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Conway AE, Lieberman J, Codispoti CD, Mahdavinia M, Anagnostou A, Hsu Blatman KS, Lang DM, Oppenheimer J, Mosnaim GS, Bukstein D, Shaker M. Pharmacoequity and Biologics in the Allergy Clinic: Providing the Right Care, at the Right Time, Every Time, to Everyone. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:1170-1180. [PMID: 38458435 DOI: 10.1016/j.jaip.2024.02.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 02/10/2024] [Accepted: 02/28/2024] [Indexed: 03/10/2024]
Abstract
Pharmacoequity refers to equity in access to pharmacotherapy for all patients and is an especially large barrier to biologic agents in patients with allergic diseases. Value-based care models can prompt clinicians to address social determinants of health, promoting pharmacoequity. Pharmacoequity is influenced by numerous factors including socioeconomic status, which may be mediated through insurance status, educational attainment, and access to specialist care. In addition to lower socioeconomic status, race and ethnicity, age, locations isolated from care systems, and off-label indications for biologic agents all constitute barriers to pharmacoequity. Whereas pharmaco-inequity is more apparent for expensive biologics, it also affects many other allergy treatments including epinephrine autoinjectors and SMART for asthma. Current programs aimed at alleviating cost barriers are imperfect. Patient assistance programs, manufacturer-sponsored free drug programs, and rebates often increase the complexity of care, with resultant inequity, particularly for patients with lower health literacy. Ultimately, single silver-bullet solutions are elusive. Long-term improvement instead requires a combination of research, advocacy, and creative problem-solving to design more intelligent and efficient systems that provide timely access to necessary care for every patient, every time.
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Affiliation(s)
| | - Jay Lieberman
- Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis, Tenn
| | - Christopher D Codispoti
- Department of Internal Medicine, Division of Allergy, Rush University Medical Center, Chicago, Ill
| | - Mahboobeh Mahdavinia
- Department of Internal Medicine, Division of Allergy, Rush University Medical Center, Chicago, Ill
| | | | - Karen S Hsu Blatman
- Section of Allergy and Clinical Immunology, Dartmouth Hitchcock Medical Center, Lebanon, NH; Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH
| | - David M Lang
- Department of Allergy and Clinical Immunology, Cleveland Clinic, Cleveland, Ohio
| | | | - Giselle S Mosnaim
- Division of Allergy and Immunology, Department of Medicine, NorthShore University Health System, Evanston, Ill
| | - Don Bukstein
- Allergy, Asthma, and Sinus Center, Milwaukee, Wis
| | - Marcus Shaker
- Section of Allergy and Clinical Immunology, Dartmouth Hitchcock Medical Center, Lebanon, NH; Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH; Department of Pediatrics, Geisel School of Medicine at Dartmouth, Hanover, NH.
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2
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Sferra SR, Salvi PS, Penikis AB, Weller JH, Canner JK, Guo M, Engwall-Gill AJ, Rhee DS, Collaco JM, Keiser AM, Solomon DG, Kunisaki SM. Racial and Ethnic Disparities in Outcomes Among Newborns with Congenital Diaphragmatic Hernia. JAMA Netw Open 2023; 6:e2310800. [PMID: 37115544 PMCID: PMC10148194 DOI: 10.1001/jamanetworkopen.2023.10800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 03/02/2023] [Indexed: 04/29/2023] Open
Abstract
Importance There is some data to suggest that racial and ethnic minority infants with congenital diaphragmatic hernia (CDH) have poorer clinical outcomes. Objective To determine what patient- and institutional-level factors are associated with racial and ethnic differences in CDH mortality. Design, Setting, and Participants Multicenter cohort study of 49 US children's hospitals using the Pediatric Health Information System database from January 1, 2015, to December 31, 2020. Participants were patients with CDH admitted on day of life 0 who underwent surgical repair. Patient race and ethnicity were guardian-reported vs hospital assigned as Black, Hispanic (White or Black), or White. Data were analyzed from August 2021 to March 2022. Exposures Patient race and ethnicity: (1) White vs Black and (2) White vs Hispanic; and institutional-level diversity (as defined by the percentage of Black and Hispanic patients with CDH at each hospital): (1) 30% or less, (2) 31% to 40%, and (3) more than 40%. Main Outcomes and Measures The primary outcomes were in-hospital and 60-day mortality. The study hypothesized that hospitals managing a more racially and ethnically diverse population of patients with CDH would be associated with lower mortality among Black and Hispanic infants. Results Among 1565 infants, 188 (12%), 306 (20%), and 1071 (68%) were Black, Hispanic, and White, respectively. Compared with White infants, Black infants had significantly lower gestational ages (mean [SD], White: 37.6 [2] weeks vs Black: 36.6 [3] weeks; difference, 1 week; 95% CI for difference, 0.6-1.4; P < .001), lower birthweights (White: 3.0 [1.0] kg vs Black: 2.7 [1.0] kg; difference, 0.3 kg; 95% CI for difference, 0.2-0.4; P < .001), and higher extracorporeal life support use (White: 316 patients [30%] vs Black: 69 patients [37%]; χ21 = 3.9; P = .05). Black infants had higher 60-day (White: 99 patients [9%] vs Black: 29 patients [15%]; χ21 = 6.7; P = .01) and in-hospital (White: 133 patients [12%] vs Black: 40 patients [21%]; χ21 = 10.6; P = .001) mortality . There were no mortality differences in Hispanic patients compared with White patients. On regression analyses, institutional diversity of 31% to 40% in Black patients (hazard ratio [HR], 0.17; 95% CI, 0.04-0.78; P = .02) and diversity greater than 40% in Hispanic patients (HR, 0.37; 95% CI, 0.15-0.89; P = .03) were associated with lower mortality without altering outcomes in White patients. Conclusions and Relevance In this cohort study of 1565 who underwent surgical repair patients with CDH, Black infants had higher 60-day and in-hospital mortality after adjusting for disease severity. Hospitals treating a more racially and ethnically diverse patient population were associated with lower mortality in Black and Hispanic patients.
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Affiliation(s)
- Shelby R. Sferra
- Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Pooja S. Salvi
- Division of Pediatric Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Annalise B. Penikis
- Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jennine H. Weller
- Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joseph K. Canner
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Matthew Guo
- Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Abigail J. Engwall-Gill
- Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Daniel S. Rhee
- Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joseph M. Collaco
- Division of Pediatric Pulmonology, Department of Pediatrics, Johns Hopkins Children’s Center, Baltimore, Maryland
| | - Amaris M. Keiser
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Johns Hopkins Children’s Center, Baltimore, Maryland
| | - Daniel G. Solomon
- Division of Pediatric Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Shaun M. Kunisaki
- Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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3
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Sylvestre S, Kaminsky LW, Al-Shaikhly T. Racial and ethnic disparities in biologic prescriptions for asthma in the United States. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:3309-3311.e1. [PMID: 35995400 PMCID: PMC10028596 DOI: 10.1016/j.jaip.2022.08.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 07/30/2022] [Accepted: 08/02/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Sebastian Sylvestre
- Section of Allergy, Asthma & Immunology, Department of Medicine, Penn State College of Medicine, Hershey, Pa
| | - Lauren W Kaminsky
- Section of Allergy, Asthma & Immunology, Department of Medicine, Penn State College of Medicine, Hershey, Pa
| | - Taha Al-Shaikhly
- Section of Allergy, Asthma & Immunology, Department of Medicine, Penn State College of Medicine, Hershey, Pa.
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Ayakannu R, Abdullah NA, Raj VL, Radhakrishnan AK, Liam CK. Clinical characteristics, cytokine profiles and plasma IgE in adults with asthma. Mol Immunol 2022; 143:50-57. [PMID: 35038659 DOI: 10.1016/j.molimm.2022.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 12/06/2021] [Accepted: 01/10/2022] [Indexed: 12/29/2022]
Abstract
Asthma is a disease with complicated network of inflammatory responses of cytokines and ImmunoglobulinE (IgE). The aim of this study was to explore the clinical characteristics, cytokine profile and plasma IgE in the Malaysian population. This is a cross-sectional study involving physician-diagnosed asthma patients (n = 287) recruited from the Chest Clinic, University of Malaya Medical Centre (UMMC). Blood (8 mL) was taken after consent was obtained. The peripheral blood leucocytes (PBL) were cultured in presence of a mitogen for 72 h to quantify cytokines [Interleukin-5(IL-5), Interleukin-9 (IL-9), Interleukin-12 Beta (IL-12ꞵ) and granulocyte-macrophage colony-stimulating factor (GM-CSF)] and plasma was used to quantify IgE levels with commercial ELISA kits. Results were compared against the same biomarkers in healthy subjects (n = 203). In addition, the amount of the biomarkers in the asthma patients were compared with their disease severity and clinical characteristics. Statistical tests in the SPSS software (Mann-Whitney U test and the Kruskal Wallis) were used to compare cytokine production and plasma IgE levels. The mean plasma IgE level was markedly higher (p < 0.0001) in asthmatics compared to controls. There were higher levels of IL-5, IL-9, IL-12ꞵ and GM-CSF (p < 0.0001) produced by cultured PBL from asthma patients compared to controls. However, our results did not expose a significant association between these cytokine levels and severity and clinical symptoms of asthma. However, there was a marked association between asthma severity and blood lymphocyte count [ꭓ2(2) = 6.745, p < 0.05]. These findings support the roles played by cytokines and IgE in the airway inflammation in asthma. The findings of this study provide new information about inflammatory cytokines in Malaysian asthma patients.
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Affiliation(s)
- Rathimalar Ayakannu
- Department of Medicine, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia; Department of Pharmacology, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - Nor Azizan Abdullah
- Department of Pharmacology, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia.
| | - Vijaya Lechimi Raj
- Faculty of Medicine, Bioscience & Nursing, MAHSA University, Jalan SP 2, Bandar Saujana Putra, 42610, Jenjarom, Selangor, Malaysia
| | - Ammu K Radhakrishnan
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Jalan Lagoon Selatan, 47500, Bandar Sunway, Selangor, Malaysia
| | - Chong Kin Liam
- Department of Medicine, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
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5
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Keaton JM, Jasper EA, Hellwege JN, Jones SH, Torstenson ES, Edwards TL, Velez Edwards DR. Evidence that geographic variation in genetic ancestry associates with uterine fibroids. Hum Genet 2021; 140:1433-1440. [PMID: 34302236 PMCID: PMC8463481 DOI: 10.1007/s00439-021-02322-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 07/18/2021] [Indexed: 12/21/2022]
Abstract
Uterine fibroids disproportionately impact Black women. Evidence suggests Black women have earlier onset and higher cumulative risk. This risk disparity may be due an imbalance of risk alleles in one parental geographic ancestry subgroup relative to others. We investigated ancestry proportions for the 1000 Genomes phase 3 populations clustered into 6 geographic groups for association with fibroid traits in Black women (n=583 cases, 797 controls) and White women (n=1,195 cases, 1,164 controls). Global ancestry proportions were estimated using ADMIXTURE. Dichotomous (fibroids status and multiple fibroid status) and continuous outcomes (volume and largest dimension) were modeled for association with ancestry proportions using logistic and linear regression adjusting for age. Effect estimates are reported per 10% increase in genetically inferred ancestry proportion. Among AAs, West African (WAFR) ancestry was associated with fibroid risk, East African ancestry was associated with risk of multiple fibroids, Northern European (NEUR) ancestry was protective for multiple fibroids, Southern European ancestry was protective for fibroids and multiple fibroids, and South Asian (SAS) ancestry was positively associated with volume and largest dimension. In EAs, NEUR ancestry was protective for fibroids, SAS ancestry was associated with fibroid risk, and WAFR ancestry was positively associated with volume and largest dimension. These results suggest that a proportion of fibroid risk and fibroid trait racial disparities are due to genetic differences between geographic groups. Further investigation at the local ancestry and single variant levels may yield novel insights about disease architecture and genetic mechanisms underlying ethnic disparities in fibroid risk.
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Affiliation(s)
- Jacob M Keaton
- Center for Precision Health Research, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA.,Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Elizabeth A Jasper
- Vanderbilt Genetics Institute, Vanderbilt University, Nashville, TN, USA.,Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, 37203, USA
| | - Jacklyn N Hellwege
- Vanderbilt Genetics Institute, Vanderbilt University, Nashville, TN, USA.,Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.,Vanderbilt Epidemiology Center, Vanderbilt University, Nashville, TN, USA
| | - Sarah H Jones
- Vanderbilt Epidemiology Center, Vanderbilt University, Nashville, TN, USA
| | - Eric S Torstenson
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.,Vanderbilt Genetics Institute, Vanderbilt University, Nashville, TN, USA
| | - Todd L Edwards
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.,Vanderbilt Genetics Institute, Vanderbilt University, Nashville, TN, USA.,Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Digna R Velez Edwards
- Vanderbilt Genetics Institute, Vanderbilt University, Nashville, TN, USA. .,Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN, USA. .,Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, 37203, USA. .,Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA.
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6
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Kirenga B, Chakaya J, Yimer G, Nyale G, Haile T, Muttamba W, Mugenyi L, Katagira W, Worodria W, Aanyu-Tukamuhebwa H, Lugogo N, Joloba M, Bekele A, Makumbi F, Green C, de Jong C, Kamya M, van der Molen T. Phenotypic characteristics and asthma severity in an East African cohort of adults and adolescents with asthma: findings from the African severe asthma project. BMJ Open Respir Res 2021; 7:7/1/e000484. [PMID: 32054641 PMCID: PMC7047479 DOI: 10.1136/bmjresp-2019-000484] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 01/16/2020] [Accepted: 01/23/2020] [Indexed: 12/20/2022] Open
Abstract
RATIONALE The relationship between clinical and biomarker characteristics of asthma and its severity in Africa is not well known. METHODS Using the Expert Panel Report 3, we assessed for asthma severity and its relationship with key phenotypic characteristics in Uganda, Kenya and Ethiopia. The characteristics included adult onset asthma, family history of asthma, exposures (smoking and biomass), comorbidities (HIV, hypertension, obesity, tuberculosis (TB), rhinosinusitis, gastro-oesophageal disease (GERD) and biomarkers (fractional exhaled nitric oxide (FeNO), skin prick test (SPT) and blood eosinophils). We compared these characteristics on the basis of severity and fitted a multivariable logistic regression model to assess the independent association of these characteristics with asthma severity. RESULTS A total of 1671 patients were enrolled, 70.7% women, with median age of 40 years. The prevalence of intermittent, mild persistent, moderate persistent and severe persistent asthma was 2.9%, 19.9%, 42.6% and 34.6%, respectively. Only 14% were on inhaled corticosteroids (ICS). Patients with severe persistent asthma had a higher rate of adult onset asthma, smoking, HIV, history of TB, FeNO and absolute eosinophil count but lower rates of GERD, rhinosinusitis and SPT positivity. In the multivariate model, Ethiopian site and a history of GERD remained associated with asthma severity. DISCUSSION The majority of patients in this cohort presented with moderate to severe persistent asthma and the use of ICS was very low. Improving access to ICS and other inhaled therapies could greatly reduce asthma morbidity in Africa.
