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Townsend EA, Guadarrama A, Shi L, Roti Roti E, Denlinger LC. P2X 7 signaling influences the production of pro-resolving and pro-inflammatory lipid mediators in alveolar macrophages derived from individuals with asthma. Am J Physiol Lung Cell Mol Physiol 2023; 325:L399-L410. [PMID: 37581221 PMCID: PMC10639011 DOI: 10.1152/ajplung.00070.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 08/16/2023] Open
Abstract
Few new therapeutics exist to target airway inflammation in mild-to-moderate asthma. Alveolar macrophages regulate airway inflammation by producing proresolving eicosanoids. We hypothesized that stimulation of the purinergic receptor P2X7 in macrophages from individuals with asthma produces eicosanoids associated with airway inflammation and resolution, and that these responses are predicted, in part, by P2X7 pore function. Study subjects were recruited in an Institutional Review Board (IRB)-approved study. Alveolar macrophages were recovered from bronchoalveolar lavage fluid following bronchoscopy. Purinergic receptor classification was performed using flow cytometry and fluorescent cell assay. Macrophages were stimulated in vitro and eicosanoids were measured via ELISA or enzyme immunoassay (EIA) in the presence and absence of P2X7-specific agonist [2'(3')-O-(4-Benzoylbenzoyl)adenosine-5'-triphosphate tri(triethylammonium) salt (Bz-ATP)] and antagonist (AZD9056). Functional P2X7 pore status was confirmed in a live cell assay using P2X7-specific agonists and antagonists. Alveolar macrophages produced increased quantities of the oxylipins lipoxin A4 (LXA4), resolvin D1 (RvD1), and 15(S)-hydroxyeicosatetraenoic acid (15(S)-HETE) following stimulation with Bz-ATP compared with vehicle controls, responses that were attenuated in the presence of the P2X7-selective antagonist, AZD9056. LXA4 and RvD1 production was greatest at 1 h, whereas 15(S)-HETE was maximally produced 24 h. Prostaglandin E-2 and resolvin E1 were minimally produced by P2X7 activation, indicating differential signaling pathways involved in eicosanoid production in alveolar macrophages derived from individuals with asthma. The early production of the proresolving eicosanoids, LXA4 and resolvin D1, is regulated by P2X7, whereas generation of the proinflammatory eicosanoid, 15(S)-HETE, is only partially regulated through P2X7 signaling and reaches maximal production after the peak in proresolving eicosanoids.NEW & NOTEWORTHY Alveolar macrophages obtained from individuals with asthma produce soluble lipid mediators in response to P2X7 purinergic receptor signaling. Proinflammatory mediators may contribute to asthma exacerbations but proresolving mediators may help with resolution of asthma loss of control. These specialized proresolving lipid mediators may serve as future potential therapeutics for asthma exacerbation resolution and recovery.
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Affiliation(s)
- Elizabeth A Townsend
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
| | - Arturo Guadarrama
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
| | - Lei Shi
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
| | - Elon Roti Roti
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
| | - Loren C Denlinger
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
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Alsayed AR, Abed A, Abu-Samak M, Alshammari F, Alshammari B. Etiologies of Acute Bronchiolitis in Children at Risk for Asthma, with Emphasis on the Human Rhinovirus Genotyping Protocol. J Clin Med 2023; 12:3909. [PMID: 37373604 DOI: 10.3390/jcm12123909] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 05/22/2023] [Accepted: 05/26/2023] [Indexed: 06/29/2023] Open
Abstract
This research aims to determine acute bronchiolitis' causative virus(es) and establish a viable protocol to classify the Human Rhinovirus (HRV) species. During 2021-2022, we included children 1-24 months of age with acute bronchiolitis at risk for asthma. The nasopharyngeal samples were taken and subjected to a quantitative polymerase chain reaction (qPCR) in a viral panel. For HRV-positive samples, a high-throughput assay was applied, directing the VP4/VP2 and VP3/VP1 regions to confirm species. BLAST searching, phylogenetic analysis, and sequence divergence took place to identify the degree to which these regions were appropriate for identifying and differentiating HRV. HRV ranked second, following RSV, as the etiology of acute bronchiolitis in children. The conclusion of the investigation of all available data in this study distributed sequences into 7 HRV-A, 1 HRV-B, and 7 HRV-C types based on the VP4/VP2 and VP3/VP1 sequences. The nucleotide divergence between the clinical samples and the corresponding reference strains was lower in the VP4/VP2 region than in the VP3/VP1 region. The results demonstrated the potential utility of the VP4/VP2 region and the VP3/VP1 region for differentiating HRV genotypes. Confirmatory outcomes were yielded, indicating how nested and semi-nested PCR can establish practical ways to facilitate HRV sequencing and genotyping.
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Affiliation(s)
- Ahmad R Alsayed
- Department of Clinical Pharmacy and Therapeutics, Applied Science Private University, Amman 11931, Jordan
| | - Anas Abed
- Pharmacological and Diagnostic Research Centre, Faculty of Pharmacy, Al-Ahliyya Amman University, Amman 11931, Jordan
| | - Mahmoud Abu-Samak
- Department of Clinical Pharmacy and Therapeutics, Applied Science Private University, Amman 11931, Jordan
| | - Farhan Alshammari
- Department of Pharmaceutics, College of Pharmacy, University of Hail, Hail 2440, Saudi Arabia
| | - Bushra Alshammari
- Department of Medical Surgical Nursing, College of Nursing, University of Hail, Hail 2440, Saudi Arabia
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Nanishi M, Chandran A, Li X, Stanford JB, Alshawabkeh AN, Aschner JL, Dabelea D, Dunlop AL, Elliott AJ, Gern JE, Hartert T, Herbstman J, Hershey GKK, Hipwell AE, Karagas MR, Karr CJ, Leve LD, Litonjua AA, McEvoy CT, Miller RL, Oken E, O’Shea TM, Paneth N, Weiss ST, Wright RO, Wright RJ, Carroll KN, Zhang X, Zhao Q, Zoratti E, Camargo CA, Hasegawa K. Association of Severe Bronchiolitis during Infancy with Childhood Asthma Development: An Analysis of the ECHO Consortium. Biomedicines 2022; 11:23. [PMID: 36672531 PMCID: PMC9855570 DOI: 10.3390/biomedicines11010023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 12/13/2022] [Indexed: 12/25/2022] Open
Abstract
Objective: Many studies have shown that severe (hospitalized) bronchiolitis during infancy is a risk factor for developing childhood asthma. However, the population subgroups at the highest risk remain unclear. Using large nationwide pediatric cohort data, namely the NIH Environmental influences on Child Health Outcomes (ECHO) Program, we aimed to quantify the longitudinal relationship of bronchiolitis hospitalization during infancy with asthma in a generalizable dataset and to examine potential heterogeneity in terms of major demographics and clinical factors. Methods: We analyzed data from infants (age <12 months) enrolled in one of the 53 prospective cohort studies in the ECHO Program during 2001−2021. The exposure was bronchiolitis hospitalization during infancy. The outcome was a diagnosis of asthma by a physician by age 12 years. We examined their longitudinal association and determined the potential effect modifications of major demographic factors. Results: The analytic cohort consisted of 11,762 infants, 10% of whom had bronchiolitis hospitalization. Overall, 15% subsequently developed asthma. In the Cox proportional hazards model adjusting for 10 patient-level factors, compared with the no-bronchiolitis hospitalization group, the bronchiolitis hospitalization group had a significantly higher rate of asthma (14% vs. 24%, HR = 2.77, 95%CI = 2.24−3.43, p < 0.001). There was significant heterogeneity by race and ethnicity (Pinteraction = 0.02). The magnitude of the association was greater in non-Hispanic White (HR = 3.77, 95%CI = 2.74−5.18, p < 0.001) and non-Hispanic Black (HR = 2.39, 95%CI = 1.60−3.56; p < 0.001) infants, compared with Hispanic infants (HR = 1.51, 95%CI = 0.77−2.95, p = 0.23). Conclusions: According to the nationwide cohort data, infants hospitalized with bronchiolitis are at a higher risk for asthma, with quantitative heterogeneity in different racial and ethnic groups.
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Affiliation(s)
- Makiko Nanishi
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Aruna Chandran
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Xiuhong Li
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Joseph B. Stanford
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT 84112, USA
| | - Akram N. Alshawabkeh
- Department of Civil and Environmental Engineering, Northeastern University, Boston, MA 02115, USA
| | - Judy L. Aschner
- Departments of Pediatrics, Hackensack Meridian School of Medicine, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Dana Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Anne L. Dunlop
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA 30307, USA
| | - Amy J. Elliott
- Avera Research Institute & Department of Pediatrics, University of South Dakota School of Medicine, Sioux Falls, SD 57069, USA
| | - James E. Gern
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI 53726, USA
| | - Tina Hartert
- Departments of Medicine and Pediatrics, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Julie Herbstman
- Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY 10027, USA
| | - Gurjit K. Khurana Hershey
- Division of Asthma Research, Cincinnati Children’s Hospital, Department of Pediatrics, University of Cincinnati, Cincinnati, OH 45221, USA
| | - Alison E. Hipwell
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Margaret R. Karagas
- Department of Epidemiology, Geisel School of Medicine, Dartmouth College, Hanover, NH 03756, USA
| | - Catherine J. Karr
- Department of Epidemiology, University of Washington, Seattle, WA 98195, USA
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA 98195, USA
- Department of Pediatrics, University of Washington, Seattle, WA 98195, USA
| | - Leslie D. Leve
- Prevention Science Institute, University of Oregon, Eugene, OR 97403, USA
| | - Augusto A. Litonjua
- Division of Pediatric Pulmonary Medicine, Department of Pediatrics, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Cindy T. McEvoy
- Department of Pediatrics, Oregon Health & Science University, Portland, OR 97239, USA
| | - Rachel L. Miller
- Division of Clinical Immunology, Department of Medicine, Icahn School of Medicine, New York, NY 10029, USA
| | - Emily Oken
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, MA 02215, USA
| | - T. Michael O’Shea
- Division of Neonatal-Perinatal Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27559, USA
| | - Nigel Paneth
- Departments of Epidemiology and Biostatistics and Pediatrics and Human Development, Michigan State University, College of Human Medicine, East Lansing, MI 49503, USA
| | - Scott T. Weiss
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Robert O. Wright
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Rosalind J. Wright
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Kecia N. Carroll
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Xueying Zhang
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Qi Zhao
- Department of Preventive Medicine, The University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Edward Zoratti
- Department of Medicine, Henry Ford Health, Detroit, MI 48202, USA
| | - Carlos A. Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Kohei Hasegawa
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
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Du X, Yuan L, Yao Y, Yang Y, Zhou K, Wu X, Wang L, Qin L, Li W, Xiang Y, Qu X, Liu H, Qin X, Yang M, Liu C. ITGB4 Deficiency in Airway Epithelium Aggravates RSV Infection and Increases HDM Sensitivity. Front Immunol 2022; 13:912095. [PMID: 35958591 PMCID: PMC9357881 DOI: 10.3389/fimmu.2022.912095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 06/13/2022] [Indexed: 11/16/2022] Open
Abstract
Background The heterogeneity of RSV-infected pathology phenotype in early life is strongly associate with increased susceptibility of asthma in later life. However, the inner mechanism of this heterogeneity is still obscure. ITGB4 is a down-regulated adhesion molecular in the airway epithelia of asthma patients which may participate in the regulation of RSV infection related intracellular pathways. Object This study was designed to observe the involvement of ITGB4 in the process of RSV infection and the effect of ITGB4 deficiency on anti-RSV responses of airway epithelia. Results RSV infection caused a transient decrease of ITGB4 expression both in vitro and in vivo. Besides, ITGB4 deficiency induced not only exacerbated RSV infection, but also enhanced HDM sensitivity in later life. Moreover, IFN III (IFN-λ) was significantly suppressed during RSV infection in ITGB4 deficient airway epithelial cells. Furthermore, the suppression of IFN-λ were regulated by IRF-1 through the phosphorylation of EGFR in airway epithelial cells after RSV infection. Conclusion These results demonstrated the involvement of ITGB4 deficiency in the development of enhance RSV infection in early life and the increased HDM sensitivity in later life by down-regulation of IFN-λ through EGFR/IRF-1 pathway in airway epithelial cells.
