1
|
Florido-López JF, Andreu-Balaguer C, Escudero C, Seoane-Rodríguez M, Hernández M, Navarro-Seisdedos LÁ, Torrecillas-Toro M, Anton-Girones M, Herrero-Lifona L, Brugaletta D, Macías J, Pineda R, Lara MÁ, López-Caballero J, Rojas MJ. Effectiveness and safety of a glutaraldehyde-modified, L-tyrosine-adsorbed and monophosphoryl lipid A-Adjuvanted allergen immunotherapy in patients with allergic asthma sensitized to olive pollen: A retrospective, controlled real-world study. World Allergy Organ J 2020; 13:100487. [PMID: 33376572 PMCID: PMC7750691 DOI: 10.1016/j.waojou.2020.100487] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/29/2020] [Accepted: 10/30/2020] [Indexed: 01/20/2023] Open
Abstract
Background Allergy to olive pollen is one of the primary causes of allergic asthma in Spain. Even though allergen immunotherapy (AIT) has shown clinical benefits in patients sensitized to different allergens, studies in asthmatic patients sensitized to olive pollen are insufficient. Objective To assess the effectiveness and safety of an ultra-short course of AIT with an L-tyrosine-adsorbed and monophosphoryl lipid A-adjuvanted olive pollen and olive/grass pollen extract (Pollinex Quattro®) in patients with allergic asthma in the real-world setting. Methods Retrospective, controlled study including patients with asthma, with and without allergic rhinitis, caused by sensitization to olive pollen from 11 centers in Spain. Patients received out-of-season (October–March) treatment with AIT in addition to their pharmacological treatment (active group) or pharmacological treatment (control group). Effectiveness variables, including unscheduled visits to the healthcare center, emergency room admissions, symptoms of asthma and rhinitis (following GEMA and ARIA classifications, respectively), and use of medication to treat asthma and rhinitis during the subsequent pollen season were compared between treatment groups. Results Of 131 study patients, 42 were treated with their usual asthma medication (control group) and 89 were treated with AIT (active group), either Pollinex Quattro® 100% olive pollen (n = 43, 48.3%) or 50% olive pollen/50% grass pollen (n = 46, 51.7%). Patients’ demographic and clinical characteristics were similar between groups. The mean (SD) number of unscheduled visits to a healthcare center and emergency room admissions due to allergy symptoms was 2.19 (1.40) and 0.43 (0.63) in the control group, and 1.09 (1.25) and 0.11 (0.51) in the active group (P = 0.001 and P = 0.006, respectively). Severity and control of asthma symptoms remained unchanged (P = 0.347 and P = 0.179, respectively), rhinitis type improved (P = 0.025), and severity remained unchanged in the active compared to the control group. The use of short-acting beta-agonists and inhaled corticosteroids to treat asthma symptoms decreased in the active vs. the control group (P = 0.001 and P = 0.031, respectively). Twelve (13.5%) and two (2.2%) patients in the active group experienced local adverse reactions (edema, swelling, erythema, hives, pruritus, and heat), and systemic adverse reactions (hypertensive crisis and low-grade fever) to AIT, respectively; none was serious. Conclusion AIT with Pollinex Quattro® specific for olive pollen and olive/grass pollens resulted in reduced visits to the healthcare center and emergency room and the use of asthma medication during the pollen season, indicating that this treatment was safe and effective in treating asthma in patients sensitized to these pollens.
Collapse
Key Words
- AAAAI, American Academy of Allergy, Asthma & Immunology
- AIT, allergen immunotherapy
- ARIA, Allergic Rhinitis and its Impact on Asthma
- ARs, adverse reactions
- Allergen immunotherapy
- Allergic asthma
- Allergic rhinitis
- Allergoid
- EAACI, European Academy of Allergy and Clinical Immunology
- GEMA, “Guía Española para el Manejo del Asma” (Spanish Guidelines for Asthma Management)
- GINA, Global Initiative for Asthma
- LABAs, long-acting beta-2 agonists
- LTRAs, leukotriene receptor antagonists
- MCT, microcrystalline tyrosine
- MPL, monophosphoryl lipid A
- Microcrystalline tyrosine
- Monophosphoryl lipid A
- Olive pollen
- SABAs, short-acting beta-agonists
- SCIT, subcutaneous immunotherapy
- Subcutaneous immunotherapy
Collapse
Affiliation(s)
| | | | - Carmelo Escudero
- Department of Allergy, Hospital Infantil Universitario Niño Jesús, IIS-P, FibHNJ. Madrid, Spain
| | | | | | | | | | | | | | | | | | | | - Maria Ángeles Lara
- Hospital Clínico Universitario (Parque Tecnológico de La Salud). Granada, Spain
| | | | - Maria José Rojas
- Hospital Clínico Universitario (Parque Tecnológico de La Salud). Granada, Spain
| |
Collapse
|
2
|
Nascimento LFM, Miranda DFH, Moura LD, Pinho FA, Werneck GL, Khouri R, Reed SG, Duthie MS, Barral A, Barral-Netto M, Cruz MSP. Allopurinol therapy provides long term clinical improvement, but additional immunotherapy is required for sustained parasite clearance, in L. infantum-infected dogs. Vaccine X 2019; 4:100048. [PMID: 31891152 PMCID: PMC6928333 DOI: 10.1016/j.jvacx.2019.100048] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 11/01/2019] [Accepted: 11/09/2019] [Indexed: 11/28/2022] Open
Abstract
L. infantum-infected dogs were treated with allopurinol alone or plus Leish-F2 + SLA-SE. Both treatment regimen generated long term clinical improvement. Immunochemotherapy, but not chemotherapy alone, generated sustained parasite control.