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Affiliation(s)
- Bruce Kirenga
- College of Health Sciences, Makerere University, Kampala, Uganda
| | - Jeremiah Chakaya
- Kenya Association of Physicians against TB and Lung Diseases (KAPTLD), Nairobi, Kenya
| | - Getnet Yimer
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - George Nyale
- Department of Medicine, Kenyatta National Hospital, Nairobi, Kenya
| | - Tewodros Haile
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Winters Muttamba
- Lung Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Levicatus Mugenyi
- Lung Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Winceslaus Katagira
- Lung Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - William Worodria
- Mulago National Referral Hospital, Uganda Ministry of Health, Kampala, Uganda
| | | | - Njira Lugogo
- Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Moses Joloba
- College of Health Sciences, Makerere University, Kampala, Uganda
| | - Amsalu Bekele
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Fred Makumbi
- College of Health Sciences, Makerere University, Kampala, Uganda
| | - Cindy Green
- Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Corina de Jong
- Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Moses Kamya
- College of Health Sciences, Makerere University, Kampala, Uganda
| | - Thys van der Molen
- University Medical Center Groningen (UMCG), University of Groningen, Groningen, Netherlands
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Yoon J, Eom EJ, Kim JT, Lim DH, Kim WK, Song DJ, Yoo Y, Suh DI, Baek HS, Shin M, Kwon JW, Jang GC, Yang HJ, Lee E, Kim HS, Seo JH, Woo SI, Kim HY, Shin YH, Lee JS, Jung S, Han M, Yu J. Heterogeneity of Childhood Asthma in Korea: Cluster Analysis of the Korean Childhood Asthma Study Cohort. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2021; 13:42-55. [PMID: 33191676 PMCID: PMC7680825 DOI: 10.4168/aair.2021.13.1.42] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 06/22/2020] [Accepted: 07/08/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE Asthma is a heterogeneous airway disease occurring in children, and it has various clinical phenotypes. A clear differentiation of the clinical phenotypes can provide better asthma management and prediction of asthma prognosis. Little is currently known about asthma phenotypes in Korean children. This study was designed to identify asthma phenotypes in school-aged Korean children. METHODS This study enrolled 674 children with physician-diagnosed asthma from the Korean childhood Asthma Study (KAS) cohort. The physicians verified the relevant histories of asthma and comorbid diseases, as well as airway lability and hyper-responsiveness from the results of pulmonary function tests and bronchial provocation tests. Questionnaires regarding the participants' baseline characteristics, their environment and self-rating of asthma control were collected at the time of enrollment. Laboratory tests were performed to assess allergy and airway inflammation. Children with asthma were classified by hierarchical cluster analysis. RESULTS Of the 674 patients enrolled from the KAS cohort, 447 were included in the cluster analysis. Cluster analysis of these 447 children revealed 4 asthma phenotypes: cluster 1 (n = 216, 48.3%) which was characterized by male-dominant atopic asthma; cluster 2 (n = 79, 17.7%) which was characterized by early-onset atopic asthma with atopic dermatitis; cluster 3 (n = 47, 10.5%) which was characterized by puberty-onset, female-dominant atopic asthma with the low lung function; and cluster 4 (n = 105, 23.5%) which was characterized by early-onset, non-atopic dominant asthma. CONCLUSIONS The asthma phenotypes among Korean children can be classified into 4 distinct clusters. Long-term follow-up with these phenotypes will be needed to define their prognosis and response to treatment.
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Affiliation(s)
- Jisun Yoon
- Department of Pediatrics, Mediplex Sejong Hospital, Incheon, Korea
| | - Eun Jin Eom
- Asan Institute for Life Sciences, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin Tack Kim
- Department of Pediatrics, School of Medicine, The Catholic University of Korea, Uijeongbu St. Mary's hospital, Uijeongbu, Korea
| | - Dae Hyun Lim
- Department of Pediatrics, College of Medicine, Inha University, Incheon, Korea
| | - Woo Kyung Kim
- Department of Pediatrics, Inje University Seoul Paik Hospital, Seoul, Korea
| | - Dae Jin Song
- Department of Pediatrics, Korea University Guro Hospital, Seoul, Korea
| | - Young Yoo
- Department of Pediatrics, Korea University Anam Hospital, Seoul, Korea
| | - Dong In Suh
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Hey Sung Baek
- Department of Pediatrics, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Meeyong Shin
- Department of Pediatrics, Soonchunhyang University School of Medicine, Bucheon, Korea
| | - Ji Won Kwon
- Department of Pediatrics, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Gwang Cheon Jang
- Department of Pediatrics, National Health Insurance Service Ilsan Hospital, Ilsan, Korea
| | - Hyeon Jong Yang
- Department of Pediatrics, Pediatric Allergy and Respiratory Center, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Eun Lee
- Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Hwan Soo Kim
- Department of Pediatrics, School of Medicine, The Catholic University of Korea, Bucheon St. Mary's Hospital, Bucheon, Korea
| | - Ju Hee Seo
- Department of Pediatrics, Dankook University Hospital, Cheonan, Korea
| | - Sung Il Woo
- Department of Pediatrics, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Hyung Young Kim
- Department of Pediatrics, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Youn Ho Shin
- Department of Pediatrics, Gangnam CHA Medical Center, CHA University School of Medicine, Seoul, Korea
| | - Ju Suk Lee
- Department of Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Sungsu Jung
- Department of Pediatrics, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Minkyu Han
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, Seoul, Korea
| | - Jinho Yu
- Department of Pediatrics, Childhood Asthma Atopy Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Yamamoto-Hanada K, Pak K, Saito-Abe M, Yang L, Sato M, Irahara M, Mezawa H, Sasaki H, Nishizato M, Ishitsuka K, Ohya Y. Allergy and immunology in young children of Japan: The JECS cohort. World Allergy Organ J 2020; 13:100479. [PMID: 33204389 PMCID: PMC7652713 DOI: 10.1016/j.waojou.2020.100479] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/30/2020] [Accepted: 10/12/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Capturing epidemiological signatures is essential to document burdens of disease and to design health care services, including prevention measures, clinical interventions, and policies. There are large geographical and ethnic variations in the epidemiology of allergic and immunological diseases. Various data are available from North America and Europe, but the epidemiology of allergic and immunological diseases in Asia is not well documented. OBJECTIVE To characterize epidemiological signatures of allergic and immunological disease in young children in Japan. METHODS This was a national, multicenter, prospective birth cohort study: Japan Environment and Children's Study (JECS). A general population of 103,060 women was enrolled during pregnancy. Allergic and immunological outcomes were assessed among young children using questionnaire data. RESULTS The prevalence of caregiver-reported immediate food allergy was 7.6%, 6.7%, and 4.9% at age 1, 2, and 3 years, respectively. Hen egg allergy was most common (5.4% prevalence at age 1 year) followed by allergies to cow milk and wheat. Several patterns of allergic symptom clusters were identified. Physician diagnosed, as reported by the caregiver, non-IgE mediated gastrointestinal food allergy affected 0.5% of infants. By contrast, caregiver-reported gastrointestinal food allergies affected 1.4% of children. Kawasaki disease affected 0.3% and 0.4% children, respectively, at age 1 and 3 years. Primary immunodeficiency disorders affected 0.005% children at age 3 years. CONCLUSION These data provide important epidemiological signatures of allergy and immunology in young Japanese children including the age-specific prevalence of allergic disease, Kawasaki disease, and primary immune deficiency.
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Affiliation(s)
- Kiwako Yamamoto-Hanada
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
- Medical Support Center for the Japan Environment and Children's Study, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Kyongsun Pak
- Division of Biostatistics, Department of Data Management, Center for Clinical Research and Development, National Center for Child Health and Development, Tokyo, Japan
| | - Mayako Saito-Abe
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
- Medical Support Center for the Japan Environment and Children's Study, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Limin Yang
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
- Medical Support Center for the Japan Environment and Children's Study, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Miori Sato
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
- Medical Support Center for the Japan Environment and Children's Study, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Makoto Irahara
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
- Medical Support Center for the Japan Environment and Children's Study, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Hidetoshi Mezawa
- Medical Support Center for the Japan Environment and Children's Study, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Hatoko Sasaki
- Medical Support Center for the Japan Environment and Children's Study, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Minaho Nishizato
- Medical Support Center for the Japan Environment and Children's Study, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Kazue Ishitsuka
- Medical Support Center for the Japan Environment and Children's Study, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Yukihiro Ohya
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
- Medical Support Center for the Japan Environment and Children's Study, National Research Institute for Child Health and Development, Tokyo, Japan
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9
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Kelly RS, Chawes BL, Guo F, Zhang L, Blighe K, Litonjua AA, Raby BA, Levy BD, Rago D, Stokholm J, Bønnelykke K, Bisgaard H, Zhou X, Lasky-Su JA, Weiss ST. The role of the 17q21 genotype in the prevention of early childhood asthma and recurrent wheeze by vitamin D. Eur Respir J 2019; 54:13993003.00761-2019. [PMID: 31439681 DOI: 10.1183/13993003.00761-2019] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 07/18/2019] [Indexed: 02/05/2023]
Abstract
Evidence suggests vitamin D has preventive potential in asthma; however, not all children benefit from this intervention. This study aimed to investigate whether variation in the functional 17q21 single nucleotide polymorphism rs12936231 affects the preventive potential of vitamin D against asthma.A combined secondary analysis of two randomised controlled trials of prenatal vitamin D supplementation for the prevention of asthma in offspring (Vitamin D Antenatal Asthma Reduction Trial (VDAART) and Copenhagen Prospective Studies on Asthma in Childhood 2010 (COPSAC2010)) was performed, stratifying by genotype and integrating metabolite data to explore underlying mechanisms.The protective effect of vitamin D on asthma/wheeze was evident among children with the low-risk rs12936231 GG genotype (hazard ratio (HR) 0.49, 95% CI 0.26-0.94, p=0.032) but not the high-risk CC genotype (HR 1.08, 95% CI 0.69-1.69, p=0.751). In VDAART, in the GG genotype vitamin D supplementation was associated with increased plasma levels of sphingolipids, including sphingosine-1-phosphate (β 0.022, 95% CI 0.001-0.044, p=0.038), but this was not evident with the CC genotype, known to be associated with increased expression of ORMDL3 in bronchial epithelial cells. Sphingolipid levels were associated with decreased risk of asthma/wheeze, and there was evidence of interactions between sphingolipid levels, vitamin D and genotype (p-interactionvitaminD*genotype*sphingosine-1-phosphate=0.035). In a cellular model, there was a significant difference in the induction of sphingosine-1-phosphate by vitamin D between a control human bronchial epithelial cell line and a cell line overexpressing ORMDL3 (p=0.002).Results suggest prenatal vitamin D supplementation may reduce the risk of early childhood asthma/wheeze via alterations of sphingolipid metabolism dependent on the 17q21 genotype.
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Affiliation(s)
- Rachel S Kelly
- Channing Division of Network Medicine, Dept of Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Co-first authors
| | - Bo L Chawes
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.,Co-first authors
| | - Feng Guo
- Channing Division of Network Medicine, Dept of Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Li Zhang
- Channing Division of Network Medicine, Dept of Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Dept of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, PR China
| | - Kevin Blighe
- Channing Division of Network Medicine, Dept of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Augusto A Litonjua
- Pulmonary Division, Dept of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Benjamin A Raby
- Channing Division of Network Medicine, Dept of Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Pulmonary and Critical Care Medicine, Dept of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Bruce D Levy
- Harvard Medical School, Boston, MA, USA.,Pulmonary and Critical Care Medicine, Dept of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Daniela Rago
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jakob Stokholm
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Klaus Bønnelykke
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Hans Bisgaard
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Xiaobo Zhou
- Channing Division of Network Medicine, Dept of Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Jessica A Lasky-Su
- Channing Division of Network Medicine, Dept of Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Co-senior authors
| | - Scott T Weiss
- Channing Division of Network Medicine, Dept of Medicine, Brigham and Women's Hospital, Boston, MA, USA .,Harvard Medical School, Boston, MA, USA.,Co-senior authors
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10
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da Silva TM, Fiaccone RL, Kehdy FSG, Tarazona-Santos E, Rodrigues LC, Costa GNO, Figueiredo CA, Dos Santos DN, Feitosa CA, Fattore GL, Santos LM, Alcantara-Neves NM, Cruz ÁA, Barreto ML. African biogeographical ancestry, atopic and non-atopic asthma and atopy: A study in Latin American children. Pediatr Pulmonol 2019; 54:125-132. [PMID: 30548437 DOI: 10.1002/ppul.24213] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 11/03/2018] [Indexed: 11/06/2022]
Abstract
BACKGROUND Genetic variants underlying African ancestry have been suggested be implicated in the ethnic-racial inequalities reported for asthma and allergies. OBJECTIVES To investigate the association between individual African ancestry and asthma symptoms, atopic and non-atopic asthma, and atopy in children. METHODS A cross-sectional study encompassing 1190 individuals was conducted. African biogeographic ancestry was estimated using 370 539 genome-wide SNPs. Serum levels of specific IgE were measured, and skin prick test (SPT) performed for the most common local aeroallergens. Information on asthma symptoms was obtained by applying the International Study of Allergy and Asthma in Childhood questionnaire. The associations between the proportion of individual African ancestry and the outcomes investigated were analyzed through multivariate models adjusted for socio-environmental variables, infections markers, and psychosocial factors. RESULTS Each 20% increase in the proportion of African ancestry was negatively associated with SPT reactivity (OR: 0.79, 95%CI: 0.66-0.96) and positively associated with asthma symptoms in non-atopic individuals (OR: 1.40, 95%CI: 1.03-1.89). We estimated that socioeconomic status and number of infections mediated 28.4% of the effect of African ancestry on SPT reactivity, while 20.2% of the effect on non-atopic asthma was explained by socioeconomic status and behavioral problems in children. CONCLUSIONS The negative association observed between African ancestry and atopy is most probably explained by unobserved environmental or social factors that covariate with ancestry. For non-atopic asthma, in turn, putative genetic variants of risk underlying African ancestry may play some role.