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Affiliation(s)
- Xizi Du
- Department of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Xiangya Hospital, Central South University, Changsha, China
- Department of Physiology, School of Basic Medicine Science, Central South University, Changsha, China
| | - Lin Yuan
- Department of Physiology, School of Basic Medicine Science, Central South University, Changsha, China
| | - Ye Yao
- Department of Physiology, School of Basic Medicine Science, Central South University, Changsha, China
| | - Yu Yang
- Department of Physiology, School of Basic Medicine Science, Central South University, Changsha, China
| | - Kai Zhou
- Department of Physiology, School of Basic Medicine Science, Central South University, Changsha, China
| | - Xinyu Wu
- Department of Physiology, School of Basic Medicine Science, Central South University, Changsha, China
| | - Leyuan Wang
- Department of Physiology, School of Basic Medicine Science, Central South University, Changsha, China
| | - Ling Qin
- Department of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Xiangya Hospital, Central South University, Changsha, China
| | - Wenkai Li
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
| | - Yang Xiang
- Department of Physiology, School of Basic Medicine Science, Central South University, Changsha, China
| | - Xiangping Qu
- Department of Physiology, School of Basic Medicine Science, Central South University, Changsha, China
| | - Huijun Liu
- Department of Physiology, School of Basic Medicine Science, Central South University, Changsha, China
| | - Xiaoqun Qin
- Department of Physiology, School of Basic Medicine Science, Central South University, Changsha, China
| | - Ming Yang
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute (HMRI), University of Newcastle, New Lambton Heights, NSW, Australia
| | - Chi Liu
- Department of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Xiangya Hospital, Central South University, Changsha, China
- Department of Physiology, School of Basic Medicine Science, Central South University, Changsha, China
- Research Center of China-Africa Infectious Diseases, Xiangya School of Medicine Central South University, Changsha, China
- *Correspondence: Chi Liu,
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5
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Kenmoe S, Atenguena Okobalemba E, Takuissu GR, Ebogo-Belobo JT, Oyono MG, Magoudjou-Pekam JN, Kame-Ngasse GI, Taya-Fokou JB, Mbongue Mikangue CA, Kenfack-Momo R, Mbaga DS, Bowo-Ngandji A, Kengne-Ndé C, Esemu SN, Njouom R, Ndip L. Association between early viral lower respiratory tract infections and subsequent asthma development. World J Crit Care Med 2022; 11:298-310. [PMID: 36051944 PMCID: PMC9305678 DOI: 10.5492/wjccm.v11.i4.298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 04/25/2022] [Accepted: 06/17/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The association between hospitalization for human respiratory syncytial virus (HRSV) bronchiolitis in early childhood and subsequent asthma is well established. The long-term prognosis for non-bronchiolitis lower respiratory tract infections (LRTI) caused by viruses different from HRSV and rhinovirus, on the other hand, has received less interest.
AIM To investigate the relationship between infant LRTI and later asthma and examine the influence of confounding factors.
METHODS The PubMed and Global Index Medicus bibliographic databases were used to search for articles published up to October 2021 for this systematic review. We included cohort studies comparing the incidence of asthma between patients with and without LRTI at ≤ 2 years regardless of the virus responsible. The meta-analysis was performed using the random effects model. Sources of heterogeneity were assessed by stratified analyses.
RESULTS This review included 15 articles (18 unique studies) that met the inclusion criteria. LRTIs at ≤ 2 years were associated with an increased risk of subsequent asthma up to 20 years [odds ratio (OR) = 5.0, 95%CI: 3.3-7.5], with doctor-diagnosed asthma (OR = 5.3, 95%CI: 3.3-8.6), current asthma (OR = 5.4, 95%CI: 2.7-10.6), and current medication for asthma (OR = 1.2, 95%CI: 0.7-3.9). Our overall estimates were not affected by publication bias (P = 0.671), but there was significant heterogeneity [I2 = 58.8% (30.6-75.5)]. Compared to studies with hospitalized controls without LRTI, those with ambulatory controls had a significantly higher strength of association between LRTIs and subsequent asthma. The strength of the association between LRTIs and later asthma varied significantly by country and age at the time of the interview. The sensitivity analyses including only studies with similar proportions of confounding factors (gender, age at LRTI development, age at interview, gestational age, birth weight, weight, height, smoking exposure, crowding, family history of atopy, and family history of asthma) between cases and controls did not alter the overall estimates.
CONCLUSION Regardless of the causative virus and confounding factors, viral LRTIs in children < 2 years are associated with an increased risk of developing a subsequent asthma. Parents and pediatricians should be informed of this risk.
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Affiliation(s)
- Sebastien Kenmoe
- Department of Microbiology and Parasitology, University of Buea, Buea 00237, Cameroon
- Department of Virology, Centre Pasteur of Cameroon, Yaounde 00237, Cameroon
| | | | - Guy Roussel Takuissu
- Centre of Research in Food, Food Security and Nutrition, Institute of Medical Research and Medicinal Plants Studies, Yaounde 00237, Cameroon
| | - Jean Thierry Ebogo-Belobo
- Medical Research Centre, Institute of Medical Research and Medicinal Plants Studies, Yaounde 00237, Cameroon
| | - Martin Gael Oyono
- Laboratory of Parasitology and Ecology, The University of Yaounde I, Yaounde 00237, Cameroon
| | | | - Ginette Irma Kame-Ngasse
- Medical Research Centre, Institute of Medical Research and Medicinal Plants Studies, Yaounde 00237, Cameroon
| | | | | | - Raoul Kenfack-Momo
- Department of Biochemistry, The University of Yaounde I, Yaounde 00237, Cameroon
| | - Donatien Serge Mbaga
- Department of Microbiology, The University of Yaounde I, Yaounde 00237, Cameroon
| | - Arnol Bowo-Ngandji
- Department of Microbiology, The University of Yaounde I, Yaounde 00237, Cameroon
| | - Cyprien Kengne-Ndé
- Epidemiological Surveillance, Evaluation and Research Unit, National Aids Control Committee, Douala 00237, Cameroon
| | - Seraphine Nkie Esemu
- Department of Microbiology and Parasitology, University of Buea, Buea 00237, Cameroon
| | - Richard Njouom
- Department of Virology, Centre Pasteur of Cameroon, Yaounde 00237, Cameroon
| | - Lucy Ndip
- Department of Microbiology and Parasitology, University of Buea, Buea 00237, Cameroon
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6
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Garegnani L, Styrmisdóttir L, Roson Rodriguez P, Escobar Liquitay CM, Esteban I, Franco JV. Palivizumab for preventing severe respiratory syncytial virus (RSV) infection in children. Cochrane Database Syst Rev 2021; 11:CD013757. [PMID: 34783356 PMCID: PMC8594174 DOI: 10.1002/14651858.cd013757.pub2] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Respiratory viruses are the leading cause of lower respiratory tract infection (LRTI) and hospitalisation in infants and young children. Respiratory syncytial virus (RSV) is the main infectious agent in this population. Palivizumab is administered intramuscularly every month during five months in the first RSV season to prevent serious RSV LRTI in children. Given its high cost, it is essential to know if palivizumab continues to be effective in preventing severe RSV disease in children. OBJECTIVES To assess the effects of palivizumab for preventing severe RSV infection in children. SEARCH METHODS We searched CENTRAL, MEDLINE, three other databases and two trials registers to 14 October 2021, together with reference checking, citation searching and contact with study authors to identify additional studies. We searched Embase to October 2020, as we did not have access to this database for 2021. SELECTION CRITERIA We included randomised controlled trials (RCTs), including cluster-RCTs, comparing palivizumab given at a dose of 15 mg/kg once a month (maximum five doses) with placebo, no intervention or standard care in children 0 to 24 months of age from both genders, regardless of RSV infection history. DATA COLLECTION AND ANALYSIS: We used Cochrane's Screen4Me workflow to help assess the search results. Two review authors screened studies for selection, assessed risk of bias and extracted data. We used standard Cochrane methods. We used GRADE to assess the certainty of the evidence. The primary outcomes were hospitalisation due to RSV infection, all-cause mortality and adverse events. Secondary outcomes were hospitalisation due to respiratory-related illness, length of hospital stay, RSV infection, number of wheezing days, days of supplemental oxygen, intensive care unit length of stay and mechanical ventilation days. MAIN RESULTS We included five studies with a total of 3343 participants. All studies were parallel RCTs, assessing the effects of 15 mg/kg of palivizumab every month up to five months compared to placebo or no intervention in an outpatient setting, although one study also included hospitalised infants. Most of the included studies were conducted in children with a high risk of RSV infection due to comorbidities like bronchopulmonary dysplasia and congenital heart disease. The risk of bias of outcomes across all studies was similar and predominately low. Palivizumab reduces hospitalisation due to RSV infection at two years' follow-up (risk ratio (RR) 0.44, 95% confidence interval (CI) 0.30 to 0.64; 5 studies, 3343 participants; high certainty evidence). Based on 98 hospitalisations per 1000 participants in the placebo group, this corresponds to 43 (29 to 62) per 1000 participants in the palivizumab group. Palivizumab probably results in little to no difference in mortality at two years' follow-up (RR 0.69, 95% CI 0.42 to 1.15; 5 studies, 3343 participants; moderate certainty evidence). Based on 23 deaths per 1000 participants in the placebo group, this corresponds to 16 (10 to 27) per 1000 participants in the palivizumab group. Palivizumab probably results in little to no difference in adverse events at 150 days' follow-up (RR 1.09, 95% CI 0.85 to 1.39; 3 studies, 2831 participants; moderate certainty evidence). Based on 84 cases per 1000 participants in the placebo group, this corresponds to 91 (71 to 117) per 1000 participants in the palivizumab group. Palivizumab probably results in a slight reduction in hospitalisation due to respiratory-related illness at two years' follow-up (RR 0.78, 95% CI 0.62 to 0.97; 5 studies, 3343 participants; moderate certainty evidence). Palivizumab may result in a large reduction in RSV infection at two years' follow-up (RR 0.33, 95% CI 0.20 to 0.55; 3 studies, 554 participants; low certainty evidence). Based on 195 cases of RSV infection per 1000 participants in the placebo group, this corresponds to 64 (39 to 107) per 1000 participants in the palivizumab group. Palivizumab also reduces the number of wheezing days at one year's follow-up (RR 0.39, 95% CI 0.35 to 0.44; 1 study, 429 participants; high certainty evidence). AUTHORS' CONCLUSIONS The available evidence suggests that prophylaxis with palivizumab reduces hospitalisation due to RSV infection and results in little to no difference in mortality or adverse events. Moreover, palivizumab results in a slight reduction in hospitalisation due to respiratory-related illness and may result in a large reduction in RSV infections. Palivizumab also reduces the number of wheezing days. These results may be applicable to children with a high risk of RSV infection due to comorbidities. Further research is needed to establish the effect of palivizumab on children with other comorbidities known as risk factors for severe RSV disease (e.g. immune deficiencies) and other social determinants of the disease, including children living in low- and middle-income countries, tropical regions, children lacking breastfeeding, living in poverty, or members of families in overcrowded situations.
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Affiliation(s)
- Luis Garegnani
- Associate Cochrane Centre, Instituto Universitario Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Pablo Roson Rodriguez
- Research Department, Instituto Universitario Hospital Italiano, Buenos Aires, Argentina
| | | | - Ignacio Esteban
- Fundación INFANT, Buenos Aires, Argentina
- Pediatric Stepdown Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Juan Va Franco
- Associate Cochrane Centre, Instituto Universitario Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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7
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Mitri EJ, Zheng DX, Garg V, Crifase CC, Herrera NM, Espinola JA, Hasegawa K, Camargo CA. Blood eosinophils, specific immunoglobulin E, and bronchiolitis severity. Pediatr Pulmonol 2021; 56:2997-3004. [PMID: 34156171 PMCID: PMC8373702 DOI: 10.1002/ppul.25543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 05/24/2021] [Accepted: 06/12/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND Bronchiolitis is the leading cause of hospitalization for United States infants. Blood eosinophil and serum specific IgE (sIgE) levels are separately linked to clinical severity but few studies have examined these biomarkers together. OBJECTIVE Among infants hospitalized for bronchiolitis, we investigated the association between (1) blood eosinophilia and severity, (2) sIgE sensitization and severity, and (3) interaction between the two biomarkers on severity. METHODS We enrolled 1016 infants hospitalized for bronchiolitis between 2011 and 2014 across 17 U.S. hospitals into a prospective cohort study. Of those, 873 (86%) had eosinophils measured and all had sIgE levels from blood collected at hospitalization. We investigated higher bronchiolitis severity using intensive care therapy as the outcome (i.e., intensive care unit admission, intubation, and/or receipt of continuous positive pressure ventilation). RESULTS Among 873 infants in the analytic cohort, 18% had blood eosinophilia of ≥3%, and 20% were positive for sIgE. With regard to bronchiolitis severity, 15% received intensive care therapy. In unadjusted analyses, eosinophils ≥3% was not associated with intensive care therapy, while sIgE was associated with a significantly higher risk (odds ratio [OR]: 1.44, 95% confidence interval [CI]: 1.08-1.92; p = .01). In a multivariable model for intensive care therapy, eosinophilia remained unassociated with severity, and sIgE remained associated (OR: 1.60, 95% CI: 1.05-2.45; p = .03). Also, sIgE did not modify the association between eosinophil level and intensive care therapy (pinteraction = .14). CONCLUSION Blood eosinophilia of ≥3% was not associated with bronchiolitis severity. By contrast, sIgE was independently associated with bronchiolitis severity and did not modify the association between eosinophil level and severity.
