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Esteves Caldeira L, Bernardino A, Paulino M, Costa C. Four-week total IgE/baseline total IgE ratio: Biomarker for omalizumab good response in chronic spontaneous urticaria real-life patients. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:3808-3811. [PMID: 37730088 DOI: 10.1016/j.jaip.2023.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 08/18/2023] [Accepted: 09/12/2023] [Indexed: 09/22/2023]
Affiliation(s)
- Leonor Esteves Caldeira
- Serviço de Imunoalergologia, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal.
| | - Ana Bernardino
- Serviço de Imunoalergologia, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Marisa Paulino
- Serviço de Imunoalergologia, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Célia Costa
- Serviço de Imunoalergologia, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal; Clínica Universitária de Imunoalergologia, Centro Académico de Medicina de Lisboa, Faculdade de Medicina de Lisboa, Lisbon, Portugal.
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Burchett JR, Dailey JM, Kee SA, Pryor DT, Kotha A, Kankaria RA, Straus DB, Ryan JJ. Targeting Mast Cells in Allergic Disease: Current Therapies and Drug Repurposing. Cells 2022; 11:3031. [PMID: 36230993 PMCID: PMC9564111 DOI: 10.3390/cells11193031] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 08/31/2022] [Accepted: 09/20/2022] [Indexed: 11/22/2022] Open
Abstract
The incidence of allergic disease has grown tremendously in the past three generations. While current treatments are effective for some, there is considerable unmet need. Mast cells are critical effectors of allergic inflammation. Their secreted mediators and the receptors for these mediators have long been the target of allergy therapy. Recent drugs have moved a step earlier in mast cell activation, blocking IgE, IL-4, and IL-13 interactions with their receptors. In this review, we summarize the latest therapies targeting mast cells as well as new drugs in clinical trials. In addition, we offer support for repurposing FDA-approved drugs to target mast cells in new ways. With a multitude of highly selective drugs available for cancer, autoimmunity, and metabolic disorders, drug repurposing offers optimism for the future of allergy therapy.
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Affiliation(s)
| | | | | | | | | | | | | | - John J. Ryan
- Department of Biology, Virginia Commonwealth University, Richmond, VA 23284, USA
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3
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Hanittinan O, Rattanapisit K, Malla A, Tharakhet K, Ketloy C, Prompetchara E, Phoolcharoen W. Feasibility of plant-expression system for production of recombinant anti-human IgE: An alternative production platform for therapeutic monoclonal antibodies. FRONTIERS IN PLANT SCIENCE 2022; 13:1012583. [PMID: 36531354 PMCID: PMC9755585 DOI: 10.3389/fpls.2022.1012583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 11/18/2022] [Indexed: 05/07/2023]
Abstract
Omalizumab, the anti-immunoglobulin IgE antibody is the only approved and available monoclonal antibody as an auxiliary medicament for the severe respiratory allergic reactions. It forms small size immune complexes by binding to free IgE, thereby inhibiting the interaction of IgE with its receptors. Additionally, the anti-IgE can also differently shape the airflow by impeding the stimulation of IgE receptors present on structural cells in the respiratory tract. The present study aimed to use plants as an expression system for anti-human IgE antibody production, using Nicotiana benthamiana as hosts. Recombinant Agrobacterium tumefaciens containing heavy chain (HC) and light chain (LC) domains of anti-human IgE were co-transformed in N. benthamiana. The assembling of the antibody and its expression was detected by SDS-PAGE and Western blot analysis. The functional ability of the anti-IgE antibody was determined via its binding capacity with target IgE by ELISA and the inhibition of basophil activation. The anti-human IgE mAb generated in plants was shown to be effective in binding to its target IgE and inhibit the IgE-crosslink in RS-ATL8 reporter cells. Although, antibody yield and purification process have to be further optimized, this study demonstrates the use of plant expression system as a promising platform for the production of Omalizumab which showed a comparable in vitro function to that of commercial Omalizumab (Xolair) in the inhibition of basophil activation.