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Affiliation(s)
- Thiago M da Silva
- Institute of Collective Health, Federal University of Bahia, Salvador, Bahia, Brazil.,Departamento de Ciências Biológicas, Universidade Estadual do Sudoeste da Bahia, Jequié, Bahia, Brazil
| | - Rosemeire L Fiaccone
- Departamento de Estatística, Instituto de Matemática, Universidade Federal da Bahia, Salvador, Bahia, Brazil.,Center of Data and Knowledge Integration for Health, Instituto Gonçalo Muniz, Fundação Osvaldo Cruz, Salvador, Brazil
| | - Fernanda S G Kehdy
- Laboratório de Hanseníase, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de, Janeiro, Brazil
| | - Eduardo Tarazona-Santos
- Departamento de Biologia Geral, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Laura C Rodrigues
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Gustavo N O Costa
- Institute of Collective Health, Federal University of Bahia, Salvador, Bahia, Brazil.,Center of Data and Knowledge Integration for Health, Instituto Gonçalo Muniz, Fundação Osvaldo Cruz, Salvador, Brazil
| | - Camila A Figueiredo
- Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Darci N Dos Santos
- Institute of Collective Health, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Caroline A Feitosa
- Institute of Collective Health, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Gisel L Fattore
- Institute of Collective Health, Federal University of Bahia, Salvador, Bahia, Brazil.,Departamento de Salud Comunitaria, Universidad Nacional de Lanús, Buenos Aires, Argentina
| | - Leticia M Santos
- Institute of Collective Health, Federal University of Bahia, Salvador, Bahia, Brazil
| | | | - Álvaro A Cruz
- ProAR-Center of Excellence in Asthma, Federal University of Bahia School of Medicine, Salvador, Brazil
| | - Maurício L Barreto
- Institute of Collective Health, Federal University of Bahia, Salvador, Bahia, Brazil.,Center of Data and Knowledge Integration for Health, Instituto Gonçalo Muniz, Fundação Osvaldo Cruz, Salvador, Brazil
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11
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Oh H, Stickley A, Singh F, Koyanagi A. Self-reported asthma diagnosis and mental health: Findings from the Collaborative Psychiatric Epidemiology Surveys. Psychiatry Res 2019; 271:721-725. [PMID: 30791347 DOI: 10.1016/j.psychres.2018.12.046] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 12/06/2018] [Accepted: 12/06/2018] [Indexed: 12/27/2022]
Abstract
Historically, asthma has had a mixed association with mental health. More research is needed to examine the associations between asthma and specific psychiatric disorders, and whether these associations hold true across racial groups in the general population of the United States. Using the Collaborative Psychiatric Epidemiology Surveys, we examined the associations between lifetime asthma and specific DSM-IV psychiatric disorders, adjusting for sociodemographic characteristics and smoking status. We found that when looking at the entire sample, self-reported diagnosis of asthma was associated with greater odds of reporting mood disorders (AOR: 1.36; 95% CI: 1.05-1.74). Asthma was not significantly associated with total anxiety disorders (AOR 1.25; 95% CI: 0.98-1.60), though it was specifically associated with generalized anxiety disorder. Asthma was associated with greater odds of having alcohol use disorders (AOR: 1.71; 95% CI: 1.24-2.37), but was not associated with total eating disorders (AOR:1.36; 95% CI: 1.17-2.51) (though it was significantly associated with higher odds for binge eating disorder, but lower odds of reporting bulimia). The strength and the significance of the associations between asthma and psychiatric disorders varied when stratified by race, underscoring the importance of examining race as a potential explanation for the mixed findings observed previously in the literature.
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Affiliation(s)
- Hans Oh
- University of Southern California, School of Social Work, 669W. 34 th St., University of Southern California, Los Angeles, CA 90089 - 0411.
| | - Andrew Stickley
- The Stockholm Center for Health and Social Change (SCOHOST), Södertörn University, Huddinge, 141 89, Sweden; Department of Preventive Intervention for Psychiatric Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashicho, Kodaira, Tokyo 1878553, Japan
| | - Fiza Singh
- University of California, San Diego, Department of Psychiatry, 9500 Gilman Drive, La Jolla, CA 92093-0810, USA
| | - Ai Koyanagi
- Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Deu, Barcelona, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona 08830, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Monforte de Lemos 3-5 Pabellón 11, Madrid 28029, Spain
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12
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What Ancestry Can Tell Us About the Genetic Origins of Inter-Ethnic Differences in Asthma Expression. Curr Allergy Asthma Rep 2017; 16:53. [PMID: 27393700 DOI: 10.1007/s11882-016-0635-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Differences in asthma prevalence have been described across different populations, suggesting that genetic ancestry can play an important role in this disease. In fact, several studies have demonstrated an association between African ancestry with increased asthma susceptibility and severity, higher immunoglobulin E levels, and lower lung function. In contrast, Native American ancestry has been shown to have a protective role for this disease. Genome-wide association studies have allowed the identification of population-specific genetic variants with varying allele frequency among populations. Additionally, the correlation of genetic ancestry at the chromosomal level with asthma and related traits by means of admixture mapping has revealed regions of the genome where ancestry is correlated with the disease. In this review, we discuss the evidence supporting the association of genetic ancestry with asthma susceptibility and asthma-related traits, and highlight the regions of the genome harboring ancestry-specific genetic risk factors.
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13
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Hughes HK, Matsui EC, Tschudy MM, Pollack CE, Keet CA. Pediatric Asthma Health Disparities: Race, Hardship, Housing, and Asthma in a National Survey. Acad Pediatr 2017; 17:127-134. [PMID: 27876585 PMCID: PMC5337434 DOI: 10.1016/j.acap.2016.11.011] [Citation(s) in RCA: 117] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 11/04/2016] [Accepted: 11/12/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE We sought to determine if racial disparities in pediatric asthma are explained by material hardship and home ownership. METHODS We performed a secondary analysis of the 2011 American Housing Survey. A total of 33,201 households with children age 6 to 17 years were surveyed regarding childhood asthma diagnosis and emergency department (ED) visits for asthma (for the youngest child with asthma in the household). Material hardship included poor housing quality, housing crowding, lack of amenities, and no vehicle access. We used logistic regression to determine the association between race, material hardship, and asthma diagnosis or ED visits, adjusting for potential confounders. RESULTS Non-Hispanic black heads of household had a higher odds of having a child diagnosed with asthma in the home compared with non-Hispanic white heads of household (odds ratio, 1.72; 95% confidence interval [CI], 1.50-1.96), and a higher odds of ED visits for asthma (odds ratio, 3.02; 95% CI, 2.29-3.99). The race-asthma association was decreased but not eliminated after adjusting for material hardship and home ownership (ED visit adjusted odds ratio [AOR], 2.07; 95% CI, 1.50-2.86). Poor housing quality was independently associated with asthma diagnosis (AOR, 1.45; 95% CI, 1.28-1.66) and ED visits (AOR, 1.59; 95% CI, 1.21-2.10). Home ownership was associated with a lower odds of asthma-related ED visits (AOR, 0.62; 95% CI, 0.46-0.84). CONCLUSIONS Observed racial disparities in pediatric asthma are lessened after controlling for material hardship. Poor housing quality in particular is strongly associated with asthma morbidity. Policy makers could target improving housing quality as a means of potentially reducing asthma disparities.
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Affiliation(s)
- Helen K Hughes
- Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Md.
| | - Elizabeth C Matsui
- Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Md
| | - Megan M Tschudy
- Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Md
| | - Craig E Pollack
- Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, Md
| | - Corinne A Keet
- Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Md
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14
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Greenblatt R, Mansour O, Zhao E, Ross M, Himes BE. Gender-specific determinants of asthma among U.S. adults. Asthma Res Pract 2017; 3:2. [PMID: 28138394 PMCID: PMC5259982 DOI: 10.1186/s40733-017-0030-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 01/05/2017] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Asthma, a chronic respiratory disease affecting over 18.7 million American adults, has marked disparities by gender, race/ethnicity and socioeconomic status. Our goal was to identify gender-specific demographic and socioeconomic determinants of asthma prevalence among U.S. adults using data from the Behavioral Risk Factors Surveillance System (BRFSS) and the National Health and Nutrition Examination Survey (NHANES). METHODS Gender-specific regression analyses were performed to model the relationship between asthma prevalence with age, race/ethnicity, income, education level, smoking status, and body mass index (BMI), while taking into account the study designs. RESULTS Based on BRFSS data from 1,003,894 respondents, weighted asthma prevalence was 6.2% in males and 10.6% in females. Asthma prevalence among grade 2 obese and grade 3 obese vs. not overweight or obese women was 2.5 and 3.5 times higher, respectively, while that in men was 1.7 and 2.4 times higher; asthma prevalence among current vs. never smoker women was 1.4 times higher, while that in men was 1.1 times higher. Similar results were obtained with NHANES data from 13,364 respondents: asthma prevalence among grade 2 obese and grade 3 obese vs. not overweight or obese respondents was 2.0 and 3.3 times higher for women, though there was no significant difference for men; asthma prevalence among current vs. never smokers was 1.8 times higher for women and not significantly different in men. Asthma prevalence by race/ethnicity and income levels did not differ considerably between men and women. CONCLUSIONS Our results underscore the importance of obesity and smoking as modifiable asthma risk factors that most strongly affect women.
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Affiliation(s)
- Rebecca Greenblatt
- Department of Biostatistics and Epidemiology, University of Pennsylvania, 219 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104 USA
| | - Omar Mansour
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21218 USA
| | - Edward Zhao
- Department of Biostatistics and Epidemiology, University of Pennsylvania, 219 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104 USA
| | - Michelle Ross
- Department of Biostatistics and Epidemiology, University of Pennsylvania, 219 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104 USA
| | - Blanca E Himes
- Department of Biostatistics and Epidemiology, University of Pennsylvania, 219 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104 USA
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15
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Neeland MR, Martino DJ, Allen KJ. The role of gene-environment interactions in the development of food allergy. Expert Rev Gastroenterol Hepatol 2016; 9:1371-8. [PMID: 26357960 DOI: 10.1586/17474124.2015.1084873] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The rates of IgE-mediated food allergy have increased globally, particularly in developed countries. The rising incidence is occurring more rapidly than changes to the genome sequence would allow, suggesting that environmental exposures that alter the immune response play an important role. Genetic factors may also be used to predict an increased predisposition to these environmental risk factors, giving rise to the concept of gene-environment interactions, whereby differential risk of environmental exposures is mediated through the genome. Increasing evidence also suggests a role for epigenetic mechanisms, which are sensitive to environmental exposures, in the development of food allergy. This paper discusses the current state of knowledge regarding the environmental and genetic risk factors for food allergy and how environmental exposures may interact with immune genes to modify disease risk or outcome.
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Affiliation(s)
- Melanie R Neeland
- a 1 Centre of Food and Allergy Research, Murdoch Childrens Research Institute, The Royal Children's Hospital, 50 Flemington Road, Parkville 3052, Victoria, Australia
| | - David J Martino
- a 1 Centre of Food and Allergy Research, Murdoch Childrens Research Institute, The Royal Children's Hospital, 50 Flemington Road, Parkville 3052, Victoria, Australia.,b 2 Department of Paediatrics, The University of Melbourne, Melbourne, Australia
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16
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Russell SB, Smith JC, Huang M, Trupin JS, Williams SM. Pleiotropic Effects of Immune Responses Explain Variation in the Prevalence of Fibroproliferative Diseases. PLoS Genet 2015; 11:e1005568. [PMID: 26540410 PMCID: PMC4634921 DOI: 10.1371/journal.pgen.1005568] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Many diseases are differentially distributed among human populations. Differential selection on genetic variants in ancestral environments that coincidentally predispose to disease can be an underlying cause of these unequal prevalence patterns. Selected genes may be pleiotropic, affecting multiple phenotypes and resulting in more than one disease or trait. Patterns of pleiotropy may be helpful in understanding the underlying causes of an array of conditions in a population. For example, several fibroproliferative diseases are more prevalent and severe in populations of sub-Saharan ancestry. We propose that this disparity is due to selection for an enhanced Th2 response that confers resistance to helminthic infections, and concurrently increases susceptibility to fibrosis due to the profibrotic action of Th2 cytokines. Many studies on selection of Th2-related genes for host resistance to helminths have been reported, but the pleiotropic impact of this selection on the distribution of fibrotic disorders has not been explicitly investigated. We discuss the disproportionate occurrence of fibroproliferative diseases in individuals of African ancestry and provide evidence that adaptation of the immune system has shaped the genetic structure of these human populations in ways that alter the distribution of multiple fibroproliferative diseases.
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Affiliation(s)
- Shirley B. Russell
- Vanderbilt Genetics Institute, Division of Dermatology, Department of Medicine, Vanderbilt University, Nashville, Tennessee, United States of America
- * E-mail: (SBR); , (SMW)
| | - Joan C. Smith
- Meharry Medical College, Nashville, Tennessee, United States of America
| | - Minjun Huang
- Department of Genetics, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, United States of America
| | - Joel S. Trupin
- Meharry Medical College, Nashville, Tennessee, United States of America
| | - Scott M. Williams
- Department of Genetics, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, United States of America
- * E-mail: (SBR); , (SMW)
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17
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Yildiz F, Mungan D, Gemicioglu B, Yorgancioglu A, Dursun B, Oner Erkekol F, Ogus C, Turktas H, Bogatekin G, Topcu F, Deveci F, Bayram H, Tor M, Kalyoncu AF. Asthma phenotypes in Turkey: a multicenter cross-sectional study in adult asthmatics; PHENOTURK study. CLINICAL RESPIRATORY JOURNAL 2015; 11:210-223. [PMID: 26073091 DOI: 10.1111/crj.12326] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 05/14/2015] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND AIMS To evaluate asthma phenotypes in patients with asthma from different regions of Turkey. METHODS A total of 1400 adult asthmatic patients (mean (SD) age: 44.0 (13.9) years, 75% females) from 14 centers across Turkey were included in this study and a standard questionnaire was applied between the time period of February 2011-January 2012. RESULTS The disease onset ≥ 40 years of age was higher percentage in obese vs. normal/overweight patients and nonallergic vs. allergic patients (P < 0.01). The percentage of patients who had FEV1 values over 80% was higher in allergic than nonallergic and normal/overweight than obese patients (P < 0.01). Uncontrolled asthmatics have more severe disease (P < 0.01). There were more frequent hospital admissions in nonallergic and uncontrolled asthmatics (P < 0.01). Chronic rhino-sinusitis was the leading comorbid disorder in normal/overweight and allergic asthma, while gastroesophageal reflux disorder was more frequent in nonallergic and uncontrolled asthma (P < 0.01). Asthma control rate was the highest (39.0%) in patients from Marmara region among all geographical regions (P < 0.05). CONCLUSION In conclusion, our findings revealed existence of clinical/trigger related phenotypes based on BMI, allergic status, control level and geographical region with more frequent respiratory dysfunction and/or adverse health outcomes in uncontrolled, obese and nonallergic phenotypes.