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Affiliation(s)
- Elie J. Mitri
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | - David X. Zheng
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | - Vebhav Garg
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | | | - Nicole M. Herrera
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | - Janice A. Espinola
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | - Kohei Hasegawa
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | - Carlos A. Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
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8
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Lai SH, Tsai MH, Hua MC, Yeh KW, Yao TC, Huang JL, Liao SL. Distinct lung function and bronchodilator responses between term and preterm young children with recurrent wheezing. Pediatr Neonatol 2021; 62:394-399. [PMID: 33962900 DOI: 10.1016/j.pedneo.2021.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 12/09/2020] [Accepted: 03/29/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Recurrent or unresolved wheezing is a common complaint in certain young children populations, especially those born preterm. Using infant lung function testing, we aimed to distinguish the differences between term and preterm young children with recurrent wheezing. METHODS Children under 2 years of corrected age were enrolled if they had 3 or more wheezing episodes during the enrollment period. Healthy term controls of comparable age were also recruited for reference. Measurements of lung function were made, including tidal breathing, passive respiratory mechanics, and forced tidal and raised-volume expiration. For children with recurrent wheezing, raised-volume forced expiration was repeated after an adequate delivery of bronchodilator nebulization was achieved. RESULTS In total, 68 young children (40 with recurrent wheezing and 28 healthy controls) were recruited. Among children with recurrent wheezing, 23 preterm children (preterm group), and 17 term children (term group) were enrolled. Compared with healthy controls, both the term and preterm groups had lower lung function as measured by absolute values and z scores. The term group performed worse than the preterm group with regard to forced vital capacity, forced expiratory volume at 0.5 s (FEV0.5), and peak expiratory flow. Following bronchodilator nebulization, the term group had significantly higher increases in FEV0.5 and forced mid-expiratory flow than the preterm group. CONCLUSION Young children with recurrent wheezing, especially term infants, demonstrated lower lung function than healthy controls. Moreover, the term group evidenced greater responsiveness to bronchodilators than the preterm group. The distinct bronchodilator responses may offer further information to guide the diagnosis and treatment of young children with recurrent wheezing.
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Affiliation(s)
- Shen-Hao Lai
- Department of Pediatrics, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan; Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan; Prediction of Allergies in Taiwanese Children (PATCH) Cohort Study, Keelung, Taiwan
| | - Ming-Han Tsai
- Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan; Department of Pediatrics, Chang Gung Memorial Hospital Keelung Branch, Keelung, Taiwan; Prediction of Allergies in Taiwanese Children (PATCH) Cohort Study, Keelung, Taiwan
| | - Man-Chin Hua
- Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan; Department of Pediatrics, Chang Gung Memorial Hospital Keelung Branch, Keelung, Taiwan; Prediction of Allergies in Taiwanese Children (PATCH) Cohort Study, Keelung, Taiwan
| | - Kuo-Wei Yeh
- Department of Pediatrics, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan; Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan; Prediction of Allergies in Taiwanese Children (PATCH) Cohort Study, Keelung, Taiwan
| | - Tsung-Chieh Yao
- Department of Pediatrics, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan; Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan; Prediction of Allergies in Taiwanese Children (PATCH) Cohort Study, Keelung, Taiwan
| | - Jing-Long Huang
- Department of Pediatrics, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan; Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan; Prediction of Allergies in Taiwanese Children (PATCH) Cohort Study, Keelung, Taiwan
| | - Sui-Ling Liao
- Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan; Department of Pediatrics, Chang Gung Memorial Hospital Keelung Branch, Keelung, Taiwan; Prediction of Allergies in Taiwanese Children (PATCH) Cohort Study, Keelung, Taiwan.
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9
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Limkar AR, Percopo CM, Redes JL, Druey KM, Rosenberg HF. Persistent Airway Hyperresponsiveness Following Recovery from Infection with Pneumonia Virus of Mice. Viruses 2021; 13:v13050728. [PMID: 33922096 PMCID: PMC8143513 DOI: 10.3390/v13050728] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/13/2021] [Accepted: 04/19/2021] [Indexed: 01/25/2023] Open
Abstract
Respiratory virus infections can have long-term effects on lung function that persist even after the acute responses have resolved. Numerous studies have linked severe early childhood infection with respiratory syncytial virus (RSV) to the development of wheezing and asthma, although the underlying mechanisms connecting these observations remain unclear. Here, we examine airway hyperresponsiveness (AHR) that develops in wild-type mice after recovery from symptomatic but sublethal infection with the natural rodent pathogen, pneumonia virus of mice (PVM). We found that BALB/c mice respond to a limited inoculum of PVM with significant but reversible weight loss accompanied by virus replication, acute inflammation, and neutrophil recruitment to the airways. At day 21 post-inoculation, virus was no longer detected in the airways and the acute inflammatory response had largely resolved. However, and in contrast to most earlier studies using the PVM infection model, all mice survived the initial infection and all went on to develop serum anti-PVM IgG antibodies. Furthermore, using both invasive plethysmography and precision-cut lung slices, we found that these mice exhibited significant airway hyperresponsiveness at day 21 post-inoculation that persisted through day 45. Taken together, our findings extend an important and versatile respiratory virus infection model that can now be used to explore the role of virions and virion clearance as well as virus-induced inflammatory mediators and their signaling pathways in the development and persistence of post-viral AHR and lung dysfunction.
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Affiliation(s)
- Ajinkya R. Limkar
- Inflammation Immunobiology Section, Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA; (A.R.L.); (C.M.P.)
| | - Caroline M. Percopo
- Inflammation Immunobiology Section, Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA; (A.R.L.); (C.M.P.)
| | - Jamie L. Redes
- Lung and Vascular Inflammation Section, Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA; (J.L.R.); (K.M.D.)
| | - Kirk M. Druey
- Lung and Vascular Inflammation Section, Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA; (J.L.R.); (K.M.D.)
| | - Helene F. Rosenberg
- Inflammation Immunobiology Section, Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA; (A.R.L.); (C.M.P.)
- Correspondence:
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10
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Bonner K, Scotney E, Saglani S. Factors and mechanisms contributing to the development of preschool wheezing disorders. Expert Rev Respir Med 2021; 15:745-760. [PMID: 33881953 DOI: 10.1080/17476348.2021.1913057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Half of all children will experience an episode of wheezing by their sixth birthday and acute episodes of wheezing in preschool children account for the majority of all childhood hospital admissions for wheeze. Recurrent preschool wheezing associates with early loss of lung function and a life-long impact on lung health. AREAS COVERED We reviewed the literature on PubMed from August 2010-2020 focussing on factors associated with wheeze inception and persistence, paying specific attention to mechanistic studies that have investigated the impact of early life exposures in shaping immune responses in children with underlying susceptibility to wheezing. In particular, the role of early allergen sensitization, respiratory infections, and the impact of the environment on shaping the airway microbiome and resulting immune responses are discussed. EXPERT OPINION There is an abundance of associative data showing the role of in utero and postnatal factors influencing wheeze onset and persistence. However, mechanistic and stratified, biomarker-based interventional studies that confirm these associations are now needed if we are to impact the significant healthcare burden resulting from preschool wheezing disorders.
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Affiliation(s)
- Katie Bonner
- Inflammation, Repair & Development Section, National Heart & Lung Institute, Imperial College London, London, UK.,Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK
| | - Elizabeth Scotney
- Inflammation, Repair & Development Section, National Heart & Lung Institute, Imperial College London, London, UK.,Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK
| | - Sejal Saglani
- Inflammation, Repair & Development Section, National Heart & Lung Institute, Imperial College London, London, UK.,Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK
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11
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Narayanan S, Elesela S, Rasky AJ, Morris SH, Kumar S, Lombard D, Lukacs NW. ER stress protein PERK promotes inappropriate innate immune responses and pathogenesis during RSV infection. J Leukoc Biol 2021; 111:379-389. [PMID: 33866604 DOI: 10.1002/jlb.3a0520-322rr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The activation of dendritic cells (DC) during respiratory viral infections is central to directing the immune response and the pathologic outcome. In these studies, the effect of RSV infection on development of ER stress responses and the impact on innate immunity was examined. The upregulation of ER stress was closely associated with the PERK pathway through the upregulation of CHOP in RSV infected DC. The inhibition of PERK corresponded with decreased EIF2a phosphorylation but had no significant effect on Nrf2 in DC, two primary pathways regulated by PERK. Subsequent studies identified that by blocking PERK activity in infected DC an altered ER stress response and innate cytokine profile was observed with the upregulation of IFNβ and IL-12, coincident to the down regulation of IL-1β. When mitochondria respiration was assessed in PERK deficient DC there were increased dysfunctional mitochondria after RSV infection that resulted in reduced oxygen consumption rates (OCR) and ATP production indicating altered cellular metabolism. Use of a CD11c targeted genetic deleted murine model, RSV infection was characterized by reduced inflammation and diminished mucus staining as well as reduced mucus-associated gene gob5 expression. The assessment of the cytokine responses showed decreased IL-13 and IL-17 along with diminished IL-1β in the lungs of PERK deficient infected mice. When PERK-deficient animals were assessed in parallel for lung leukocyte numbers, animals displayed significantly reduced myeloid and activated CD4 and CD8 T cell numbers. Thus, the PERK activation pathway may provide a rational target for altering the severe outcome of an RSV infection through modifying immune responses.
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Affiliation(s)
- Samanthi Narayanan
- Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA
| | - Srikanth Elesela
- Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA.,Mary H. Weiser Food Allergy Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Andrew J Rasky
- Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA
| | - Susan H Morris
- Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA
| | - Surinder Kumar
- Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA
| | - David Lombard
- Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA
| | - Nicholas W Lukacs
- Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA.,Mary H. Weiser Food Allergy Center, University of Michigan, Ann Arbor, Michigan, USA
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12
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Geller RJ, Espinola JA, Fabiano Filho RC, Hasegawa K, Mansbach JM, Sullivan AF, Camargo CA. A comparison of childhood asthma case definitions based on parent-reported data. Ann Epidemiol 2021; 55:64-68.e4. [PMID: 33065267 PMCID: PMC7870539 DOI: 10.1016/j.annepidem.2020.10.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 09/20/2020] [Accepted: 10/01/2020] [Indexed: 02/05/2023]
Abstract
PURPOSE The purpose of this study was to compare research definitions of childhood asthma based on parent-reported data. METHODS We conducted a multicenter, prospective cohort study of 921 infants hospitalized for bronchiolitis. Follow-up was conducted via biannual parent interviews. Asthma definitions were developed using parent-reported data: clinician diagnosis by the age of 5 years ("broad definition"), clinician diagnosis by the age of 5 years with either asthma medication use or asthma symptoms during the age of 4-4.9 years ("epidemiologic definition"), clinician diagnosis by the age of 5 years with either long-term inhaled corticosteroid use or asthma symptoms during the age of 4-4.9 years ("strict definition"), and a "flexible definition" met by any two of the three criteria in the epidemiologic definition. Asthma outcome definitions were evaluated using unadjusted associations with known major asthma risk factors and validated against the medical record in a subset (n = 116). RESULTS Asthma prevalence for the broad definition was 294 of 875 (34%); epidemiologic definition, 235 of 859 (27%); strict definition, 229 of 859 (27%); and flexible definition, 364 of 826 (44%). Risk factors had similarly strong associations with definitions that required clinician diagnosis and weaker associations with the flexible definition. The epidemiologic and strict definitions had the highest specificity (96%) and positive predictive value (92%). CONCLUSIONS The parent report of clinician-diagnosed asthma correlates well with known asthma risk factors.
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Affiliation(s)
- Ruth J Geller
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | - Janice A Espinola
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | | | - Kohei Hasegawa
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | | | - Ashley F Sullivan
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA.
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13
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Palivizumab for preventing respiratory syncytial virus (RSV) infection in children. Hippokratia 2020. [DOI: 10.1002/14651858.cd013757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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14
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Simpson J, Loh Z, Ullah MA, Lynch JP, Werder RB, Collinson N, Zhang V, Dondelinger Y, Bertrand MJM, Everard ML, Blyth CC, Hartel G, Van Oosterhout AJ, Gough PJ, Bertin J, Upham JW, Spann KM, Phipps S. Respiratory Syncytial Virus Infection Promotes Necroptosis and HMGB1 Release by Airway Epithelial Cells. Am J Respir Crit Care Med 2020; 201:1358-1371. [PMID: 32105156 DOI: 10.1164/rccm.201906-1149oc] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Rationale: Respiratory syncytial virus (RSV) bronchiolitis causes significant infant mortality. Bronchiolitis is characterized by airway epithelial cell (AEC) death; however, the mode of death remains unknown.Objectives: To determine whether necroptosis contributes to RSV bronchiolitis pathogenesis via HMGB1 (high mobility group box 1) release.Methods: Nasopharyngeal samples were collected from children presenting to the hospital with acute respiratory infection. Primary human AECs and neonatal mice were inoculated with RSV and murine Pneumovirus, respectively. Necroptosis was determined via viability assays and immunohistochemistry for RIPK1 (receptor-interacting protein kinase-1), MLKL (mixed lineage kinase domain-like pseudokinase) protein, and caspase-3. Necroptosis was blocked using pharmacological inhibitors and RIPK1 kinase-dead knockin mice.Measurements and Main Results: HMGB1 levels were elevated in nasopharyngeal samples of children with acute RSV infection. RSV-induced epithelial cell death was associated with increased phosphorylated RIPK1 and phosphorylated MLKL but not active caspase-3 expression. Inhibition of RIPK1 or MLKL attenuated RSV-induced HMGB1 translocation and release, and lowered viral load. MLKL inhibition increased active caspase-3 expression in a caspase-8/9-dependent manner. In susceptible mice, Pneumovirus infection upregulated RIPK1 and MLKL expression in the airway epithelium at 8 to 10 days after infection, coinciding with AEC sloughing, HMGB1 release, and neutrophilic inflammation. Genetic or pharmacological inhibition of RIPK1 or MLKL attenuated these pathologies, lowered viral load, and prevented type 2 inflammation and airway remodeling. Necroptosis inhibition in early life ameliorated asthma progression induced by viral or allergen challenge in later life.Conclusions: Pneumovirus infection induces AEC necroptosis. Inhibition of necroptosis may be a viable strategy to limit the severity of viral bronchiolitis and break its nexus with asthma.
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Affiliation(s)
- Jennifer Simpson
- QIMR Berghofer Medical Research Institute, Herston, Australia.,School of Biomedical Science, University of Queensland, Brisbane, Queensland, Australia
| | - Zhixuan Loh
- School of Biomedical Science, University of Queensland, Brisbane, Queensland, Australia
| | - Md Ashik Ullah
- QIMR Berghofer Medical Research Institute, Herston, Australia.,School of Biomedical Science, University of Queensland, Brisbane, Queensland, Australia
| | - Jason P Lynch
- QIMR Berghofer Medical Research Institute, Herston, Australia.,School of Biomedical Science, University of Queensland, Brisbane, Queensland, Australia
| | - Rhiannon B Werder
- QIMR Berghofer Medical Research Institute, Herston, Australia.,School of Biomedical Science, University of Queensland, Brisbane, Queensland, Australia
| | | | - Vivian Zhang
- QIMR Berghofer Medical Research Institute, Herston, Australia.,School of Biomedical Science, University of Queensland, Brisbane, Queensland, Australia
| | - Yves Dondelinger
- VIB Center for Inflammation Research, Ghent, Belgium.,Department of Biomedical Molecular Biology, Ghent University, Ghent, Belgium
| | - Mathieu J M Bertrand
- VIB Center for Inflammation Research, Ghent, Belgium.,Department of Biomedical Molecular Biology, Ghent University, Ghent, Belgium
| | | | - Christopher C Blyth
- School of Medicine and.,Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.,Department of Infectious Diseases, Perth Children's Hospital, Perth, Western Australia, Australia.,Department of Microbiology, PathWest Laboratory Medicine WA, QEII Medical Centre, Perth, Western Australia, Australia
| | - Gunter Hartel
- QIMR Berghofer Medical Research Institute, Herston, Australia
| | | | | | | | - John W Upham
- University of Queensland Diamantina Institute, Brisbane, Queensland, Australia.,Australian Infectious Diseases Research Centre, Brisbane, Queensland, Australia; and
| | - Kirsten M Spann
- Queensland University of Technology, Brisbane, Queensland, Australia
| | - Simon Phipps
- QIMR Berghofer Medical Research Institute, Herston, Australia.,School of Biomedical Science, University of Queensland, Brisbane, Queensland, Australia.,Australian Infectious Diseases Research Centre, Brisbane, Queensland, Australia; and
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15
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Symptom-based screening tool for asthma syndrome among young children in Uganda. NPJ Prim Care Respir Med 2020; 30:18. [PMID: 32376892 PMCID: PMC7203121 DOI: 10.1038/s41533-020-0175-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 04/09/2020] [Indexed: 11/08/2022] Open
Abstract
Under-diagnosis of asthma in ‘under-fives’ may be alleviated by improved inquiry into disease history. We assessed a questionnaire-based screening tool for asthma among 614 ‘under-fives’ with severe respiratory illness in Uganda. The questionnaire responses were compared to post hoc consensus diagnoses by three pediatricians who were guided by study definitions that were based on medical history, physical examination findings, laboratory and radiological tests, and response to bronchodilators. Children with asthma or bronchiolitis were categorized as “asthma syndrome”. Using this approach, 253 (41.2%) had asthma syndrome. History of and present breathing difficulties and present cough and wheezing was the best performing combination of four questionnaire items [sensitivity 80.8% (95% CI 77.6–84.0); specificity 84.7% (95% CI 81.8–87.6)]. The screening tool for asthma syndrome in ‘under-fives’ may provide a simple, cheap and quick method of identifying children with possible asthma. The validity and reliability of this tool in primary care settings should be tested.
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16
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A Durable Relationship: Respiratory Syncytial Virus Bronchiolitis and Asthma past Their Golden Anniversary. Vaccines (Basel) 2020; 8:vaccines8020201. [PMID: 32357557 PMCID: PMC7350256 DOI: 10.3390/vaccines8020201] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 04/13/2020] [Accepted: 04/22/2020] [Indexed: 01/16/2023] Open
Abstract
Numerous preventive strategies against respiratory syncytial virus (RSV) are undergoing late stage evaluation in humans and, in addition to their intended benefit for acute illness, may impact long term consequences of infection in infants. Severe RSV infection has been repeatedly associated in the literature with long term complications, including impaired lung function, recurrent wheezing, and asthma. However, whether RSV lower respiratory tract infection (LRTI) causally affects the odds for developing wheezing and/or asthma during childhood requires further study, and the biological mechanisms underlying this hypothetical progression from viral illness to chronic lung disease are poorly characterized. In this review, we summarize the literature exploring the association between RSV LRTI in infancy and subsequent recurrent wheezing and pediatric asthma.
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17
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Zheng DX, Mitri EJ, Garg V, Crifase CC, Sullivan AF, Espinola JA, Camargo CA. Socioeconomic Status and Bronchiolitis Severity Among Hospitalized Infants. Acad Pediatr 2020; 20:348-355. [PMID: 31254632 PMCID: PMC6930979 DOI: 10.1016/j.acap.2019.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 03/28/2019] [Accepted: 06/02/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To investigate the relationship between socioeconomic factors and bronchiolitis severity among hospitalized infants. METHODS We performed a 17-center, prospective cohort study from 2011 to 2014. Children <1 year old hospitalized with bronchiolitis were enrolled. Socioeconomic factors included estimated median household income (MHI) per home ZIP code, parent-reported household income, number of adults and children in household, and insurance type. We defined higher bronchiolitis severity as receipt of intensive care treatment. Multivariable logistic regression was used to analyze the association between socioeconomic factors and bronchiolitis severity, with the final model adjusted for potential clustering by site. RESULTS In multivariable models adjusted for demographic and clinical characteristics, estimated MHI was the socioeconomic factor most strongly associated with severity. Compared to infants with an intermediate MHI ($40,000-$79,999), odds of receiving intensive care treatment were significantly higher for those with MHI of ≥$80,000 (aOR 2.05, 95% CI 1.19-3.53). No significant associations were found for the other socioeconomic factors (all P > .30). While there were no significant differences in clinical presentation between income groups (all P > .25) or in receipt of mechanical ventilation alone (P = .98), infants with estimated MHI ≥$80,000 were significantly more likely to specifically have been admitted to the intensive care unit (P = .01). CONCLUSIONS In this multicenter study of infants hospitalized with bronchiolitis, we identified higher median household income as a risk factor for intensive care treatment. This work may yield important biological or nonbiological insights for the future management of infants with bronchiolitis.
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18
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Amaral-Machado L, Oliveira WN, Moreira-Oliveira SS, Pereira DT, Alencar ÉN, Tsapis N, Egito EST. Use of Natural Products in Asthma Treatment. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2020; 2020:1021258. [PMID: 32104188 PMCID: PMC7040422 DOI: 10.1155/2020/1021258] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 12/31/2019] [Accepted: 01/06/2020] [Indexed: 12/14/2022]
Abstract
Asthma, a disease classified as a chronic inflammatory disorder induced by airway inflammation, is triggered by a genetic predisposition or antigen sensitization. Drugs currently used as therapies present disadvantages such as high cost and side effects, which compromise the treatment compliance. Alternatively, traditional medicine has reported the use of natural products as alternative or complementary treatment. The aim of this review was to summarize the knowledge reported in the literature about the use of natural products for asthma treatment. The search strategy included scientific studies published between January 2006 and December 2017, using the keywords "asthma," "treatment," and "natural products." The inclusion criteria were as follows: (i) studies that aimed at elucidating the antiasthmatic activity of natural-based compounds or extracts using laboratory experiments (in vitro and/or in vivo); and (ii) studies that suggested the use of natural products in asthma treatment by elucidation of its chemical composition. Studies that (i) did not report experimental data and (ii) manuscripts in languages other than English were excluded. Based on the findings from the literature search, aspects related to asthma physiopathology, epidemiology, and conventional treatment were discussed. Then, several studies reporting the effectiveness of natural products in the asthma treatment were presented, highlighting plants as the main source. Moreover, natural products from animals and microorganisms were also discussed and their high potential in the antiasthmatic therapy was emphasized. This review highlighted the importance of natural products as an alternative and/or complementary treatment source for asthma treatment, since they present reduced side effects and comparable effectiveness as the drugs currently used on treatment protocols.
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Affiliation(s)
- Lucas Amaral-Machado
- Graduate Program in Health Sciences, Dispersed System Laboratory (LaSid), Pharmacy Department, Federal University of Rio Grande do Norte (UFRN), Av. General Gustavo de Cordeiro-SN-Petrópolis, Natal 59012-570, Brazil
- Institut Galien Paris-Sud, CNRS, Univ. Paris-Sud, Université Paris-Saclay, 92296 Châtenay-Malabry, France
| | - Wógenes N. Oliveira
- Graduate Program in Health Sciences, Dispersed System Laboratory (LaSid), Pharmacy Department, Federal University of Rio Grande do Norte (UFRN), Av. General Gustavo de Cordeiro-SN-Petrópolis, Natal 59012-570, Brazil
| | - Susiane S. Moreira-Oliveira
- Graduate Program in Health Sciences, Dispersed System Laboratory (LaSid), Pharmacy Department, Federal University of Rio Grande do Norte (UFRN), Av. General Gustavo de Cordeiro-SN-Petrópolis, Natal 59012-570, Brazil
| | - Daniel T. Pereira
- Graduate Program in Health Sciences, Dispersed System Laboratory (LaSid), Pharmacy Department, Federal University of Rio Grande do Norte (UFRN), Av. General Gustavo de Cordeiro-SN-Petrópolis, Natal 59012-570, Brazil
| | - Éverton N. Alencar
- Graduate Program in Pharmaceutical Nanotechnology, LaSid, UFRN, Av. General Gustavo de Cordeiro-SN-Petropolis, Natal 59012-570, Brazil
| | - Nicolas Tsapis
- Institut Galien Paris-Sud, CNRS, Univ. Paris-Sud, Université Paris-Saclay, 92296 Châtenay-Malabry, France
| | - Eryvaldo Sócrates T. Egito
- Graduate Program in Health Sciences, Dispersed System Laboratory (LaSid), Pharmacy Department, Federal University of Rio Grande do Norte (UFRN), Av. General Gustavo de Cordeiro-SN-Petrópolis, Natal 59012-570, Brazil
- Graduate Program in Pharmaceutical Nanotechnology, LaSid, UFRN, Av. General Gustavo de Cordeiro-SN-Petropolis, Natal 59012-570, Brazil
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Driscoll AJ, Arshad SH, Bont L, Brunwasser SM, Cherian T, Englund JA, Fell DB, Hammitt LL, Hartert TV, Innis BL, Karron RA, Langley GE, Mulholland EK, Munywoki PK, Nair H, Ortiz JR, Savitz DA, Scheltema NM, Simões EAF, Smith PG, Were F, Zar HJ, Feikin DR. Does respiratory syncytial virus lower respiratory illness in early life cause recurrent wheeze of early childhood and asthma? Critical review of the evidence and guidance for future studies from a World Health Organization-sponsored meeting. Vaccine 2020; 38:2435-2448. [PMID: 31974017 PMCID: PMC7049900 DOI: 10.1016/j.vaccine.2020.01.020] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 11/20/2019] [Accepted: 01/07/2020] [Indexed: 12/21/2022]
Abstract
Respiratory syncytial virus (RSV) is a leading cause of lower respiratory tract infection (LRTI) and hospitalization in infants and children globally. Many observational studies have found an association between RSV LRTI in early life and subsequent respiratory morbidity, including recurrent wheeze of early childhood (RWEC) and asthma. Conversely, two randomized placebo-controlled trials of efficacious anti-RSV monoclonal antibodies (mAbs) in heterogenous infant populations found no difference in physician-diagnosed RWEC or asthma by treatment group. If a causal association exists and RSV vaccines and mAbs can prevent a substantial fraction of RWEC/asthma, the full public health value of these interventions would markedly increase. The primary alternative interpretation of the observational data is that RSV LRTI in early life is a marker of an underlying predisposition for the development of RWEC and asthma. If this is the case, RSV vaccines and mAbs would not necessarily be expected to impact these outcomes. To evaluate whether the available evidence supports a causal association between RSV LRTI and RWEC/asthma and to provide guidance for future studies, the World Health Organization convened a meeting of subject matter experts on February 12-13, 2019 in Geneva, Switzerland. After discussing relevant background information and reviewing the current epidemiologic evidence, the group determined that: (i) the evidence is inconclusive in establishing a causal association between RSV LRTI and RWEC/asthma, (ii) the evidence does not establish that RSV mAbs (and, by extension, future vaccines) will have a substantial effect on these outcomes and (iii) regardless of the association with long-term childhood respiratory morbidity, severe acute RSV disease in young children poses a substantial public health burden and should continue to be the primary consideration for policy-setting bodies deliberating on RSV vaccine and mAb recommendations. Nonetheless, the group recognized the public health importance of resolving this question and suggested good practice guidelines for future studies.
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Affiliation(s)
- Amanda J Driscoll
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, 685 W. Baltimore St, Suite 480, Baltimore, MD, USA
| | - S Hasan Arshad
- The David Hide Asthma and Allergy Research Centre, St. Mary's Hospital, Newport PO30 5TG, Isle of Wight, UK; Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK
| | - Louis Bont
- The ReSViNET Foundation, Zeist, the Netherlands; Department of Pediatric Infectious Diseases, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Lundlaan 6, Utrecht, the Netherlands; Department of Translational Immunology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Lundlaan 6, Utrecht, the Netherlands
| | - Steven M Brunwasser
- Center for Asthma Research, Allergy, Pulmonary & Critical Care Medicine, Vanderbilt University School of Medicine, 2525 West End Ave, Suite 450, Nashville, TN 37203, USA
| | - Thomas Cherian
- MM Global Health Consulting, Chemin Maurice Ravel 11C, 1290 Versoix, Switzerland
| | - Janet A Englund
- Seattle Children's Hospital, 4800 Sand Point Way NE Seattle, WA 98105, USA; Department of Pediatrics, University of Washington, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - Deshayne B Fell
- School of Epidemiology and Public Health, University of Ottawa, Children's Hospital of Eastern Ontario (CHEO) Research Institute, 401 Smyth Road, CPCR, Room L-1154, Ottawa, Ontario K1H 8L1, Canada
| | - Laura L Hammitt
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD 21205, USA
| | - Tina V Hartert
- Center for Asthma Research, Allergy, Pulmonary & Critical Care Medicine, Vanderbilt University School of Medicine, 2525 West End Ave, Suite 450, Nashville, TN 37203, USA
| | - Bruce L Innis
- Center for Vaccine Innovation and Access, PATH, 455 Massachusetts Avenue NW, Suite 1000, WA, DC 20001, USA
| | - Ruth A Karron
- Center for Immunization Research, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Suite 217, Baltimore, MD 21205, USA
| | - Gayle E Langley
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30329, USA
| | - E Kim Mulholland
- Murdoch Children's Research Institute, Flemington Rd, Parkville, VIC 3052, Australia; Department of Paediatrics, University of Melbourne, Flemington Rd, Parkville, VIC 3052, Australia; Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London WC1E 7HT, UK
| | - Patrick K Munywoki
- Division of Global Health Protection, US Centers for Disease Control and Prevention, PO Box 606-00621, Nairobi, Kenya
| | - Harish Nair
- The ReSViNET Foundation, Zeist, the Netherlands; Centre for Global Health Research, Usher Institute, University of Edinburgh, Medical School, Teviot Place, Edinburgh EH8 9AG, Scotland, United Kingdom
| | - Justin R Ortiz
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, 685 W. Baltimore St, Suite 480, Baltimore, MD, USA
| | - David A Savitz
- Department of Epidemiology, Brown University School of Public Health, Providence, RI 02903, USA
| | - Nienke M Scheltema
- Department of Pediatric Infectious Diseases, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Lundlaan 6, Utrecht, the Netherlands
| | - Eric A F Simões
- Department of Pediatrics, Section of Infectious Diseases, University of Colorado School of Medicine, and Children's Hospital Colorado 13123 E. 16th Ave, B065, Aurora, CO 80045, USA; Department of Epidemiology, Center for Global Health Colorado School of Public Health, 13001 E 17th Pl B119, Aurora, CO 80045, USA
| | - Peter G Smith
- Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London WC1E 7HT, UK
| | - Fred Were
- Department of Pediatrics and Child Health, University of Nairobi, P.O. Box 30197, GPO, Nairobi, Kenya
| | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, Cape Town, South Africa; SA-Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, 5th Floor ICH Building, Klipfontein Road, Cape Town, South Africa
| | - Daniel R Feikin
- Department of Immunizations, Vaccines and Biologicals, World Health Organization, 20 Avenue Appia, Geneva, Switzerland
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Harvey JL, Kumar SAP. Machine Learning for Predicting Development of Asthma in Children. 2019 IEEE SYMPOSIUM SERIES ON COMPUTATIONAL INTELLIGENCE (SSCI) 2019. [DOI: 10.1109/ssci44817.2019.9002692] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
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21
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Reuter S, Lemmermann NAW, Maxeiner J, Podlech J, Beckert H, Freitag K, Teschner D, Ries F, Taube C, Buhl R, Reddehase MJ, Holtappels R. Coincident airway exposure to low-potency allergen and cytomegalovirus sensitizes for allergic airway disease by viral activation of migratory dendritic cells. PLoS Pathog 2019; 15:e1007595. [PMID: 30845208 PMCID: PMC6405056 DOI: 10.1371/journal.ppat.1007595] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 01/24/2019] [Indexed: 01/08/2023] Open
Abstract
Despite a broad cell-type tropism, cytomegalovirus (CMV) is an evidentially pulmonary pathogen. Predilection for the lungs is of medical relevance in immunocompromised recipients of hematopoietic cell transplantation, in whom interstitial CMV pneumonia is a frequent and, if left untreated, fatal clinical manifestation of human CMV infection. A conceivable contribution of CMV to airway diseases of other etiology is an issue that so far attracted little medical attention. As the route of primary CMV infection upon host-to-host transmission in early childhood involves airway mucosa, coincidence of CMV airway infection and exposure to airborne environmental antigens is almost unavoidable. For investigating possible consequences of such a coincidence, we established a mouse model of airway co-exposure to CMV and ovalbumin (OVA) representing a protein antigen of an inherently low allergenic potential. Accordingly, intratracheal OVA exposure alone failed to sensitize for allergic airway disease (AAD) upon OVA aerosol challenge. In contrast, airway infection at the time of OVA sensitization predisposed for AAD that was characterized by airway inflammation, IgE secretion, thickening of airway epithelia, and goblet cell hyperplasia. This AAD histopathology was associated with a T helper type 2 (Th2) transcription profile in the lungs, including IL-4, IL-5, IL-9, and IL-25, known inducers of Th2-driven AAD. These symptoms were all prevented by a pre-challenge depletion of CD4+ T cells, but not of CD8+ T cells. As to the underlying mechanism, murine CMV activated migratory CD11b+ as well as CD103+ conventional dendritic cells (cDCs), which have been associated with Th2 cytokine-driven AAD and with antigen cross-presentation, respectively. This resulted in an enhanced OVA uptake and recruitment of the OVA-laden cDCs selectively to the draining tracheal lymph nodes for antigen presentation. We thus propose that CMV, through activation of migratory cDCs in the airway mucosa, can enhance the allergenic potential of otherwise poorly allergenic environmental protein antigens.
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Affiliation(s)
- Sebastian Reuter
- Department of Pulmonary Medicine, University Medical Center Essen-Ruhrlandklinik, Essen, Germany
| | - Niels A. W. Lemmermann
- Institute for Virology and Research Center for Immunotherapy (FZI), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Joachim Maxeiner
- Asthma Core Facility and Research Center for Immunotherapy (FZI), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Jürgen Podlech
- Institute for Virology and Research Center for Immunotherapy (FZI), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Hendrik Beckert
- Department of Pulmonary Medicine, University Medical Center Essen-Ruhrlandklinik, Essen, Germany
- Department of Hematology, Medical Oncology and Pneumonology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Kirsten Freitag
- Institute for Virology and Research Center for Immunotherapy (FZI), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Daniel Teschner
- Department of Hematology, Medical Oncology and Pneumonology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Frederic Ries
- Department of Hematology, Medical Oncology and Pneumonology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Christian Taube
- Department of Pulmonary Medicine, University Medical Center Essen-Ruhrlandklinik, Essen, Germany
| | - Roland Buhl
- Department of Hematology, Medical Oncology and Pneumonology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Matthias J. Reddehase
- Institute for Virology and Research Center for Immunotherapy (FZI), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Rafaela Holtappels
- Institute for Virology and Research Center for Immunotherapy (FZI), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
- * E-mail:
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Kawahara T, Tezuka J, Ninomiya T, Honjo S, Masumoto N, Nanishi M, Nakayama H, Ohga S. Risk prediction of severe reaction to oral challenge test of cow's milk. Eur J Pediatr 2019; 178:181-188. [PMID: 30377799 DOI: 10.1007/s00431-018-3274-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 10/14/2018] [Accepted: 10/19/2018] [Indexed: 11/28/2022]
Abstract
Cow's milk is one of the most common food allergens among children. Oral food challenge tests determine the threshold dose of allergens, but have not been standardized. To reduce the severe reactions, we developed a practical model of the test. We studied 111 high-risk patients who underwent a first milk oral food challenge on the risk-stratified dose between 2011 and 2017 for predicting the severe reaction risk. Severe reactions were defined as showing > 3 of Sampson's classification grade. Twenty-eight patients (25%) showed severe reactions without death. Prior to oral food challenge, severe reaction patients experienced milk avoidance (71% vs. 45%, p = 0.02) or bronchial asthma (61% vs. 28%, p = 0.003) more frequently and showed higher milk-specific IgE levels (median 28.3 vs. 7.7 UA/mL, p < 0.0001) than non-severe reaction patients. Multivariate logistic regression analyses established a formula including severe reaction-associated factors; increased levels of milk-specific IgE (odds ratio 11.61, p = 0.001), milk avoidance (odds ratio 3.88, p = 0.02), and bronchial asthma (odds ratio 3.75, p = 0.02). This model had 86% sensitivity and 56% specificity (cut-off 0.25) for risk. Five patients with < 25% probability developed severe reactions, which started in > 3 grade dyspnea up to 20 mL of challenge.Conclusion: This model could effectively reduce the severe reaction development on the first milk oral food challenge test according to the individual needs. What is Known: •Higher levels of milk-specific IgE values, bronchial asthma, and complete milk avoidance are independent risk factors of severe reactions during the cow's milk oral food challenge. What is New: •Statistical analyses of our milk oral food challenge records for 111 patients helped us develop a model formula predicting severe reactions at the first test with high specificity and sensitivity. •This simple risk-stratified protocol is useful for minimizing the adverse events in the first milk challenge.
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Affiliation(s)
- Takahiro Kawahara
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi Higashi-ku, Fukuoka, 812-8582, Japan
- Division of Pediatrics, National Hospital Organization Fukuoka Higashi Medical Center, 1-1-1 Chidori, Koga city, Fukuoka, 811-3195, Japan
| | - Junichiro Tezuka
- Division of Allergy and Pulmonology, Fukuoka Children's Hospital, 5-1-1 Kashiiteriha, Higashi-ku, Fukuoka, 813-0017, Japan.
| | - Takahito Ninomiya
- Division of Pediatrics, National Hospital Organization Fukuoka Hospital, 1-39-1 Yakatabaru Minami-ku, Fukuoka, 811-1394, Japan
| | - Satoshi Honjo
- Division of Pediatrics, National Hospital Organization Fukuoka Hospital, 1-39-1 Yakatabaru Minami-ku, Fukuoka, 811-1394, Japan
| | - Natsuko Masumoto
- Division of Pediatrics, National Hospital Organization Fukuoka Higashi Medical Center, 1-1-1 Chidori, Koga city, Fukuoka, 811-3195, Japan
| | - Makiko Nanishi
- Division of Pediatrics, National Hospital Organization Fukuoka Higashi Medical Center, 1-1-1 Chidori, Koga city, Fukuoka, 811-3195, Japan
| | - Hideki Nakayama
- Division of Pediatrics, National Hospital Organization Kyushu Cancer Center, 1-1-3 Nodame Minami-ku, Fukuoka, 811-1395, Japan
| | - Shouichi Ohga
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi Higashi-ku, Fukuoka, 812-8582, Japan
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Lei WT, Lin HH, Tsai MC, Hung HH, Cheng YJ, Liu SJ, Lin CY, Yeh TL. The effects of macrolides in children with reactive airway disease: a systematic review and meta-analysis of randomized controlled trials. DRUG DESIGN DEVELOPMENT AND THERAPY 2018; 12:3825-3845. [PMID: 30510399 PMCID: PMC6231435 DOI: 10.2147/dddt.s183527] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Purpose Childhood reactive airway diseases (RADs) are concerning problems in children’s airways and may be preceded by bronchiolitis and may progress to childhood asthma. The severity of the disease is indicated by deterioration in pulmonary functions, increased usage of rescue medications, and recurrent wheezing episodes. Macrolides have both antimicrobial and anti-inflammatory functions and have been used as adjunctive therapy in childhood RADs. Patients and methods We conducted a meta-analysis to evaluate the effect of macrolides in children with RAD. Literature searches were systematically conducted using an electronic database from inception to August 2018. The Cochrane review risk of bias assessment tool was used to assess the quality of each randomized controlled trial. Results Sixteen randomized controlled trials comprising 1,415 participants were investigated in this meta-analysis. Children treated with macrolide therapy showed significantly better pulmonary functions in both forced expiratory volume in one second (% predicted) (difference in means=−9.77, 95% CI=−14.18 to −5.35, P<0.001; I2=0%) and forced expiratory flow 25–75 (% predicted) (difference in means=−14.14, 95% CI=−26.11 to −2.18, P=0.02; I2=29.56%). In addition, the short-acting β-agonist usage days and recurrent wheezing risk were significantly lowered in children with macrolide treatment (standardized difference in means=−0.34, 95% CI=−0.59 to −0.09, P=0.007, I2=27.05% and standardized difference in means=−0.53, 95% CI=−0.81 to −0.26, P<0.001, I2=0%, respectively). Furthermore, the growth of Moraxella catarrhalis from nasal swabs was less in children treated with macrolides (odds ratio=0.19, 95% CI=0.11–0.35, P<0.001). Children who took macrolides had a lower risk of adverse events (risk ratio=0.83, 95% CI=0.70–0.98, P=0.024, I2=0%). Conclusion This current meta-analysis suggested that adjunctive therapy with macrolides is safe and effective for achieving better outcomes in childhood RAD.
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Affiliation(s)
- Wei-Te Lei
- Department of Pediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
| | - Hsin Hui Lin
- Department of Family Medicine, Taipei Mackay Memorial Hospital, Taipei, Taiwan
| | - Mu-Chieh Tsai
- Department of Pediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
| | - Hua-His Hung
- Department of Pediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
| | - Yu-Jyun Cheng
- Department of Pediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
| | - Shu-Jung Liu
- Department of Medical Library, MacKay Memorial Hospital, Tamsui Branch, New Taipei City, Taiwan
| | - Chien Yu Lin
- Department of Pediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
| | - Tzu-Lin Yeh
- Department of Family Medicine, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan,
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Wong L, Van Bever HP. Primary Prevention of Asthma: Will It Be Possible in the Future? CURRENT TREATMENT OPTIONS IN ALLERGY 2018. [DOI: 10.1007/s40521-018-0192-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Alharbi AS, Alqwaiee M, Al-Hindi MY, Mosalli R, Al-Shamrani A, Alharbi S, Yousef A, Al Aidaroos A, Alahmadi T, Alshammary A, Miqdad A, Said Y, Alnemri A. Bronchiolitis in children: The Saudi initiative of bronchiolitis diagnosis, management, and prevention (SIBRO). Ann Thorac Med 2018; 13:127-143. [PMID: 30123331 PMCID: PMC6073791 DOI: 10.4103/atm.atm_60_18] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 05/09/2018] [Indexed: 12/19/2022] Open
Abstract
Bronchiolitis is the leading cause of admissions in children less than two years of age. It has been recognized as highly debated for many decades. Despite the abundance of literature and the well-recognized importance of palivizumab in the high risk groups, and despite the existence of numerous, high-quality, recent guidelines on bronchiolitis, the number of admissions continues to increase. Only supportive therapy and few therapeutic interventions are evidence based and proved to be effective. Since Respiratory Syncytial Virus (RSV) is the major cause of bronchiolitis, we will focus on this virus mostly in high risk groups like the premature babies and children with chronic lung disease and cardiac abnormalities. Further, the prevention of RSV with palivizumab in the high risk groups is effective and well known since 1998; we will discuss the updated criteria for allocating infants to this treatment, as this medication is expensive and should be utilized in the best condition. Usually, diagnosis of bronchiolitis is not challenging, however there has been historically no universally accepted and validated scoring system to assess the severity of the condition. Severe RSV, especially in high risk children, is unique because it can cause serious respiratory sequelae. Currently there is no effective curative treatment for bronchiolitis. The utility of different therapeutic interventions is worth a discussion.
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Affiliation(s)
- Adel S. Alharbi
- Department of Pediatrics, Prince Sultan Military City, Ministry of Defense, Riyadh, Saudi Arabia
| | - Mansour Alqwaiee
- Department of Pediatrics, Prince Sultan Military City, Ministry of Defense, Riyadh, Saudi Arabia
| | - Mohammed Y Al-Hindi
- King Abdullah International Medical Research Center/King Saud bin Abdulaziz University for Health Sciences, Department of Pediatric, Ministry of National Guard, Jeddah, Saudi Arabia
| | - Rafat Mosalli
- Department of Pediatrics, Umm Al Qura university, Makkah, Saudi Arabia
| | - Abdullah Al-Shamrani
- Department of Pediatrics, Prince Sultan Military City, Ministry of Defense, Riyadh, Saudi Arabia
| | - Saleh Alharbi
- Department of Pediatrics, Umm Al Qura university, Makkah, Saudi Arabia
| | - Abdullah Yousef
- Department of Pediatrics, College of Medicine, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
| | - Amal Al Aidaroos
- Department of Pediatrics, Prince Sultan Military City, Ministry of Defense, Riyadh, Saudi Arabia
| | - Turki Alahmadi
- King Abdulaziz University, College of Medicine, Department of Pediatrics, Jeddah, Saudi Arabia
| | | | - Abeer Miqdad
- Department of Pediatrics, Security forces hospital, Riyadh, Saudi Arabia
| | - Yazan Said
- King Fahad Specialist Hospital, Ministry of Health, Dammam, Saudi Arabia
| | - Abdulrahman Alnemri
- College of Medicine, Peadiatric Department, King Saud University, Riyadh, Saudi Arabia
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27
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Jartti T, Gern JE. Role of viral infections in the development and exacerbation of asthma in children. J Allergy Clin Immunol 2017; 140:895-906. [PMID: 28987219 PMCID: PMC7172811 DOI: 10.1016/j.jaci.2017.08.003] [Citation(s) in RCA: 273] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 08/03/2017] [Accepted: 08/22/2017] [Indexed: 12/31/2022]
Abstract
Viral infections are closely linked to wheezing illnesses in children of all ages. Respiratory syncytial virus (RSV) is the main causative agent of bronchiolitis, whereas rhinovirus (RV) is most commonly detected in wheezing children thereafter. Severe respiratory illness induced by either of these viruses is associated with subsequent development of asthma, and the risk is greatest for young children who wheeze with RV infections. Whether viral illnesses actually cause asthma is the subject of intense debate. RSV-induced wheezing illnesses during infancy influence respiratory health for years. There is definitive evidence that RSV-induced bronchiolitis can damage the airways to promote airway obstruction and recurrent wheezing. RV likely causes less structural damage and yet is a significant contributor to wheezing illnesses in young children and in the context of asthma. For both viruses, interactions between viral virulence factors, personal risk factors (eg, genetics), and environmental exposures (eg, airway microbiome) promote more severe wheezing illnesses and the risk for progression to asthma. In addition, allergy and asthma are major risk factors for more frequent and severe RV-related illnesses. Treatments that inhibit inflammation have efficacy for RV-induced wheezing, whereas the anti-RSV mAb palivizumab decreases the risk of severe RSV-induced illness and subsequent recurrent wheeze. Developing a greater understanding of personal and environmental factors that promote more severe viral illnesses might lead to new strategies for the prevention of viral wheezing illnesses and perhaps reduce the subsequent risk for asthma.
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Affiliation(s)
- Tuomas Jartti
- Department of Paediatrics, Turku University Hospital and University of Turku, Turku, Finland.
| | - James E Gern
- Departments of Pediatrics and Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis
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28
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Husby A, Pasanen A, Waage J, Sevelsted A, Hodemaekers H, Janssen R, Karjalainen MK, Stokholm J, Chawes BL, Korppi M, Wennergren G, Heinzmann A, Bont L, Bisgaard H, Bønnelykke K. CDHR3 gene variation and childhood bronchiolitis. J Allergy Clin Immunol 2017; 140:1469-1471.e7. [PMID: 28782631 DOI: 10.1016/j.jaci.2017.06.044] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 06/12/2017] [Accepted: 06/26/2017] [Indexed: 01/10/2023]
Affiliation(s)
- Anders Husby
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Faculty of Health and Medical Sciences, University of Copenhagen & Danish Pediatric Asthma Center, Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Anu Pasanen
- PEDEGO Research Center and Medical Research Center Oulu, University of Oulu, Oulu, Finland; Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland
| | - Johannes Waage
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Faculty of Health and Medical Sciences, University of Copenhagen & Danish Pediatric Asthma Center, Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Astrid Sevelsted
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Faculty of Health and Medical Sciences, University of Copenhagen & Danish Pediatric Asthma Center, Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Hennie Hodemaekers
- Centre for Health Protection, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Riny Janssen
- Centre for Health Protection, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Minna K Karjalainen
- PEDEGO Research Center and Medical Research Center Oulu, University of Oulu, Oulu, Finland; Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland
| | - Jakob Stokholm
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Faculty of Health and Medical Sciences, University of Copenhagen & Danish Pediatric Asthma Center, Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Bo L Chawes
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Faculty of Health and Medical Sciences, University of Copenhagen & Danish Pediatric Asthma Center, Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Matti Korppi
- Pediatric Research Center, Tampere University and Tampere University Hospital, Tampere, Finland
| | - Göran Wennergren
- Department of Pediatrics, University of Gothenburg, Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - Andrea Heinzmann
- Center for Pediatrics, Department of General Pediatrics, Adolescent Medicine and Neonatology, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Louis Bont
- University Medical Center Utrecht, Utrecht, The Netherlands; Respiratory Syncytial Virus Network (ReSViNET), Utrecht, The Netherlands
| | - Hans Bisgaard
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Faculty of Health and Medical Sciences, University of Copenhagen & Danish Pediatric Asthma Center, Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.
| | - Klaus Bønnelykke
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Faculty of Health and Medical Sciences, University of Copenhagen & Danish Pediatric Asthma Center, Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
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Han YY, Forno E, Badellino HA, Celedón JC. Antibiotic Use in Early Life, Rural Residence, and Allergic Diseases in Argentinean Children. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2017; 5:1112-1118.e2. [PMID: 28174014 PMCID: PMC5503768 DOI: 10.1016/j.jaip.2016.12.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 12/13/2016] [Accepted: 12/28/2016] [Indexed: 12/27/2022]
Abstract
BACKGROUND Little is known about differential effects of antibiotic use on allergic diseases in rural versus urban environments. OBJECTIVE To examine whether area of residence in the first year of life modifies the relation between antibiotic use in early life and allergic diseases during childhood. METHODS Cross-sectional study of allergic diseases in 1517 children (ages 6-7 years) attending 101 schools in urban and rural areas of San Francisco (Córdoba, Argentina). Current asthma, wheeze, and allergic rhinoconjunctivitis were defined on the basis of responses to a validated questionnaire from the International Study of Asthma and Allergies in Childhood. Multivariate logistic regression was used for the analysis of antibiotic use and allergic diseases. RESULTS After adjustment for paracetamol use, bronchiolitis, and other covariates, antibiotic use in the first year of life was associated with increased odds of current wheeze (odds ratio [OR], 1.8; 95% CI, 1.3-2.6) and allergic rhinoconjunctivitis (OR, 1.9; 95% CI, 1.3-2.7). After stratification by area of residence, antibiotic use was associated with current wheeze (OR, 2.4; 95% CI, 1.5-4.0) and allergic rhinoconjunctivitis (OR, 2.1; 95% CI, 1.3-3.4) among children who lived in an urban area in their first year of life, but not among those who lived in a rural area in their first year of life. CONCLUSIONS Early-life antibiotic use is associated with current wheeze and allergic rhinoconjunctivitis in Argentinean children who lived in urban areas during their first year of life. Exposure to a rural environment early in life may protect against the adverse effects of antibiotics on atopic diseases in children.
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Affiliation(s)
- Yueh-Ying Han
- Division of Pediatric Pulmonary Medicine, Allergy, and Immunology, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, Pa
| | - Erick Forno
- Division of Pediatric Pulmonary Medicine, Allergy, and Immunology, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, Pa
| | - Héctor A Badellino
- Department of Pediatric Respiratory Medicine, Regional Eastern Clinic, San Francisco, Córdoba, Argentina
| | - Juan C Celedón
- Division of Pediatric Pulmonary Medicine, Allergy, and Immunology, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, Pa.
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Role of human metapneumovirus and respiratory syncytial virus in asthma exacerbations: where are we now? Clin Sci (Lond) 2017; 131:1713-1721. [PMID: 28667069 DOI: 10.1042/cs20160011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Revised: 04/18/2017] [Accepted: 05/02/2017] [Indexed: 12/30/2022]
Abstract
Since its discovery in 2001, human metapneumovirus (hMPV) has been identified as an important cause of respiratory tract infection in young children, second only to the closely related respiratory syncytial virus (RSV). Clinical evidence suggests that hMPV is associated with acute exacerbations of asthma in both children and adults, and may play a role in initiating asthma development in children. Animal models have demonstrated that airway hyperresponsiveness (AHR) and inflammation are triggered following hMPV infection, and hMPV is able to persist in vivo by inhibiting innate immune responses and causing aberrant adaptive responses. In this review, we discuss the prevalence of hMPV infection in pediatric and adult populations and its potential role in asthma exacerbation. We also review recent advances made in animal models to determine immune responses following hMPV infection, and compare to what is known about RSV.
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31
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Villafana T, Falloon J, Griffin MP, Zhu Q, Esser MT. Passive and active immunization against respiratory syncytial virus for the young and old. Expert Rev Vaccines 2017; 16:1-13. [PMID: 28525961 DOI: 10.1080/14760584.2017.1333425] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Respiratory syncytial virus (RSV) is the leading cause of lower respiratory tract infections in infants worldwide and also causes significant disease in the elderly. Despite 60 years of RSV research and vaccine development, there is only one approved medicine to prevent RSV infections. Palivizumab, a monoclonal antibody (mAb) against the RSV fusion (F) protein, is indicated for preterm infants and children at high-risk for RSV infections. It is an active time in RSV vaccine and mAb development with 14 vaccines and 2 mAbs currently being tested in clinical trials as of 13 February 2017. Active vaccination of women in the third trimester or passive immunization of infants with a mAb are particularly attractive approaches as the most severe disease occurs within the first 6 months of life. Areas covered: Here, we review current approaches for preventing RSV in the young and old, describe proposed clinical endpoints for studies in pediatric and adult clinical trials and highlight results from recent and ongoing clinical studies. Expert commentary: With 16 candidates in clinical development, approval of the first RSV vaccine or mAb for the prevention of RSV in all infants or the elderly is likely to occur in the next five years.
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Affiliation(s)
| | | | | | - Qing Zhu
- a MedImmune LLC , Gaithersburg , MD , USA
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Lee SY, Noh Y, Goo JH, Rho S, Kim MJ, Kang CY, Song M, Kim JO. Natural killer T cell sensitization during neonatal respiratory syncytial virus infection induces eosinophilic lung disease in re-infected adult mice. PLoS One 2017; 12:e0176940. [PMID: 28570692 PMCID: PMC5453428 DOI: 10.1371/journal.pone.0176940] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 04/19/2017] [Indexed: 01/13/2023] Open
Abstract
Respiratory syncytial virus (RSV) is a major viral pathogen that causes severe lower respiratory tract infections in infants and the elderly worldwide. Infants with severe RSV bronchiolitis tend to experience more wheezing and asthma in later childhood. Because invariant natural killer T (iNKT) cells are associated with the asthma pathology, we investigated whether neonatal iNKT cells are involved in the aggravation of pulmonary diseases following RSV infection in mice. Intranasal exposure to the iNKT cell ligand α-galactosylceramide (α-GC) with RSV primary infection in neonatal mice elicited neither cytokine production (except for a slight increase of IL-5) nor pulmonary eosinophilia, despite the presence of both CD1d+ cells and NKT cells. Interestingly, in adult mice re-infected with RSV, neonatal iNKT cell sensitization by α-GC during RSV primary infection resulted in much higher levels of pulmonary Th2 cytokines and elevated eosinophilia with airway hyperresponsiveness, whereas this was not observed in cd1d knockout mice. In contrast, α-GC priming of adults during RSV re-infection did not induce more severe airway symptoms than RSV re-infection in the absence of α-GC. α-GC co-administration during RSV primary infection facilitated RSV clearance regardless of age, but viral clearance following re-infection was not iNKT cell-dependent. This study clearly demonstrates that RSV-induced immune responses can be altered by iNKT cells, suggesting that neonatal iNKT cell sensitization during RSV primary infection is associated with exacerbation of pulmonary diseases following RSV re-infection in adulthood.
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Affiliation(s)
- Seung Young Lee
- Molecular Immunology Section, Clinical Research Lab, International Vaccine Institute, SNU Research Park, 1 Gwankak-ro, Gwanak-gu, Seoul, Korea
- College of Pharmacy, Seoul National University, Seoul, Korea
| | - Youran Noh
- Molecular Immunology Section, Clinical Research Lab, International Vaccine Institute, SNU Research Park, 1 Gwankak-ro, Gwanak-gu, Seoul, Korea
| | - Jung Hyun Goo
- Molecular Immunology Section, Clinical Research Lab, International Vaccine Institute, SNU Research Park, 1 Gwankak-ro, Gwanak-gu, Seoul, Korea
| | - Semi Rho
- Molecular Immunology Section, Clinical Research Lab, International Vaccine Institute, SNU Research Park, 1 Gwankak-ro, Gwanak-gu, Seoul, Korea
| | - Min Jung Kim
- Molecular Immunology Section, Clinical Research Lab, International Vaccine Institute, SNU Research Park, 1 Gwankak-ro, Gwanak-gu, Seoul, Korea
| | - Chang-Yuil Kang
- College of Pharmacy, Seoul National University, Seoul, Korea
| | - Manki Song
- Molecular Immunology Section, Clinical Research Lab, International Vaccine Institute, SNU Research Park, 1 Gwankak-ro, Gwanak-gu, Seoul, Korea
| | - Jae-Ouk Kim
- Molecular Immunology Section, Clinical Research Lab, International Vaccine Institute, SNU Research Park, 1 Gwankak-ro, Gwanak-gu, Seoul, Korea
- * E-mail:
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Role of Parental Smoking in Severe Bronchiolitis: A Hospital Based Case-Control Study. Int J Pediatr 2017; 2017:9476367. [PMID: 28356915 PMCID: PMC5357531 DOI: 10.1155/2017/9476367] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Revised: 02/20/2017] [Accepted: 02/21/2017] [Indexed: 10/25/2022] Open
Abstract
Objective. Bronchiolitis is one of the commonest causes of hospitalization of infants and young children in Bangladesh. About 21% of under 5 children attending different hospitals of Bangladesh have bronchiolitis. Fifty percent (50%) men and three percent (3%) women of Bangladesh are smokers. Parental smoking is an important risk factor for both susceptibility and severity of bronchiolitis. The aim of this study was to find out the role of parental smoking in severe bronchiolitis. Design. Case-control study. Place and Duration of Study. The study was conducted in the Department of Paediatrics, Sylhet MAG Osmani Medical College Hospital, Bangladesh, from July 2013 to December 2015. Patients and Methods. Sixty-four patients admitted into the ward with severe bronchiolitis were enrolled as cases and sixty-four suitably matched apparently healthy children attending EPI centre and outpatient department presenting with nonrespiratory illness were enrolled as controls. Sample size was calculated using Guilford and Frucher formula. The technique was systematic random sampling. Every second case satisfying the inclusion and exclusion criteria was enrolled in the study. Results. The mean age of the patients was 7.53 (SD ± 4.75) months. Forty (62.5%) patients were male and twenty four (37.5%) patients were female. Male-to-female ratio was 1.7 : 1. Most of the cases (60.95%) came from low socioeconomic background. More than half of the cases (53.13%) were not exclusively breastfed babies. Mean length of hospital stay was 6.41 (SD ± 2.82) days. Thirty eight (59%) cases and twenty six (34%) controls were exposed to parental smoking. Result was highly significant (p = 0.005). Odds ratio was 2.8 (95% CI from 1.36 to 5.72). Conclusion. Exposure to parental smoking causes a statistically significant (p = 0.005, odds ratio = 2.8) increase in the risk of developing severe bronchiolitis in the first year of life.
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34
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Martínez-Girón R, Pantanowitz L. Lower respiratory tract viral infections: Diagnostic role of exfoliative cytology. Diagn Cytopathol 2017; 45:614-620. [PMID: 28247571 PMCID: PMC7163526 DOI: 10.1002/dc.23697] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 02/09/2017] [Accepted: 02/15/2017] [Indexed: 12/17/2022]
Abstract
Viral lower respiratory tract infections (VLRTI) remain one of the most common causes of morbidity and mortality worldwide. For many years, the diagnosis of VLRTI was based on laboratory techniques such as viral isolation in cell culture, antigen detection by direct fluorescent antibody staining, and rapid enzyme immunoassay. Radiological imaging and morphology also play an important role in diagnosing these infections. Exfoliative cytology provides a simple, rapid, inexpensive, and valuable means to diagnose and manage VLRTI. Here we review viral‐associated cytomorphological changes seen in exfoliated cells of the lower respiratory tract. Diagn. Cytopathol. 2017;45:614–620. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Rafael Martínez-Girón
- INCLÍNICA Foundation for Clinical, Pneumological and Carcinogenic Research, Oviedo, 16. 33007, Spain
| | - Liron Pantanowitz
- Department of Pathology, UPMC Shadyside, UPMC Cancer Pavilion Suite 201, Pittsburgh, Pennsylvania
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35
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Rinawi F, Kassis I, Tamir R, Kugelman A, Srugo I, Miron D. Bronchiolitis in young infants: is it a risk factor for recurrent wheezing in childhood? World J Pediatr 2017; 13:41-48. [PMID: 27650524 DOI: 10.1007/s12519-016-0056-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Accepted: 06/09/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Acute bronchiolitis in infancy is considered a risk factor for recurrent wheezing episodes in childhood. The present study assessed prevalence, clinical manifestations and risk factors for recurrent wheezing events during the first 3 years of life and persistent wheezing events beyond this age in children hospitalized as young infants with acute bronchiolitis. METHODS Two groups of children aged 6 years were included. The study group comprised 150 children with a history of hospitalization for bronchiolitis, with the first event at <6 months of age. The control group comprised 66 age- and sex-matched children with no history of bronchiolitis before 6 months of age. Children in both groups had been followed until 6 years of age by their pediatricians; data were obtained retrospectively by reviewing ambulatory records during children's visits in pediatricians' clinics. The data included epidemiological parameters, prevalence, age at onset, number of and treatments given for episodes of wheezing events prior to 6 years of age, pathogens detected, and severity of acute bronchiolitis in the study group. RESULTS Overall, 58% and 27% of children in the study and control groups, respectively (P=0.001) had recurrent wheezing episodes prior to the age of 3 years. Children in the study group had earlier onset of recurrent wheezing, had more episodes of wheezing, and required more bronchodilator and systemic steroids treatments compared to the control group. CONCLUSION Hospitalization within the first six months of life for acute bronchiolitis is an independent risk factor for recurrent wheezing episodes during the first 3 years of life.
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Affiliation(s)
- Firas Rinawi
- Pediatric Department A', HaEmeq Medical Center, POB 10535, 16100, Afula, Israel.
| | - Imad Kassis
- Pediatric Infectious Disease unit, Meyer Children Hospital, Haifa, Israel.,The Ruth and Bruce Rappaport School of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Rina Tamir
- The Ruth and Bruce Rappaport School of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Amir Kugelman
- The Ruth and Bruce Rappaport School of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.,Pediatric Department, Bnai Zion Medical Center, Haifa, Israel
| | - Isaac Srugo
- The Ruth and Bruce Rappaport School of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.,Pediatric Department, Bnai Zion Medical Center, Haifa, Israel
| | - Dan Miron
- The Ruth and Bruce Rappaport School of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.,Pediatric Infectious Disease Consultation Service, HaEmeq Medical Center, Afula, Israel
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36
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Gupta RS, Singh AM, Walkner M, Caruso D, Bryce PJ, Wang X, Pongracic JA, Smith BM. Hygiene factors associated with childhood food allergy and asthma. Allergy Asthma Proc 2016; 37:e140-e146. [PMID: 27931290 DOI: 10.2500/aap.2016.37.3988] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Childhood food allergy and asthma rates are increasing. The hygiene hypothesis has been proposed as an explanation for the increased incidence of allergic disease. OBJECTIVE To describe the association of childhood food allergy and asthma with hygiene factors, such as the number of siblings, antibiotic use, infection history, pet exposure, child care exposure, and maternalchild factors. METHODS Children ages 021 years old (N = 1359) were recruited for a cross-sectional family-based study, including children with food allergy and children without food allergy, and their siblings. We assessed the associations between childhood food allergy and asthma with hygiene factors. RESULTS Of the 1359 children, 832 (61.2%) had food allergy, and 406 (30%) had asthma. In the adjusted analysis, the prevalence of food allergy was increased if there was a history of skin infection (prevalence ratio [RRR] 1.12 [95% confidence interval {CI}, 1.011.24]) or eczema (RRR 1.89 [95% CI, 1.702.10]). The prevalence of asthma was increased with a history of respiratory syncytial virus infection (RRR 1.60 [95% CI, 1.341.90]) or eczema (RRR 1.54 [95% CI, 1.271.86]). A greater number of siblings were associated with a decreased prevalence of food allergy (RRR 0.79 [95% CI, 0.750.84]) and asthma (RRR 0.82 [95% CI, 0.740.91]). CONCLUSION Our findings supported the accumulating evidence of an association between skin infections and eczema with food allergy. Because these results could be subject to recall bias, additional prospective studies are needed to substantiate these findings.
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Affiliation(s)
- Ruchi S. Gupta
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
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37
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Luoto R, Jartti T, Ruuskanen O, Waris M, Lehtonen L, Heikkinen T. Review of the clinical significance of respiratory virus infections in newborn infants. Acta Paediatr 2016; 105:1132-9. [PMID: 27387520 PMCID: PMC7159705 DOI: 10.1111/apa.13519] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 03/30/2016] [Accepted: 07/05/2016] [Indexed: 12/24/2022]
Abstract
Respiratory viruses have been recognised as causative agents for a wide spectrum of clinical manifestations and severe respiratory compromise in neonates during birth hospitalisation. Early‐life respiratory virus infections have also been shown to be associated with adverse long‐term consequences. Conclusion Preventing virus infections by intensifying hygiene measures and cohorting infected infants should be a major goal for neonatal intensive care units, as well as more common use of virus diagnostics. Active virus surveillance and long‐term follow‐up are needed to ascertain the causality and exact underlying mechanisms for adverse long‐term consequences.
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Affiliation(s)
- Raakel Luoto
- Department of Paediatrics and Adolescent Medicine; University of Turku and Turku University Hospital; Turku Finland
| | - Tuomas Jartti
- Department of Paediatrics and Adolescent Medicine; University of Turku and Turku University Hospital; Turku Finland
| | - Olli Ruuskanen
- Department of Paediatrics and Adolescent Medicine; University of Turku and Turku University Hospital; Turku Finland
| | - Matti Waris
- Department of Virology; University of Turku; Turku Finland
| | - Liisa Lehtonen
- Department of Paediatrics and Adolescent Medicine; University of Turku and Turku University Hospital; Turku Finland
| | - Terho Heikkinen
- Department of Paediatrics and Adolescent Medicine; University of Turku and Turku University Hospital; Turku Finland
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Srinivasa BT, Restori KH, Shan J, Cyr L, Xing L, Lee S, Ward BJ, Fixman ED. STAT6 inhibitory peptide given during RSV infection of neonatal mice reduces exacerbated airway responses upon adult reinfection. J Leukoc Biol 2016; 101:519-529. [PMID: 27566834 DOI: 10.1189/jlb.4a0215-062rr] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Revised: 06/09/2016] [Accepted: 08/02/2016] [Indexed: 11/24/2022] Open
Abstract
Respiratory syncytial virus (RSV)-related hospitalization during infancy is strongly associated with the subsequent development of asthma. Early life RSV infection results in a Th2-biased immune response, which is also typical of asthma. Murine models of neonatal RSV infection have been developed to examine the possible contribution of RSV-driven Th2 responses to the development of airway hyper-responsiveness later in childhood. We have investigated the ability of a cell-penetrating STAT6 inhibitory peptide (STAT6-IP), when delivered selectively during neonatal RSV infection, to modify pathogenesis induced upon secondary RSV reinfection of adults 6 wk later. Neonatal STAT6-IP treatment inhibited the development of airway hyper-responsiveness (AHR) and significantly reduced lung eosinophilia and collagen deposition in adult mice following RSV reinfection. STAT6-IP-treated, RSV-infected neonates had reduced levels of both IL-4 and alternatively activated macrophages (AAMs) in the lungs. Our findings suggest that targeting STAT6 activity at the time of early-life RSV infection may effectively reduce the risk of subsequent asthma development.
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Affiliation(s)
- Bharat T Srinivasa
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada; and
| | - Katherine H Restori
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada; and
| | - Jichuan Shan
- Meakins-Christie Laboratories, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Louis Cyr
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada; and
| | - Li Xing
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada; and
| | - Soojin Lee
- Meakins-Christie Laboratories, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Brian J Ward
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada; and
| | - Elizabeth D Fixman
- Meakins-Christie Laboratories, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
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Heinonen S, Jartti T, Garcia C, Oliva S, Smitherman C, Anguiano E, de Steenhuijsen Piters WAA, Vuorinen T, Ruuskanen O, Dimo B, Suarez NM, Pascual V, Ramilo O, Mejias A. Rhinovirus Detection in Symptomatic and Asymptomatic Children: Value of Host Transcriptome Analysis. Am J Respir Crit Care Med 2016; 193:772-82. [PMID: 26571305 DOI: 10.1164/rccm.201504-0749oc] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
RATIONALE Rhinoviruses (RVs) are a major cause of symptomatic respiratory tract infection in all age groups. However, RVs can frequently be detected in asymptomatic individuals. OBJECTIVES To evaluate the ability of host transcriptional profiling to differentiate between symptomatic RV infection and incidental detection in children. METHODS Previously healthy children younger than 2 years old (n = 151) were enrolled at four study sites and classified into four clinical groups: RV- healthy control subjects (n = 37), RV+ asymptomatic subjects (n = 14), RV+ outpatients (n = 30), and RV+ inpatients (n = 70). Host responses were analyzed using whole-blood RNA transcriptional profiles. MEASUREMENTS AND MAIN RESULTS RV infection induced a robust transcriptional signature, which was validated in three independent cohorts and by quantitative real-time polymerase chain reaction with high prediction accuracy. The immune profile of symptomatic RV infection was characterized by overexpression of innate immunity and underexpression of adaptive immunity genes, whereas negligible changes were observed in asymptomatic RV+ subjects. Unsupervised hierarchical clustering identified two main clusters of subjects. The first included 93% of healthy control subjects and 100% of asymptomatic RV+ subjects, and the second comprised 98% of RV+ inpatients and 88% of RV+ outpatients. Genomic scores of healthy control subjects and asymptomatic RV+ children were similar and significantly lower than those of RV+ inpatients and outpatients (P < 0.0001). CONCLUSIONS Symptomatic RV infection induced a robust and reproducible transcriptional signature, whereas identification of RV in asymptomatic children was not associated with significant systemic transcriptional immune responses. Transcriptional profiling represents a useful tool to discriminate between active infection and incidental virus detection.
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Affiliation(s)
- Santtu Heinonen
- 1 Center for Vaccines and Immunity, The Research Institute at Nationwide Children's Hospital, and
| | | | - Carla Garcia
- 3 Division of Pediatric Infectious Diseases, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Silvia Oliva
- 4 Division of Pediatric Emergency Medicine and Critical Care, Regional University Hospital of Malaga, Malaga, Spain
| | | | | | - Wouter A A de Steenhuijsen Piters
- 6 Department of Pediatric Immunology and Infectious Diseases, The Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, the Netherlands; and
| | - Tytti Vuorinen
- 7 Department of Clinical Virology, Turku University Hospital, Turku, Finland
| | | | - Blerta Dimo
- 1 Center for Vaccines and Immunity, The Research Institute at Nationwide Children's Hospital, and
| | - Nicolas M Suarez
- 1 Center for Vaccines and Immunity, The Research Institute at Nationwide Children's Hospital, and
| | | | - Octavio Ramilo
- 1 Center for Vaccines and Immunity, The Research Institute at Nationwide Children's Hospital, and.,8 Division of Pediatric Infectious Diseases, Nationwide Children's Hospital, Columbus, Ohio.,9 The Ohio State University College of Medicine, Columbus, Ohio
| | - Asuncion Mejias
- 1 Center for Vaccines and Immunity, The Research Institute at Nationwide Children's Hospital, and.,8 Division of Pediatric Infectious Diseases, Nationwide Children's Hospital, Columbus, Ohio.,9 The Ohio State University College of Medicine, Columbus, Ohio
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Balekian DS, Linnemann RW, Hasegawa K, Thadhani R, Camargo CA. Cohort Study of Severe Bronchiolitis during Infancy and Risk of Asthma by Age 5 Years. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2016; 5:92-96. [PMID: 27523277 DOI: 10.1016/j.jaip.2016.07.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 06/30/2016] [Accepted: 07/01/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Severe bronchiolitis (ie, bronchiolitis requiring hospital admission) is thought to markedly increase asthma risk, with 30%-50% developing asthma by age 5 years. To date, studies of this association are small, and most are from outside the United States. OBJECTIVE The objective of this study was to investigate the association between severe bronchiolitis and risk of asthma in a US birth cohort. METHODS We studied a cohort nested within the Massachusetts General Hospital Obstetric Maternal Study (MOMS), a prospective cohort of pregnant women enrolled during 1998-2006. Children of mothers enrolled in MOMS were included in the analysis if they received care within our health system (n = 3653). Diagnoses and medications were extracted from the children's electronic health records; we also examined pregnancy and perinatal risk factors collected for the underlying pregnancy study. RESULTS The birth cohort was 52% male, 49% white, and 105 infants (2.9%) had severe bronchiolitis. Overall, 421 children (11.5%) developed asthma by age 5 years. Among the children with severe bronchiolitis, 27.6% developed asthma by age 5 years. In multivariable logistic regression adjusting for 12 risk factors, severe bronchiolitis remained a strong risk factor for developing asthma by age 5 years (odds ratio 2.57; 95% confidence interval 1.61-4.09). CONCLUSIONS In a large Boston birth cohort, the frequency of severe bronchiolitis and childhood asthma was similar to published data. Among children with severe bronchiolitis, the risk of developing asthma was lower than prior studies but still high (27.6%). This difference may be due to different study designs, populations, and outcome definitions studied.
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Affiliation(s)
- Diana S Balekian
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass; Harvard Medical School, Boston, Mass
| | - Rachel W Linnemann
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Ga
| | - Kohei Hasegawa
- Harvard Medical School, Boston, Mass; Department of Emergency Medicine, Massachusetts General Hospital, Boston, Mass
| | - Ravi Thadhani
- Harvard Medical School, Boston, Mass; Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, Mass
| | - Carlos A Camargo
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass; Harvard Medical School, Boston, Mass; Department of Emergency Medicine, Massachusetts General Hospital, Boston, Mass.
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Balekian DS, Linnemann RW, Castro VM, Perlis R, Thadhani R, Camargo CA. Pre-birth cohort study of atopic dermatitis and severe bronchiolitis during infancy. Pediatr Allergy Immunol 2016; 27:413-8. [PMID: 26766307 PMCID: PMC10983116 DOI: 10.1111/pai.12532] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/09/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Infants hospitalized for bronchiolitis (i.e. severe bronchiolitis) are at increased risk of childhood asthma. There are many known risk factors for severe bronchiolitis, including cardiac and pulmonary diseases. Less is known about the association between atopic diseases and risk of severe bronchiolitis. We sought to further examine risk factors for severe bronchiolitis, focusing on atopic dermatitis (AD). METHODS We conducted a nested cohort study within the Massachusetts General Hospital Obstetric Maternal Study (MOMS), a prospective cohort of pregnant women enrolled during 1998-2006. Children of mothers enrolled in MOMS were included in the analysis if they received care within our health system (n = 5407). Potential risk factors for bronchiolitis and hospitalization data were extracted from the children's electronic health records; we also examined pregnancy and perinatal risk factors collected from the underlying MOMS data. RESULTS During the first year of life, 125 infants (2.3%) had severe bronchiolitis. Eighteen of these patients had AD; 11 (61%) were diagnosed with AD prior to bronchiolitis hospitalization. In unadjusted analyses, AD was associated with severe bronchiolitis (χ(2) 14.6; p < 0.001). In multivariable analyses adjusting for nine known risk factors for severe bronchiolitis, including demographics, birth season, disposition at birth, cardiac disease, maternal parity, and delivery mode, AD was associated with increased odds of severe bronchiolitis (odds ratio 2.72, 95% confidence interval 1.60-4.63). CONCLUSIONS Atopic dermatitis is significantly associated with severe bronchiolitis in infancy. The mechanism of the AD-bronchiolitis association is unclear and merits further study; this research may shed light on the pathogenesis of asthma.
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Affiliation(s)
- Diana S. Balekian
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Rachel W. Linnemann
- Harvard Medical School, Boston, MA, USA
- Division of Pediatric Pulmonology, Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA
| | - Victor M. Castro
- Research Information Systems and Computing, Partners HealthCare System, Boston, MA, USA
- Department of Neurology, Laboratory of Computer Science, Massachusetts General Hospital, Boston, MA, USA
| | - Roy Perlis
- Center for Experimental Drugs and Diagnostics, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Psychiatric and Neurodevelopmental Genetics Unit, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Ravi Thadhani
- Harvard Medical School, Boston, MA, USA
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Carlos A. Camargo
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
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Suárez-Cuartín G, Crespo A, Mateus E, Torrejón M, Giner J, Belda A, Ramos-Barbón D, Torrego A, Plaza V. Variability in Asthma Inflammatory Phenotype in Induced Sputum. Frequency and Causes. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.arbr.2015.12.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Viral-Induced Wheeze and Asthma Development. ALLERGY, IMMUNITY AND TOLERANCE IN EARLY CHILDHOOD 2016. [PMCID: PMC7173475 DOI: 10.1016/b978-0-12-420226-9.00005-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Luo G, Nkoy FL, Stone BL, Schmick D, Johnson MD. A systematic review of predictive models for asthma development in children. BMC Med Inform Decis Mak 2015; 15:99. [PMID: 26615519 PMCID: PMC4662818 DOI: 10.1186/s12911-015-0224-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Accepted: 11/26/2015] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Asthma is the most common pediatric chronic disease affecting 9.6 % of American children. Delay in asthma diagnosis is prevalent, resulting in suboptimal asthma management. To help avoid delay in asthma diagnosis and advance asthma prevention research, researchers have proposed various models to predict asthma development in children. This paper reviews these models. METHODS A systematic review was conducted through searching in PubMed, EMBASE, CINAHL, Scopus, the Cochrane Library, the ACM Digital Library, IEEE Xplore, and OpenGrey up to June 3, 2015. The literature on predictive models for asthma development in children was retrieved, with search results limited to human subjects and children (birth to 18 years). Two independent reviewers screened the literature, performed data extraction, and assessed article quality. RESULTS The literature search returned 13,101 references in total. After manual review, 32 of these references were determined to be relevant and are discussed in the paper. We identify several limitations of existing predictive models for asthma development in children, and provide preliminary thoughts on how to address these limitations. CONCLUSIONS Existing predictive models for asthma development in children have inadequate accuracy. Efforts to improve these models' performance are needed, but are limited by a lack of a gold standard for asthma development in children.
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Affiliation(s)
- Gang Luo
- Department of Biomedical Informatics, University of Utah, Suite 140, 421 Wakara Way, Salt Lake City, UT 84108 USA
| | - Flory L. Nkoy
- Department of Pediatrics, University of Utah, 100 N Mario Capecchi Drive, Salt Lake City, UT 84113 USA
| | - Bryan L. Stone
- Department of Pediatrics, University of Utah, 100 N Mario Capecchi Drive, Salt Lake City, UT 84113 USA
| | - Darell Schmick
- Spencer S. Eccles Health Sciences Library, 10 N 1900 E, Salt Lake City, UT 84112 USA
| | - Michael D. Johnson
- Department of Pediatrics, University of Utah, 100 N Mario Capecchi Drive, Salt Lake City, UT 84113 USA
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45
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Wu P, Larkin EK, Reiss SS, Carroll KN, Summar ML, Minton PA, