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Salter B, Zhao N, Son K, Tan NS, Dvorkin-Gheva A, Radford K, LaVigne N, Huang C, Kjarsgaard M, Li QZ, Tselios K, Lim HF, Khalidi N, Nair P, Mukherjee M. Airway autoantibodies are determinants of asthma severity. Eur Respir J 2022; 60:2200442. [PMID: 35777765 DOI: 10.1183/13993003.00442-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 06/03/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Local airway autoimmune responses may contribute to steroid dependence and persistent eosinophilia in severe asthma. Auto-IgG antibodies directed against granule proteins such as eosinophil peroxidase (EPX), macrophage scavenger receptor with collagenous structure (MARCO) and nuclear/extranuclear antigens (antinuclear antibodies (ANAs)) have been reported. Our objective was to describe the prevalence and clinical characteristics of asthmatic patients with airway autoreactivity, and to assess if this could be predicted from clinical history of autoreactivity. METHODS We analysed anti-EPX, anti-MARCO and ANAs in 218 sputum samples collected prospectively from 148 asthmatic patients, and evaluated their association with lung function parameters, blood/airway inflammation, severity indices and exacerbations. Additionally, 107 of these patients consented to fill out an autoimmune checklist to determine personal/family history of systemic autoimmune disease and symptoms. RESULTS Out of the 148 patients, 59 (40%) were anti-EPX IgG+, 53 (36%) were anti-MARCO IgG+ and 64 out of 129 (50%) had ≥2 nuclear/extranuclear autoreactivities. A composite airway autoreactivity score (CAAS) demonstrated that 82 patients (55%) had ≥2 airway autoreactivities (considered as CAAS+). Increased airway eosinophil degranulation (OR 15.1, 95% CI 1.1-199.4), increased blood leukocytes (OR 3.5, 95% CI 1.3-10.1) and reduced blood lymphocytes (OR 0.19, 95% CI 0.04-0.84) predicted CAAS+. A third of CAAS+ patients reported an exacerbation, associated with increased anti-EPX and/or anti-MARCO IgG (p<0.05). While no association was found between family history or personal diagnosis of autoimmune disease, 30% of CAAS+ asthmatic patients reported sicca symptoms (p=0.02). Current anti-inflammatory (inhaled/oral corticosteroids and/or adjunct anti-interleukin-5 biologics) treatment does not attenuate airway autoantibodies, irrespective of eosinophil suppression. CONCLUSION We report 55% of moderate-severe asthmatic patients to have airway autoreactivity that persists despite anti-inflammatory treatment and is associated with exacerbations.
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Affiliation(s)
- Brittany Salter
- Dept of Medicine, Firestone Institute of Respiratory Health and St Joseph's Healthcare, McMaster University, Hamilton, ON, Canada
- Brittany Salter and Nan Zhao contributed equally
| | - Nan Zhao
- Dept of Medicine, Firestone Institute of Respiratory Health and St Joseph's Healthcare, McMaster University, Hamilton, ON, Canada
- Lady David Institute, Jewish General Hospital, Montreal, QC, Canada
- Pulmonary Division, Jewish General Hospital, McGill University, Montreal, QC, Canada
- Brittany Salter and Nan Zhao contributed equally
| | - Kiho Son
- Dept of Medicine, Firestone Institute of Respiratory Health and St Joseph's Healthcare, McMaster University, Hamilton, ON, Canada
| | - Nadia Suray Tan
- Dept of Medicine, Firestone Institute of Respiratory Health and St Joseph's Healthcare, McMaster University, Hamilton, ON, Canada
| | - Anna Dvorkin-Gheva
- McMaster Immunology Research Centre, Dept of Medicine, McMaster University, Hamilton, ON, Canada
| | - Katherine Radford
- Dept of Medicine, Firestone Institute of Respiratory Health and St Joseph's Healthcare, McMaster University, Hamilton, ON, Canada
| | - Nicola LaVigne
- Dept of Medicine, Firestone Institute of Respiratory Health and St Joseph's Healthcare, McMaster University, Hamilton, ON, Canada
| | - Chynna Huang
- Dept of Medicine, Firestone Institute of Respiratory Health and St Joseph's Healthcare, McMaster University, Hamilton, ON, Canada
| | - Melanie Kjarsgaard
- Dept of Medicine, Firestone Institute of Respiratory Health and St Joseph's Healthcare, McMaster University, Hamilton, ON, Canada
| | - Quan-Zhen Li
- Dept of Immunology and Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Konstantinos Tselios
- Division of Rheumatology, Dept of Medicine, McMaster University, Hamilton, ON, Canada
| | - Hui Fang Lim
- Dept of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Nader Khalidi
- Division of Rheumatology, Dept of Medicine, McMaster University, Hamilton, ON, Canada
| | - Parameswaran Nair
- Dept of Medicine, Firestone Institute of Respiratory Health and St Joseph's Healthcare, McMaster University, Hamilton, ON, Canada
| | - Manali Mukherjee
- Dept of Medicine, Firestone Institute of Respiratory Health and St Joseph's Healthcare, McMaster University, Hamilton, ON, Canada
- McMaster Immunology Research Centre, Dept of Medicine, McMaster University, Hamilton, ON, Canada
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Venegas Garrido C, Mukherjee M, Bhalla A, Nair P. Airway autoimmunity, asthma exacerbations, and response to biologics. Clin Exp Allergy 2022; 52:1365-1378. [PMID: 35993511 DOI: 10.1111/cea.14220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 08/16/2022] [Indexed: 01/26/2023]
Abstract
Biologic therapies in asthma are indicated in severe disease, and they are directed against specific inflammatory modulators that contribute to pathogenesis and severity. Currently approved biologics target T2 cytokines (IgE, IL-5, IL-4/IL-13, and TLSP) and have demonstrated efficacy in clinical outcomes such as exacerbation rate and oral corticosteroid dose reductions, blood and airway eosinophil depletion, and lung function improvement. However, a proportion of these patients may show inadequate responses to biologics, with either initial lack of improvement or clinical and functional worsening after an optimal initial response. Exacerbations while on a biologic may be due to several reasons, including imprecise identification of the dominant effector pathway contributing to severity, additional inflammatory pathways that are not targeted by the biologic, inaccuracies of the biomarker used to guide therapy, inadequate dosing schedules, intercurrent airway infections, anti-drug neutralizing antibodies, and a novel phenomenon of autoimmune responses in the airways interfering with the effectiveness of the monoclonal antibodies. This review, illustrated using case scenarios, describes the underpinnings of airway autoimmune responses in driving exacerbations while patients are being treated with biologics, device a strategy to evaluate such exacerbations, an algorithm to switch between biologics, and perhaps to consider two biologics concurrently.
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Affiliation(s)
- Carmen Venegas Garrido
- Firestone Institute for Respiratory Health, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada.,Division of Respirology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Manali Mukherjee
- Firestone Institute for Respiratory Health, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada.,Division of Respirology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Anurag Bhalla
- Division of Respirology, Department of Medicine, Western University, London, Ontario, Canada
| | - Parameswaran Nair
- Firestone Institute for Respiratory Health, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada.,Division of Respirology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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3
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Taniguchi M, Mitsui C, Hayashi H, Ono E, Kajiwara K, Mita H, Watai K, Kamide Y, Fukutomi Y, Sekiya K, Higashi N. Aspirin-exacerbated respiratory disease (AERD): Current understanding of AERD. Allergol Int 2019; 68:289-295. [PMID: 31235242 DOI: 10.1016/j.alit.2019.05.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 05/06/2019] [Indexed: 12/17/2022] Open
Abstract
The characteristics in AERD are severe adult-onset asthma, eosinophilic rhinosinusitis with nasal polyposis, and CysLT overproduction. The cause of AERD have remained unclear, however the decrease in the production of PGE2 caused by the reduction in COX-2 activity is considered to main pathological mechanism of AERD. The mast cell activation and the interaction between platelets and granulocytes are lead to the CysLT overproduction and severe eosinophilic inflammation. The ongoing activation of mast cells is important key pathogenesis in not only stable AERD but exacerbated AERD by aspirin and NSAIDs. In recent years, type 2 inflammation caused by ILC2 activation in patients with AERD have been attracting attention. Omalizumab is effective option for AERD via suppression of mast cell activation and CysLT overproduction. Dupilumab improves sinus symptoms especially in patients with AERD. In near future, anti-platelet drug, CRTH2 antagonist, and anti-TSLP antibody may be useful candidates of therapeutic options in patients with AERD.
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Affiliation(s)
- Masami Taniguchi
- National Hospital Organization Sagamihara National Hospital, Clinical Research Center, Kanagawa, Japan.
| | - Chihiro Mitsui
- National Hospital Organization Sagamihara National Hospital, Clinical Research Center, Kanagawa, Japan
| | - Hiroaki Hayashi
- National Hospital Organization Sagamihara National Hospital, Clinical Research Center, Kanagawa, Japan
| | - Emiko Ono
- National Hospital Organization Sagamihara National Hospital, Clinical Research Center, Kanagawa, Japan
| | - Keiichi Kajiwara
- National Hospital Organization Sagamihara National Hospital, Clinical Research Center, Kanagawa, Japan
| | - Haruhisa Mita
- National Hospital Organization Sagamihara National Hospital, Clinical Research Center, Kanagawa, Japan
| | - Kentaro Watai
- National Hospital Organization Sagamihara National Hospital, Clinical Research Center, Kanagawa, Japan
| | - Yosuke Kamide
- National Hospital Organization Sagamihara National Hospital, Clinical Research Center, Kanagawa, Japan
| | - Yuma Fukutomi
- National Hospital Organization Sagamihara National Hospital, Clinical Research Center, Kanagawa, Japan
| | - Kiyoshi Sekiya
- National Hospital Organization Sagamihara National Hospital, Clinical Research Center, Kanagawa, Japan
| | - Noritaka Higashi
- National Hospital Organization Sagamihara National Hospital, Clinical Research Center, Kanagawa, Japan
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Abstract
PURPOSE OF REVIEW Glucocorticosteroids (GCSs) remain the cornerstone of therapy for treating the inflammatory component of asthma. Clinical response to GCS is heterogeneous, varying both within asthma 'endotypes', as well as the same individual. Different factors and micro-environment can alter the canonical GCS-induced signalling pathways leading to reduced efficacy, collectively termed as GCS subsensitivity, which includes the entire spectrum of steroid insensitivity and steroid resistance. RECENT FINDINGS In the past, steroid subsensitivity has been associated with dysregulated expression of glucocorticoid-receptor isoforms, neutrophilic inflammation and Th17 cytokines, oxidative stress-inducing factors and their downstream effect on histone deacetylase activities and gene expression. The review highlights recent observations, such as GCS-induced dysregulation of key transcription factors involved in host defence, role of airway infections altering expression of critical regulatory elements like the noncoding microRNAs, and the importance of interleukin (IL)-10 in reinstating steroid response in key immune cells. Further, emerging concepts of autoimmunity triggered because of delayed resolution of eosinophilic inflammation (due to GCS subsensitivity) and observed lymphopenia (plausibly a side-effect of continued GCS use) are discussed. SUMMARY This review bridges concepts that have been known, and those under current investigation, providing both molecular and clinical insights to aid therapeutic strategies for optimal management of asthmatics with varying degree of steroid subsensitivity and disease severity, with particular emphasis on the PI3 kinase pathways.