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Affiliation(s)
- Fusun Yildiz
- Pulmonary Diseases Department, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Dilsad Mungan
- Department of Allergy, Ankara University School of Medicine, Ankara, Turkey
| | - Bilun Gemicioglu
- Pulmonary Diseases Department, Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Arzu Yorgancioglu
- Pulmonary Diseases Department, Celal Bayar University School of Medicine, Manisa, Turkey
| | - Berna Dursun
- Pulmonary Diseases Department, Recep Tayyip Erdoğan University School of Medicine, Rize, Turkey
| | - Ferda Oner Erkekol
- Department of Allergy, Ataturk Chest Diseases and Thoracic Surgery Research Hospital, Ankara, Turkey
| | - Candan Ogus
- Pulmonary Diseases Department, Akdeniz University School of Medicine, Antalya, Turkey
| | - Haluk Turktas
- Pulmonary Diseases Department, Gazi University School of Medicine, Ankara, Turkey
| | | | - Fusun Topcu
- Pulmonary Diseases Department, Dicle University School of Medicine, Diyarbakir, Turkey
| | - Figen Deveci
- Pulmonary Diseases Department, Firat University School of Medicine, Elazig, Turkey
| | - Hasan Bayram
- Pulmonary Diseases Department, Gaziantep University School of Medicine, Gaziantep, Turkey
| | - Meltem Tor
- Pulmonary Diseases Department, Bulent Ecevit University School of Medicine, Zonguldak, Turkey
| | - A Fuat Kalyoncu
- Department of Allergy, Hacettepe University School of Medicine, Ankara, Turkey
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18
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Pino-Yanes M, Gignoux CR, Galanter JM, Levin AM, Campbell CD, Eng C, Huntsman S, Nishimura KK, Gourraud PA, Mohajeri K, O'Roak BJ, Hu D, Mathias RA, Nguyen EA, Roth LA, Padhukasahasram B, Moreno-Estrada A, Sandoval K, Winkler CA, Lurmann F, Davis A, Farber HJ, Meade K, Avila PC, Serebrisky D, Chapela R, Ford JG, Lenoir MA, Thyne SM, Brigino-Buenaventura E, Borrell LN, Rodriguez-Cintron W, Sen S, Kumar R, Rodriguez-Santana JR, Bustamante CD, Martinez FD, Raby BA, Weiss ST, Nicolae DL, Ober C, Meyers DA, Bleecker ER, Mack SJ, Hernandez RD, Eichler EE, Barnes KC, Williams LK, Torgerson DG, Burchard EG. Genome-wide association study and admixture mapping reveal new loci associated with total IgE levels in Latinos. J Allergy Clin Immunol 2014; 135:1502-10. [PMID: 25488688 DOI: 10.1016/j.jaci.2014.10.033] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 09/06/2014] [Accepted: 10/15/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND IgE is a key mediator of allergic inflammation, and its levels are frequently increased in patients with allergic disorders. OBJECTIVE We sought to identify genetic variants associated with IgE levels in Latinos. METHODS We performed a genome-wide association study and admixture mapping of total IgE levels in 3334 Latinos from the Genes-environments & Admixture in Latino Americans (GALA II) study. Replication was evaluated in 454 Latinos, 1564 European Americans, and 3187 African Americans from independent studies. RESULTS We confirmed associations of 6 genes identified by means of previous genome-wide association studies and identified a novel genome-wide significant association of a polymorphism in the zinc finger protein 365 gene (ZNF365) with total IgE levels (rs200076616, P = 2.3 × 10(-8)). We next identified 4 admixture mapping peaks (6p21.32-p22.1, 13p22-31, 14q23.2, and 22q13.1) at which local African, European, and/or Native American ancestry was significantly associated with IgE levels. The most significant peak was 6p21.32-p22.1, where Native American ancestry was associated with lower IgE levels (P = 4.95 × 10(-8)). All but 22q13.1 were replicated in an independent sample of Latinos, and 2 of the peaks were replicated in African Americans (6p21.32-p22.1 and 14q23.2). Fine mapping of 6p21.32-p22.1 identified 6 genome-wide significant single nucleotide polymorphisms in Latinos, 2 of which replicated in European Americans. Another single nucleotide polymorphism was peak-wide significant within 14q23.2 in African Americans (rs1741099, P = 3.7 × 10(-6)) and replicated in non-African American samples (P = .011). CONCLUSION We confirmed genetic associations at 6 genes and identified novel associations within ZNF365, HLA-DQA1, and 14q23.2. Our results highlight the importance of studying diverse multiethnic populations to uncover novel loci associated with total IgE levels.
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Affiliation(s)
- Maria Pino-Yanes
- Department of Medicine, University of California, San Francisco, Calif; CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.
| | - Christopher R Gignoux
- Department of Medicine, University of California, San Francisco, Calif; Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, Calif; Department of Genetics, Stanford University, Palo Alto, Calif
| | - Joshua M Galanter
- Department of Medicine, University of California, San Francisco, Calif; Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, Calif
| | - Albert M Levin
- Department of Public Health Sciences, Henry Ford Health System, Detroit, Mich
| | | | - Celeste Eng
- Department of Medicine, University of California, San Francisco, Calif
| | - Scott Huntsman
- Department of Medicine, University of California, San Francisco, Calif
| | | | | | - Kiana Mohajeri
- Department of Genome Sciences, University of Washington, Seattle, Wash
| | - Brian J O'Roak
- Department of Genome Sciences, University of Washington, Seattle, Wash; Molecular & Medical Genetics Department, Oregon Health and Science University, Portland, Ore
| | - Donglei Hu
- Department of Medicine, University of California, San Francisco, Calif
| | - Rasika A Mathias
- Division of Allergy & Clinical Immunology, Department of Medicine, Johns Hopkins University, Baltimore, Md
| | | | - Lindsey A Roth
- Department of Medicine, University of California, San Francisco, Calif
| | - Badri Padhukasahasram
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Mich
| | | | - Karla Sandoval
- Department of Genetics, Stanford University, Palo Alto, Calif
| | - Cheryl A Winkler
- Basic Research Laboratory, Center for Cancer Research, National Cancer Institute, Leidos Biomedical, Frederick National Laboratory for Cancer Research, Frederick, Md
| | | | - Adam Davis
- Children's Hospital and Research Center Oakland, Oakland, Calif
| | - Harold J Farber
- Department of Pediatrics, Section of Pulmonology, Baylor College of Medicine and Texas Children's Hospital, Houston, Tex
| | - Kelley Meade
- Children's Hospital and Research Center Oakland, Oakland, Calif
| | - Pedro C Avila
- Department of Medicine, Northwestern University, Chicago, Ill
| | | | - Rocio Chapela
- Instituto Nacional de Enfermedades Respiratorias (INER), Mexico City, Mexico
| | - Jean G Ford
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md
| | | | - Shannon M Thyne
- Department of Pediatrics, University of California San Francisco, San Francisco General Hospital, San Francisco, Calif
| | | | - Luisa N Borrell
- Department of Health Sciences, Graduate Program in Public Health, City University of New York, Bronx, NY
| | | | - Saunak Sen
- Department of Epidemiology and Biostatistics, University of California, San Francisco, Calif
| | - Rajesh Kumar
- Children's Memorial Hospital and the Feinberg School of Medicine, Northwestern University, Chicago, Ill
| | | | | | - Fernando D Martinez
- Arizona Respiratory Center, University of Arizona, Tucson, Ariz; BIO5 Institute, University of Arizona, Tucson, Ariz
| | - Benjamin A Raby
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Scott T Weiss
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Dan L Nicolae
- Department of Human Genetics, University of Chicago, Chicago, Ill
| | - Carole Ober
- Department of Human Genetics, University of Chicago, Chicago, Ill
| | - Deborah A Meyers
- Center for Genomics and Personalized Medicine Research, Wake Forest School of Medicine, Winston-Salem, NC
| | - Eugene R Bleecker
- Center for Genomics and Personalized Medicine Research, Wake Forest School of Medicine, Winston-Salem, NC
| | - Steven J Mack
- Children's Hospital Oakland Research Institute, Oakland, Calif
| | - Ryan D Hernandez
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, Calif
| | - Evan E Eichler
- Department of Genome Sciences, University of Washington, Seattle, Wash; Howard Hughes Medical Institute, Seattle, Wash
| | - Kathleen C Barnes
- Division of Allergy & Clinical Immunology, Department of Medicine, Johns Hopkins University, Baltimore, Md
| | - L Keoki Williams
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Mich; Department of Internal Medicine, Henry Ford Health System, Detroit, Mich
| | - Dara G Torgerson
- Department of Medicine, University of California, San Francisco, Calif
| | - Esteban G Burchard
- Department of Medicine, University of California, San Francisco, Calif; Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, Calif
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Yitshak-Sade M, Novack V, Katra I, Gorodischer R, Tal A, Novack L. Non-anthropogenic dust exposure and asthma medication purchase in children. Eur Respir J 2014; 45:652-60. [PMID: 25323244 DOI: 10.1183/09031936.00078614] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Air pollution has been shown to increase frequency of asthma attacks, as usually measured by hospitalisation rates. We hypothesise that purchase of asthma reliever medications will reflect a broader association between the environmental exposure and asthma exacerbations. In a time series analysis, we estimated the association of dust storms with mild asthma manifestations, as indicated by medication purchases, during 2005-2011. We compared our results with the estimation of the association of dust storms with hospitalisations due to asthma and asthma-like symptoms. We detected 289 dust storms characterised by high levels of particulate matter <10 μm in diameter. We identified 42,920 children with asthma, wheezing or asthma-like symptoms, of whom 2418 were hospitalised. We observed a higher risk of asthma medication purchase on the day of a mild dust storm (relative risk 1.05, 95% CI 1.00-1.10). The next peak in drug purchases was 3 days later and was more pronounced among Bedouin-Arab children. Stratified analyses showed higher risks for hospitalisation among Bedouin-Arab children; especially among children living in temporary houses (relative risk 1.33, 95% CI 1.04-1.71). We observed an increased risk of asthma medication purchase associated with mild dust storms. The risk observed for hospitalisation was more pronounced among the rural Bedouin-Arab population.
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Affiliation(s)
- Maayan Yitshak-Sade
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel
| | - Victor Novack
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel
| | - Itzhak Katra
- Dept of Geography and Environmental Development, Faculty of Humanities and Social Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Rafael Gorodischer
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel Dept of Pediatrics, Soroka University Medical Center, Beer-Sheva, Israel
| | - Asher Tal
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel Dept of Pediatrics, Soroka University Medical Center, Beer-Sheva, Israel
| | - Lena Novack
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Wang T, Moreno-Vinasco L, Ma SF, Zhou T, Shimizu Y, Sammani S, Epshtein Y, Watterson DM, Dudek SM, Garcia JGN. Nonmuscle myosin light chain kinase regulates murine asthmatic inflammation. Am J Respir Cell Mol Biol 2014; 50:1129-35. [PMID: 24428690 PMCID: PMC4068916 DOI: 10.1165/rcmb.2013-0434oc] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Myosin light chain kinase (MLCK; gene code, MYLK) is a multifunctional enzyme involved in isoform-specific nonmuscle (nm) and smooth muscle contraction, inflammation, and vascular permeability, processes directly relevant to asthma pathobiology. In this report, we highlight the contribution of the nm isoform (nmMLCK) to asthma susceptibility and severity, supported by studies in two lines of transgenic mice with knocking out nmMLCK or selectively overexpressing nmMLCK in endothelium. These mice were sensitized to exhibit ovalbumin-mediated allergic inflammation. Genetically engineered mice with targeted nmMLCK deletion (nmMLCK(-/-)) exhibited significant reductions in lung inflammation and airway hyperresponsiveness. Conversely, mice with overexpressed nmMLCK in endothelium (nmMLCK(ec/ec)) exhibited elevated susceptibility and severity in asthmatic inflammation. In addition, reduction of nmMLCK expression in pulmonary endothelium by small interfering RNA results in reduced asthmatic inflammation in wild-type mice. These pathophysiological assessments demonstrate the positive contribution of nmMLCK to asthmatic inflammation, and a clear correlation of the level of nmMLCK with the degree of experimental allergic inflammation. This study confirms MYLK as an asthma candidate gene, and verifies nmMLCK as a novel molecular target in asthmatic pathobiology.
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Affiliation(s)
- Ting Wang
- 1 Arizona Respiratory Center and Department of Medicine, University of Arizona, Tucson, Arizona
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21
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Association of serum cytokines levels, interleukin 10 -1082G/A and interferon-γ +874T/A polymorphisms with atopic asthma children from Saudi Arabia. Cell Immunol 2014; 289:21-6. [PMID: 24709010 DOI: 10.1016/j.cellimm.2014.03.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Revised: 02/22/2014] [Accepted: 03/14/2014] [Indexed: 12/22/2022]
Abstract
The aim of this study was to clarify the role of IL-4, IL-10, IL-13 and interferon (IFN) -γ levels in atopic asthma patients by studying the relation between their serum levels and severity of the disease. The effect of IL-10 -1082G/A and IFN-γ +874T/A SNPs was also studied. The study included 200 atopic children with asthma and 50 age- and gender matched healthy children as controls. The levels of both IL-4 and IL-13 were significantly (p<0.001) higher, while IFN-γ was significantly (p<0.001) lower in patients compared to that of the controls. There was a significant effect of gene polymorphisms of IL-10 (p<0.05) and IFN-γ (p<0.001) in occurrence of atopic asthma and increased IgE level. Polymorphism of IFN-γ gene had an effect on the serum level of IFN-γ. In conclusion, IFN-γ gene polymorphism at position +874 and IL-10 gene polymorphism at position -1082A/G are genetic determinants which contribute to susceptibility to atopic asthma in children from Saudi Arabia.