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Affiliation(s)
- Oranicha Hanittinan
- Center of Excellence in Plant-produced Pharmaceuticals, Chulalongkorn University, Bangkok, Thailand
- Department of Pharmacognosy and Pharmaceutical Botany, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand
| | | | | | - Kittipan Tharakhet
- Department of Laboratory Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Center of Excellence in Vaccine Research and Development (Chula VRC), Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Chutitorn Ketloy
- Department of Laboratory Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Center of Excellence in Vaccine Research and Development (Chula VRC), Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Eakachai Prompetchara
- Department of Laboratory Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Center of Excellence in Vaccine Research and Development (Chula VRC), Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- *Correspondence: Eakachai Prompetchara, ; Waranyoo Phoolcharoen,
| | - Waranyoo Phoolcharoen
- Center of Excellence in Plant-produced Pharmaceuticals, Chulalongkorn University, Bangkok, Thailand
- Department of Pharmacognosy and Pharmaceutical Botany, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand
- *Correspondence: Eakachai Prompetchara, ; Waranyoo Phoolcharoen,
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4
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Altrichter S, Zampeli V, Ellrich A, Zhang K, Church MK, Maurer M. IgM and IgA in addition to IgG autoantibodies against FcɛRIα are frequent and associated with disease markers of chronic spontaneous urticaria. Allergy 2020; 75:3208-3215. [PMID: 32446275 DOI: 10.1111/all.14412] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 03/16/2020] [Accepted: 04/02/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND IgG autoantibodies against the high-affinity IgE receptor, FcɛRIα, contribute the pathogenesis of autoimmune chronic spontaneous urticaria (CSU). However, it is not known whether such patients also exhibit IgM or IgA autoantibodies against FcɛRIα. To address this question we developed an ELISA to assess serum levels of IgG, IgM, and IgA autoantibodies against FcɛRIα and investigated whether their presence is linked to clinical features of CSU including the response to autologous serum skin testing (ASST). METHODS Serum samples of 35 CSU patients (25 ASST-positive) and 52 healthy control individuals were analyzed using a newly developed competitive ELISA for IgG, IgM, and IgA autoantibodies to FcɛRIα. RESULTS One in four CSU patients (8/35, 24%) had elevated serum levels of IgG-anti-FcɛRIα compared with (3/52, 6%) healthy controls. More than half of patients had IgM (21/35, 60%) and IgA (20/35, 57%) vs (3/52, 5%) each in healthy controls. Elevated IgM, but not IgG or IgA, autoantibodies were significantly more frequent in ASST-positive CSU patients (18/25, 72%) compared with ASSTnegative patients (3/10, 33%, P = .022). Also, elevated levels of IgM-anti-FcɛRIα, but not of IgG or IgA against FcɛRIα, were linked to low blood basophil (r = .414, P = .021) and eosinophil (r = .623, P < .001) counts. CONCLUSIONS Increased serum levels of IgM-anti-FcɛRIα are common in patients with CSU and linked to features of autoimmune CSU. The role and relevance of autoantibodies to FcɛRIα in CSU can and should be further characterized in future studies, and our novel assay can help with this.