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Mukherjee M, Nair P. Autoimmune Responses in Severe Asthma. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2018; 10:428-447. [PMID: 30088364 PMCID: PMC6082822 DOI: 10.4168/aair.2018.10.5.428] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 01/29/2018] [Accepted: 02/13/2018] [Indexed: 12/11/2022]
Abstract
Asthma and autoimmune diseases both result from a dysregulated immune system, and have been conventionally considered to have mutually exclusive pathogenesis. Autoimmunity is believed to be an exaggerated Th1 response, while asthma with a Th2 underpinning is congruent with the well-accepted Th1/Th2 paradigm. The hypothesis of autoimmune involvement in asthma has received much recent interest, particularly in the adult late-onset non-atopic patients (the “intrinsic asthma”). Over the past decades, circulating autoantibodies against diverse self-targets (beta-2-adrenergic receptors, epithelial antigens, nuclear antigens, etc.) have been reported and subsequently dismissed to be epiphenomena resulting from a chronic inflammatory condition, primarily due to lack of evidence of causality/pathomechanism. Recent evidence of ‘granulomas’ in the lung biopsies of severe asthmatics, detection of pathogenic sputum autoantibodies against autologous eosinophil proteins (e.g., eosinophil peroxidase) and inadequate response to monoclonal antibody therapies (e.g., subcutaneous mepolizumab) in patients with evidence of airway autoantibodies suggest that the role of autoimmune mechanisms be revisited. In this review, we have gathered available reports of autoimmune responses in the lungs, reviewed the evidence in the context of immunogenic tissue-response and danger-associated molecular patterns, and constructed the possibility of an autoimmune-associated pathomechanism that may contribute to the severity of asthma.
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Affiliation(s)
- Manali Mukherjee
- Division of Respirology, Department of Medicine, St. Joseph's Healthcare Hamilton, McMaster University, Hamilton, Canada
| | - Parameswaran Nair
- Division of Respirology, Department of Medicine, St. Joseph's Healthcare Hamilton, McMaster University, Hamilton, Canada.
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6
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Antinuclear antibodies in autoimmune and allergic diseases. Reumatologia 2017; 55:298-304. [PMID: 29491538 PMCID: PMC5825968 DOI: 10.5114/reum.2017.72627] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 12/14/2017] [Indexed: 01/25/2023] Open
Abstract
Antinuclear antibodies (ANA) are primarily significant in the diagnosis of systemic connective tissue diseases. The relationship between their occurrence in allergic diseases is poorly documented. However, the mechanism of allergic and autoimmune diseases has a common thread. In both cases, an increased production of IgE antibodies and presence of ANA in selected disease entities is observed. Equally important is the activation of basophils secreting proinflammatory factors and affecting the differentiation of TH17 lymphocytes. Both autoimmune and allergic diseases have complex multi-pathogenesis and often occur in genetically predisposed individuals. The presence of antinuclear antibodies was confirmed in many systemic connective tissue diseases and some allergic diseases. Examples include atopic dermatitis, non-allergic asthma, and pollen allergy. Co-occurring allergic and autoimmune disorders induce further search for mechanisms involved in the aetiopathogenesis of both groups of diseases.
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7
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Mukherjee M, Bulir DC, Radford K, Kjarsgaard M, Huang CM, Jacobsen EA, Ochkur SI, Catuneanu A, Lamothe-Kipnes H, Mahony J, Lee JJ, Lacy P, Nair PK. Sputum autoantibodies in patients with severe eosinophilic asthma. J Allergy Clin Immunol 2017; 141:1269-1279. [PMID: 28751233 DOI: 10.1016/j.jaci.2017.06.033] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 06/08/2017] [Accepted: 06/12/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND The persistence of eosinophils in sputum despite high doses of corticosteroids indicates disease severity in asthmatic patients. Chronic inflamed airways can lose tolerance over time to immunogenic entities released on frequent eosinophil degranulation, which further contributes to disease severity and necessitates an increase in maintenance corticosteroids. OBJECTIVES We sought to investigate the possibility of a polyclonal autoimmune event in the airways of asthmatic patients and to identify associated clinical and molecular characteristics. METHODS The presence of autoantibodies against eosinophil peroxidase (EPX) and anti-nuclear antibodies was investigated in patients with eosinophilic asthma maintained on high-dose corticosteroids, prednisone, or both. The ability of sputum immunoglobulins to induce eosinophil degranulation in vitro was assessed. In addition, the associated inflammatory microenvironment in patients with detectable autoantibodies was examined. RESULTS We report a "polyclonal" autoimmune event occurring in the airways of prednisone-dependent asthmatic patients with increased eosinophil activity, recurrent pulmonary infections, or both, as evident by the concomitant presence of sputum anti-EPX and anti-nuclear antibodies of the IgG subtype. Extensive cytokine profiling of sputum revealed a TH2-dominated microenvironment (eotaxin-2, IL-5, IL-18, and IL-13) and increased signalling molecules that support the formation of ectopic lymphoid structures (B-cell activating factor and B cell-attracting chemokine 1). Immunoprecipitated sputum immunoglobulins from patients with increased autoantibody levels triggered eosinophil degranulation in vitro, with release of extensive histone-rich extracellular traps, an event unsuppressed by dexamethasone and possibly contributing to the steroid-unresponsive nature of these eosinophilic patients. CONCLUSION This study identifies an autoimmune endotype of severe asthma that can be identified by the presence of sputum autoantibodies against EPX and autologous cellular components.
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Affiliation(s)
- Manali Mukherjee
- Division of Respirology, McMaster University, Hamilton, Ontario, Canada
| | - David C Bulir
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Katherine Radford
- Division of Respirology, McMaster University, Hamilton, Ontario, Canada
| | | | | | | | - Sergei I Ochkur
- Division of Pulmonary Medicine, Mayo Clinic, Scottsdale, Ariz
| | - Ana Catuneanu
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | | | - James Mahony
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - James J Lee
- Division of Pulmonary Medicine, Mayo Clinic, Scottsdale, Ariz
| | - Paige Lacy
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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8
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Takejima P, Agondi RC, Rodrigues H, Aun MV, Kalil J, Giavina-Bianchi P. Allergic and Nonallergic Asthma Have Distinct Phenotypic and Genotypic Features. Int Arch Allergy Immunol 2017; 172:150-160. [PMID: 28380482 DOI: 10.1159/000458151] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 01/26/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Identification of asthma phenotypes enables a better understanding and management of this heterogeneous disease. Studies have reported associations between human leukocyte antigens (HLA) and asthma in different populations, but the results have been inconclusive and they have rarely considered the distinct disease phenotypes. Our objective was to characterize allergic and nonallergic asthma phenotypes and evaluate possible associations with the HLA system. METHODS A total of 109 patients with asthma were prospectively followed during 2 years. They were divided into 2 groups, i.e., allergic and nonallergic asthma, according to their clinical history and skin prick test and serum-specific immunoglobulin E (IgE) results. The control group comprised 297 deceased donors of solid organs. Patients' features and HLA class I and II genotypes were assessed and compared. RESULTS This study showed different features between asthma phenotypes. Nonallergic patients were older at the onset of asthma symptoms and had a higher rate of intolerance to nonsteroidal anti-inflammatory drugs. Allergic patients had higher total serum IgE levels, reported atopic dermatitis and rhinoconjunctivitis more frequently, and, unexpectedly, had a greater disease severity. New associations between the HLA genotypes and allergic and nonallergic asthma were identified. The HLA-B*42, HLA-C*17, HLA-DPA1*03, and HLA-DPB1*105 genotypes were associated with allergic asthma and the HLA-B*48 genotype with the nonallergic phenotype. The presence of the haplotype HLA-DPA1*03 DQA*05 was associated with allergic asthma, and the presence of HLA-DPA1*03 and the absence of HLA-DQA*05 with nonallergic asthma. CONCLUSIONS Allergic and nonallergic asthma have distinct phenotypic and genotypic features. New associations between asthma phenotypes and HLA class I and II were identified.