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22
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Ortega VE, Hawkins GA, Moore WC, Hastie AT, Ampleford EJ, Busse WW, Castro M, Chardon D, Erzurum SC, Israel E, Montealegre F, Wenzel SE, Peters SP, Meyers DA, Bleecker ER. Effect of rare variants in ADRB2 on risk of severe exacerbations and symptom control during longacting β agonist treatment in a multiethnic asthma population: a genetic study. THE LANCET RESPIRATORY MEDICINE 2014; 2:204-13. [PMID: 24621682 DOI: 10.1016/s2213-2600(13)70289-3] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Severe adverse life-threatening events associated with longacting β agonist (LABA) use have caused the US Food and Drug Administration (FDA) to review the safety of these drugs, resulting in a boxed warning and a mandatory safety study in 46 800 patients with asthma. Identification of an at-risk, susceptible subpopulation on the basis of predictive biomarkers is crucial for understanding LABA safety. The β2-adrenergic receptor gene (ADRB2) contains a common, non-synonymous single nucleotide polymorphism, Gly16Arg, that is unlikely to account for the rare, life-threatening events seen with LABA use. We hypothesise that rare ADRB2 variants modulate therapeutic responses to LABA therapy and contribute to rare, severe adverse events. METHODS In this genetic study, ADRB2 was sequenced in 197 African American, 191 non-Hispanic white, and 73 Puerto Rican patients. Sequencing identified six rare variants, which were genotyped in 1165 patients with asthma. The primary hypothesis was that severe asthma exacerbations requiring hospital admission were associated with rare ADRB2 variants in patients receiving LABA therapy. This outcome was assessed overall and by ethnic group. Replication was done in 659 non-Hispanic white patients with asthma. FINDINGS Patients receiving LABA with a rare ADRB2 variant had increased asthma-related hospital admissions (15 [44%] of 34 patients with rare variant vs 121 [22%] of 553 patients with common ADRB2 alleles admitted to hospital in past 12 months; meta-analysis for all ethnic groups, p=0·0003). Specifically, increases in hospital admission rates were recorded in LABA-treated non-Hispanic white patients with the rare Ile 164 allele compared with non-Hispanic white patients with the common allele (odds ratio [OR] 4·48, 95% CI 1·40-13·96, p=0·01) and African American patients with a 25 bp promoter polynucleotide insertion, -376ins, compared with African American patients with the common allele (OR 13·43, 95% CI 2·02-265·42, p=0·006). The subset of non-Hispanic white and African American patients receiving LABAs with these rare variants had increased exacerbations requiring urgent outpatient health-care visits (non-Hispanic white patients with or without the rare Ile 164 allele, 2·6 [SD 3·5] vs 1·1 [2·1] visits, p<0·0001; and African American patients with or without the rare insertion, 3·7 [4·6] vs 2·4 [3·4] visits, p=0·01), and more frequently were treated with chronic systemic corticosteroids (OR 4·25, 95% CI 1·38-14·41, p=0·01, and 12·83, 1·96-251·93, p=0·006). Non-Hispanic white patients from the primary and replication cohorts with the rare Ile 164 allele were more than twice as likely as Thr 164 homozygotes to have uncontrolled, persistent symptoms during LABA treatment (p=0·008-0·04). INTERPRETATION The rare ADRB2 variants Ile164 and -376ins are associated with adverse events during LABA therapy and should be evaluated in large clinical trials including the current FDA-mandated safety study. FUNDING US National Institutes of Health.
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Affiliation(s)
- Victor E Ortega
- Center for Genomics and Personalized Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Gregory A Hawkins
- Center for Genomics and Personalized Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Wendy C Moore
- Center for Genomics and Personalized Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Annette T Hastie
- Center for Genomics and Personalized Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Elizabeth J Ampleford
- Center for Genomics and Personalized Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - William W Busse
- Department of Medicine, University of Wisconsin, Madison, WI, USA
| | - Mario Castro
- Department of Medicine, Washington University School of Medicine, St Louis, MO, USA
| | - Domingo Chardon
- Hospital Episcopal San Lucas, Ponce School of Medicine, Ponce, Puerto Rico
| | - Serpil C Erzurum
- Department of Pathobiology and Respiratory Institute, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Elliot Israel
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Sally E Wenzel
- Asthma Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Stephen P Peters
- Center for Genomics and Personalized Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Deborah A Meyers
- Center for Genomics and Personalized Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Eugene R Bleecker
- Center for Genomics and Personalized Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA.
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Whitmarsh I. Troubling "environments": postgenomics, Bajan wheezing, and Lévi-Strauss. Med Anthropol Q 2013; 27:489-509. [PMID: 24285248 DOI: 10.1111/maq.12061] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Postgenomics is intended to move beyond the search for genes to explore disease as a result of genes interacting with their environment, revealing how they have relevance for health. This addition of environment confers genomic research with new cultural life, making it relevant to public health discourse, government interventions, and health disparities. Drawing on ethnographic research following an American genetics of asthma study conducted in Barbados, I explore the ways environment gets construed by the multiple communities involved-U.S. researchers, Bajan officials, medical practitioners, and patient participants. I draw on Lévi-Strauss to argue that plural competing environments give mana to the American postgenomic project as intervention on racial injustice, household practices, pollution, and other aspects of asthma.
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Affiliation(s)
- Ian Whitmarsh
- Department of Anthropology, History, and Social Medicine, University of California, San Francisco
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24
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Kumar R, Nguyen EA, Roth LA, Oh SS, Gignoux CR, Huntsman S, Eng C, Moreno-Estrada A, Sandoval K, Peñaloza-Espinosa RI, López-López M, Avila PC, Farber HJ, Tcheurekdjian H, Rodriguez-Cintron W, Rodriguez-Santana JR, Serebrisky D, Thyne SM, Williams LK, Winkler C, Bustamante CD, Pérez-Stable EJ, Borrell LN, Burchard EG. Factors associated with degree of atopy in Latino children in a nationwide pediatric sample: the Genes-environments and Admixture in Latino Asthmatics (GALA II) study. J Allergy Clin Immunol 2013; 132:896-905.e1. [PMID: 23684070 DOI: 10.1016/j.jaci.2013.02.046] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Revised: 12/05/2012] [Accepted: 02/07/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND Atopy varies by ethnicity, even within Latino groups. This variation might be due to environmental, sociocultural, or genetic factors. OBJECTIVE We sought to examine risk factors for atopy within a nationwide study of US Latino children with and without asthma. METHODS Aeroallergen skin test responses were analyzed in 1830 US Latino subjects. Key determinants of atopy included country/region of origin, generation in the United States, acculturation, genetic ancestry, and site to which subjects migrated. Serial multivariate zero-inflated negative binomial regressions stratified by asthma status examined the association of each key determinant variable with the number of positive skin test responses. In addition, the independent effect of each key variable was determined by including all key variables in the final models. RESULTS In baseline analyses African ancestry was associated with 3 times (95% CI, 1.62-5.57) as many positive skin test responses in asthmatic participants and 3.26 times (95% CI, 1.02-10.39) as many positive skin test responses in control participants. Generation and recruitment site were also associated with atopy in crude models. In final models adjusted for key variables, asthmatic patients of Puerto Rican (exp[β] [95% CI], 1.31 [1.02-1.69]) and mixed (exp[β] [95% CI], 1.27 [1.03-1.56]) ethnicity had a greater probability of positive skin test responses compared with Mexican asthmatic patients. Ancestry associations were abrogated by recruitment site but not region of origin. CONCLUSIONS Puerto Rican ethnicity and mixed origin were associated with degree of atopy within US Latino children with asthma. African ancestry was not associated with degree of atopy after adjusting for recruitment site. Local environment variation, represented by site, was associated with degree of sensitization.
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Affiliation(s)
- Rajesh Kumar
- Division of Allergy and Immunology, Children's Memorial Hospital, and the Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Ill.
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Liao M, Shi D, Wang Y, Zhang K, Chen X, Gao Y, Tan A, Xuan Q, Yang X, Hu Y, Qin X, Zhang H, Mo Z. Genome-wide scan on total serum IgE levels identifies no common variants in a healthy Chinese male population. Immunogenetics 2013; 65:561-8. [PMID: 23661040 DOI: 10.1007/s00251-013-0706-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Accepted: 04/18/2013] [Indexed: 12/30/2022]
Abstract
Immunoglobulin E (IgE) provides important information on the humoral immune status, and the IgE level is routinely detected in clinical practice. There are many diseases associated with IgE, such as atopic disease, autoimmune diseases, and so on. IgE is a genetically complex trait, but comprehensive genetic assessment of the variability in serum IgE levels is lacking. Previous genome-wide association studies (GWAS) on total serum IgE levels have identified FCER1A as the susceptibility locus; however, the candidate gene association study in southern Chinese patients reported no association. Given the genetic difference in different populations, we firstly conducted this two-stage GWAS in a Chinese population of 3,495 men, including 1,999 unrelated subjects in the first stage and 1,496 independent individuals replicated in the second stage. In the first stage, we totally identified three single nucleotide polymorphisms (SNPs) which reached a P value of 1.0 × 10⁻⁵. Rs17090302 on chromosome 3 and Rs28708846 on chromosome 13 are intergenic. Rs432085 from chromosome 3p28 is located in the gene CCDC50. When the two-stage data was combined, none of the SNPs reached the genome-wide significant level. Collectively, we did not identify novel loci associated with the serum IgE level in Chinese males, but we hypothesized that CCDC50 was a candidate gene in regulation on IgE level.
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Affiliation(s)
- Ming Liao
- Institute of Urology and Nephrology, First Affiliated Hospital of Guangxi Medical University, No. 22 Shuangyong Road, 530021, Nanning, Guangxi Zhuang Autonomous Region, People's Republic of China
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Vergara C, Murray T, Rafaels N, Lewis R, Campbell M, Foster C, Gao L, Faruque M, Oliveira RR, Carvalho E, Araujo MI, Cruz AA, Watson H, Mercado D, Knight-Madden J, Ruczinski I, Dunston G, Ford J, Caraballo L, Beaty TH, Mathias RA, Barnes KC. African ancestry is a risk factor for asthma and high total IgE levels in African admixed populations. Genet Epidemiol 2013; 37:393-401. [PMID: 23554133 DOI: 10.1002/gepi.21702] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Revised: 11/21/2012] [Accepted: 11/22/2012] [Indexed: 12/16/2022]
Abstract
Characterization of genetic admixture of populations in the Americas and the Caribbean is of interest for anthropological, epidemiological, and historical reasons. Asthma has a higher prevalence and is more severe in populations with a high African component. Association of African ancestry with asthma has been demonstrated. We estimated admixture proportions of samples from six trihybrid populations of African descent and determined the relationship between African ancestry and asthma and total serum IgE levels (tIgE). We genotyped 237 ancestry informative markers in asthmatics and nonasthmatic controls from Barbados (190/277), Jamaica (177/529), Brazil (40/220), Colombia (508/625), African Americans from New York (207/171), and African Americans from Baltimore/Washington, D.C. (625/757). We estimated individual ancestries and evaluated genetic stratification using Structure and principal component analysis. Association of African ancestry and asthma and tIgE was evaluated by regression analysis. Mean ± SD African ancestry ranged from 0.76 ± 0.10 among Barbadians to 0.33 ± 0.13 in Colombians. The European component varied from 0.14 ± 0.05 among Jamaicans and Barbadians to 0.26 ± 0.08 among Colombians. African ancestry was associated with risk for asthma in Colombians (odds ratio (OR) = 4.5, P = 0.001) Brazilians (OR = 136.5, P = 0.003), and African Americans of New York (OR: 4.7; P = 0.040). African ancestry was also associated with higher tIgE levels among Colombians (β = 1.3, P = 0.04), Barbadians (β = 3.8, P = 0.03), and Brazilians (β = 1.6, P = 0.03). Our findings indicate that African ancestry can account for, at least in part, the association between asthma and its associated trait, tIgE levels.
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Affiliation(s)
- Candelaria Vergara
- Division of Allergy and Clinical Immunology, Department of Medicine, Johns Hopkins University (JHU), Baltimore, MD, USA
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Leong AB, Ramsey CD, Celedón JC. The challenge of asthma in minority populations. Clin Rev Allergy Immunol 2013; 43:156-83. [PMID: 21538075 DOI: 10.1007/s12016-011-8263-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The burden and disparity of asthma in race/ethnic minorities present a significant challenge. In this review, we will evaluate data on asthma epidemiology in minorities, examine potential reasons for asthma disparities, and discuss strategies of intervention and culturally sensitive care.
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Affiliation(s)
- Albin B Leong
- Pediatric Pulmonology and Allergy, Roseville Kaiser Medical Center, 1600 Eureka Road, Roseville, CA 95661, USA.
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28
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Levin AM, Mathias RA, Huang L, Roth LA, Daley D, Myers RA, Himes BE, Romieu I, Yang M, Eng C, Park JE, Zoratti K, Gignoux CR, Torgerson DG, Galanter JM, Huntsman S, Nguyen EA, Becker AB, Chan-Yeung M, Kozyrskyj AL, Kwok PY, Gilliland FD, Gauderman WJ, Bleecker ER, Raby BA, Meyers DA, London SJ, Martinez FD, Weiss ST, Burchard EG, Nicolae DL, Ober C, Barnes KC, Williams LK. A meta-analysis of genome-wide association studies for serum total IgE in diverse study populations. J Allergy Clin Immunol 2012; 131:1176-84. [PMID: 23146381 DOI: 10.1016/j.jaci.2012.10.002] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Revised: 09/28/2012] [Accepted: 10/02/2012] [Indexed: 01/27/2023]
Abstract
BACKGROUND IgE is both a marker and mediator of allergic inflammation. Despite reported differences in serum total IgE levels by race-ethnicity, African American and Latino subjects have not been well represented in genetic studies of total IgE. OBJECTIVE We sought to identify the genetic predictors of serum total IgE levels. METHODS We used genome-wide association data from 4292 subjects (2469 African Americans, 1564 European Americans, and 259 Latinos) in the EVE Asthma Genetics Consortium. Tests for association were performed within each cohort by race-ethnic group (ie, African American, Latino, and European American) and asthma status. The resulting P values were meta-analyzed, accounting for sample size and direction of effect. Top single nucleotide polymorphism associations from the meta-analysis were reassessed in 6 additional cohorts comprising 5767 subjects. RESULTS We identified 10 unique regions in which the combined association statistic was associated with total serum IgE levels (P<5.0×10(-6)) and the minor allele frequency was 5% or greater in 2 or more population groups. Variant rs9469220, corresponding to HLA-DQB1, was the single nucleotide polymorphism most significantly associated with serum total IgE levels when assessed in both the replication cohorts and the discovery and replication sets combined (P=.007 and 2.45×10(-7), respectively). In addition, findings from earlier genome-wide association studies were also validated in the current meta-analysis. CONCLUSION This meta-analysis independently identified a variant near HLA-DQB1 as a predictor of total serum IgE levels in multiple race-ethnic groups. This study also extends and confirms the findings of earlier genome-wide association analyses in African American and Latino subjects.
