 10.1055/s-0030-1251263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
43
|
Zielen S, Lieb A, Munzu C, Koehne-Voss S, Rivière GJ, Jaffe J. Omalizumab schützt vor allergeninduzierter Bronchokonstriktion bei Patienten mit allergischem (IgE-vermitteltem) Asthma und hohen IgE-Werten. Pneumologie 2010. [DOI: 10.1055/s-0030-1251139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
44
|
Voß S, Rose M, Stuetzer R, Swidenbank M, Zielen S, Schulze J. Sicherheit und Ergebnisse einer repetitiven bronchialen Allergenprovokation. Pneumologie 2010. [DOI: 10.1055/s-0030-1251135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
45
|
Zielen S, Peckitt C, Maykut R, Peachey G. Prädiktor für den Behandlungserfolg mit Omalizumab (XOLAIR®, OMA) bei Patienten mit schwerem allergischem (IgE-vermitteltem) Asthma. Pneumologie 2010. [DOI: 10.1055/s-0030-1251140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
46
|
Kopp MV, Hamelmann E, Zielen S, Kamin W, Bergmann KC, Sieder C, Stenglein S, Seyfried S, Wahn U. Combination of omalizumab and specific immunotherapy is superior to immunotherapy in patients with seasonal allergic rhinoconjunctivitis and co-morbid seasonal allergic asthma. Clin Exp Allergy 2009; 39:271-9. [DOI: 10.1111/j.1365-2222.2008.03121.x] [Citation(s) in RCA: 125] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
47
|
Schubert R, Kitz R, Beermann C, Rose MA, Lieb A, Sommerer PC, Moskovits J, Alberternst H, Böhles HJ, Schulze J, Zielen S. Effect of n-3 polyunsaturated fatty acids in asthma after low-dose allergen challenge. Int Arch Allergy Immunol 2008; 148:321-9. [PMID: 19001792 DOI: 10.1159/000170386] [Citation(s) in RCA: 57] [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] [Received: 03/25/2008] [Accepted: 06/04/2008] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND We investigated the anti-inflammatory potential of n-3 polyunsaturated fatty acids (PUFA) on specific bronchial inflammation. Allergic asthmatics were challenged using a low-dose allergen provocation model. METHODS Our parallel double-blinded study randomly assigned 23 house dust mite-allergic asthmatics (aged 22-29 years; 13 females, 10 males) to dietary supplementation with either an n-3 PUFA-enriched fat blend (0.69 g/day) or placebo for 5 weeks. After 3 weeks, the patients were challenged daily with low doses of mite allergen for 2 weeks. Primary outcome parameters were effects on lung function (forced expiratory volume in 1 s, FEV(1)) and exhaled nitric oxide (eNO) as a marker of bronchial inflammation. RESULTS Even before the bronchial challenge, eNO was significantly lower in the n-3 PUFA group (p=0.014). Levels of eNO increased during allergen exposure in both groups, but differences in means were significantly lower in the n-3 PUFA group (p=0.022). During the low-dose allergen challenge, there were no differences between the groups with regard to symptoms, FEV(1) or the allergen dose required to induce deterioration of lung function (PD(20)). Numbers of sputum eosinophils did not differ significantly, while serum eosinophils (10.1+/-0.1.84 vs. 5.79+/-0.69%) as well as changes in eosinophilic cationic protein (20.5+/-9.93 vs. -1.68+/-4.36 ng/ml) and in vitro cysteinyl leukotriene release (2,889+/-872 vs. 1,120+/-173 ng/ml) were significantly lower in the n-3 PUFA group (p<0.05 each). CONCLUSION Our results provide evidence that dietary supplementation with n-3 PUFA is able to reduce bronchial inflammation even after low-dose allergen challenge.
Collapse
Affiliation(s)
- R Schubert
- Department of Pediatrics/ZAFES, J.W. Goethe University, Frankfurt/Main, Germany
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Schubert R, Eickmeier O, Garn H, Baer PC, Mueller T, Schulze J, Rose MA, Rosewich M, Renz H, Zielen S. Safety and immunogenicity of a cluster specific immunotherapy in children with bronchial asthma and mite allergy. Int Arch Allergy Immunol 2008; 148:251-60. [PMID: 18849616 DOI: 10.1159/000161585] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2008] [Accepted: 06/10/2008] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Cluster specific immunotherapy (SIT) is a modern form of allergen immunotherapy allowing safe administration of high allergen doses in a short time interval compared to classic SIT. In the current study, we investigated the safety profile and immunological effect of cluster SIT in children with allergic asthma due to house dust mite allergy. METHODS A total of 34 children (6-18 years) with allergic asthma were assigned to cluster (n = 22) or classic SIT (n = 12). To achieve a maintenance dose of allergen extract, cluster patients received 14 injections of house dust mite allergen within 6 weeks, whereas the classic SIT group received 14 injections within 14 weeks. Safety was monitored by recording adverse events. Immunogenicity was measured by specific IgG(Mite) and IgG4(Mite), by antibody-blocking properties on basophil activation, and by the T cell subset transcription factors Foxp3, T-bet, and GATA-3. RESULTS There were no significant differences in local and systemic side effects between the two groups. In the cluster group, serum levels of specific IgG(Mite) (p < 0.001) and specific IgG4(Mite) (p < 0.001) significantly increased after 8 weeks, while it took 12 weeks in the classic SIT group. These data were confirmed by blocking CD63 expression as well as release of cysteinyl leukotrienes after in vitro basophil stimulation. No differences in transcription factor expression were found in the two groups. CONCLUSION Cluster SIT is safe in children. Additionally, our data demonstrated an even more rapid induction of specific immune tolerance. Cluster SIT is an attractive alternative to conventional up-dosing schedules with fewer consultations for the patients.