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Affiliation(s)
- Priscila Takejima
- Clinical Immunology and Allergy Division, University of São Paulo School of Medicine, São Paulo, Brazil
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9
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Autoantibody profiles and their association with blood eosinophils in asthma and COPD. Allergol Int 2017; 66:332-337. [PMID: 27592398 DOI: 10.1016/j.alit.2016.08.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Revised: 07/12/2016] [Accepted: 08/03/2016] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Autoimmune involvement in the pathogenesis of asthma and chronic obstructive pulmonary disease (COPD) has been proposed, and autoantibodies are a hallmark of autoimmunity. This study aimed to compare the autoantibody profiles of asthma and COPD, and the relationship between autoantibodies and features of these diseases. METHODS We recruited 110 asthma patients and 92 COPD patients for a prospective study. Six autoantibody types were evaluated: antinuclear antibody, anti-cytoplasmic antibodies, rheumatoid factor, anti-cyclic citrullinated peptide antibody, myeloperoxidase-anti-neutrophil cytoplasmic autoantibody (MPO-ANCA) and proteinase 3-ANCA. Other clinical data were also recorded concurrently. RESULTS An antinuclear antibody titre of ≥1:160 presented only in asthma but not in COPD (10% vs. 0%, p = 0.0002). Eosinophil counts in blood were negative predictors of antinuclear antibody in asthma. Conversely, eosinophil counts in blood and immunoglobulin-E levels of ≥100 IU/mL were positively associated with rheumatoid factor in asthma but not in COPD. There was no relationship between antinuclear antibody or rheumatoid factor and disease severity. CONCLUSIONS It is possible that asthma tends to involve autoimmunity associated with antinuclear antibody more frequently than COPD because asthma is the more robust factor for antinuclear antibody positivity. Antinuclear antibody and rheumatoid factor are associated with eosinophilic responses, but they do not work as biomarkers for disease severity.
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10
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Shim JM, Lee JS, Russell KE, Wiegman CH, Barnes PJ, Fear D, Adcock IM, Durham AL. BET proteins are a key component of immunoglobulin gene expression. Epigenomics 2017; 9:393-406. [PMID: 28322577 PMCID: PMC5476213 DOI: 10.2217/epi-2016-0147] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim BET proteins have been shown to regulate gene expression including inflammatory genes. Methods In order to investigate the role of the BET proteins in immunoglobulin production we treated the human B-cell line CLNH11.4 and primary human B cells and ozone-exposed mice with BET inhibitors (JQ1 or IBET151). Results Both proliferation and IgG production were reduced by JQ1 in a concentration-dependent manner. JQ1 significantly reduced immunoglobulin gene transcription. In vivo treatment of ozone-exposed mice with the BET inhibitor IBET151 similarly inhibited ozone-induced immunoglobulin production. JQ1 did not reduce the protein levels of Brd4 or Oct2 per se but reduced the ability of Brd4 and Oct2 to co-immunoprecipitate and of Oct2 to bind to immunoglobulin gene promoters. Conclusion Our results indicate that BET proteins including Brd4 play a crucial role regulation B-cell-specific gene expression and immunoglobulin production.
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Affiliation(s)
- Jung Min Shim
- Airways Disease Section, National Heart & Lung Institute, Imperial College London, London, SW7 2AZ, UK
| | - Jin S Lee
- Airways Disease Section, National Heart & Lung Institute, Imperial College London, London, SW7 2AZ, UK
| | - Kirsty E Russell
- Airways Disease Section, National Heart & Lung Institute, Imperial College London, London, SW7 2AZ, UK
| | - Coen H Wiegman
- Airways Disease Section, National Heart & Lung Institute, Imperial College London, London, SW7 2AZ, UK
| | - Peter J Barnes
- Airways Disease Section, National Heart & Lung Institute, Imperial College London, London, SW7 2AZ, UK
| | - David Fear
- MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, Department of Respiratory Medicine & Allergy, King's College London, London, WC2R 2LS, UK
| | - Ian M Adcock
- Airways Disease Section, National Heart & Lung Institute, Imperial College London, London, SW7 2AZ, UK
| | - Andrew L Durham
- Airways Disease Section, National Heart & Lung Institute, Imperial College London, London, SW7 2AZ, UK
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11
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Trejo Bittar HE, Doberer D, Mehrad M, Strollo DC, Leader JK, Wenzel S, Yousem SA. Histologic Findings of Severe/Therapy-Resistant Asthma From Video-assisted Thoracoscopic Surgery Biopsies. Am J Surg Pathol 2017; 41:182-188. [PMID: 28079597 PMCID: PMC5234856 DOI: 10.1097/pas.0000000000000777] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The histologic changes occurring in severe/therapy-resistant asthma (SA) as defined by the European Respiratory Society/American Thoracic Society guidelines, particularly at the level of the distal airways are unknown. This study describes the clinical, radiologic, and histologic characteristics of 29 SA patients who underwent video-assisted thoracoscopic surgery lung biopsy. Pathologic observations were correlated with clinical features, especially the presence of autoimmune disease (AID) (15/29, 51.7%). Ten biopsies (10/29, 34.5%) showed only small airway manifestations of asthma, whereas in 19 (65.5%) asthmatic granulomatosis, manifested by asthmatic bronchiolitis supplemented by an alveolar septal mononuclear infiltrates with non-necrotizing granulomas, was present. SA patients without asthmatic granulomatosis showed more striking small airway injury, subbasement membrane thickening, and neutrophilic infiltrates. Cases with concurrent AID had a tendency to more parenchymal eosinophilic inflammation, more bronchiolocentric granulomas, and a suggestion of increased responsivity to nonsteroidal immunosuppressive therapy. Histologic examination of video-assisted thoracoscopic surgery lung biopsies in SA demonstrates diverse pathologies including cases associated with granulomatous inflammation in addition to eosinophilic infiltrates. This spectrum of histologies may link to a high incidence of AID.
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Affiliation(s)
| | - Daniel Doberer
- University of Pittsburgh Asthma Institute at University of Pittsburgh Medical Center, Pulmonary Allergy and Critical Care Medicine Division, Department of Medicine, Pittsburgh, PA, USA
| | - Mitra Mehrad
- University of Pittsburgh Medical Center, Department of Pathology, Pittsburgh, PA, USA
| | - Diane C. Strollo
- University of Pittsburgh Medical Center, Department of Cardiothoracic Surgery, Pittsburgh, PA, USA
| | - Joseph K. Leader
- University of Pittsburgh Medical Center, Department of Cardiothoracic Surgery, Pittsburgh, PA, USA
| | - Sally Wenzel
- University of Pittsburgh Asthma Institute at University of Pittsburgh Medical Center, Pulmonary Allergy and Critical Care Medicine Division, Department of Medicine, Pittsburgh, PA, USA
| | - Samuel A. Yousem
- University of Pittsburgh Medical Center, Department of Pathology, Pittsburgh, PA, USA
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12
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Shida H, Nakazawa D, Tateyama Y, Miyoshi A, Kusunoki Y, Hattanda F, Masuda S, Tomaru U, Kawakami T, Atsumi T, Ishizu A. The Presence of Anti-Lactoferrin Antibodies in a Subgroup of Eosinophilic Granulomatosis with Polyangiitis Patients and Their Possible Contribution to Enhancement of Neutrophil Extracellular Trap Formation. Front Immunol 2016; 7:636. [PMID: 28066444 PMCID: PMC5179553 DOI: 10.3389/fimmu.2016.00636] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 12/12/2016] [Indexed: 11/26/2022] Open
Abstract
Lactoferrin (Lf) is one of the antigens of antineutrophil cytoplasmic antibodies (ANCA) and functions as an endogenous suppressor of neutrophil extracellular trap (NET) formation. However, the prevalence and pathogenicity of anti-lactoferrin antibodies (aLf) in ANCA-associated vasculitis (AAV) remain unrevealed. This study aimed to examine the significance of aLf in AAV, initially. Sixty-five sera from AAV patients, including 41 microscopic polyangiitis, 5 granulomatosis with polyangiitis, and 19 eosinophilic granulomatosis with polyangiitis (EGPA) patients, were subjected to aLf detection using enzyme-linked immunosorbent assay. Clinical characteristics were compared between aLf-positive and aLf-negative patients. Neutrophils from healthy donors were exposed to suboptimal dose (10 nM) of phorbol myristate acetate (PMA) with aLf followed by evaluation of NET formation. Results demonstrated that 4 out of 65 AAV sera (6.2%) were positive for aLf. All of them were EGPA sera (4/19, 21.1%). In EGPA, the frequency of renal involvement, serum CRP levels, and Birmingham Vasculitis Activity Score (BVAS) in the aLf-positive patients was significantly higher than those in the aLf-negative patients, and the aLf titer correlated positively with the serum CRP level and BVAS. The NET formation was particularly enhanced by combined stimulation of 10 nM PMA and 1 µg/mL aLf. IgG isolated from sera of the aLf-positive EGPA patients (250 µg/mL) enhanced NET formation induced by 10 nM of PMA, and the effect was abolished completely by absorption of the aLf. This pilot study suggests that aLf enhance NET formation induced by PMA and are associated with disease activity of EGPA.
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Affiliation(s)
- Haruki Shida
- Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine , Sapporo , Japan
| | - Daigo Nakazawa
- Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine , Sapporo , Japan
| | - Yu Tateyama
- Undergraduate School of Health Sciences, Hokkaido University , Sapporo , Japan
| | - Arina Miyoshi
- Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine , Sapporo , Japan
| | - Yoshihiro Kusunoki
- Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine , Sapporo , Japan
| | - Fumihiko Hattanda
- Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine , Sapporo , Japan
| | - Sakiko Masuda
- Department of Pathology, Hokkaido University Graduate School of Medicine , Sapporo , Japan
| | - Utano Tomaru
- Department of Dermatology, St. Marianna University School of Medicine , Kawasaki , Japan
| | | | - Tatsuya Atsumi
- Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine , Sapporo , Japan
| | - Akihiro Ishizu
- Department of Pathology, Hokkaido University Graduate School of Medicine , Sapporo , Japan
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Vodounon CA, Chabi CB, Skibo YV, Ezin V, Aikou N, Kotchoni SO, Akpona SA, Baba-Moussa L, Abramova ZI. Influence of the programmed cell death of lymphocytes on the immunity of patients with atopic bronchial asthma. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2014; 10:14. [PMID: 24646379 PMCID: PMC3994547 DOI: 10.1186/1710-1492-10-14] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 02/28/2014] [Indexed: 01/15/2023]
Abstract
BACKGROUND Fairly recent data highlight the role of programmed cell death and autoimmunity, as potentially important factors in the pathogenesis of chronic obstructive airway diseases. The purpose of our research was to determine the influence of apoptotic factors on the immunity of patients with atopic bronchial asthma according to the degree of severity. METHOD The study was performed on the peripheral blood of patients with atopic bronchial asthma with different severity. The Immunological aspects were determined with ELISA, the fluorimetric method and the method of precipitation with polyethylene glycol. And the quantification of the parameters of the programmed cell death was performed by the method of flow cytometry and electron microscopy method. RESULTS The data obtained from morphological and biochemical parameters show the deregulation of Programmed Death of lymphocytes of patients with atopic bronchial asthma but individual for each group of patients. This dysfunction might induce the secretion of autoantibodies against DNA. This could explain the accumulation of circulating immune complex with average size considered as the most pathogenic in patients with bronchial asthma especially in the patients of serious severity. It should be noted that Patients with bronchial asthma of mild and severe severity had different way and did not have the same degree of deficiency of the immune system. CONCLUSION These data suggested that apoptotic factor of lymphocytes may play an important role in controlling immunity of patients with atopic bronchial asthma.