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Affiliation(s)
- Albert M Levin
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, USA
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Torgerson DG, Capurso D, Ampleford EJ, Li X, Moore WC, Gignoux CR, Hu D, Eng C, Mathias RA, Busse WW, Castro M, Erzurum SC, Fitzpatrick AM, Gaston B, Israel E, Jarjour NN, Teague WG, Wenzel SE, Rodríguez-Santana JR, Rodríguez-Cintrón W, Avila PC, Ford JG, Barnes KC, Burchard EG, Howard TD, Bleecker ER, Meyers DA, Cox NJ, Ober C, Nicolae DL. Genome-wide ancestry association testing identifies a common European variant on 6q14.1 as a risk factor for asthma in African American subjects. J Allergy Clin Immunol 2012; 130:622-629.e9. [PMID: 22607992 DOI: 10.1016/j.jaci.2012.03.045] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Revised: 02/22/2012] [Accepted: 03/06/2012] [Indexed: 12/14/2022]
Abstract
BACKGROUND Genetic variants that contribute to asthma susceptibility might be present at varying frequencies in different populations, which is an important consideration and advantage for performing genetic association studies in admixed populations. OBJECTIVE We sought to identify asthma-associated loci in African American subjects. METHODS We compared local African and European ancestry estimated from dense single nucleotide polymorphism genotype data in African American adults with asthma and nonasthmatic control subjects. Allelic tests of association were performed within the candidate regions identified, correcting for local European admixture. RESULTS We identified a significant ancestry association peak on chromosome 6q. Allelic tests for association within this region identified a single nucleotide polymorphism (rs1361549) on 6q14.1 that was associated with asthma exclusively in African American subjects with local European admixture (odds ratio, 2.2). The risk allele is common in Europe (42% in the HapMap population of Utah residents with Northern and Western European ancestry from the Centre d'Etude du Polymorphisme Humain collection) but absent in West Africa (0% in the HapMap population of Yorubans in Ibadan, Nigeria), suggesting the allele is present in African American subjects because of recent European admixture. We replicated our findings in Puerto Rican subjects and similarly found that the signal of association is largely specific to subjects who are heterozygous for African and non-African ancestry at 6q14.1. However, we found no evidence for association in European American or Puerto Rican subjects in the absence of local African ancestry, suggesting that the association with asthma at rs1361549 is due to an environmental or genetic interaction. CONCLUSION We identified a novel asthma-associated locus that is relevant to admixed populations with African ancestry and highlight the importance of considering local ancestry in genetic association studies of admixed populations.
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Affiliation(s)
- Dara G Torgerson
- Department of Human Genetics, University of Chicago, Chicago, Il 60637, USA
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Hawkins GA, Robinson MB, Hastie AT, Li X, Li H, Moore WC, Howard TD, Busse WW, Erzurum SC, Wenzel SE, Peters SP, Meyers DA, Bleecker ER. The IL6R variation Asp(358)Ala is a potential modifier of lung function in subjects with asthma. J Allergy Clin Immunol 2012; 130:510-5.e1. [PMID: 22554704 DOI: 10.1016/j.jaci.2012.03.018] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Revised: 03/09/2012] [Accepted: 03/16/2012] [Indexed: 11/20/2022]
Abstract
BACKGROUND The IL6R single nucleotide polymorphism (SNP) rs4129267 has recently been identified as an asthma susceptibility locus in subjects of European ancestry but has not been characterized with respect to asthma severity. The SNP rs4129267 is in linkage disequilibrium (r(2) = 1) with the IL6R coding SNP rs2228145 (Asp(358)Ala). This IL6R coding change increases IL-6 receptor (IL-6R) shedding and promotes IL-6 transsignaling. OBJECTIVES We sought to evaluate the IL6R SNP rs2228145 with respect to asthma severity phenotypes. METHODS The IL6R SNP rs2228145 was evaluated in subjects of European ancestry with asthma from the Severe Asthma Research Program (SARP). Lung function associations were replicated in the Collaborative Study on the Genetics of Asthma (CSGA) cohort. Serum soluble IL-6R levels were measured in subjects from SARP. Immunohistochemistry was used to qualitatively evaluate IL-6R protein expression in bronchoalveolar lavage cells and endobronchial biopsies. RESULTS The minor C allele of IL6R SNP rs2228145 was associated with a lower percent predicted FEV(1) in the SARP cohort (P= .005), the CSGA cohort (P= .008), and in a combined cohort analysis (P= .003). Additional associations with percent predicted forced vital capacity (FVC), FEV(1)/FVC ratio, and PC(20) were observed. The rs2228145 C allele (Ala(358)) was more frequent in severe asthma phenotypic clusters. Elevated serum soluble IL-6R levels were associated with lower percent predicted FEV(1) (P= .02) and lower percent predicted FVC (P= .008) (n= 146). IL-6R protein expression was observed in bronchoalveolar lavage macrophages, airway epithelium, vascular endothelium, and airway smooth muscle. CONCLUSIONS The IL6R coding SNP rs2228145 (Asp(358)Ala) is a potential modifier of lung function in subjects with asthma and might identify subjects at risk for more severe asthma. IL-6 transsignaling might have a pathogenic role in the lung.
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Affiliation(s)
- Gregory A Hawkins
- Center for Genomics and Personalized Medicine Research, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA.
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Resequencing candidate genes implicates rare variants in asthma susceptibility. Am J Hum Genet 2012; 90:273-81. [PMID: 22325360 DOI: 10.1016/j.ajhg.2012.01.008] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Revised: 12/20/2011] [Accepted: 01/13/2012] [Indexed: 01/12/2023] Open
Abstract
Common variation in over 100 genes has been implicated in the risk of developing asthma, but the contribution of rare variants to asthma susceptibility remains largely unexplored. We selected nine genes that showed the strongest signatures of weak purifying selection from among 53 candidate asthma-associated genes, and we sequenced the coding exons and flanking noncoding regions in 450 asthmatic cases and 515 nonasthmatic controls. We observed an overall excess of p values <0.05 (p = 0.02), and rare variants in four genes (AGT, DPP10, IKBKAP, and IL12RB1) contributed to asthma susceptibility among African Americans. Rare variants in IL12RB1 were also associated with asthma susceptibility among European Americans, despite the fact that the majority of rare variants in IL12RB1 were specific to either one of the populations. The combined evidence of association with rare noncoding variants in IL12RB1 remained significant (p = 3.7 × 10(-4)) after correcting for multiple testing. Overall, the contribution of rare variants to asthma susceptibility was predominantly due to noncoding variants in sequences flanking the exons, although nonsynonymous rare variants in DPP10 and in IL12RB1 were associated with asthma in African Americans and European Americans, respectively. This study provides evidence that rare variants contribute to asthma susceptibility. Additional studies are required for testing whether prioritizing genes for resequencing on the basis of signatures of purifying selection is an efficient means of identifying novel rare variants that contribute to complex disease.
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African ancestry is associated with asthma risk in African Americans. PLoS One 2012; 7:e26807. [PMID: 22235241 PMCID: PMC3250386 DOI: 10.1371/journal.pone.0026807] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Accepted: 10/04/2011] [Indexed: 11/19/2022] Open
Abstract
Background Asthma is a common complex condition with clear racial and ethnic differences in both prevalence and severity. Asthma consultation rates, mortality, and severe symptoms are greatly increased in African descent populations of developed countries. African ancestry has been associated with asthma, total serum IgE and lower pulmonary function in African-admixed populations. To replicate previous findings, here we aimed to examine whether African ancestry was associated with asthma susceptibility in African Americans. In addition, we examined for the first time whether African ancestry was associated with asthma exacerbations. Methodology/Principal Findings After filtering for self-reported ancestry and genotype data quality, samples from 1,117 self-reported African-American individuals from New York and Baltimore (394 cases, 481 controls), and Chicago (321 cases followed for asthma exacerbations) were analyzed. Genetic ancestry was estimated based on ancestry informative markers (AIMs) selected for being highly divergent among European and West African populations (95 AIMs for New York and Baltimore, and 66 independent AIMs for Chicago). Among case-control samples, the mean African ancestry was significantly higher in asthmatics than in non-asthmatics (82.0±14.0% vs. 77.8±18.1%, mean difference 4.2% [95% confidence interval (CI):2.0–6.4], p<0.0001). This association remained significant after adjusting for potential confounders (odds ratio: 4.55, 95% CI: 1.69–12.29, p = 0.003). African ancestry failed to show an association with asthma exacerbations (p = 0.965) using a model based on longitudinal data of the number of exacerbations followed over 1.5 years. Conclusions/Significance These data replicate previous findings indicating that African ancestry constitutes a risk factor for asthma and suggest that elevated asthma rates in African Americans can be partially attributed to African genetic ancestry.
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Loisel DA, Tan Z, Tisler CJ, Evans MD, Gangnon RE, Jackson DJ, Gern JE, Lemanske RF, Ober C. IFNG genotype and sex interact to influence the risk of childhood asthma. J Allergy Clin Immunol 2011; 128:524-31. [PMID: 21798578 PMCID: PMC3548570 DOI: 10.1016/j.jaci.2011.06.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Revised: 04/29/2011] [Accepted: 06/17/2011] [Indexed: 12/11/2022]
Abstract
BACKGROUND Asthma is a complex disease characterized by sex-specific differences in incidence, prevalence, and severity, but little is known about the molecular basis of these sex-based differences. OBJECTIVE To investigate the genetic architecture of sex differences in asthma risk, we evaluated (1) associations between polymorphisms in the IFNG gene and childhood-onset asthma in combined and sex-specific samples and (2) interactions between polymorphisms and sex on asthma risk. METHODS Main and sex-interaction effects of IFNG genetic diversity on asthma risk and IFN-γ levels were examined in a birth cohort of children at high risk for asthma and allergic diseases. Replication of the genetic association was assessed in an independent sample of asthma cases. RESULTS Significant genotype-sex interactions on asthma were observed for 2 IFNG single nucleotide polymorphisms, rs2069727 and rs2430561, which were in strong linkage disequilibrium with each other. In contrast, none of the 10 IFNG single nucleotide polymorphisms showed significant main effects on asthma. The observed genotype-sex interaction on asthma was characterized by nonadditivity; that is, heterozygous boys had the highest risk for asthma, and heterozygous girls had the lowest risk. The interaction effect was robust to other asthma risk factors but was limited to children who experienced wheezing illnesses with viral infections during the first 3 years of life. Genotype-sex interactions were also observed in the IFN-γ response to LPS in the first year of life. Finally, the sex-interaction effect was replicated in an independent population of childhood asthma cases. CONCLUSIONS These results provide insight into the genetic basis of sex differences in asthma and highlight the potential importance of interactions among sex, genotype, and environmental factors in asthma pathogenesis.
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Affiliation(s)
- Dagan A Loisel
- Department of Human Genetics, University of Chicago, Chicago, IL 60637, USA.
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Motika CA, Papachristou C, Abney M, Lester LA, Ober C. Rising prevalence of asthma is sex-specific in a US farming population. J Allergy Clin Immunol 2011; 128:774-9. [PMID: 21840584 DOI: 10.1016/j.jaci.2011.06.046] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Revised: 06/21/2011] [Accepted: 06/22/2011] [Indexed: 01/07/2023]
Abstract
BACKGROUND Asthma prevalence is increasing worldwide in most populations, likely due to a combination of heritable factors and environmental changes. Curiously, however, some European farming populations are protected from asthma, which has been attributed to their traditional lifestyles and farming practices. OBJECTIVE We conducted population-based studies of asthma and atopy in the Hutterites of South Dakota, a communal farming population, to assess temporal trends in asthma and atopy prevalence and describe the risk factors for asthma. METHODS We studied 1325 Hutterites (ages 6-91 years) at 2 time points from 1996 to 1997 and from 2006 to 2009 by using asthma questionnaires, pulmonary function and methacholine bronchoprovocation tests, and measures of atopy. RESULTS The overall prevalence of asthma increased over the 10- to 13-year study period (7.5%-11.1%, P = .049), whereas the overall prevalence of atopy did not change (45.0%-44.8%, P = .95). Surprisingly, the rise in asthma was only among females (5.8%-11.2%, P = .02); the prevalence among males remained largely unchanged (9.4%-10.9%, P = .57). Atopy, which was not associated with asthma risk in 1996 to 1997, was the strongest risk factor for asthma among Hutterites studied in 2006 to 2009 (P = .003). CONCLUSIONS Asthma has increased over a 10- to 13-year period among Hutterite females and atopy has become a significant risk factor for asthma, suggesting a change in environmental exposures that are either sex limited or that elicit a sex-specific response.
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Affiliation(s)
- Caroline A Motika
- Department of Medicine, Section of Pulmonary and Critical Care, The University of Chicago, Chicago, IL 60637, USA.
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Aly H, Nada A, Ahmad T, Mohamed M, Massaro AN, Bathgate S, Macri CJ, Larsen JW. Maternal asthma, race and low birth weight deliveries. Early Hum Dev 2011; 87:457-60. [PMID: 21511412 DOI: 10.1016/j.earlhumdev.2011.03.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2010] [Revised: 03/08/2011] [Accepted: 03/16/2011] [Indexed: 01/01/2023]
Abstract
BACKGROUND Asthma during pregnancy may compromise the well-being of the fetus and potentially impact an infant's birth weight via different mechanisms. AIMS 1) To assess the influence of asthma during pregnancy on the incidence of LBW outcomes in white non-Hispanic (WNH) and black non-Hispanic (BNH) women. 2) To identify other risk factors that affect low birth weight (LBW) (birth weight<2500g) outcomes among asthmatic women. DESIGN/SUBJECTS We conducted a retrospective analysis of compiled perinatal data on 17,073 patients including 9348 WNH and 7725 BNH women delivering at the George Washington University Hospital between 1990 and 2003. Univariate and logistic regression analyses were used to examine associations. RESULTS A total of 423 (2.5%) women had an asthma diagnosis, with a higher incidence in BNH women when compared to WNH women (3.4% vs. 1.7%, P<0.001). In the WNH population, asthmatic women had higher incidences of gravidity, thyroid disease, and illicit drug use, whereas in the BNH population, asthmatic women had higher incidences of increased body mass index (BMI), and use of alcohol, tobacco and illicit drugs. After controlling for confounders in multiple logistic regression analyses, there was an association between asthma and LBW outcomes in BNH women (OR: 1.7, CI: 1.1-2.6, p=0.01), but not in WNH women (OR=0.99, CI=0.5-2.2, p=0.97). CONCLUSIONS Asthma during pregnancy is a risk factor for LBW outcomes in BNH but not WNH women. The increased alcohol and illicit drug use in BNH women with asthma is an unexpected finding that deserves further study.
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Affiliation(s)
- Hany Aly
- Department of Neonatology, the George Washington University and Children's National Medical Center, Washington, DC, USA.
