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Martín-González E, Hernández-Pérez JM, Pérez JAP, Pérez-García J, Herrera-Luis E, González-Pérez R, González-González O, Mederos-Luis E, Sánchez-Machín I, Poza-Guedes P, Sardón O, Corcuera P, Cruz MJ, González-Barcala FJ, Martínez-Rivera C, Mullol J, Muñoz X, Olaguibel JM, Plaza V, Quirce S, Valero A, Sastre J, Korta-Murua J, Del Pozo V, Lorenzo-Díaz F, Villar J, Pino-Yanes M, González-Carracedo MA. Alpha-1 antitrypsin deficiency and Pi*S and Pi*Z SERPINA1 variants are associated with asthma exacerbations. Pulmonology 2023:S2531-0437(23)00091-0. [PMID: 37236906 DOI: 10.1016/j.pulmoe.2023.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 05/04/2023] [Accepted: 05/06/2023] [Indexed: 05/28/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES Asthma is a chronic inflammatory disease of the airways. Asthma patients may experience potentially life-threatening episodic flare-ups, known as exacerbations, which may significantly contribute to the asthma burden. The Pi*S and Pi*Z variants of the SERPINA1 gene, which usually involve alpha-1 antitrypsin (AAT) deficiency, had previously been associated with asthma. The link between AAT deficiency and asthma might be represented by the elastase/antielastase imbalance. However, their role in asthma exacerbations remains unknown. Our objective was to assess whether SERPINA1 genetic variants and reduced AAT protein levels are associated with asthma exacerbations. MATERIALS AND METHODS In the discovery analysis, SERPINA1 Pi*S and Pi*Z variants and serum AAT levels were analyzed in 369 subjects from La Palma (Canary Islands, Spain). As replication, genomic data from two studies focused on 525 Spaniards and publicly available data from UK Biobank, FinnGen, and GWAS Catalog (Open Targets Genetics) were analyzed. The associations between SERPINA1 Pi*S and Pi*Z variants and AAT deficiency with asthma exacerbations were analyzed with logistic regression models, including age, sex, and genotype principal components as covariates. RESULTS In the discovery, a significant association with asthma exacerbations was found for both Pi*S (odds ratio [OR]=2.38, 95% confidence interval [CI]= 1.40-4.04, p-value=0.001) and Pi*Z (OR=3.49, 95%CI=1.55-7.85, p-value=0.003)Likewise, AAT deficiency was associated with a higher risk for asthma exacerbations (OR=5.18, 95%CI=1.58-16.92, p-value=0.007) as well as AAT protein levels (OR= 0.72, 95%CI=0.57-0.91, p-value=0.005). The Pi*Z association with exacerbations was replicated in samples from Spaniards with two generations of Canary Islander origin (OR=3.79, p-value=0.028), and a significant association with asthma hospitalizations was found in the Finnish population (OR=1.12, p-value=0.007). CONCLUSIONS AAT deficiency could be a potential therapeutic target for asthma exacerbations in specific populations.