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Affiliation(s)
- Cyrille Alode Vodounon
- Laboratory Acid Nucleic, Institute of Fundamental Medicine and Biology, Kazan Federal University (KFU-Russian), Kremlyovskaya str. 18, Kazan 480008, Republic of Tatarstan, Russian Fédération
- Laboratoire de Biologie et de Typage Moléculaire en Microbiologie, Département de biochimie et biologie cellulaire, Faculté des sciences et Techniques (FAST), Université d’Abomey-Calavi (UAC-Benin), 05PB1604 Cotonou, Benin
- Laboratoire de Biochimie et Biologie Moléculaire, Faculté de Médecine, Université de Parakou, BP: 123 Parakou, Parakou, Benin
| | - Christophe Boni Chabi
- Laboratoire de Biochimie et Biologie Moléculaire, Faculté de Médecine, Université de Parakou, BP: 123 Parakou, Parakou, Benin
| | - Ylia Valerevna Skibo
- Laboratory Acid Nucleic, Institute of Fundamental Medicine and Biology, Kazan Federal University (KFU-Russian), Kremlyovskaya str. 18, Kazan 480008, Republic of Tatarstan, Russian Fédération
| | - Vincent Ezin
- Laboratoire de Biologie et de Typage Moléculaire en Microbiologie, Département de biochimie et biologie cellulaire, Faculté des sciences et Techniques (FAST), Université d’Abomey-Calavi (UAC-Benin), 05PB1604 Cotonou, Benin
| | - Nicolas Aikou
- Laboratoire de Biologie et de Typage Moléculaire en Microbiologie, Département de biochimie et biologie cellulaire, Faculté des sciences et Techniques (FAST), Université d’Abomey-Calavi (UAC-Benin), 05PB1604 Cotonou, Benin
| | - Simeon Oloni Kotchoni
- Department of Biology and Center for Computational & Integrative Biology, Rutgers University, Camden, NJ 08102, USA
| | - Simon Ayeleroun Akpona
- Laboratoire de Biochimie et Biologie Moléculaire, Faculté de Médecine, Université de Parakou, BP: 123 Parakou, Parakou, Benin
| | - Lamine Baba-Moussa
- Laboratoire de Biologie et de Typage Moléculaire en Microbiologie, Département de biochimie et biologie cellulaire, Faculté des sciences et Techniques (FAST), Université d’Abomey-Calavi (UAC-Benin), 05PB1604 Cotonou, Benin
| | - Zinaida Ivanovna Abramova
- Laboratory Acid Nucleic, Institute of Fundamental Medicine and Biology, Kazan Federal University (KFU-Russian), Kremlyovskaya str. 18, Kazan 480008, Republic of Tatarstan, Russian Fédération
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14
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Nakano H, Shibata Y, Inoue S, Igarashi A, Yamauchi K, Abe S, Sato M, Aida Y, Nunomiya K, Kimura T, Nemoto T, Watanabe T, Konta T, Ueno Y, Kato T, Kayama T, Kubota I. Relationships between values of antibodies to several connective tissue disease autoantigens and pulmonary function in a Japanese general population: the Takahata study. PLoS One 2013; 8:e81678. [PMID: 24312572 PMCID: PMC3849382 DOI: 10.1371/journal.pone.0081678] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 10/15/2013] [Indexed: 11/18/2022] Open
Abstract
Background Accumulating evidence suggests the involvement of an autoimmune mechanism in the pathogenesis of respiratory dysfunction. The aim of this study was to investigate the relationship between pulmonary function and serum antibodies to several connective tissue disease autoantigens (ACTDA) levels, which has not been investigated in a general population. Methods Blood sampling and spirometry were performed for subjects (n = 3,257) aged ≥40 years who participated in a community-based annual health check in Takahata, Japan, from 2004 to 2006. ACTDA was measured by enzyme immunoassay, and subjects with ACTDA values ≥20 were defined as positive. Results In males, there were significant inverse relationships between logarithmically transformed ACTDA values and spirometric parameters, including % predicted values for forced expiratory volume in 1 s (FEV1) and maximal midexpiratory flow (MMF) as well as FEV1/forced vital capacity (FVC). Multiple linear regression analysis revealed that except for the relationship between ACTDA and FEV1/FVC, these relationships were still significant after adjustment for Brinkman index (a measure of inhaled cigarette consumption). The prevalence of positive ACTDA was greater in male never-smokers with mixed ventilation disorders and relatively severe airflow obstruction (% predicted FEV1 below the median value). Conclusions Autoimmunity may be involved in the mechanism of impaired pulmonary function in the general population.
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Affiliation(s)
- Hiroshi Nakano
- Department of Cardiology, Pulmonology and Nephrology, School of Medicine, Yamagata University, Yamagata City, Yamagata, Japan
| | - Yoko Shibata
- Department of Cardiology, Pulmonology and Nephrology, School of Medicine, Yamagata University, Yamagata City, Yamagata, Japan
- * E-mail:
| | - Sumito Inoue
- Department of Cardiology, Pulmonology and Nephrology, School of Medicine, Yamagata University, Yamagata City, Yamagata, Japan
| | - Akira Igarashi
- Department of Cardiology, Pulmonology and Nephrology, School of Medicine, Yamagata University, Yamagata City, Yamagata, Japan
| | - Keiko Yamauchi
- Department of Cardiology, Pulmonology and Nephrology, School of Medicine, Yamagata University, Yamagata City, Yamagata, Japan
| | - Shuichi Abe
- Department of Cardiology, Pulmonology and Nephrology, School of Medicine, Yamagata University, Yamagata City, Yamagata, Japan
| | - Masamichi Sato
- Department of Cardiology, Pulmonology and Nephrology, School of Medicine, Yamagata University, Yamagata City, Yamagata, Japan
| | - Yasuko Aida
- Department of Cardiology, Pulmonology and Nephrology, School of Medicine, Yamagata University, Yamagata City, Yamagata, Japan
| | - Keiko Nunomiya
- Department of Cardiology, Pulmonology and Nephrology, School of Medicine, Yamagata University, Yamagata City, Yamagata, Japan
| | - Tomomi Kimura
- Department of Cardiology, Pulmonology and Nephrology, School of Medicine, Yamagata University, Yamagata City, Yamagata, Japan
| | - Takako Nemoto
- Department of Cardiology, Pulmonology and Nephrology, School of Medicine, Yamagata University, Yamagata City, Yamagata, Japan
| | - Tetsu Watanabe
- Department of Cardiology, Pulmonology and Nephrology, School of Medicine, Yamagata University, Yamagata City, Yamagata, Japan
| | - Tsuneo Konta
- Department of Cardiology, Pulmonology and Nephrology, School of Medicine, Yamagata University, Yamagata City, Yamagata, Japan
| | - Yoshiyuki Ueno
- Global Center of Excellence Program Study Group, School of Medicine, Yamagata University, Yamagata City, Yamagata, Japan
| | - Takeo Kato
- Global Center of Excellence Program Study Group, School of Medicine, Yamagata University, Yamagata City, Yamagata, Japan
| | - Takamasa Kayama
- Global Center of Excellence Program Study Group, School of Medicine, Yamagata University, Yamagata City, Yamagata, Japan
| | - Isao Kubota
- Department of Cardiology, Pulmonology and Nephrology, School of Medicine, Yamagata University, Yamagata City, Yamagata, Japan
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15
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Primary Cutaneous Vasculitis Masquerading as Drug Induced following Aspirin Desensitization. Case Rep Med 2013; 2013:745714. [PMID: 24348575 PMCID: PMC3857825 DOI: 10.1155/2013/745714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 10/08/2013] [Accepted: 10/14/2013] [Indexed: 11/17/2022] Open
Abstract
Aspirin-exacerbated respiratory disease (AERD) is a well-known clinical condition. Aspirin desensitization followed by daily aspirin therapy is the treatment of choice. We report a challenging case of primary cutaneous vasculitis following aspirin desensitization in a patient with AERD. The vasculitis was likely suppressed with higher dose systemic steroid use to control asthma. Aspirin desensitization led to improved asthma control and steroid reduction, which led to manifestation of prior suppressed cutaneous vasculitis. In our case, there was no evidence of systemic involvement and the patient had a favorable outcome with appropriate therapy.
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16
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Wenzel SE, Vitari CA, Shende M, Strollo DC, Larkin A, Yousem SA. Asthmatic granulomatosis: a novel disease with asthmatic and granulomatous features. Am J Respir Crit Care Med 2012; 186:501-7. [PMID: 22773731 DOI: 10.1164/rccm.201203-0476oc] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
RATIONALE Severe asthma represents 5-10% of all asthma, yet remains problematic and poorly understood. Although it is increasingly recognized as consisting of numerous heterogenous phenotypes, their immunopathology, particularly in the distal airways and interstitium, remains poorly described. OBJECTIVES To identify the pathobiology of atypical difficult asthma. METHODS We report 10 from a total of 19 patients (17 women and 2 men) meeting asthma and severe asthma definitions, requiring daily systemic corticosteroid (CS) use, with inconsistent abnormalities on chest computed tomography scans, who underwent video-assisted thoracoscopic biopsies for further diagnosis and management. MEASUREMENTS AND MAIN RESULTS The pathology of 10 of the 19 cases revealed small airway changes consistent with asthma (eosinophilia, goblet cell hyperplasia), but with the unexpected finding of interstitial nonnecrotizing granulomas. These patients had no evidence for hypersensitivity pneumonitis, but 70% of cases had a personal or family history of autoimmune-like disease. The 10 cases were treated with azathioprine, mycophenolic acid, methotrexate, or infliximab. Nine of 10 showed decreased CS requirements and improved or maintained FEV(1) despite lower CS doses. Of the remaining nine patients, six manifested asthmatic small airway disease, alone or in combination with alveolar septal mononuclear cells, but no granulomas, whereas three manifested other pathologic findings (aspiration, pneumonia, or thromboemboli). CONCLUSIONS These data suggest that a subset of severe "asthma" manifests a granulomatous pathology, which we term "asthmatic granulomatosis." Although identification of this disease currently requires a thorascopic biopsy, alternative approaches to therapy lead to improvement in outcomes.