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Fitzpatrick AM, Stephenson ST, Hadley GR, Burwell L, Penugonda M, Simon DM, Hansen J, Jones DP, Brown LAS. Thiol redox disturbances in children with severe asthma are associated with posttranslational modification of the transcription factor nuclear factor (erythroid-derived 2)-like 2. J Allergy Clin Immunol 2011; 127:1604-11. [PMID: 21514635 DOI: 10.1016/j.jaci.2011.03.031] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Revised: 03/27/2011] [Accepted: 03/28/2011] [Indexed: 12/30/2022]
Abstract
BACKGROUND Airway thiol redox disturbances, including depletion of the antioxidant, glutathione, are differentiating features of severe asthma in children. OBJECTIVES Given the role of the transcription factor nuclear factor (erythroid-derived 2)-like 2 (Nrf2) in maintaining glutathione homeostasis and antioxidant defense, we quantified expression and activity of Nrf2 and its downstream targets in the airways and systemic circulation of children with asthma. We hypothesized that Nrf2 activation and function would be impaired in severe asthma, resulting in depletion of thiol pools and insufficient glutathione synthesis and conjugation. METHODS PBMCs and airway lavage cells were collected from children 6 to 17 years with severe (n = 51) and mild-to-moderate asthma (n = 38). The thiols glutathione and cysteine were quantified, and expression and activity of Nrf2 and its downstream targets were assessed. RESULTS Children with severe asthma had greater oxidation and lower concentrations of glutathione and cysteine in the plasma and airway lavage. Although Nrf2 mRNA and protein increased in severe asthma as a function of increased thiol oxidation, the Nrf2 expressed was highly dysfunctional. Nrf2 activation and downstream targets of Nrf2 binding, including glutathione-dependent enzymes, were not different between groups. The duration of asthma was a key factor associated with Nrf2 dysfunction in severe asthma. CONCLUSION Children with severe asthma have a global disruption of thiol redox signaling and control in both the airways and systemic circulation that is associated with posttranslational modification of Nrf2. We conclude that the Nrf2 pathway is disrupted in severe asthma as a function of chronic oxidative stress, which ultimately inhibits glutathione synthesis and antioxidant defense.
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Li X, Howard TD, Moore WC, Ampleford EJ, Li H, Busse WW, Calhoun WJ, Castro M, Chung KF, Erzurum SC, Fitzpatrick AM, Gaston B, Israel E, Jarjour NN, Teague WG, Wenzel SE, Peters SP, Hawkins GA, Bleecker ER, Meyers DA. Importance of hedgehog interacting protein and other lung function genes in asthma. J Allergy Clin Immunol 2011; 127:1457-65. [PMID: 21397937 DOI: 10.1016/j.jaci.2011.01.056] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Revised: 01/07/2011] [Accepted: 01/20/2011] [Indexed: 11/24/2022]
Abstract
BACKGROUND Two recent large meta-analyses of genome-wide association studies of lung function in general populations of European descent identified 11 candidate genes/regions. The importance of these genes in lung function in white and African American subjects with asthma is unknown. OBJECTIVES To determine whether genes that regulate lung function in general populations are associated with lung function abnormalities in subjects with asthma from different racial groups. METHODS Single nucleotide polymorphisms (SNPs) were tested in 5 asthma populations (N = 1441) for association with pulmonary function, and meta-analysis was performed across populations. The SNPs with the highest significance were then tested for association with bronchodilator reversibility and bronchial hyperresponsiveness to methacholine. A joint analysis of consistently replicated SNPs was performed to predict lung function in asthma. RESULTS Hedgehog interacting protein (HHIP) on chromosome 4q31 was associated with lung function in all 5 populations (rs1512288: P(meta) = 9.62E-05 and 3.23E-05 for percent predicted FEV(1) [ppFEV(1)] and percent predicted forced vital capacity [ppFVC], respectively). The SNPs in HHIP were also associated with reversibility (P < .05) but not bronchial hyperresponsiveness to methacholine. Because of differences in linkage disequilibrium in the African American subjects, the most relevant SNPs in HHIP were identified. A subset of normal lung function genes, including HHIP, family with sequence similarity 13, member A (FAM13A), and patched homolog 1 (PTCH1), together predict lung function abnormalities, a measure of severity in white and African American subjects with asthma. CONCLUSION A subset of the genes, including HHIP, that regulate lung function in general populations are associated with abnormal lung function in asthma in non-Hispanic white and African American subjects.
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Affiliation(s)
- Xingnan Li
- Center for Genomics and Personalized Medicine Research, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
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Duan QL, Gaume BR, Hawkins GA, Himes BE, Bleecker ER, Klanderman B, Irvin CG, Peters SP, Meyers DA, Hanrahan JP, Lima JJ, Litonjua AA, Tantisira KG, Liggett SB. Regulatory haplotypes in ARG1 are associated with altered bronchodilator response. Am J Respir Crit Care Med 2011; 183:449-54. [PMID: 20851928 PMCID: PMC3056223 DOI: 10.1164/rccm.201005-0758oc] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2010] [Accepted: 09/17/2010] [Indexed: 11/16/2022] Open
Abstract
RATIONALE β₂-agonists, the most common treatment for asthma, have a wide interindividual variability in response, which is partially attributed to genetic factors. We previously identified single nucleotide polymorphisms in the arginase 1 (ARG1) gene, which are associated with β₂-agonist bronchodilator response (BDR). OBJECTIVES To identify cis-acting haplotypes in the ARG1 locus that are associated with BDR in patients with asthma and regulate gene expression in vitro. METHODS We resequenced ARG1 in 96 individuals and identified three common, 5' haplotypes (denoted 1, 2, and 3). A haplotype-based association analysis of BDR was performed in three independent, adult asthma drug trial populations. Next, each haplotype was cloned into vectors containing a luciferase reporter gene and transfected into human airway epithelial cells (BEAS-2B) to ascertain its effect on gene expression. MEASUREMENTS AND MAIN RESULTS BDR varied by haplotype in each of the three populations with asthma. Individuals with haplotype 1 were more likely to have higher BDR, compared to those with haplotypes 2 and 3, which is supported by odds ratios of 1.25 (95% confidence interval, 1.03-1.71) and 2.18 (95% confidence interval, 1.34-2.52), respectively. Luciferase expression was 50% greater in cells transfected with haplotype 1 compared to haplotypes 2 and 3. CONCLUSIONS The identified ARG1 haplotypes seem to alter BDR and differentially regulate gene expression with a concordance of decreased BDR and reporter activity from haplotypes 2 and 3. These findings may facilitate pharmacogenetic tests to predict individuals who may benefit from other therapeutic agents in addition to β(2)-agonists for optimal asthma management. Clinical trial registered with www.clinicaltrials.gov (NCT00156819, NCT00046644, and NCT00073840).
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Affiliation(s)
- Qing Ling Duan
- Channing Laboratory, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA.
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Lyons TW, Wakefield DB, Cloutier MM. Mold and Alternaria skin test reactivity and asthma in children in Connecticut. Ann Allergy Asthma Immunol 2011; 106:301-7. [PMID: 21457878 DOI: 10.1016/j.anai.2010.12.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Revised: 12/06/2010] [Accepted: 12/08/2010] [Indexed: 11/24/2022]
Abstract
BACKGROUND Sensitivity to mold has been associated with asthma incidence, persistence, and severity. OBJECTIVE To examine the relationship between skin test reactivity (STR) to molds and specifically to Alternaria and asthma severity in a group of ethnically diverse children in Connecticut. METHODS Demographics and STR to 14 local allergens, including Alternaria, Penicillium, and mold mix, were obtained for 914 Puerto Rican, African American, and non-Hispanic white children. RESULTS A total of 126 children (14%) had a positive skin test result to mold, and 58 (6%) demonstrated STR to Alternaria. Compared with non-Hispanic white children, there was no difference in the likelihood of being sensitized to Alternaria for Puerto Rican and African American children (odds ratio [OR], 0.7; 95% confidence interval [CI], 0.3-1.5; and OR, 0.9; 95% CI, 0.4-2.2; respectively). In an adjusted analysis, Alternaria STR was associated with severe, persistent asthma (OR, 3.4; 95% CI, 1.2-8.6) but did not predict increasing asthma severity. STR to cat (OR, 2.5; 95% CI, 1.3-4.9) and dog (OR, 2.9; 95% CI, 1.3-6.0) was also associated with severe persistent asthma. Alternaria STR was associated with severe persistent asthma independent of the total number of positive skin test results. CONCLUSIONS Mold and Alternaria STR were uncommon among children in Connecticut. Alternaria STR was not associated with increasing asthma severity but was associated with severe, persistent asthma independent of the total number of positive skin test results. There was no association between ethnicity and Alternaria STR.
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Affiliation(s)
- Todd W Lyons
- University of Connecticut School of Medicine, Farmington, USA
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Heterogeneity of severe asthma in childhood: confirmation by cluster analysis of children in the National Institutes of Health/National Heart, Lung, and Blood Institute Severe Asthma Research Program. J Allergy Clin Immunol 2010; 127:382-389.e1-13. [PMID: 21195471 DOI: 10.1016/j.jaci.2010.11.015] [Citation(s) in RCA: 325] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2010] [Revised: 11/08/2010] [Accepted: 11/12/2010] [Indexed: 12/28/2022]
Abstract
BACKGROUND Asthma in children is a heterogeneous disorder with many phenotypes. Although unsupervised cluster analysis is a useful tool for identifying phenotypes, it has not been applied to school-age children with persistent asthma across a wide range of severities. OBJECTIVES This study determined how children with severe asthma are distributed across a cluster analysis and how well these clusters conform to current definitions of asthma severity. METHODS Cluster analysis was applied to 12 continuous and composite variables from 161 children at 5 centers enrolled in the Severe Asthma Research Program. RESULTS Four clusters of asthma were identified. Children in cluster 1 (n = 48) had relatively normal lung function and less atopy. Children in cluster 2 (n = 52) had slightly lower lung function, more atopy, and increased symptoms and medication use. Cluster 3 (n = 32) had greater comorbidity, increased bronchial responsiveness, and lower lung function. Cluster 4 (n = 29) had the lowest lung function and the greatest symptoms and medication use. Predictors of cluster assignment were asthma duration, the number of asthma controller medications, and baseline lung function. Children with severe asthma were present in all clusters, and no cluster corresponded to definitions of asthma severity provided in asthma treatment guidelines. CONCLUSION Severe asthma in children is highly heterogeneous. Unique phenotypic clusters previously identified in adults can also be identified in children, but with important differences. Larger validation and longitudinal studies are needed to determine the baseline and predictive validity of these phenotypic clusters in the larger clinical setting.
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Gamble C, Talbott E, Youk A, Holguin F, Pitt B, Silveira L, Bleecker E, Busse W, Calhoun W, Castro M, Chung KF, Erzurum S, Israel E, Wenzel S. Racial differences in biologic predictors of severe asthma: Data from the Severe Asthma Research Program. J Allergy Clin Immunol 2010; 126:1149-56.e1. [PMID: 21051082 DOI: 10.1016/j.jaci.2010.08.049] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Revised: 08/24/2010] [Accepted: 08/26/2010] [Indexed: 11/28/2022]
Abstract
BACKGROUND Biologic factors are known to contribute to asthma severity. It is unknown whether these factors differentially contribute to asthma severity in black compared with white subjects. OBJECTIVE We sought to assess the extent to which racial disparities between black and white subjects with severe asthma are attributable to physiologic, immunoinflammatory, and sociodemographic variables. METHODS Black and white asthmatic adults enrolled in a cross-sectional study focused on severe asthma were evaluated. Severe asthma was identified by using the American Thoracic Society definition. After initial univariable analyses, unconditional logistic regression models were used to estimate the probability of having severe asthma for black and white subjects. RESULTS Differences in severe asthma in black compared with white subjects were observed. In univariable analysis IgE level was not associated with severe asthma in black or white subjects, whereas in multivariable analysis IgE level was significantly associated with severe asthma for black subjects (P = .014) but not for white subjects. The odds of having severe asthma more than doubled for black subjects with 2 or more family members with asthma (P = .026), whereas the odds of severe asthma for white participants with a strong family history of asthma decreased by almost half (P = .05). Atopy was negatively associated with severe asthma in both races in univariable analysis but remained significant only in black subjects, whereas comorbidities were associated with severe asthma in white subjects. CONCLUSION Biologic factors were distinctly associated with severe asthma only in black subjects. Studies that incorporate comprehensive evaluation of biologic factors associated with asthma might lead to the development of therapies that target biologic abnormalities in black subjects.
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Parks CG, Biagini RE, Cooper GS, Gilkeson GS, Dooley MA. Total serum IgE levels in systemic lupus erythematosus and associations with childhood onset allergies. Lupus 2010; 19:1614-22. [PMID: 20937624 DOI: 10.1177/0961203310379870] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Elevated serum IgE has been described in systemic lupus erythematosus (SLE), but associations with disease risk and characteristics remain unresolved. We assessed total serum IgE levels and atopy (IgE > 100 IU/ml) in recently diagnosed SLE patients (n = 228) compared with population controls (n = 293) and in relation to disease activity, autoantibodies, clinical features, total immunoglobulins, C-reactive protein, and allergy history. Multivariate models estimated determinants of IgE and atopy in patients and controls, and associations of SLE with allergy and atopy. Total IgE levels were higher in patients than controls (median = 42 vs. 29 IU/ml); 32% of patients and 25% of controls were atopic (p = 0.06). IgE levels were significantly higher in non-Whites and patients reporting childhood onset (<18 years) asthma and hives, and in controls reporting childhood asthma, hay fever, eczema, and adult onset hives. After accounting for racial differences, atopy was not associated with SLE, nephritis, or other clinical and laboratory parameters. In sum, our findings provide limited evidence of a direct association between total serum IgE and SLE overall or with other disease characteristics after adjusting for demographic characteristics and allergy history. Future studies may want to explore potentially shared risk factors for development of allergy, atopy, and SLE.
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Affiliation(s)
- C G Parks
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Durham, NC 27599, USA.
