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Bagnasco D, Ferrando M, Varricchi G, Passalacqua G, Canonica GW. A Critical Evaluation of Anti-IL-13 and Anti-IL-4 Strategies in Severe Asthma. Int Arch Allergy Immunol 2016; 170:122-31. [PMID: 27637004 DOI: 10.1159/000447692] [Citation(s) in RCA: 133] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Asthma is a high-prevalence disease, still accounting for mortality and high direct and indirect costs. It is now recognized that, despite the implementation of guidelines, a large proportion of cases remain not controlled. Certainly, adherence to therapy and the education of patients remain the primary objective, but the increasingly detailed knowledge about the pathogenic mechanisms and new biotechnologies offer the opportunity to better address and treat the disease. Interleukin (IL)-13 and IL-4 appear as the most suitable targets to treat the T helper 2 (TH2)-mediated forms (endotypes) of asthma. IL-13 and IL-4 partly share the same receptor and signaling pathways and both are deeply involved in immunoglobulin E (IgE) synthesis, eosinophil activation, mucus secretion and airways remodeling. Several anti-IL-13 strategies have been proposed (anrukinzumab, lebrikizunab and tralokinumab), with relevant clinical results reported with lebrikizumab. Such studies facilitate better definition of the possible predictive markers of response to a specific treatment (e.g. eosinophils, total IgE, fraction of exhaled nitric oxide and periostin). In parallel, anti-IL-4 strategies have been attempted (pascolizumab, pitakinra and dupilumab). So far, dupilumab was reported capable of reducing the severity of asthma and the rate of exacerbations. IL-13 and IL-4 are crucial in TH2-mediated inflammation in asthma, but it remains clear that only specific endotypes respond to these treatments. Although the use of anti-IL-14 and anti-IL-13 strategies is promising, the search for appropriate predictive biomarkers is urgently needed to better apply biological treatments.
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Affiliation(s)
- Diego Bagnasco
- Allergy and Respiratory Diseases, DIMI Department of Internal Medicine, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
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Malinovschi A, Fonseca JA, Jacinto T, Alving K, Janson C. Exhaled nitric oxide levels and blood eosinophil counts independently associate with wheeze and asthma events in National Health and Nutrition Examination Survey subjects. J Allergy Clin Immunol 2013; 132:821-7.e1-5. [PMID: 23890753 DOI: 10.1016/j.jaci.2013.06.007] [Citation(s) in RCA: 187] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Revised: 06/03/2013] [Accepted: 06/05/2013] [Indexed: 01/01/2023]
Abstract
BACKGROUND Fraction of exhaled nitric oxide (Feno) and blood eosinophil count (B-Eos) values, markers of local and systemic eosinophilic inflammation, respectively, are increased in asthmatic patients. Little is known about the relation of these markers to reported wheeze and asthma events in a random population sample. OBJECTIVES We sought to determine the individual and independent values of B-Eos and Feno in relation to wheeze, asthma diagnosis, and asthma events in a cross-sectional study. METHODS Feno and B-Eos values were measured in 12,408 subjects aged 6 to 80 years from the National Health and Nutrition Examination Survey 2007-2008 and 2009-2010. Current wheeze and asthma diagnosis, as well as asthma attacks and asthma-related emergency department (ED) visits within the last 12 months, were assessed by means of questionnaires. RESULTS Intermediate or high Feno values and intermediate or high B-Eos values were independently associated with having asthma, wheeze, and asthma attacks. However, only intermediate and high B-Eos values were independently associated with asthma-related ED visits. High Feno (≥ 50 ppb) and B-Eos (≥ 500 cells/mm(3)) values rendered an adjusted odds ratio of 4.5 of having wheeze, 5.1 of having asthma, 5.4 for asthma attacks, and 2.9 for asthma-related ED visits compared with normal Feno (<25 ppb) and B-Eos (<300 cells/mm(3)) values. CONCLUSIONS Exhaled nitric oxide and B-Eos values offered independent information in relation to the prevalence of wheeze, asthma diagnosis, and asthma events in this random population sample. The clinical importance of these findings in asthmatic patients with regard to phenotyping and individualized treatment, considering both local and systemic eosinophilic inflammation, needs to be determined.