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Affiliation(s)
- Sabine Altrichter
- Department of Dermatology and Allergy Dermatological Allergology Allergie‐Centrum‐Charité Charité‐Universitätsmedizin Berlin Germany
| | - Vasiliki Zampeli
- Department of Dermatology and Allergy Dermatological Allergology Allergie‐Centrum‐Charité Charité‐Universitätsmedizin Berlin Germany
| | - André Ellrich
- Department of Dermatology and Allergy Dermatological Allergology Allergie‐Centrum‐Charité Charité‐Universitätsmedizin Berlin Germany
| | - Ke Zhang
- Department of Pediatrics David Geffen School of Medicine at UCLA Los Angeles CA USA
| | - Martin K Church
- Department of Dermatology and Allergy Dermatological Allergology Allergie‐Centrum‐Charité Charité‐Universitätsmedizin Berlin Germany
| | - Marcus Maurer
- Department of Dermatology and Allergy Dermatological Allergology Allergie‐Centrum‐Charité Charité‐Universitätsmedizin Berlin Germany
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5
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Effects of omalizumab on basophils: Potential biomarkers in asthma and chronic spontaneous urticaria. Cell Immunol 2020; 358:104215. [PMID: 33137647 DOI: 10.1016/j.cellimm.2020.104215] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 07/28/2020] [Accepted: 09/09/2020] [Indexed: 12/13/2022]
Abstract
Omalizumab is an anti-IgE humanized monoclonal antibody approved for the treatment of severe asthma and chronic spontaneous urticaria. Omalizumab binds free serum IgE and antagonizes its interaction with FcεRI, which is considered the main pharmacodynamic mechanism responsible for the clinical response to the treatment. The reduction of IgE serum concentration down-regulates the cellular expression of FcεRI on basophils. However, the biological events occurring on basophils during the therapy with omalizumab are multiple and complex. Here we review the current evidence regarding the specific biological effects of omalizumab on basophils in patients with asthma and chronic spontaneous urticaria. In addition to the modulation of IgE receptors, omalizumab may affect basophils homeostasis, intra-cellular signaling, cellular responsiveness/activation and cytokine release. These effects may be partially responsible for the clinical success of omalizumab and potentially provide useful biological markers for future assessment of the clinical response to the treatment. However, further investigation is required to better elucidate the role of basophils during the treatment with omalizumab.
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6
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Oda Y, Fukunaga A, Washio K, Imamura S, Mizuno M, Hatakeyama M, Ogura K, Nishigori C. Improved FcεRI-Mediated CD203c Basophil Responsiveness Reflects Rapid Responses to Omalizumab in Chronic Spontaneous Urticaria. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 9:1166-1176.e8. [PMID: 32898709 DOI: 10.1016/j.jaip.2020.08.048] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 07/30/2020] [Accepted: 08/20/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Omalizumab is effective in patients with chronic spontaneous urticaria (CSU) although its mechanism of action is poorly understood. Several studies reported that decreased high-affinity IgE receptor (FcεRI)-mediated histamine release and/or responsiveness was characteristic of basophils in patients with CSU. However, few studies have focused on the relationship between changes in basophil responsiveness via FcεRI after omalizumab treatment and the therapeutic effect in patients with CSU. OBJECTIVE To assess basophil responsiveness via FcεRI stimulation, as well as FcεRI expression and IgE binding on blood basophils from patients with CSU before and after omalizumab treatment and its possible association with the clinical response. METHODS We analyzed 34 patients with CSU treated with omalizumab who were categorized as fast responders (FRs) (n = 20) and non or slow responders (N/SRs) (n = 14). CD203c expression induced by FcεRI stimulation, and IgE and FcεRI expressions on blood basophils from patients with CSU before and after omalizumab treatment were analyzed. Basophil responsiveness via FcεRI stimulation was observed in vitro using basophils pretreated with omalizumab. RESULTS FRs had increased CD203c responsiveness after treatment with omalizumab compared with N/SRs. This improvement of basophil responsiveness via FcεRI stimulation in FRs was not observed in peripheral blood basophils preincubated with omalizumab in vitro, suggesting that omalizumab does not directly affect circulating pre-existing abnormal basophils. CONCLUSION Increased basophil responsiveness via FcεRI after omalizumab treatment is associated with the therapeutic effect and mechanism of action of omalizumab.
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Affiliation(s)
- Yoshiko Oda
- Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Atsushi Fukunaga
- Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, Kobe, Japan.