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Affiliation(s)
- Elena Martín-González
- Genomics and Health Group, Department of Biochemistry, Microbiology, Cell Biology and Genetics, Universidad de La Laguna (ULL), 38200 La Laguna, Tenerife, Spain
| | - José M Hernández-Pérez
- Department of Respiratory Medicine, Hospital Universitario de N.S de Candelaria, 38010 Santa Cruz de Tenerife, Spain; Respiratory Medicine, Hospital Universitario de La Palma, 38713 Breña Alta, Santa Cruz de Tenerife, Spain
| | - José A Pérez Pérez
- Genomics and Health Group, Department of Biochemistry, Microbiology, Cell Biology and Genetics, Universidad de La Laguna (ULL), 38200 La Laguna, Tenerife, Spain; Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias, Universidad de La Laguna (ULL), La Laguna, Tenerife, Spain
| | - Javier Pérez-García
- Genomics and Health Group, Department of Biochemistry, Microbiology, Cell Biology and Genetics, Universidad de La Laguna (ULL), 38200 La Laguna, Tenerife, Spain
| | - Esther Herrera-Luis
- Genomics and Health Group, Department of Biochemistry, Microbiology, Cell Biology and Genetics, Universidad de La Laguna (ULL), 38200 La Laguna, Tenerife, Spain
| | - Ruperto González-Pérez
- Allergy Department, Hospital Universitario de Canarias, 38320 La Laguna, Tenerife, Spain; Severe Asthma Unit, Allergy Department, Hospital Universitario de Canarias, 38320 La Laguna, Spain
| | | | - Elena Mederos-Luis
- Allergy Department, Hospital Universitario de Canarias, 38320 La Laguna, Tenerife, Spain
| | | | - Paloma Poza-Guedes
- Allergy Department, Hospital Universitario de Canarias, 38320 La Laguna, Tenerife, Spain; Severe Asthma Unit, Allergy Department, Hospital Universitario de Canarias, 38320 La Laguna, Spain
| | - Olaia Sardón
- Division of Pediatric Respiratory Medicine, Hospital Universitario Donostia, San Sebastián, Spain; Department of Pediatrics, University of the Basque Country (UPV/EHU), San Sebastián, Spain
| | - Paula Corcuera
- Division of Pediatric Respiratory Medicine, Hospital Universitario Donostia, San Sebastián, Spain
| | - María J Cruz
- Department of Respiratory Medicine, Hospital Vall d'Hebron, Barcelona, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Francisco J González-Barcala
- Department of Respiratory Medicine, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, La Coruña, Spain
| | - Carlos Martínez-Rivera
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Department of Respiratory Medicine, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Joaquim Mullol
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Rhinology Unit & Smell Clinic, ENT Department, Clinical and Experimental Respiratory Immunoallergy (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Xavier Muñoz
- Department of Respiratory Medicine, Hospital Vall d'Hebron, Barcelona, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - José M Olaguibel
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Department of Allergy, Hospital Universitario de Navarra, Pamplona, Navarra, Spain
| | - Vicente Plaza
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Department of Respiratory Medicine, Hospital de la Santa Creu i Sant Pau, Instituto de Investigación Biomédica Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Santiago Quirce
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Department of Allergy, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | - Antonio Valero
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Allergy Unit & Severe Asthma Unit, Pneumonology and Allergy Department, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Joaquín Sastre
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Department of Allergy, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Javier Korta-Murua
- Division of Pediatric Respiratory Medicine, Hospital Universitario Donostia, San Sebastián, Spain
| | - Victoria Del Pozo
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Department of Immunology, Instituto de Investigación Sanitaria Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Fabián Lorenzo-Díaz
- Genomics and Health Group, Department of Biochemistry, Microbiology, Cell Biology and Genetics, Universidad de La Laguna (ULL), 38200 La Laguna, Tenerife, Spain; Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias, Universidad de La Laguna (ULL), La Laguna, Tenerife, Spain
| | - Jesús Villar
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Multidisciplinary Organ Dysfunction Evaluation Research Network (MODERN), Research Unit, Hospital Universitario Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | - María Pino-Yanes
- Genomics and Health Group, Department of Biochemistry, Microbiology, Cell Biology and Genetics, Universidad de La Laguna (ULL), 38200 La Laguna, Tenerife, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Instituto de Tecnologías Biomédicas (ITB), Universidad de La Laguna (ULL), San Cristóbal de La Laguna, Tenerife, Spain.
| | - Mario A González-Carracedo
- Genomics and Health Group, Department of Biochemistry, Microbiology, Cell Biology and Genetics, Universidad de La Laguna (ULL), 38200 La Laguna, Tenerife, Spain; Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias, Universidad de La Laguna (ULL), La Laguna, Tenerife, Spain.