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Affiliation(s)
- Andrei Malinovschi
- Department of Medical Sciences: Clinical Physiology, Uppsala University, Uppsala, Sweden.
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Reddel HK, Taylor DR, Bateman ED, Boulet LP, Boushey HA, Busse WW, Casale TB, Chanez P, Enright PL, Gibson PG, de Jongste JC, Kerstjens HAM, Lazarus SC, Levy ML, O'Byrne PM, Partridge MR, Pavord ID, Sears MR, Sterk PJ, Stoloff SW, Sullivan SD, Szefler SJ, Thomas MD, Wenzel SE. An Official American Thoracic Society/European Respiratory Society Statement: Asthma Control and Exacerbations. Am J Respir Crit Care Med 2009; 180:59-99. [DOI: 10.1164/rccm.200801-060st] [Citation(s) in RCA: 1321] [Impact Index Per Article: 88.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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Fedulov AV, Leme A, Yang Z, Dahl M, Lim R, Mariani TJ, Kobzik L. Pulmonary exposure to particles during pregnancy causes increased neonatal asthma susceptibility. Am J Respir Cell Mol Biol 2007; 38:57-67. [PMID: 17656681 PMCID: PMC2176127 DOI: 10.1165/rcmb.2007-0124oc] [Citation(s) in RCA: 152] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Maternal immune responses can promote allergy development in offspring, as shown in a model of increased susceptibility to asthma in babies of ovalbumin (OVA)-sensitized and -challenged mother mice. We investigated whether inflammatory responses to air pollution particles (diesel exhaust particles, DEP) or control "inert" titanium dioxide (TiO(2)) particles are enhanced during pregnancy and whether exposure to particles can cause increased neonatal susceptibility to asthma. Pregnant BALB/c mice (or nonpregnant controls) received particle suspensions intranasally at Day 14 of pregnancy. Lung inflammatory responses were evaluated 48 hours after exposure. Offspring of particle- or buffer-treated mothers were sensitized and aerosolized with OVA, followed by assays of airway hyperresponsiveness (AHR) and allergic inflammation (AI). Nonpregnant females had the expected minimal response to "inert" TiO(2). In contrast, pregnant mice showed robust and persistent acute inflammation after both TiO(2) and DEP. Genomic profiling identified genes differentially expressed in pregnant lungs exposed to TiO(2). Neonates of mothers exposed to TiO(2) (and DEP, but not PBS) developed AHR and AI, indicating that pregnancy exposure to both "inert" TiO(2) and DEP caused increased asthma susceptibility in offspring. We conclude that (1) pregnancy enhances lung inflammatory responses to otherwise relatively innocuous inert particles; and (2) exposures of nonallergic pregnant females to inert or toxic environmental air particles can cause increased allergic susceptibility in offspring.
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Affiliation(s)
- Alexey V Fedulov
- Harvard School of Public Health, Dept. of Environmental Health, Molecular and Integrative Physiological Sciences Program, 665 Huntington Ave, HSPH-12, Room 1313, Boston, MA 02115, USA.
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Malm-Erjefält M, Greiff L, Ankerst J, Andersson M, Wallengren J, Cardell LO, Rak S, Persson CGA, Erjefält JS. Circulating eosinophils in asthma, allergic rhinitis, and atopic dermatitis lack morphological signs of degranulation. Clin Exp Allergy 2006; 35:1334-40. [PMID: 16238793 DOI: 10.1111/j.1365-2222.2005.02335.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND In allergic diseases, eosinophils in affected tissues release granule proteins with cytotoxic, immunoregulatory, and remodelling-promoting properties. From recent observations, it may be assumed that eosinophils degranulate already in circulating blood. If degranulation occurs in the circulation, this could contribute to widespread systemic effects and provide an important marker of disease. OBJECTIVE To determine the degranulation status of circulating eosinophils in common allergic diseases. METHODS Using a novel approach of whole blood fixation and leucocyte preparation, the granule morphology of blood eosinophils from healthy subjects, non-symptomatic patients, symptomatic patients with asthma, asthma and Churg-Strauss syndrome, allergic rhinitis, and atopic dermatitis was evaluated by transmission electron microscopy (TEM) and eosinophil peroxidase (TEM) histochemistry. Plasma and serum levels of eosinophil cationic protein were measured by fluoroenzymeimmunoassay. Selected tissue biopsies were examined by TEM. RESULTS Regardless of symptoms, circulating eosinophils from allergic patients showed the same granule morphology as cells from healthy subjects. The majority of eosinophil-specific granules had preserved intact electron-density (96%; range: 89-98%), while the remaining granules typically exhibited marginal coarsening or mild lucency of the matrix structure. Abnormalities of the crystalline granule core were rarely detected. Furthermore, granule matrix alterations were not associated with any re-localization of intracellular EPO or increase in plasma eosinophil cationic protein. By contrast, eosinophils in diseased tissues exhibited cytolysis (granule release through membrane rupture) and piecemeal degranulation (loss of granule matrix and core structures). CONCLUSION In symptomatic eosinophilic diseases, circulating blood eosinophils retain their granule contents until they have reached their target organ.