| | - Ken Washio
- Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shinya Imamura
- Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Mayuko Mizuno
- Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Mayumi Hatakeyama
- Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kanako Ogura
- Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Chikako Nishigori
- Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, Kobe, Japan
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7
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Okayama Y, Matsumoto H, Odajima H, Takahagi S, Hide M, Okubo K. Roles of omalizumab in various allergic diseases. Allergol Int 2020; 69:167-177. [PMID: 32067933 DOI: 10.1016/j.alit.2020.01.004] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Accepted: 01/08/2020] [Indexed: 12/14/2022] Open
Abstract
IgE and mast cells play a pivotal role in various allergic diseases, including asthma, allergic rhinitis, and urticaria. Treatment with omalizumab, a monoclonal anti-IgE antibody, has significantly improved control of these allergic diseases and introduced a new era for the management of severe allergic conditions. About 10 years of experience with omalizumab treatment for severe allergic asthma confirmed its effectiveness and safety, reducing symptoms, frequency of reliever use, and severe exacerbations in patients with intractable conditions. Omalizumab is particularly useful in childhood asthma, where atopic conditions often determine clinical courses of asthma. Recently, omalizumab is approved for the treatment of chronic spontaneous urticaria (CSU) with the fixed dose of 300 mg. Although the mechanisms underlying the actions of omalizumab in CSU are not fully clarified, nearly 90% of patients with CSU showed a complete or a partial response to omalizumab treatment. Furthermore, omalizumab is just approved for the treatment of severe Japanese cedar pollinosis (JC) based on the successful results of an add-on study of omalizumab for inadequately controlled severe pollinosis despite antihistamines and nasal corticosteroids. For proper use of omalizumab to treat severe JC, co-administration of antihistamines is necessary, while patients should meet the criteria including strong sensitization to Japanese cedar pollen (≥class 3) and poor control under standard treatment. In the management of severe allergic diseases using omalizumab, issues including cost and concerns about relapse after its discontinuation should be overcome. At the same time, possibilities for application to other intractable allergic diseases should be considered.
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8
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Gatta A, Della Valle L, Farinelli A, Cavallucci E, Paganelli R, Di Gioacchino M. Omalizumab in chronic spontaneous urticaria: steroid sparing effect. J DERMATOL TREAT 2019; 29:6-9. [PMID: 30247931 DOI: 10.1080/09546634.2018.1527988] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Omalizumab has been recognized to be effective in the treatment of chronic spontaneous urticaria (CSU). The Italian Medicines Agency authorizes two omalizumab courses, only for patients with CSU unresponsive to antihistamines, and this schedule may limit omalizumab use. Unfortunately, in the majority of CSU, the schedule is unsatisfactory because symptoms usually recur shortly after discontinuation of treatment. A case of a patient needing more than two treatment courses with omalizumab is reported, in order to discuss the rationale for its long-term use. Patient had needed systemic steroids almost continuously for 4 years. Two severe glucocorticoid-associated adverse events (GAEs) occurred during long-term treatment. Omalizumab 300 mg monthly was started with immediate disappearance of the urticarial lesions. Beneficial effects waned shortly after discontinuation of treatment, and further steroid use was needed. A second omalizumab course showed the same clinical pattern, with prompt response and recurrence of symptoms after suspension. Therefore, we decided to repeat the 6 months omalizumab treatment as soon as symptoms recurred, to avoid further emergency steroid treatments and GAEs. This experience suggests that long-term use of omalizumab could be useful. Evidences show that omalizumab is effective and safe for re-treatment and long-term use of responding patients after recurrence.
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Affiliation(s)
- Alessia Gatta
- a Department of Medicine and Science of Ageing, Specialization School of Allergy and Clinical Immunology , G. D'Annunzio University , Chieti , Italy