There is little evidence that current control strategies for canine leishmaniosis (CanL), the veterinary disease caused by L. infantum infection, are having a positive impact. This is of critical importance because dogs are a primary reservoir for L. infantum and a significant source of parasite transmission to humans. Drugs intended primarily for human use are prohibited for the treatment of CanL because of concerns over the propagation of resistant parasites. Although allopurinol effectively decreases parasite burden in CanL the treatment needs to be maintained for life. We hypothesized that during the allopurinol-induced parasite reduction dogs may become capable of developing a more robust immune response that may permit more effective control of parasites. To test this, we investigated the clinical and parasitological impact of short-term treatment with allopurinol, either alone or in combination with a defined subunit vaccine, on dogs naturally infected with L. infantum. A total of 28 dogs were distributed as follows: untreated; oral allopurinol alone (20 mg/kg, once each day for 90 days); or allopurinol with immunization with the Leish-F2 antigen formulated with the Toll-like receptor (TLR) 4 agonist Second generation Lipid Adjuvant (SLA) in stable emulsion (SE; SLA-SE). Dogs that did not receive treatment had a progressive decline in their clinical condition and an increase in their infection levels, while treatment with allopurinol alone alleviated the clinical symptoms of CanL but did not generate sustained reduction in parasites. Concomitant immunization with Leish-F2 + SLA-SE, however, improved clinical condition while also providing long-term clearance of L. infantum from lymphoid tissues and systemic organs. These results have important implications for both the management of CanL and for limiting L. infantum transmission to humans.
Collapse
Key Words
- CanL, canine leishmaniosis
- Canine visceral leishmaniasis
- Clinical signs
- Drug
- GLA, glycopyranosyl lipid
- IFN, interferon
- IL, interleukin
- MPL, monophosphoryl lipid A
- Parasite
- SE, stable emulsion
- SLA, Second generation Lipid Adjuvant
- TLR, Toll-like receptor
- Th1, T helper 1-like cells
- VL, visceral leishmaniasis
- Vaccine
Collapse
Affiliation(s)
- Leopoldo F M Nascimento
- Universidade Federal do Piauí, Departamento de Morfofisiologia Veterinária, Teresina, PI, Brazil
| | | | - Luana D Moura
- Universidade Federal do Piauí, Departamento de Morfofisiologia Veterinária, Teresina, PI, Brazil
| | - Flaviane A Pinho
- Universidade Federal da Bahia, Faculdade de Medicina, Salvador, BA, Brazil
| | - Guilherme Loureiro Werneck
- Universidade Federal do Rio de Janeiro, Instituto de Estudos em Saúde Coletiva, Rio de Janeiro, RJ, Brazil
| | - Ricardo Khouri
- Fundação Oswaldo Cruz- Fiocruz, Instituto Gonçalo Moniz, Salvador, BA, Brazil.,Universidade Federal da Bahia, Faculdade de Medicina, Salvador, BA, Brazil
| | - Steven G Reed
- Infectious Diseases Research Institute, Seattle, WA 98102, USA.,HDT Biotech Corporation, Seattle, WA 98102, USA
| | - Malcolm S Duthie
- Infectious Diseases Research Institute, Seattle, WA 98102, USA.,HDT Biotech Corporation, Seattle, WA 98102, USA
| | - Aldina Barral
- Fundação Oswaldo Cruz- Fiocruz, Instituto Gonçalo Moniz, Salvador, BA, Brazil.,Universidade Federal da Bahia, Faculdade de Medicina, Salvador, BA, Brazil.,Instituto Nacional de Ciência e Tecnologia, Instituto de Investigação em Imunologia, São Paulo, SP, Brazil
| | - Manoel Barral-Netto
- Fundação Oswaldo Cruz- Fiocruz, Instituto Gonçalo Moniz, Salvador, BA, Brazil.,Universidade Federal da Bahia, Faculdade de Medicina, Salvador, BA, Brazil.,Instituto Nacional de Ciência e Tecnologia, Instituto de Investigação em Imunologia, São Paulo, SP, Brazil
| | - Maria S P Cruz
- Universidade Federal do Piauí, Departamento de Morfofisiologia Veterinária, Teresina, PI, Brazil