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Plaza V, Alobid I, Alvarez C, Blanco M, Ferreira J, García G, Gómez-Outes A, Gómez F, Hidalgo A, Korta J, Molina J, Pellegrini FJ, Pérez M, Plaza J, Praena M, Quirce S, Sanz J. [Translated article] Spanish Asthma Management Guidelines (GEMA) v.5.1. Highlights and Controversies. Arch Bronconeumol 2022; 58:T150-T158. [PMID: 35971814 DOI: 10.1016/j.arbres.2021.05.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 05/04/2021] [Indexed: 12/12/2022]
Abstract
In this fifth phase of development, the contents of the Spanish Asthma Management Guidelines (GEMA), which include versions 5.0 and 5.1, have undergone a thorough review. The aim here is to set the main changes in context. These could be summarized as follows: DIAGNOSIS: new FENO cut-off and severity classification based on treatment needed to maintain control; INTERMITTENT ASTHMA: a more restrictive concept and treatment extended to include a glucocorticoid/adrenergic combination as needed; MILD ASTHMA: glucocorticoid/adrenergic therapy as needed as an alternative in case of low therapeutic adherence to conventional fixed-dose steroids; SEVERE ASTHMA: readjustment of phenotypes, incorporation of triple therapy in a single inhaler, and criteria for selection of a biologic in severe uncontrolled asthma; OTHERS: specific scoring in childhood asthma, incorporation of certain organizational aspects (care circuits, asthma units, telemedicine), new sections on COVID-19 and nasal polyposis.
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Affiliation(s)
- Vicente Plaza
- Comité Ejecutivo GEMA, Servicio de Neumología y Alergia, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
| | - Isam Alobid
- Sociedad Española de Otorrinolaringología (SEORL), Hospital Clinic, Universidad de Barcelona, Barcelona, Spain
| | - Cesáreo Alvarez
- Sociedad Española de Medicina de Urgencias y Emergencias (SEMES), Hospital de Verín, Orense, Spain
| | - Marina Blanco
- Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - Jorge Ferreira
- Sociedad Portuguesa de Pneumologia (SPP), Hospital de São Sebastião • CHEDV, Santa Maria da Feira, Portugal
| | - Gabriel García
- Asociación Latinoamericana del Tórax (ALAT), Hospital Rossi La Plata, Buenos Aires, Argentina
| | - Antonio Gómez-Outes
- Sociedad Española de Farmacología Clínica (SEFC), Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Madrid, Spain
| | - Fernando Gómez
- Sociedad Española de Médicos Generales y de Familia (SEMG), Centro de Salud de Bargas, Toledo, Spain
| | - Antonio Hidalgo
- Sociedad Española de Médicos de Atención Primaria (SEMERGEN), Centro de Salud Lucena I. Lucena, Córdoba, Spain
| | - Javier Korta
- Sociedad Española de Neumología Pediátrica (SENP), Hospital Universitario Donostia, Donostia-San Sebastián, Spain
| | - Jesús Molina
- Sociedad Española de Medicina Familiar y Comunitaria (semFYC) y Sociedad de Respiratorio de Atención Primaria (GRAP), Centro de Salud Francia, Fuenlabrada, Dirección Asistencial Oeste, Madrid, Spain
| | - Francisco Javier Pellegrini
- Sociedad Española de Pediatría Extrahospitalaria y Atención Primaria (SEPEAP), Centro de Salud de Pizarrales, Salamanca, Spain
| | - Montserrat Pérez
- Sociedad Española de Farmacia Hospitalaria (SEFH), Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Javier Plaza
- Sociedad Española de Farmacia Clínica, Familiar y Comunitaria (SEFAC), Farmacia Dres. Zamora Navarro, Mazarrón, Murcia, Spain
| | - Manuel Praena
- Asociación Española de Pediatría de Atención Primaria (AEPap), Centro de Salud La Candelaria, Sevilla, Spain
| | - Santiago Quirce
- Sociedad Española de Alergia e Inmunología Clínica (SEAIC), Hospital Universitario La Paz, Madrid, Spain
| | - José Sanz
- Sociedad Española de Inmunología Clínica•Alergología y Asma Pediátrica (SEICAP), Hospital Católico Universitario Casa de Salud, Valencia, Spain
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Plaza V, Alobid I, Alvarez C, Blanco M, Ferreira J, García G, Gómez-Outes A, Gómez F, Hidalgo A, Korta J, Molina J, Pellegrini FJ, Pérez M, Plaza J, Praena M, Quirce S, Sanz J. Spanish Asthma Management Guidelines (GEMA) VERSION 5.1. Highlights and Controversies. Arch Bronconeumol 2021; 58:150-158. [PMID: 34167859 DOI: 10.1016/j.arbres.2021.05.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 05/04/2021] [Indexed: 12/24/2022]
Abstract
In this fifth phase of development, the contents of the Spanish Asthma Management Guidelines (GEMA), which include versions 5.0 and 5.1, have undergone a thorough review. The aim here is to set the main changes in context. These could be summarized as follows: DIAGNOSIS: new FENO cut-off and severity classification based on treatment needed to maintain control; INTERMITTENT ASTHMA: a more restrictive concept and treatment extended to include a glucocorticoid/adrenergic combination as needed; MILD ASTHMA: glucocorticoid/adrenergic therapy as needed as an alternative in case of low therapeutic adherence to conventional fixed-dose steroids; SEVERE ASTHMA: readjustment of phenotypes, incorporation of triple therapy in a single inhaler, and criteria for selection of a biologic in severe uncontrolled asthma; OTHERS: specific scoring in childhood asthma, incorporation of certain organizational aspects (care circuits, asthma units, telemedicine), new sections on COVID-19 and nasal polyposis.