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Affiliation(s)
- M Malm-Erjefält
- Clinical and Experimental Pharmacology, Department of Laboratory Medicine, Lund University Hospital, University of Lund, Sweden.
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Affiliation(s)
- Gary M Doherty
- Department of Child Health, Queen's University Belfast, Belfast, UK.
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Scalfaro P, Sly PD, Sims C, Habre W. Salbutamol prevents the increase of respiratory resistance caused by tracheal intubation during sevoflurane anesthesia in asthmatic children. Anesth Analg 2001; 93:898-902. [PMID: 11574353 DOI: 10.1097/00000539-200110000-00019] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
UNLABELLED Asthmatic children having their tracheas intubated with sevoflurane often have an increase in respiratory system resistance (Rrs). In this randomized, placebo-controlled, double-blinded study, we investigated the protective effect of an inhaled beta2-adrenergic agonist. Either salbutamol or placebo was administered 30 to 60 min before anesthesia to 30 mildly to moderately asthmatic children scheduled for elective surgery. Induction was performed with sevoflurane in a mixture of 50% nitrous oxide in oxygen and maintained at 3%, with children breathing spontaneously via a face mask and Jackson-Rees modification of the T-piece. Airway opening pressure and flow were measured before and after insertion of an oral endotracheal tube. Rrs and respiratory system compliance were calculated with multilinear regression analysis. The groups were comparable with respect to age, weight, asthma history, and breathing pattern. Intubation induced a different Rrs response in the two groups: children treated with salbutamol showed a 6.0% (-25.2% to +13.2%) decrease (mean, 95% confidence interval), whereas in the Placebo group there was a 17.7% (+4.4% to +30.9%) increase (P = 0.04). Neither asthma history nor the serum inflammation marker eosinophilic cationic protein was predictive for this response. We conclude that when using sevoflurane in mildly to moderately asthmatic children, a preanesthetic treatment with inhaled salbutamol is protective of an increase in Rrs. IMPLICATIONS Tracheal intubation with sevoflurane as the sole anesthetic is now often performed in children. It can induce an increase in respiratory system resistance in children with asthma. This study shows that in children with mild to moderate asthma, a preanesthetic treatment with inhaled salbutamol can prevent the increase of respiratory system resistance.
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Affiliation(s)
- P Scalfaro
- Pediatric Intensive Care Unit, Pediatric Department, CHUV University Hospital, Lausanne, Switzerland
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de Jongste JC. Surrogate markers of airway inflammation: inflammometry in paediatric respiratory medicine. Paediatr Respir Rev 2000; 1:354-60. [PMID: 16263464 DOI: 10.1053/prrv.2000.0076] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Until recently, there has not been any practical way to assess airway inflammation non-invasively in paediatrics. Surrogate markers of airway inflammation are potentially of great importance in the diagnosis and monitoring of inflammatory airways disease in children. A large number of substances in blood, urine and exhaled air or induced sputum are currently under study to evaluate their possible usefulness as markers of airway inflammation. To be useful, a marker should be valid, preferably non-invasive, quick, reproducible, repeatable and cheap. In addition, markers should be studied in relation to their specific purpose because different markers may be useful for different types of airway inflammation. Few, if any, markers will fulfill all these requirements. Most research has focused on applications of markers in asthma, some data refer to cystic fibrosis, infections and ciliary dyskinesia. Of all surrogate markers, exhaled nitric oxide has been studied the most and seems to offer information that should be evaluated for its relevance to clinical practice. Before introducing markers of inflammation into daily practice, analysis of benefits and costs are needed. There is little doubt that 'inflammometry' will be a major step forward and will be useful in differentiating airways diseases and improving treatment.