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Sun X, Ma SF, Wade MS, Flores C, Pino-Yanes M, Moitra J, Ober C, Kittles R, Husain AN, Ford JG, Garcia JGN. Functional variants of the sphingosine-1-phosphate receptor 1 gene associate with asthma susceptibility. J Allergy Clin Immunol 2010; 126:241-9, 249.e1-3. [PMID: 20624651 DOI: 10.1016/j.jaci.2010.04.036] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2009] [Revised: 03/15/2010] [Accepted: 04/23/2010] [Indexed: 01/16/2023]
Abstract
BACKGROUND The genetic mechanisms underlying asthma remain unclear. Increased permeability of the microvasculature is a feature of asthma, and the sphingosine-1-phosphate receptor (S1PR1) is an essential participant regulating lung vascular integrity and responses to lung inflammation. OBJECTIVE We explored the contribution of polymorphisms in the S1PR1 gene to asthma susceptibility. METHODS A combination of gene resequencing for single nucleotide polymorphism (SNP) discovery, case-control association, functional evaluation of associated SNPs, and protein immunochemistry studies was used. RESULTS Immunohistochemistry studies demonstrated significantly decreased S1PR1 protein expression in pulmonary vessels in lungs of asthmatic patients compared with those of nonasthmatic subjects (P < .05). Direct DNA sequencing of 27 multiethnic samples identified 39 S1PR1 variants (18 novel SNPs). Association studies were performed based on genotyping results from cosmopolitan tagging SNPs in 3 case-control cohorts from Chicago and New York totaling 1,061 subjects (502 cases and 559 control subjects). The promoter SNP rs2038366 (-1557G/T) was found to be associated with asthma (P = .03) in European Americans. In African Americans an association was found for both asthma and severe asthma for intronic SNP rs3753194 (c.-164+170A/G; P = .006 and P = .040, respectively) and for promoter SNP rs59317557 (-532C/G) with severe asthma (P = .028). Consistent with predicted in silico functionality, alleles of the promoter SNPs rs2038366 (-1557G/T) and rs59317557 (-532C/G) influenced the activity of a luciferase S1PR1 reporter vector in transfected endothelial cells exposed to growth factors (epidermal growth factor, platelet-derived growth factor, and vascular endothelial growth factor) known to be increased in asthmatic airways. CONCLUSION These data provide strong support for a role for S1PR1 gene variants in asthma susceptibility and severity.
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Affiliation(s)
- Xiaoguang Sun
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, Ill, USA
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Victorino CC, Gauthier AH. The social determinants of child health: variations across health outcomes - a population-based cross-sectional analysis. BMC Pediatr 2009; 9:53. [PMID: 19686599 PMCID: PMC2734529 DOI: 10.1186/1471-2431-9-53] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2008] [Accepted: 08/17/2009] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Disparities in child health outcomes persist despite advances in medical technology and increased global wealth. The social determinants of health approach is useful in explaining the disparities in health. Our objective in this paper is four-fold: (1) to test whether the income relationship (and the related income gradient) is the same across different child health outcomes; (2) to test whether the association between income and child health outcomes persists after controlling for other traditional socioeconomic characteristics of children and their family (education and employment status); (3) to test the role of other potentially mediating variables, namely parental mental health, number of children, and family structure; and (4) to test the interaction between income and education. METHODS This population-based cross-sectional study used data from the 2003 US National Survey of Children's Health involving 102,353 children aged 0 to 17 years. Using multivariate logistic regression models, the association between household income, education, employment status, parental mental health, number of children, family structure and the following child health outcomes were examined: presence or absence of asthma, headaches/migraine, ear infections, respiratory allergy, food/digestive allergy, or skin allergy. RESULTS While the associations of some determinants were found to be consistent across different health outcomes, the association of other determinants such as household income depended on the specific outcome. Controlling for other factors, a gradient association persisted between household income and a child having asthma, migraine/severe headaches, or ear infections with children more likely to have the illness if their family is closer to the federal poverty level. Potentially mediating variables, namely parental mental health, number of children, and family structure had consistent associations across health outcomes. CONCLUSION There appears to be evidence of an income gradient for certain child health outcomes, even after controlling for other traditional measures of socioeconomic status. Our study also found evidence of an association between certain child health outcomes and potential mediating factors.
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Affiliation(s)
- Charlemaigne C Victorino
- Department of Pediatrics, Alberta Children's Hospital/University of Calgary, 2888 Shaganappi Trail NW, Calgary, AB, Canada
- Department of Sociology, University of Calgary, 2500 University Drive NW, Calgary, AB, Canada
| | - Anne H Gauthier
- Department of Sociology, University of Calgary, 2500 University Drive NW, Calgary, AB, Canada
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Chew GL, Reardon AM, Correa JC, Young M, Acosta L, Mellins R, Chew FT, Perzanowski MS. Mite sensitization among Latina women in New York, where dust-mite allergen levels are typically low. INDOOR AIR 2009; 19:193-197. [PMID: 19220508 PMCID: PMC2697277 DOI: 10.1111/j.1600-0668.2008.00578.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
UNLABELLED In New York (NY), Latinos often have greater asthma morbidity than other ethnicities, and dust-mite sensitization is common despite low allergen levels. We investigated mite allergen exposure and sensitization in atopic and/or asthmatic women, the majority being Puerto Rican. Women (n = 274) recruited for a birth cohort study were visited postnatally. Dust from their homes was analyzed for mite allergens (Der f 1, Der p 1, and Blo t 5). Serum was analyzed for total and allergen-specific IgE. Thirty-seven percent were sensitized to Dermatophagoides pteronyssinus, 34% to Dermatophagoides farinae, and 21% to Blomia tropicalis. Only 5% of NY homes had levels of Der f 1 >2 microg/g; none had Blo t 5 or Der p 1 above this level. Caribbean or Latin American birthplace (a proxy for childhood exposure) was not associated with mite sensitization. Sensitization to D. pteronyssinus and D. farinae was associated with a report of doctor-diagnosed asthma [Odds ratio (OR) = 3.27, P = 0.003; OR = 2.81, P = 0.010, respectively]; sensitization to any mite was associated with asthma medication use in the past 12 months (OR = 3.12, P = 0.004). These associations held even after adjustment for cockroach, mouse, and cat sensitization. PRACTICAL IMPLICATIONS Despite the low concentrations of mite allergen in our community, many of the women in the atopically enriched cohort were sensitized to mites, even Blomia tropicalis which is typically found only in tropical environments.
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Affiliation(s)
- G L Chew
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY 10032, USA.
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Ma SF, Flores C, Wade MS, Dudek SM, Nicolae DL, Ober C, Garcia JGN. A common cortactin gene variation confers differential susceptibility to severe asthma. Genet Epidemiol 2009; 32:757-66. [PMID: 18521921 DOI: 10.1002/gepi.20343] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Genomic regions with replicated linkage to asthma-related phenotypes likely harbor multiple susceptibility loci with relatively minor effects on disease susceptibility. The 11q13 chromosomal region has repeatedly been linked to asthma with five genes residing in this region with reported replicated associations. Cortactin, an actin-binding protein encoded by the CTTN gene in 11q13, constitutes a key regulator of cytoskeletal dynamics and contractile cell machinery, events facilitated by interaction with myosin light chain kinase; encoded by MYLK, a gene we recently reported as associated with severe asthma in African Americans. To evaluate potential association of CTTN gene variation with asthma susceptibility, CTTN exons and flanking regions were re-sequenced in 48 non-asthmatic multiethnic samples, leading to selection of nine tagging polymorphisms for case-control association studies in individuals of European and African descent. After ancestry adjustments, an intronic variant (rs3802780) was significantly associated with severe asthma (odds ratio [OR]: 1.71; 95% confidence interval [CI]: 1.20-2.43; p=0.003) in a joint analysis. Further analyses evidenced independent and additive effects of CTTN and MYLK risk variants for severe asthma susceptibility in African Americans (accumulated OR: 2.93, 95% CI: 1.40-6.13, p=0.004). These data suggest that CTTN gene variation may contribute to severe asthma and that the combined effects of CTTN and MYLK risk polymorphisms may further increase susceptibility to severe asthma in African Americans harboring both genetic variants.
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Affiliation(s)
- Shwu-Fan Ma
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
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Lenoir M, McGill CLW, Graham LM, Foggs M, Robinson S, Crim C, Stempel DA. A new focus on assessing and treating asthma control in the African-American community: a call to action. J Natl Med Assoc 2008; 100:1-23. [PMID: 18924317 DOI: 10.1016/s0027-9684(15)30098-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Asthma continues to be a highly prevalent disease characterized by significant morbidity, unnecessary mortality, and substantial cost to the health care system. After decades of increasing prevalence, the number of current asthmatics in recent years has plateaued at approximately 22 million people in the United States. An additional 10 million Americans have a past history of asthma that is not active. The burden of asthma is higher among African Americans than in any other racial or ethnic group in America. The African-American community continues to experience a disproportional increase in asthma prevalence, morbidity, and mortality. The educational initiatives stemming from the newly revised National Heart Lung and Blood Institute (NHLBI) guidelines provide the opportunity to address the increased burden of asthma in the African American community. These new guidelines, released in August 2007, focus on asthma control as the primary goal of therapy, routine monitoring of asthma control, and use of asthma control assessments to direct treatment. The present review discusses the following: I. The impact of health disparities on outcomes of African Americans with asthma, II. The barriers that prevent asthmatic patients from achieving optimal control, III. The unique factors that challenge practitioners and patients in achieving optimal asthma control in the African American Community, IV. The impact of good asthma control and the need for patients and clinicians to assess asthma control in with a standardized assessment tool, and V. Strategic initiatives and the role of the End The Attacks NOW program in improving outcomes for African American patients with asthma.
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Affiliation(s)
- Michael Lenoir
- Bay Area Pediatrics, 401 29th St, Oakland, CA 94609-3581, USA.
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Johnson M, Nriagu J, Hammad A, Savoie K, Jamil H. Asthma, environmental risk factors, and hypertension among Arab Americans in metro Detroit. J Immigr Minor Health 2008; 12:640-51. [PMID: 18998210 DOI: 10.1007/s10903-008-9205-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2007] [Accepted: 10/20/2008] [Indexed: 12/22/2022]
Abstract
Asthma and obesity-related health problems disproportionately impact low-income ethnic minority communities residing in urban areas. Environmental risk factors, particularly those related to housing and indoor air, may impact the development or exacerbation of asthma. There is increasing evidence to suggest a link between obesity-related health problems and asthma. Previous studies have also reported that immigrant status may influence myriad risk factors and health outcomes among immigrant populations. The Arab American Environmental Health Project (AAEHP) was the first study to explore environmental health problems among Arab Americans. This paper examined whether hypertensive status modified the relationship between environmental risk factors and asthma among Arab Americans in metro Detroit. An environmental risk index (ERI) was used to quantify household environmental risk factors associated with asthma. Physician diagnosed hypertension was self-reported, and asthma status was determined using responses to a validated symptoms checklist and self-reported diagnosis by a physician. Hypertension significantly modified the relationship between ERI and asthma in this study population. The positive association between household environmental risk factors and asthma was stronger among participants diagnosed with hypertension. Effect modification of the relationship between environmental risk factors and asthma could have serious implications among high-risk communities. However, further research is needed to elucidate the relationships between hypertension, environmental risk factors, and asthma.
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Affiliation(s)
- Markey Johnson
- Epidemiology and Biomarkers Branch, Human Studies Division MD 58A, U.S. Environmental Protection Agency, Research Triangle Park, NC 27711, USA.
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Vergara C, Tsai YJ, Grant AV, Rafaels N, Gao L, Hand T, Stockton M, Campbell M, Mercado D, Faruque M, Dunston G, Beaty TH, Oliveira RR, Ponte EV, Cruz AA, Carvalho E, Araujo MI, Watson H, Schleimer RP, Caraballo L, Nickel RG, Mathias RA, Barnes KC. Gene encoding Duffy antigen/receptor for chemokines is associated with asthma and IgE in three populations. Am J Respir Crit Care Med 2008; 178:1017-22. [PMID: 18827265 DOI: 10.1164/rccm.200801-182oc] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Asthma prevalence and severity are high among underserved minorities, including those of African descent. The Duffy antigen/receptor for chemokines is the receptor for Plasmodium vivax on erythrocytes and functions as a chemokine-clearing receptor. Unlike European populations, decreased expression of the receptor on erythrocytes is common among populations of African descent, and results from a functional T-46C polymorphism (rs2814778) in the promoter. This variant provides an evolutionary advantage in malaria-endemic regions, because Duffy antigen/receptor for chemokines-negative erythrocytes are more resistant to infection by P. vivax. OBJECTIVES To determine the role of the rs2814778 polymorphism in asthma and atopy as measured by total serum IgE levels among four populations of African descent (African Caribbean, African American, Brazilian, and Colombian) and a European American population. METHODS Family-based association tests were performed in each of the five populations to test for association between the rs2814778 polymorphism and asthma or total IgE concentration. MEASUREMENTS AND MAIN RESULTS Asthma was significantly associated with the rs2814778 polymorphism in the African Caribbean, Colombian, and Brazilian families (P < 0.05). High total IgE levels were associated with this variant in African Caribbean and Colombian families (P < 0.05). The variant allele was not polymorphic among European Americans. CONCLUSIONS Susceptibility to asthma and atopy among certain populations of African descent is influenced by a functional polymorphism in the gene encoding Duffy antigen/receptor for chemokines. This genetic variant, which confers resistance to malarial parasitic infection, may also partially explain ethnic differences in morbidity of asthma.
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Affiliation(s)
- Candelaria Vergara
- Department of Medicine, Division of Allergy and Clinical Immunology, Johns Hopkins University, Baltimore, Maryland 21224, USA
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Smith AK, Lange LA, Ampleford EJ, Meyers DA, Bleecker ER, Howard TD. Association of polymorphisms in CASP10 and CASP8 with FEV(1)/FVC and bronchial hyperresponsiveness in ethnically diverse asthmatics. Clin Exp Allergy 2008; 38:1738-44. [PMID: 18823309 DOI: 10.1111/j.1365-2222.2008.03095.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Several chromosomal regions have been identified using family-based linkage analysis to contain genes contributing to the development of asthma and allergic disorders. One of these regions, chromosome 2q32-q33, contains a gene cluster containing CFLAR, CASP10 and CASP8. These genes regulate the extrinsic apoptosis pathway utilized by several types of immune and structural cells that have been implicated in the pathogenesis of asthma. OBJECTIVE To assess the role of genetic variation in CFLAR, CASP10 and CASP8 in asthma and related phenotypes in individuals of diverse ethnic backgrounds. METHODS We tested 26 single nucleotide polymorphisms (SNPs) in the CFLAR, CASP10 and CASP8 gene cluster for association with asthma and related phenotypes in African-American, non-Hispanic whites, and Hispanic case-control populations (cases, N=517, controls, N=644). RESULTS Five CASP10 SNPS were associated with forced expiratory volume in 1 s (FEV(1))/forced expiration volume capacity (FVC) in the African-American subjects with asthma (P=0.0009-0.047). Nine SNPs, seven in CASP10 and two in CASP8, were also associated with the degree of bronchial hyperresponsiveness (BHR) (as determined by PC(20)) in race-specific analysis, predominately in the Non-Hispanic white cases. Two SNPs, rs6750157 in CASP10 and rs1045485 in CASP8 were modestly associated with asthma in the African-American (P=0.025) and Hispanic (P=0.033) populations, respectively. CONCLUSION These data suggest a role for CASP10 as a potential modifier of the asthma phenotype, specifically with measures of airway obstruction and BHR.
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Affiliation(s)
- Alicia K Smith
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA
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