| | - Loredana Della Valle
- a Department of Medicine and Science of Ageing, Specialization School of Allergy and Clinical Immunology , G. D'Annunzio University , Chieti , Italy
| | - Anila Farinelli
- a Department of Medicine and Science of Ageing, Specialization School of Allergy and Clinical Immunology , G. D'Annunzio University , Chieti , Italy
| | - Enrico Cavallucci
- a Department of Medicine and Science of Ageing, Specialization School of Allergy and Clinical Immunology , G. D'Annunzio University , Chieti , Italy
| | - Roberto Paganelli
- a Department of Medicine and Science of Ageing, Specialization School of Allergy and Clinical Immunology , G. D'Annunzio University , Chieti , Italy
| | - Mario Di Gioacchino
- a Department of Medicine and Science of Ageing, Specialization School of Allergy and Clinical Immunology , G. D'Annunzio University , Chieti , Italy
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9
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Erlich TH, Sharkia I, Landolina N, Assayag M, Goldberger O, Berkman N, Levi-Schaffer F, Razin E. Modulation of allergic responses by mitochondrial STAT3 inhibitors. Allergy 2018; 73:2160-2171. [PMID: 29683527 DOI: 10.1111/all.13467] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Recently, we have shown that mast cell mitochondrial STAT3 could serve as a new target for the regulation of the allergic response as it plays an essential role in immunologically mediated degranulation of mast cells. In the present work, we explored how two recently developed mitochondrial STAT3 inhibitors (Mitocur-1 and Mitocur-3) modulate the allergic response. METHODS Experiments were performed both in vitro in cultured human/mouse mast cells and with rat basophilic leukemia (RBL) cells and also in vivo in mice. The effect of mitochondrial STAT3 inhibition on mast cell function was determined via checking degranulation and several cytokines secretion levels. RESULTS Here, we show that treatment of rodent and human cultured mast cells with low concentrations of mitochondrial STAT3 inhibitors had no effect on STAT3 target gene expression. However, these inhibitors caused a significant reduction in mast cell exocytosis and cytokine release, due to a decrease in OXPHOS activity and STAT3 serine 727 phosphorylation. It was also observed in an OVA mouse model of allergic asthma that one of the inhibitors used significantly reduced eosinophilia and neutrophilia compared to the control mice group. Furthermore, it was observed that treatment with this inhibitor resulted in a significant reduction in blood histamine levels in mice after IgE-Ag challenge. CONCLUSION The present data strongly suggest that the development of mitochondrial STAT3 inhibitors could serve as a potential treatment for allergy-associated diseases.
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Affiliation(s)
- T. H. Erlich
- Faculty of Medicine; The Department of Biochemistry and Molecular Biology; The Institute for Medical Research Israel-Canada; The Hebrew University; Jerusalem Israel
| | - I. Sharkia
- Faculty of Medicine; The Department of Biochemistry and Molecular Biology; The Institute for Medical Research Israel-Canada; The Hebrew University; Jerusalem Israel
| | - N. Landolina
- Faculty of Medicine; Pharmacology and Experimental Therapeutics Unit; School of Pharmacy; Institute for Drug Research; Hebrew University of Jerusalem; Jerusalem Israel
| | - M. Assayag
- The Institute of Pulmonary Medicine at Hadassah-Hebrew University Medical Center; Jerusalem Israel
| | - O. Goldberger
- Faculty of Medicine; The Department of Biochemistry and Molecular Biology; The Institute for Medical Research Israel-Canada; The Hebrew University; Jerusalem Israel
| | - N. Berkman
- The Institute of Pulmonary Medicine at Hadassah-Hebrew University Medical Center; Jerusalem Israel
| | - F. Levi-Schaffer
- Faculty of Medicine; Pharmacology and Experimental Therapeutics Unit; School of Pharmacy; Institute for Drug Research; Hebrew University of Jerusalem; Jerusalem Israel
| | - E. Razin
- Faculty of Medicine; The Department of Biochemistry and Molecular Biology; The Institute for Medical Research Israel-Canada; The Hebrew University; Jerusalem Israel
- Singapore-HUJI Alliance for Research and Enterprise; Molecular Mechanisms of Inflammatory Diseases Interdisciplinary Research Group; Campus for Research Excellence and Technological Enterprise; Singapore city Singapore
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10