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Affiliation(s)
- J C de Jongste
- Department of Paediatrics/Respiratory Medicine, Erasmus University and University Hospital/Sophia Children's Hospital, Rotterdam, The Netherlands
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PESCOLLDERUNGG LIDIA, PERONI DIEGO, LOCATELLI FRANCESCA, PLEBANI MARIO, BONER ATTILIOLORIS. Determination of Serum Eosinophil Cationic Protein, Eosinophil Count, and Total IgE in Children with Different Severities of Atopic Diseases. ACTA ACUST UNITED AC 2000. [DOI: 10.1089/pai.2000.14.109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Fitch PS, Brown V, Schock BC, Taylor R, Ennis M, Shields MD. Serum eosinophil cationic protein (ECP): reference values in healthy nonatopic children. Allergy 1999; 54:1199-203. [PMID: 10604557 DOI: 10.1034/j.1398-9995.1999.00137.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Although serum ECP concentrations have been reported in normal children, there are currently no published upper cutoff reference limits for serum ECP in normal, nonatopic, nonasthmatic children aged 1-15 years. METHODS We recruited 123 nonatopic, nonasthmatic normal children attending the Royal Belfast Hospital for Sick Children for elective surgery and measured serum ECP concentrations. The effects of age and exposure to environmental tobacco smoke (ETS) on the upper reference limits were studied by multiple regression and fractional polynomials. RESULTS The median serum ECP concentration was 6.5 microg/l and the 95th and 97.5 th percentiles were 18.8 and 19.9 microg/l. The median and 95th percentile did not vary with age. Exposure to ETS was not associated with altered serum ECP concentrations (P = 0.14). CONCLUSIONS The 95th and 97.5 th percentiles for serum ECP for normal, nonatopic, nonasthmatic children (aged 1-15 years) were 19 and 20 microg/l, respectively. Age and exposure to parental ETS did not significantly alter serum ECP concentrations or the normal upper reference limits. Our data provide cutoff upper reference limits for normal children for use of serum ECP in a clinical or research setting.
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Affiliation(s)
- P S Fitch
- Department of Clinical Biochemistry, The Queen's University of Belfast, UK
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Abstract
Several non-invasive biomarkers of inflammation in asthma such as exhaled NO and eosinophil numbers in induced sputum have been developed. Their usefulness in experimental asthma models has been validated but there is less experience in their use in clinical practice. Because specific cooperation may be needed from the patient in producing samples from the airways for assay of biomarkers, younger children may not be suitable. Specific experience in these age groups is required. There remains a need to examine these biomarkers in patients from the mild asymptomatic to the more symptomatic difficult asthmatic in longitudinal studies. Is it useful to monitor these biomarkers as a response to treatment rather than the more conventional measures of symptoms and lung function measurements for prevention of exacerbations and long-term reduction in lung function? Answers to such issues will be crucial in adopting the routine measurement of certain biomarkers from the airways in the assessment of asthma severity and control.
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Affiliation(s)
- K F Chung
- National Heart and Lung Institute, Imperial College School of Medicine, London, UK.
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Abstract
Asthma is a disease characterized by chronic eosinophilic inflammation of the airways. Serum eosinophil cationic protein (ECP) has been increasingly used as a noninvasive inflammatory marker in asthma. The serum ECP level seems to reflect, although indirectly, the intensity of ongoing eosinophilic inflammation of the airways and respond sensitively to intervention, whereas it is unlikely to be useful for establishing the diagnosis of asthma in an individual patient. Monitoring of serum ECP could be of utility in the long-term follow-up of asthmatic patients. However, further longitudinal studies are required to establish the role of serum ECP measurement in the treatment modulation in asthma.
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Affiliation(s)
- A Niimi
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Japan
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Affiliation(s)
- S T Holgate
- Department of Respiratory Medicine, University of Southampton, UK
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