Collapse
Affiliation(s)
- R Schubert
- Paediatric Pulmonology and Allergology, Department of Internal Medicine III, J.W. Goethe University, Frankfurt am Main, Germany.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Rolinck-Werninghaus C, Keil T, Kopp M, Zielen S, Schauer U, von Berg A, Wahn U, Hamelmann E. Specific IgE serum concentration is associated with symptom severity in children with seasonal allergic rhinitis. Allergy 2008; 63:1339-44. [PMID: 18782113 DOI: 10.1111/j.1398-9995.2008.01692.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The impact of allergen-specific and total IgE serum levels before and during the pollen season on symptom severity as well as efficacy of treatment with anti-IgE requires further delineation. METHODS Birch and grass pollen allergic patients aged 6-17 years with seasonal allergic rhinitis (SAR) were analyzed for the association of IgE serum concentration with symptom severity and rescue medication use (combination: symptom load, SL) during the grass pollen season. Reference group A (n = 53) received placebo, while group B (n = 54) received Omalizumab (anti-IgE) monotherapy before and during the grass pollen season. RESULTS Patients on placebo with high baseline specific grass pollen IgE (>50 kU/l) had a significantly higher SL compared with those with low IgE levels (< or =50 kU/l): SL 1.28 vs 0.61, P = 0.015. This association was nonexistent in patients treated with anti-IgE. In contrast, baseline total IgE levels did not correlate with SL in any group. Patients with anti-IgE treatment and high free total IgE levels (>16.7 ng/ml) had a significantly higher SL compared with those with low free total IgE levels (< or =16.7 ng/ml): SL 0.63 vs 0.23, P = 0.031. CONCLUSIONS Baseline specific IgE, but not total IgE, is associated with symptom severity during the pollen season in children with SAR. Likewise, the symptom load in SAR patients with anti-IgE correlates with free total IgE levels. Although further research in larger populations is needed to confirm our findings, our data suggest that specific IgE can be used as a parameter for patient selection for this kind of treatment.
Collapse
MESH Headings
- Adolescent
- Anti-Allergic Agents/pharmacology
- Antibodies, Anti-Idiotypic
- Antibodies, Monoclonal/pharmacology
- Antibodies, Monoclonal, Humanized
- Child
- Humans
- Immunoglobulin E/adverse effects
- Immunoglobulin E/biosynthesis
- Immunoglobulin E/blood
- Omalizumab
- Rhinitis, Allergic, Seasonal/diagnosis
- Rhinitis, Allergic, Seasonal/drug therapy
- Rhinitis, Allergic, Seasonal/immunology
- Severity of Illness Index
Collapse
Affiliation(s)
- C Rolinck-Werninghaus
- Pediatric Pneumology and Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | | | | | | | | | | | | |
Collapse
|
50
|
Abstract
Tobacco abuse is especially a public health problem among children and teenagers in Germany. While the proportion of adolescents smoking regularly was 18% in 1997, this has increased to more than 30% in 2001. The high impact of peer groups in young people aggravates the development of smoking habits. Furthermore, an addiction to nicotine develops mainly before the age of 20 (80% of all adults smokers have started as teenagers). Early and continued damage to health will result in long-term sequelae due to immaturity of the organs. Fortunately, the proportion of smoking adolescents has decreased in the last few years. Besides the well known effects of active smoking, children are especially endangered by environmental tobacco smoke (ETS). Exposure to cigarette smoke during pregnancy is directly correlated to premature rupture of the membranes, premature birth, delayed foetal development, and reduced lung function. Children are suffering from impairments of their health not only due to ETS exposure in utero but also after birth (e. g., diseases of upper and lower airways, delayed physical and mental development). Therefore, the prevention of active and passive smoking must be intensified and should consider the special situation of children and adolescents.
Collapse
Affiliation(s)
- M Rosewich
- Klinikum und Fachbereich Medizin-Johann Wolfgang Goethe-Universität Frankfurt am Main, Zentrum für Kinder- und Jugendmedizin.
| | | | | |
Collapse
|