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Affiliation(s)
- Sally E Wenzel
- University of Pittsburgh Asthma Institute at University of Pittsburgh Medical Center/University of Pittsburgh School of Medicine, Pulmonary Allergy and Critical Care Medicine Division, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
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Liu M, Subramanian V, Christie C, Castro M, Mohanakumar T. Immune responses to self-antigens in asthma patients: clinical and immunopathological implications. Hum Immunol 2012; 73:511-6. [PMID: 22386692 PMCID: PMC3338898 DOI: 10.1016/j.humimm.2012.02.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Revised: 02/08/2012] [Accepted: 02/10/2012] [Indexed: 12/29/2022]
Abstract
Asthma leads to chronic airway inflammation that shares pathological features of chronic rejection after lung transplantation. Due to the significant role of autoimmunity in chronic rejection, we hypothesized that immunity to self-antigens may also be present in asthma. The goal was to define immune responses to self-antigens in patients with asthma. Blood and clinical data were collected from 99 asthmatics and 60 controls. Serum was analyzed for antibodies (Abs) to collagen V (ColV) by enzyme-linked immunosorbent assay and correlated with disease severity. Asthmatics' sera were tested in a human protein array to determine immune responses to other self-antigens. Asthmatics had higher concentrations of Abs to ColV (predominantly immunoglobulin G isotype) compared with controls (p < 0.01). These Abs correlated with severe asthma (p < 0.01) and corticosteroid use (p = 0.032). Additionally, Abs to novel self-antigens epidermal group factor receptor (EGFr), activin A type 1 receptor, and α-catenin were detected in asthmatics. We conclude that Abs to self-antigens (ColV, EGFr, activin A type 1 receptor, and α-catenin) are present in the sera of asthmatics, correlating with clinical disease. Epithelial damage from airway inflammation during asthma may result in the exposure of cryptic self-antigens or their determinants, resulting in immune response to self-antigens, which may contribute to the pathogenesis of asthma.
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Affiliation(s)
- Michael Liu
- Washington University, Department of Surgery, Saint Louis, MO, USA
| | | | - Chandrika Christie
- Washington University, Department of Pulmonary and Critical Care, Saint Louis, MO, USA
| | - Mario Castro
- Washington University, Department of Pulmonary and Critical Care, Saint Louis, MO, USA
| | - T. Mohanakumar
- Washington University, Department of Surgery, Saint Louis, MO, USA
- Washington University, Department of Pathology and Immunology, Saint Louis, MO, USA
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18
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Dumoulin FL, Liese H. Acute hepatitis E virus infection and autoimmune thyroiditis: yet another trigger? BMJ Case Rep 2012; 2012:bcr.12.2011.5441. [PMID: 22604767 DOI: 10.1136/bcr.12.2011.5441] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A middle aged woman, previously healthy with the exception of mild seasonal asthma was presented with signs of acute hepatitis. The further investigation showed acute hepatitis E virus infection associated with autoimmune thyroiditis. Treatment was started with propranolol and carbimazol whereupon hepatitis and hyperthyroidism resolved. The authors think that the observed association of acute hepatitis E virus infection and autoimmune thyroiditis suggests a role of hepatitis E virus as putative trigger of autoimmune thyroiditis. The alternative possibility of thyroid dysfunction due to pre-existing autoantibodies cannot be completely excluded but seems to be unlikely given the very mild course of seasonal asthma in this patient.
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Abstract
Allergic inflammation is due to a complex interplay between several inflammatory cells, including mast cells, basophils, lymphocytes, dendritic cells, eosinophils, and sometimes neutrophils. These cells produce multiple inflammatory mediators, including lipids, purines, cytokines, chemokines, and reactive oxygen species. Allergic inflammation affects target cells, such as epithelial cells, fibroblasts, vascular cells, and airway smooth muscle cells, which become an important source of inflammatory mediators. Sensory nerves are sensitized and activated during allergic inflammation and produce symptoms. Allergic inflammatory responses are orchestrated by several transcription factors, particularly NF-κB and GATA3. Inflammatory genes are also regulated by epigenetic mechanisms, including DNA methylation and histone modifications. There are several endogenous anti-inflammatory mechanisms, including anti-inflammatory lipids and cytokines, which may be defective in allergic disease, thus amplifying and perpetuating the inflammation. Better understanding of the pathophysiology of allergic inflammation has identified new therapeutic targets but developing effective novel therapies has been challenging. Corticosteroids are highly effective with a broad spectrum of anti-inflammatory effects, including epigenetic modulation of the inflammatory response and suppression of GATA3.
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Affiliation(s)
- Peter J Barnes
- National Heart and Lung Institute, Imperial College, London, UK.
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20
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Tedeschi A, Asero R. Asthma and autoimmunity: a complex but intriguing relation. Expert Rev Clin Immunol 2010; 4:767-76. [PMID: 20477126 DOI: 10.1586/1744666x.4.6.767] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Asthma and autoimmune diseases apparently have little to share except for the involvement of the immune system in both types of disorder. However, epidemiological studies have shown that asthma and Type 1 diabetes, a typical autoimmune disease, are associated at the population level, and some experimental findings have suggested that autoimmune mechanisms might be operating in asthma as well. Female preponderance, increased incidence of antinuclear autoantibodies and detection of autoantibodies against either bronchial epithelial antigens or endothelial antigens in patients with nonallergic asthma suggest that the disease may have an autoimmune basis. Approximately 50% of patients with nonallergic asthma react to intradermal injection of autologous serum, indicating the presence of circulating vasoactive factors and suggesting an autoreactive mechanism. Recent findings in experimental animals support the involvement of an autoreactive mechanism in allergic asthma as well, indicating that human alpha-nascent polypeptide-associated complex, identified as an IgE-reactive autoantigen, has the potential to sensitize and induce immediate skin reactions and airway inflammation. In summary, asthma is a heterogeneous disorder characterized by chronic inflammation of the respiratory airways that can be triggered by allergen exposure or by other mechanisms, possibly autoreactive/autoimmune. The autoimmune hypothesis is further, indirectly, supported by the response to immunosuppressive drugs.
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Affiliation(s)
- Alberto Tedeschi
- Allergy and Clinical Immunology Unit, Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Fondazione IRCCS, Via Pace, 9, 20122 Milano, Italy.
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21
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Hitomi Y, Ebisawa M, Tomikawa M, Imai T, Komata T, Hirota T, Harada M, Sakashita M, Suzuki Y, Shimojo N, Kohno Y, Fujita K, Miyatake A, Doi S, Enomoto T, Taniguchi M, Higashi N, Nakamura Y, Tamari M. Associations of functional NLRP3 polymorphisms with susceptibility to food-induced anaphylaxis and aspirin-induced asthma. J Allergy Clin Immunol 2009; 124:779-85.e6. [PMID: 19767079 DOI: 10.1016/j.jaci.2009.07.044] [Citation(s) in RCA: 140] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2009] [Revised: 07/06/2009] [Accepted: 07/21/2009] [Indexed: 01/01/2023]
Abstract
BACKGROUND NLR family, pyrin domain containing 3 (NLRP3), controls the activity of inflammatory caspase-1 by forming inflammasomes, which leads to cleavage of the procytokines IL-1beta and IL-18. Recent studies have shown associations of human NLRP3 polymorphisms with susceptibility to various inflammatory diseases; however, the association with allergic diseases remains unclear. OBJECTIVE We sought to examine whether NLRP3 polymorphisms are associated with susceptibility to food allergy, food-induced anaphylaxis, and aspirin-induced asthma (AIA). METHODS We selected 15 tag single nucleotide polymorphisms (SNPs) of NLRP3 and conducted association analyses of NLRP3 using 574 and 1279 samples for food allergy and AIA, respectively. We further performed functional analyses of the susceptible SNPs. RESULTS Two NLRP3 SNPs (rs4612666 and rs10754558) were significantly associated with susceptibility to food-induced anaphylaxis (P = .00086 and P = .00068, respectively). The NLRP3 haplotype of the 2 SNPs also showed a significant association (P = .000098). We could confirm the association with susceptibility to another hypersensitivity phenotype, AIA (rs4612666, P = .0096). Functional analysis revealed that the risk alleles of rs4612666 and rs10754558 increased the enhancer activity of NLRP3 expression and NLRP3 mRNA stability, respectively. CONCLUSION Our results indicate that the NLRP3 SNPs might play an important role in the development of food-induced anaphylaxis and AIA in a gain-of-function manner. Further research on the NLRP3 inflammasome will contribute to the development of novel diagnostic and therapeutic methods for food-induced anaphylaxis and AIA.
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Affiliation(s)
- Yuki Hitomi
- Laboratory for Respiratory Diseases, Center for Genomic Medicine, RIKEN, Kanagawa, Japan
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22
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Barnes PJ. Intrinsic asthma: not so different from allergic asthma but driven by superantigens? Clin Exp Allergy 2009; 39:1145-51. [PMID: 19538350 DOI: 10.1111/j.1365-2222.2009.03298.x] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The mechanisms of intrinsic or non-allergic asthma remain uncertain as allergens have no obvious role in driving the inflammatory process in the airways. However, IgE synthesis occurs in the airways, despite negative skin prick tests and serum-specific IgE. Furthermore, the inflammatory process in the airways is very similar between allergic and non-allergic asthma, with increased T-helper type 2 (Th2) cells, mast cell activation and infiltration of eosinophils. This pattern of inflammation is associated with a similar expression of inflammatory mediators, including Th2 cytokines and eosinophilotactic chemokines. There is increasing evidence that microbial superantigens, particularly Staphylococcal enterotoxins are important in amplifying inflammation in atopic dermatitis and chronic rhinosinusitis, in atopic and non-atopic patients. Superantigens may also be important in intrinsic asthma as airway epithelial cells may be colonized by Staphylococci and other superantigen-producing microbes. Superantigens produced locally in the airways may lead to class switching of local B cells, resulting in polyclonal IgE production in the airways and also specific IgE against the superantigen (which functions as a 'superallergen'). This leads to sensitization of mast cells, which can be activated by the usual asthma triggers, such as exercise. Superantigens also cause clonal expansion of T cells, resulting in increased Th2 cells and CD8(+) cells, while suppressing regulatory T cells. Superantigens may also reduce responsiveness to corticosteroids, resulting in more severe asthma. Finally, cytotoxic autoantibodies may also be implicated as IgG antibodies directed against epithelial proteins, such as cytokeratin-18, have been detected in intrinsic asthma, possibly as a result of epithelial damage and this may make epithelial cells more susceptible to microbial colonization. The therapeutic implications are that antibodies against local IgE and microbial superantigens or antibiotic therapy to eradicate the relevant superantigen-producing microorganisms may improve the efficacy of conventional therapy with corticosteroids.
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Affiliation(s)
- P J Barnes
- National Heart & Lung Institute, Imperial College London, London, UK.
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Sun RS, Chen XH, Sui JF, Liu RQ, Cheng TM, Ran XZ, Yang T. Detecting anti-FcepsilonRI autoantibodies in patients with asthma by flow cytometry. J Int Med Res 2009; 36:1214-9. [PMID: 19094429 DOI: 10.1177/147323000803600607] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Autoimmune diseases have been implicated in the development of intrinsic asthma, however little data are available on the role of autoimmunity in the pathogenesis of asthma. The purpose of this study was to investigate circulating autoantibodies against the high-affinity receptor for immunoglobulin E, FcepsilonRI, in patients with asthma. Seventy-eight patients with asthma and 32 healthy control subjects were included. All individuals were tested using a triple-staining flow cytometry-based basophil activation test (BAT) for the potential presence of autoantibodies against FcepsilonRI. Of the 78 asthma patients, 29 (37.2%) had a positive BAT result, indicating that their serum was able to activate basophils, compared with only four (12.5%) of the control group, a statistically significant between-group difference. These data suggest that some asthma patients have aberrant anti-FcepsilonRI autoantibodies, which implies that autoimmunity may be one factor involved in the pathogenesis of intrinsic asthma.
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Affiliation(s)
- R S Sun
- Department of Dermatology, Institute of Battle Surgery, Daping Hospital, Third Military Medical University, Chongqing, China
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24
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Clinical course and urinary eicosanoids in patients with aspirin-induced urticaria followed up for 4 years. J Allergy Clin Immunol 2009; 123:174-8. [DOI: 10.1016/j.jaci.2008.09.005] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2008] [Revised: 09/02/2008] [Accepted: 09/03/2008] [Indexed: 11/19/2022]
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25
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Lee HA, Kwon B, Hur GY, Choi SJ, Nahm DH, Park HS. Isotype and IgG subclass distribution of autoantibody response to alpha-enolase protein in adult patients with severe asthma. Yonsei Med J 2008; 49:923-30. [PMID: 19108015 PMCID: PMC2628024 DOI: 10.3349/ymj.2008.49.6.923] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE A possible involvement of autoimmune mechanism in the pathogenesis of bronchial asthma has been proposed. Recently, alpha-enolase protein was identified as a major autoantigen recognized by circulating IgG autoantibodies in patients with severe asthma. To evaluate a possible pathogenetic significance of these autoantibodies in severe asthma, isotype (IgG, IgA, IgM, and IgE) and IgG subclass (IgG1, IgG2, IgG3, and IgG4) distributions of autoantibodies to recombinant human alpha-enolase protein were analyzed. PATIENTS AND METHODS We examined serum samples from 10 patients with severe asthma and 7 patients with mild-to-moderate asthma, and 5 healthy controls by immunoblot analysis. Severe asthma was defined as patients having at least 1 severe asthmatic exacerbation requiring an emergency department visit or admission in the last year despite continuous typical therapies. RESULTS IgG1 was the predominant IgG subclass antibody response to alpha-enolase protein in patients with severe asthma. IgG1 autoantibody to alpha-enolase protein was detected in 7 of 10 patients with severe asthma (70%), 1 of 7 patients with mild-to-moderate asthma (14.3%), and none of 5 healthy controls (0%) (chi-square test; p < 0.05). IgA, IgM, and IgE autoantibodies to alpha-enolase protein could not be detected in patients with severe asthma. CONCLUSION IgG1 subclass was the predominant type of autoantibody response to alpha-enolase protein in patients with severe asthma, suggests a possibility of IgG1 autoantibody-mediated complement activation in the pathogenesis of severe asthma.
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Affiliation(s)
- Hye-Ah Lee
- Department of Allergy and Rheumatology, Ajou University School of Medicine, Suwon, Korea
| | - Byul Kwon
- Department of Allergy and Rheumatology, Ajou University School of Medicine, Suwon, Korea
| | - Gyu-Young Hur
- Department of Allergy and Rheumatology, Ajou University School of Medicine, Suwon, Korea
| | - Sung-Jin Choi
- Department of Allergy and Rheumatology, Ajou University School of Medicine, Suwon, Korea
| | - Dong-Ho Nahm
- Department of Allergy and Rheumatology, Ajou University School of Medicine, Suwon, Korea
| | - Hae-Sim Park
- Department of Allergy and Rheumatology, Ajou University School of Medicine, Suwon, Korea
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Comi AL, Tedeschi A, Lorini M, Miadonna A. Novel clinical and serological aspects in non-allergic asthma. Respir Med 2007; 101:2526-33. [PMID: 17884421 DOI: 10.1016/j.rmed.2007.07.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2007] [Revised: 05/31/2007] [Accepted: 07/16/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND We have recently observed that skin reactivity to autologous serum injection is common in patients with non-allergic asthma. However, clinical significance of skin reactivity to autologous serum remains to be defined. OBJECTIVE To evaluate the possible relation between skin reactivity to autologous serum and clinical and laboratory characteristics in a series of patients with non-allergic asthma. METHODS Fifty-five patients with non-allergic asthma underwent in vivo autologous serum skin test (ASST) and in vitro basophil histamine release assay using basophils from a normal donor. Clinical and laboratory characteristics including peripheral blood eosinophilia, antinuclear antibodies and total IgE concentration were evaluated. As control, ASST was performed in 10 allergic asthmatic patients, 10 patients with allergic rhinitis and 10 normal subjects. RESULTS ASST was positive in 29/55 non-allergic asthmatics (53%), whereas it was negative in all 30 control subjects (P<0.001). The sera of 6 out of 51 patients induced in vitro histamine release from autologous basophils. The sera from two patients induced histamine release from membrane IgE-stripped basophils. A significant predominance of female sex (83%) and a high incidence of antinuclear antibodies (ANA) positivity (55%) were found among ASST-positive patients. CONCLUSION These findings indicate that ASST is positive in about half patients with non-allergic asthma and that a proportion of patients (16%) has functional evidence of circulating histamine-releasing factors. In addition, predominance of female sex and frequent ANA positivity are in line with an autoimmune basis of non-allergic asthma.
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Affiliation(s)
- A L Comi
- Divisione di Medicina Interna e Pneumologia, Ospedale Fatebenefratelli, Corso di Porta Nuova, Milano, Italy
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Affiliation(s)
- Burton Zweiman
- Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
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Ozen Z, Mumbuc S, Sari I, Baglam T, Karatas E, Kanlikama M. Cysteinyl Leukotriene Receptor Expression in Aspirin-Sensitive Nasal Polyposis Patients. ORL J Otorhinolaryngol Relat Spec 2007; 69:176-80. [PMID: 17264534 DOI: 10.1159/000099228] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2006] [Accepted: 08/09/2006] [Indexed: 11/19/2022]
Abstract
BACKGROUND The aim of this study was to detect cysteinyl leukotriene (Cys-LT) receptors in aspirin-sensitive nasal polyposis patients, and compare them with nasal polyposis and chronic rhinosinusitis patients without aspirin sensitivity. METHODS The formalin-fixed, paraffin-embedded tissue blocks of a total of 52 patients undergoing endoscopic sinus surgery were reviewed by an experienced head and neck pathologist. Of these 52 cases, there were 22 nasal polyposis cases with aspirin sensitivity, 15 nasal polyposis cases without aspirin sensitivity and 15 chronic rhinosinusitis cases without aspirin sensitivity. Immunohistochemical analyses for Cys-LT(1) receptors were performed with polyclonal rabbit antibody. RESULTS Eosinophil receptor intensity levels were 27.68, 21.67, and 14.40, respectively. This was statistically insignificant (p <0.089). Mast cell receptor intensity levels were 8.41, 5.27, and 4.27, respectively. In the aspirin-sensitive group, mast cell receptor intensity was significantly higher when compared to the nasal polyposis and chronic rhinosinusitis group (p < 0.0001 and p < 0.0001, respectively). The difference in Cys-LT(1) receptor immunoreactivity in both eosinophils and mast cells among the 3 groups was also found to be statistically significant (p < 0.001). CONCLUSIONS Our study revealed that nasal polyps of aspirin-sensitive patients were infiltrated with eosinophils and mast cells, Cys-LT(1) receptor proportions in these inflammatory cells were found to be higher and Cys-LT(1) receptor immunoreactivity in eosinophils and mast cells was increased.
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Affiliation(s)
- Zeki Ozen
- Mardin State Hospital, Gaziantep, Turkey
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Kudou M, Yasuba H, Kobayashi Y, Hamada K, Kita H. Correlation between rheumatoid factor and peripheral eosinophil count in chronic eosinophilic pneumonia. Respirology 2006; 11:830-2. [PMID: 17052317 DOI: 10.1111/j.1440-1843.2006.00924.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The relationship between the blood level of rheumatoid factor (RF) and the peripheral blood eosinophil (Eo) count (white blood cellsx%Eo, Eo count) in a patient diagnosed with chronic eosinophilic pneumonia was evaluated from before the onset till resolution of the disease. RF levels correlated with Eo counts, and showed a strong correlation with the logarithmic value of the Eo counts (r=0.816). RF levels tended to become elevated earlier and decline later than Eo counts or abnormal X-ray shadows. We concluded that the RF level may reflect the activity of this disease. The mechanism of RF elevation in eosinophil-activated disorders needs to be clarified.
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Affiliation(s)
- Megumi Kudou
- Department of Respiratory Medicine, Takatsuki Red Cross Hospital, Osaka, Japan.
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30
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Jang AS, Park JS, Lee JH, Park SW, Kim DJ, Park CS. Autologous serum skin test for autoantibodies is associated with airway hyperresponsiveness in patients with asthma. Respiration 2006; 74:293-6. [PMID: 17028420 DOI: 10.1159/000096079] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2006] [Accepted: 05/16/2006] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Autoimmune diseases have been implicated as a cause of intrinsic asthma; however, there is little data on the role of autoimmunity in the pathogenesis of asthma. OBJECTIVE The purpose of this study was to investigate circulating functional autoantibodies against the high-affinity IgE receptor FcepsilonRI or IgE in patients with asthma. METHODS Twenty-eight patients with asthma and 19 control subjects were included. All subjects were skin tested with autologous serum to assess for the potential presence of receptor FcepsilonRI or IgE autoantibodies. If the serum-induced wheal diameter was 1.5 mm larger than the histamine-induced wheal diameter and that was 3 mm larger than the saline-induced wheal diameter at 30 min, the reaction was defined positive. RESULTS Of the 47 total subjects (both asthma patients and control subjects), 13 (27.7%) had a positive autologous serum skin test (ASST). Of the 28 asthma patients, 8 (28.6%) were regarded as having autoimmune origin. Autoantibodies against FcepsilonRI or IgE were found in asthma patients, irrespective of atopic status (atopy+ 3/13 vs. atopy- 5/15). The wheal diameter related to ASST was not related to atopy. Asthma patients with ASST-positive results as compared with patients with ASST-negative results exhibited a significant increased airway hyperresponsiveness (PC(20) methacholine, 2.70 +/- 1.27 vs. 9.08 +/- 2.35; p < 0.026). CONCLUSION Our data demonstrate that aberrant autoantibodies against the high-affinity IgE receptor FcepsilonRI or IgE are related to airway hyperresponsiveness in patients with asthma.
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Affiliation(s)
- An-Soo Jang
- Asthma and Allergy Research Group, Division of Allergy and Respiratory Diseases, Soonchunhyang University, Bucheon Hospital, Wonmi-gu, Gyeonggi-do, Republic of Korea.
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Ye YM, Nahm DH, Kim SH, Kim SH, Choi JH, Suh CH, Park HS. Circulating autoantibodies in patients with aspirin-intolerant asthma: an epiphenomenon related to airway inflammation. J Korean Med Sci 2006; 21:412-7. [PMID: 16778381 PMCID: PMC2729943 DOI: 10.3346/jkms.2006.21.3.412] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Several studies have suggested the involvement of an autoimmune mechanism in aspirin (ASA)-intolerant asthma. To test this hypothesis, we measured the levels of circulating autoantibodies, such as IgG and IgA to tissue transglutaminase (TGase), IgG to cytokeratins (CKs) 8, 18, and 19, Clq-binding immune complex (CIC), and antinuclear antibody (ANA), in the sera of 79 patients with ASA-intolerant asthma (Group I) and those of two control groups, consisting of 61 patients with ASA-tolerant asthma (Group II) and 88 healthy control subjects (Group III) by means of ELISA. Significantly higher prevalences of IgG antibodies to CK18 (13.9%) and CK19 (17.7%) were noted in Group I, as compared with Group III (p<0.05 for all) not with Group II. Regarding the prevalences of other autoantibodies, the levels of ANA (1.3%), IgG to TGase (3.8%), and CIC (24.7%) in Group I were not significantly different from those in Groups II and III. Significant correlations were found between positivities for the anti-CK18 and anti-CK19 autoantibodies and the PC(20) methacholine values in the analysis of asthma Groups I and II vs. normal controls, (p=0.001 and p=0.003, respectively). Further studies are needed to explore the potential involvement of an autoantibody-mediated mechanism in the clinical manifestation of bronchial asthma.
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Affiliation(s)
- Young-Min Ye
- Department of Allergy & Rheumatology, Ajou University School of Medicine, Suwon, Korea
| | - Dong-Ho Nahm
- Department of Allergy & Rheumatology, Ajou University School of Medicine, Suwon, Korea
| | - Sang-Ha Kim
- Department of Allergy & Rheumatology, Ajou University School of Medicine, Suwon, Korea
| | - Seung-Hyun Kim
- Department of Allergy & Rheumatology, Ajou University School of Medicine, Suwon, Korea
| | - Jeong-Hee Choi
- Department of Pulmonology & Allergy, Bundang Jesaeng General Hospital, Seongnam, Korea
| | - Chang-Hee Suh
- Department of Allergy & Rheumatology, Ajou University School of Medicine, Suwon, Korea
| | - Hae-Sim Park
- Department of Allergy & Rheumatology, Ajou University School of Medicine, Suwon, Korea
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DEKKER JW, NIZANKOWSKA E, SCHMITZ-SCHUMANN M, PILE K, BOCHENEK G, DYCZEK A, COOKSON WOCM, SZEZEKLIK A. Aspirin-induced asthma and HLA-DRB1 and HLA-DPB1 genotypes. Clin Exp Allergy 2006. [DOI: 10.1111/j.1365-2222.1997.tb00747.x] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Szczeklik A, Sanak M. The broken balance in aspirin hypersensitivity. Eur J Pharmacol 2006; 533:145-55. [PMID: 16457808 DOI: 10.1016/j.ejphar.2005.12.053] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2005] [Indexed: 10/25/2022]
Abstract
Aspirin was introduced into medicine over a century ago and has become the most popular drug in the world. Although the first hypersensitivity reaction was described soon after aspirin had been marketed, only recently a phenomenon of cysteinyl leukotriene overproduction brought new insights on a balance between pro- and anti-inflammatory mediators derived from arachidonic acid. We describe the most common clinical presentations of aspirin hypersensitivity, i.e. aspirin-induced asthma, rhinosinusitis and aspirin-induced urticaria. We also present their biochemical background. Despite relatively high incidence of these reactions, aspirin hypersensitivity remains underdiagnosed worldwide. Acute reactions of aspirin hypersensitivity are elicited via cyclooxygenase inhibition by non-steroid anti-inflammatory drugs. Coxibs, selective inhibitors of cyclooxygenase-2 isoenzyme, do not precipitate symptoms in susceptible patients. Though hypersensitivity correlates with cyclooxygenase-1 inhibition, diminished tissue expression was described only for cyclooxygenase-2. Aspirin-induced asthma and aspirin-induced urticaria, in a substantial part of the patients, are driven by a release of mediators from activated mast cells. These cells in physiological conditions are under inhibitory control of prostaglandin E2. The origin of aspirin hypersensitivity remains unknown, but accumulating data from genetic studies strongly suggest that environmental factor, possibly a common viral infection, can trigger the disease in susceptible subjects.
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Affiliation(s)
- Andrzej Szczeklik
- Department of Medicine, Jagiellonian University School of Medicine, Skawinska 8, 31-066 Krakow, Poland.
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Hamad AM, Sutcliffe AM, Knox AJ. Aspirin-induced asthma: clinical aspects, pathogenesis and management. Drugs 2005; 64:2417-32. [PMID: 15482000 DOI: 10.2165/00003495-200464210-00004] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Aspirin (acetylsalicylic acid)-induced asthma (AIA) consists of the clinical triad of asthma, chronic rhinosinusitis with nasal polyps, and precipitation of asthma and rhinitis attacks in response to aspirin and other NSAIDs. The prevalence of the syndrome in the adult asthmatic populations is approximately 4-10%. Respiratory disease in these patients may be aggressive and refractory to treatment. The aetiology of AIA is complex and not fully understood, but most evidence points towards an abnormality of arachidonic acid (AA) metabolism. Cyclo-oxygenase (COX), the rate-limiting enzyme in AA metabolism, exists as two main isoforms. COX-1 is the constitutive enzyme responsible for synthesis of protective prostanoids, whereas COX-2 is induced under inflammatory conditions. A number of theories regarding its pathogenesis have been proposed. The shunting hypothesis proposes that inhibition of COX-1 shunts AA metabolism away from production of protective prostanoids and towards cysteinyl leukotriene (cys-LT) biosynthesis, resulting in bronchoconstriction and increased mucus production. The COX-2 hypothesis proposes that aspirin causes a structural change in COX-2 that results in the generation of products of the lipoxygenase pathway. It is speculated that this may result in the formation of mediators that cause respiratory reactions in AIA. Related studies provide evidence for abnormal regulation of the lipoxygenase pathway, demonstrating elevated levels of cys-LTs in urine, sputum and peripheral blood, before and following aspirin challenge in AIA patients. These studies suggest that cys-LTs are continually and aggressively synthesised before exposure to aspirin and, during aspirin-induced reactions, acceleration of synthesis occurs. A genetic polymorphism of the LTC4S gene has been identified consisting of an A to C transversion 444 nucleotides upstream of the first codon, conferring a relative risk of AIA of 3.89. Furthermore, carriers of the C444 allele demonstrate a dramatic rise in urinary LTE(4) following aspirin provocation, and respond better to the cys-LT antagonist pranlukast than A444 homozygotes.AIA patients have an aggressive form of disease, and treatment should include combination therapy with inhaled corticosteroids, beta(2)-adrenoceptor agonists and LT modifiers. Furthermore, recently developed inhibitors of COX-2 may be safer in patients with AIA.