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Affiliation(s)
- Vicente Plaza
- Comité Ejecutivo GEMA, Servicio de Neumología y Alergia, Hospital de la Santa Creu i Sant Pau, Barcelona, España.
| | - Isam Alobid
- Sociedad Española de Otorrinolaringología (SEORL), Hospital Clinic, Universidad de Barcelona, Barcelona, España
| | - Cesáreo Alvarez
- Sociedad Española de Medicina de Urgencias y Emergencias (SEMES), Hospital de Verín, Orense, España
| | - Marina Blanco
- Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Complejo Hospitalario Universitario A Coruña, A Coruña, España
| | - Jorge Ferreira
- Sociedad Portuguesa de Pneumologia (SPP), Hospital de São Sebastião - CHEDV, Santa Maria da Feira, Portugal
| | - Gabriel García
- Asociación Latinoamericana del Tórax (ALAT), Hospital Rossi La Plata, Buenos Aires, Argentina
| | - Antonio Gómez-Outes
- Sociedad Española de Farmacología Clínica (SEFC), Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Madrid, España
| | - Fernando Gómez
- Sociedad Española de Médicos Generales y de Familia (SEMG), Centro de Salud de Bargas, Toledo, España
| | - Antonio Hidalgo
- Sociedad Española de Médicos de Atención Primaria (SEMERGEN), Centro de Salud Lucena I. Lucena, Córdoba, España
| | - Javier Korta
- Sociedad Española de Neumología Pediátrica (SENP), Hospital Universitario Donostia, Donostia-San Sebastián, España
| | - Jesús Molina
- Sociedad Española de Medicina Familiar y Comunitaria (semFYC) y Sociedad de Respiratorio de Atención Primaria (GRAP), Centro de Salud Francia, Fuenlabrada, Dirección Asistencial Oeste, Madrid, España
| | - Francisco Javier Pellegrini
- Sociedad Española de Pediatría Extrahospitalaria y Atención Primaria (SEPEAP), Centro de Salud de Pizarrales, Salamanca, España
| | - Montserrat Pérez
- Sociedad Española de Farmacia Hospitalaria (SEFH), Hospital Universitario Fundación Alcorcón, Madrid, España
| | - Javier Plaza
- Sociedad Española de Farmacia Clínica, Familiar y Comunitaria (SEFAC), Farmacia Dres. Zamora Navarro, Mazarrón, Murcia, España
| | - Manuel Praena
- Asociación Española de Pediatría de Atención Primaria (AEPap), Centro de Salud La Candelaria, Sevilla, España
| | - Santiago Quirce
- Sociedad Española de Alergia e Inmunología Clínica (SEAIC), Hospital Universitario La Paz, Madrid, España
| | - José Sanz
- Sociedad Española de Inmunología Clínica-Alergología y Asma Pediátrica (SEICAP), Hospital Católico Universitario Casa de Salud, Valencia, España
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