| |
Collapse
|
3
|
Starchenka S, Heath MD, Lineberry A, Higenbottam T, Skinner MA. Transcriptome analysis and safety profile of the early-phase clinical response to an adjuvanted grass allergoid immunotherapy. World Allergy Organ J 2019; 12:100087. [PMID: 31768216 PMCID: PMC6872854 DOI: 10.1016/j.waojou.2019.100087] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 10/11/2019] [Accepted: 10/23/2019] [Indexed: 12/24/2022] Open
Abstract
Background Specific immunotherapy is the only type of disease-modifying treatment, which induces rapid desensitization and long-term sustained unresponsiveness in patients with seasonal allergic rhinoconjunctivitis. The safety and tolerability of a new cumulative dose regimen of 35600 SU Grass MATA MPL for subcutaneous immunotherapy were assessed in pre-seasonal, single-blind, placebo controlled Phase I clinical study. Underlying immunological mechanisms were explored using transcriptome analysis of peripheral blood mononuclear cells. Methods Study subjects with a history of moderate to severe seasonal allergic rhinitis and/or conjunctivitis (SAR) due to grass (Pooideae) pollen exposure were randomized on a 1:1 ratio to receive either six 1.0 mL injections of cumulative dose regimen 35600 SU of Grass MATA MPL or placebo. The study consisted of three periods: screening, randomization and treatment and End of Study period. Blood samples were taken for clinical safety laboratory assessments and for the assessment of gene expression analysis during screening visit and End of Study visit. The safety statistics was calculated using Fisher's exact test. Delta Delta Ct method analysis of RT2 Profiler PCR Array gene expression results was used to calculate changes in gene expression level. Genes with the absolute value of log2 fold change greater than ±1.1 and p-value less than 0.05 were identified as differentially expressed and underwent IPA data analysis. Results The results of the study indicated that the higher cumulative dose regimen of the immunotherapy was well-tolerated. Changes in gene expression profile were associated with early immune responses implicating innate and adaptive immune mechanisms. Pathways and mechanistic network analysis via IPA mapped differentially expressed genes onto canonical pathways related to T cell differentiation, cytokine signalling and Th1/Th2 activation pathways. The transcriptome findings of the study could be further verified in large-scale field studies in order to explore their potential as predictive markers of successful immunotherapy. Conclusions The higher dose cumulative regime 35600 SU of Grass MATA MPL vaccine was well tolerated and safe. Molecular markers IL-27, IL-10, IL-4, TNF, IFNγ, TGFβ and TLR4 were the main predicted molecular drivers of the observed gene expression changes following early stages of SIT with Grass MATA MPL immunotherapy.
Collapse
Key Words
- ADRs, adverse drug reactions
- AE, adverse events
- AIT, allergen mmunotherapy
- ARC, adverse reaction complex
- Allergen immunotherapy
- Allergoid
- DC, dendritic cell
- EAACI, European Academy of Allergy and Clinical Immunology
- FEV, forced expiratory volume
- FVC, forced vital capacity
- Grass pollen
- IPA, Ingenuity Pathway Analysis
- MATA, modified allergen tyrosine adsorbate
- MCT, microcrystalline tyrosine
- MPL, monophosphoryl lipid A
- SAEs, serious adverse events
- SAR, seasonal allergic rhinoconjunctivitis
- SD, standard deviation
- SIT, specific immunotherapy
- SU, standardized units
- Safety
- TEAEs, treatment-emergent adverse events
- TLR, toll-like receptor
- TSS, total symptom score
- Transcriptome
- URA, Upstream Regulator Analysis
- mRNA, messenger ribosomal nucleic acid
Collapse
Affiliation(s)
- Sviatlana Starchenka
- Corresponding author. Allergy Therapeutics (UK) Ltd, Worthing, BN14 8SA, United Kingdom.
| | | | | | | | | |
Collapse
|