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Affiliation(s)
- Ahmed M Hamad
- Department of Respiratory Medicine, Al-Mansourah University, Al-Dakahlia, Egypt
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35
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Bratke K, Böttcher B, Leeder K, Schmidt S, Küpper M, Virchow JC, Luttmann W. Increase in granzyme B+ lymphocytes and soluble granzyme B in bronchoalveolar lavage of allergen challenged patients with atopic asthma. Clin Exp Immunol 2004; 136:542-8. [PMID: 15147358 PMCID: PMC1809040 DOI: 10.1111/j.1365-2249.2004.02468.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Asthma has been linked to a chronic, T-cell-mediated bronchial inflammation. Because other T-lymphocyte-mediated, chronic inflammatory disorders have been associated with elevated granzyme B (grB) expression we tested the hypothesis that atopic asthma might be associated with elevated grB levels in the bronchoalveolar compartment. Therefore we performed intracellular grB staining in lymphocytes from bronchoalveolar lavage (BAL) collected 42 h after segmental allergen provocation (SAP) in allergic patients with bronchial asthma. There was a significant increase in CD3(+), CD8(+), and CD16/56(+) lymphocytes expressing grB in BAL 42 h after SAP as compared to saline challenged controls. However, compared to peripheral blood the percentages of these lymphocyte subsets detected as grB(+) in BAL remained significantly lower. Measurement of extracellular grB in BAL fluids by a particle immunoassay revealed significantly elevated grB levels in the allergen challenged bronchoalveolar compartment 42 h following SAP in six of the eight patients (range, <1.0-348.1 pg/ml) as compared to saline challenged controls (range, <1.0-70.5 pg/ml). We conclude that total cell numbers of grB(+) lymphocyte subsets increase 42 h after SAP in the lower respiratory tract. In addition there is evidence to suggest that grB is released into the airways of asthmatic patients. This suggests a role for grB in the pathophysiological processes following SAP but its definitive role in allergic bronchial asthma needs to be established.
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Affiliation(s)
- K Bratke
- Department of Pneumology, University Medical Clinic, Rostock, Germany.
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36
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Choi JH, Lee KW, Oh HB, Lee KJ, Suh YJ, Park CS, Park HS. HLA association in aspirin-intolerant asthma: DPB1*0301 as a strong marker in a Korean population. J Allergy Clin Immunol 2004; 113:562-4. [PMID: 15007363 DOI: 10.1016/j.jaci.2003.12.012] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Mastalerz L, Setkowicz M, Sanak M, Szczeklik A. Hypersensitivity to aspirin: common eicosanoid alterations in urticaria and asthma. J Allergy Clin Immunol 2004; 113:771-5. [PMID: 15100686 DOI: 10.1016/j.jaci.2003.12.323] [Citation(s) in RCA: 145] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) can precipitate adverse reactions in two apparently different clinical conditions: bronchial asthma and chronic idiopathic urticaria (CIU). Recent evidence indicates that the reactions are triggered by the drugs that inhibit cyclooxygenase-1 but not cyclooxygenase-2. OBJECTIVE To assess whether patients with CIU and aspirin sensitivity share common eicosanoid alterations with patients who have aspirin-sensitive asthma. METHODS Seventy-four patients with CIU and a history of sensitivity to aspirin and NSAIDs underwent placebo-controlled oral aspirin challenge tests. Concentrations of urinary leukotriene E4 (uLTE4) were measured by ELISA and plasma stable prostaglandin D2 metabolite, 9alpha,11beta prostaglandin F(2) by GC/MS. All measurements were carried out at baseline and after aspirin dosing. Patients were genotyped for the leukotriene C4 synthase (LTC4S) promoter single nucleotide polymorphism. RESULTS In 30 of 74 patients, the aspirin challenge was positive, resulting in urticaria/angioedema. In these 30 patients, baseline uLTE4 levels were higher than in nonresponders and the healthy control subjects and increased further (significantly) after the onset of clinical reaction. No such increase occurred in subjects with negative aspirin challenge. Baseline uLTE4 levels correlated with severity of skin reactions. Plasma 9alpha,11beta prostaglandin F(2) levels rose significantly in both aspirin responders and nonresponders, although in the latter group the increase occurred later than in the former. In patients who reacted to aspirin, frequency of (-444)C allele of LTC4S was significantly higher than in patients who did not react. CONCLUSIONS CIU with aspirin sensitivity is characterized by the eicosanoid alterations, which are similar to those present in aspirin-induced asthma.
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Affiliation(s)
- Lucyna Mastalerz
- Departments of Medicine and Dermatology, Jagiellonian University School of Medicine, ul. Skawinska 8, 31-066 Kraków, Poland
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Szczeklik A, Sanak M, Nizankowska-Mogilnicka E, Kiełbasa B. Aspirin intolerance and the cyclooxygenase-leukotriene pathways. Curr Opin Pulm Med 2004; 10:51-6. [PMID: 14749606 DOI: 10.1097/00063198-200401000-00009] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW In up to 10% of patients with bronchial asthma, aspirin and other nonsteroidal antiinflammatory drugs precipitate asthmatic attacks. This is a hallmark of a distinct clinical syndrome that develops according to a characteristic sequence of symptoms. Here we discuss its clinical picture and management as related to the abnormalities in arachidonic acid transformations. RECENT FINDINGS At the biochemical level, the characteristic feature is profound alteration in eicosanoid biosynthesis and metabolism. Major advances in the molecular biology of eicosanoids, exemplified by the cloning of cysteinyl-leukotriene receptors and discovery of a whole family of cyclooxygenase enzymes, offer new insights into mechanisms operating in aspirin-induced asthma. Clinical interest has been enhanced by the introduction into therapy of highly specific cyclooxygenase-2 inhibitors and antileukotriene drugs. SUMMARY Recent studies have improved our understanding of mechanisms operating in asthma and unvieled the role of eicosanoid mediators in pulmonary disease.
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Affiliation(s)
- Andrew Szczeklik
- Department of Medicine, Jagiellonian University School of Medicine, Kraków, Poland.
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Nahm DH, Lee YE, Yim EJ, Park HS, Yim H, Kang Y, Kim JK. Identification of cytokeratin 18 as a bronchial epithelial autoantigen associated with nonallergic asthma. Am J Respir Crit Care Med 2002; 165:1536-9. [PMID: 12045129 DOI: 10.1164/rccm.200201-009oc] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The allergic response to common environmental agents (allergens) has been regarded as an important mechanism in the development of airway inflammation of patients with asthma. However, allergic sensitization cannot be detected in a significant number of adult patients with asthma. The etiologic mechanism responsible for nonallergic asthma has not yet been identified. The idea of a possible involvement of autoimmunity in the pathogenesis of nonallergic asthma has been proposed by earlier studies. To test for the possible presence of an autoimmune response to bronchial epithelial cell antigens in nonallergic asthma, we examined circulating autoantibodies to cultured human bronchial epithelial cells (BEAS-2B) in sera from patients with nonallergic asthma by immunoblot analysis. IgG autoantibodies to the 49-kD bronchial epithelial cell antigen were detected in 10 of 23 patients with nonallergic asthma (43%), 3 of 27 patients with allergic asthma (11%), 2 of 20 patients with systemic lupus erythematosus (10%), and 3 of 34 healthy volunteers (9%) (p < 0.005). The 49-kD auto-antigen was purified and identified as cytokeratin 18 by amino acid sequencing. In this study, we identified cytokeratin 18 as a bronchial epithelial autoantigen associated with nonallergic asthma. Further studies are needed to determine the significance of autoimmunity in nonallergic asthma.
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Affiliation(s)
- Dong-Ho Nahm
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea.
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Arnold V, Balkow S, Staats R, Matthys H, Luttmann W, Virchow JC. Increase in perforin-positive peripheral blood lymphocytes in extrinsic and intrinsic asthma. Am J Respir Crit Care Med 2000; 161:182-6. [PMID: 10619818 DOI: 10.1164/ajrccm.161.1.9902104] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The cause of asthma, which has been linked to a chronic, T-cell-mediated bronchial inflammation, remains unclear. A number of other T-lymphocyte-mediated, chronic inflammatory disorders have been associated with autoimmunity and there are data indicating that autoimmune phenomena might also be present in asthma. Expression of perforin, a cytotoxic molecule produced by lymphocytes, has been implicated in the pathogenesis of autoimmune diseases. We therefore tested the hypothesis that allergic and intrinsic asthma might be associated with an increase in lymphocytes producing perforin by comparing the expression of intracellular perforin in peripheral blood lymphocytes of patients with extrinsic asthma (n = 13), intrinsic asthma (n = 7), and healthy control subjects (n = 18). Lymphocytes were identified using flow cytometry and subdivided into CD3(+), CD4(+), CD8(+), CD16(+), and CD56(+) subpopulations after staining with appropriate monoclonal antibodies. The percentage of perforin-positive total lymphocytes was significantly elevated in patients with allergic as well as intrinsic asthma when compared with normal control subjects. Analysis of lymphocyte subpopulations also revealed a significant increase in the percentage of CD3(+), CD4(+), CD8(+), and CD56(+) cells expressing perforin in allergic asthma and a significant increase in the percentage of CD4(+) and CD56(+) cells in intrinsic asthma when compared with healthy control subjects. Perforin expression in CD4(+) cells in intrinsic asthma was also significantly elevated compared with allergic asthma. We conclude that allergic and intrinsic asthma is associated with increased expression of perforin in T-lymphocyte subsets.
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Affiliation(s)
- V Arnold
- Department of Pneumology, Medical University Clinics, Freiburg, Germany
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Affiliation(s)
- A Szczeklik
- Jagiellonian University School of Medicine, Department of Medicine, Krakow, Poland
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Szczeklik A, Musial J, Pulka G. Autoimmune vasculitis and aortic stenosis in aspirin-induced asthma (AIA). Allergy 1997; 52:352-4. [PMID: 9140532 DOI: 10.1111/j.1398-9995.1997.tb01006.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- A Szczeklik
- Jagiellonian University, School of Medicine, Department of Medicine, Krakow, Poland
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