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Jörg L, Pecaric-Petkovic T, Reichenbach S, Coslovsky M, Stalder O, Pichler W, Hausmann O. Double-blind placebo-controlled trial of the effect of omalizumab on basophils in chronic urticaria patients. Clin Exp Allergy 2017; 48:196-204. [DOI: 10.1111/cea.13066] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 10/20/2017] [Accepted: 11/05/2017] [Indexed: 12/01/2022]
Affiliation(s)
- L. Jörg
- Department of Rheumatology, Immunology and Allergology, Inselspital; Bern University Hospital; University of Bern; Bern Switzerland
| | - T. Pecaric-Petkovic
- Adverse Drug Reactions, Analysis and Consulting; ADR-AC GmbH; Bern Switzerland
| | - S. Reichenbach
- Department of Rheumatology, Immunology and Allergology, Inselspital; Bern University Hospital; University of Bern; Bern Switzerland
- Clinical Trial Unit; University of Bern; Bern Switzerland
| | - M. Coslovsky
- Clinical Trial Unit; University of Bern; Bern Switzerland
| | - O. Stalder
- Clinical Trial Unit; University of Bern; Bern Switzerland
| | - W. Pichler
- Adverse Drug Reactions, Analysis and Consulting; ADR-AC GmbH; Bern Switzerland
| | - O. Hausmann
- Department of Rheumatology, Immunology and Allergology, Inselspital; Bern University Hospital; University of Bern; Bern Switzerland
- Adverse Drug Reactions, Analysis and Consulting; ADR-AC GmbH; Bern Switzerland
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11
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Dreyfus DH. Differential Diagnosis of Chronic Urticaria and Angioedema Based on Molecular Biology, Pharmacology, and Proteomics. Immunol Allergy Clin North Am 2016; 37:201-215. [PMID: 27886907 DOI: 10.1016/j.iac.2016.08.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Differential diagnosis of urticaria and angioedema has been based on the phenotype as either acute or chronic depending on the duration of more than 6 to 8 weeks, respectively. Additional subdivisions include poorly defined terms such as idiopathic, spontaneous, or autoimmune. In this article, the author suggests that an increased understanding of the acquired and innate immune system and data from novel proteomic technology have blurred the lines between these categories of diagnosis. Specific molecular pathways and response to specific medications should be incorporated in classification and diagnosis schemes.
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Affiliation(s)
- David H Dreyfus
- Yale School of Medicine, Gesher LLC, Allergy, Asthma and Clinical Immunology, 4 Clifton Avenue, Waterbury CT 06710, USA.
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12
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Serrano-Candelas E, Martinez-Aranguren R, Valero A, Bartra J, Gastaminza G, Goikoetxea MJ, Martín M, Ferrer M. Comparable actions of omalizumab on mast cells and basophils. Clin Exp Allergy 2016; 46:92-102. [PMID: 26509363 DOI: 10.1111/cea.12668] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 10/17/2015] [Accepted: 10/21/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND Omalizumab (OmAb) has recently been approved for the treatment of diseases other than allergic asthma, including chronic urticaria. The exploration of the use of OmAb in chronic urticaria was based on the presence of IgE autoantibodies against autoantigens such as anti-IgE, anti-FcεRI, and IgE antibodies against thyroid peroxidase in certain patients with chronic urticaria. OmAb recognizes and sequesters free IgE to prevent its interaction with FcεRI. However, OmAb is equally and rapidly effective against autoimmune and non-autoimmune urticaria, suggesting the possible involvement of additional mechanisms of IgE. OBJECTIVES We sought to investigate the in vitro mechanism of action of OmAb in mast cells and basophils. METHODS Both LAD2 human mast cell line, previously sensitized with IgE, and ex vivo basophils were incubated with OmAb at different doses, analysing its effect on IgE-dependent events (e.g., degranulation, phosphorylation-mediated signalling, and eicosanoid release). RESULTS We found that OmAb dissociates pre-bound IgE from mast cells and basophils, resulting in a reduction of proximal phosphorylation-mediated signalling events (Syk, PLCγ, and LAT) and in a decrease in degranulation and leukotriene synthesis. CONCLUSION Our data prove the existence of common mechanisms of action of OmAb in mast cells and basophils that would explain its effectiveness and rapid effect in chronic urticaria and provide a basis for its use in other diseases mediated by these cells.
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Affiliation(s)
- E Serrano-Candelas
- Biochemistry Unit, Faculty of Medicine, University of Barcelona, Barcelona, Spain.,Laboratory of Clinical and Experimental Respiratory Immunoallergy, IDIBAPS, Barcelona, Spain
| | - R Martinez-Aranguren
- Department of Allergy and Clinical Immunology, Clinica Universidad de Navarra, Instituto de Investigación Sanitaria de Navarra (IDISNA), Pamplona, Spain
| | - A Valero
- Laboratory of Clinical and Experimental Respiratory Immunoallergy, IDIBAPS, Barcelona, Spain.,Department of Pneumology and Allergy, Immunoallèrgia Respiratòria Clínica I Experimental, IDIBAPS, Hospital Clínic, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - J Bartra
- Laboratory of Clinical and Experimental Respiratory Immunoallergy, IDIBAPS, Barcelona, Spain.,Department of Pneumology and Allergy, Immunoallèrgia Respiratòria Clínica I Experimental, IDIBAPS, Hospital Clínic, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - G Gastaminza
- Department of Allergy and Clinical Immunology, Clinica Universidad de Navarra, Instituto de Investigación Sanitaria de Navarra (IDISNA), Pamplona, Spain
| | - M J Goikoetxea
- Department of Allergy and Clinical Immunology, Clinica Universidad de Navarra, Instituto de Investigación Sanitaria de Navarra (IDISNA), Pamplona, Spain
| | - M Martín
- Biochemistry Unit, Faculty of Medicine, University of Barcelona, Barcelona, Spain.,Laboratory of Clinical and Experimental Respiratory Immunoallergy, IDIBAPS, Barcelona, Spain
| | - M Ferrer
- Department of Allergy and Clinical Immunology, Clinica Universidad de Navarra, Instituto de Investigación Sanitaria de Navarra (IDISNA), Pamplona, Spain
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13
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Kasperska-Zajac A, Jarząb J, Żerdzińska A, Bąk K, Grzanka A. Effective treatment of different phenotypes of chronic urticaria with omalizumab: Case reports and review of literature. Int J Immunopathol Pharmacol 2016; 29:320-8. [PMID: 26729404 PMCID: PMC5806710 DOI: 10.1177/0394632015623795] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 11/27/2015] [Indexed: 11/15/2022] Open
Abstract
Despite the excellent efficacy and safety profile of omalizumab in chronic spontaneous urticaria (CSU), there are scarce data concerning its role in the treatment of refractory cases with different phenotypes of urticaria. We describe our experience with the therapy of nine patients with CSU co-existing with delayed pressure urticaria (DPU) or angioedema or both and refractory to treatment with high-dose antihistamines. The first patient, with severe CSU and recurrent angioedema, did not respond well to cyclosporine A or corticosteroids and suffered from numerous side effects of long-term corticosteroid therapy. The second patient presented with severe symptoms of DPU, which first of all prevented any daily activities of the professional routines. Both patients showed a complete remission of urticaria after the first injection of omalizumab. The third patient with CSU and severe DPU had been ineffectively treated for more than 20 years with various medications. Following the administration of omalizumab, the symptoms of CSU subsided but those of DPU intensified, and the drug was withdrawn after two cycles. In another four patients with refractory CSU and angioedema, the symptoms subsided after the first administration of omalizumab, and the patients have been in remission for about 5 weeks. In the remaining two patients, the symptoms did not resolve despite four 300 mg doses of omalizumab. It is important to establish a therapeutic regimen with omalizumab (150-300 mg; every 4-8 weeks) tailored to individual patient's needs and dependent on the type of urticaria; this may minimize unnecessary the medication exposure, adverse drug effects, and healthcare costs.
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Affiliation(s)
- A Kasperska-Zajac
- Department of Internal Diseases, Dermatology and Allergology in Zabrze, SMDZ in Zabrze, Medical University of Silesia in Katowice, Poland
| | - J Jarząb
- Department of Internal Diseases, Dermatology and Allergology in Zabrze, SMDZ in Zabrze, Medical University of Silesia in Katowice, Poland
| | - A Żerdzińska
- Department of Internal Diseases, Dermatology and Allergology in Zabrze, SMDZ in Zabrze, Medical University of Silesia in Katowice, Poland
| | - K Bąk
- Department of Internal Diseases, Dermatology and Allergology in Zabrze, SMDZ in Zabrze, Medical University of Silesia in Katowice, Poland
| | - A Grzanka
- Department of Internal Diseases, Dermatology and Allergology in Zabrze, SMDZ in Zabrze, Medical University of Silesia in Katowice, Poland
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Hoffmann HJ. News in Cellular Allergology: A Review of the Human Mast Cell and Basophil Granulocyte Literature from January 2013 to May 2015. Int Arch Allergy Immunol 2016; 168:253-62. [DOI: 10.1159/000443960] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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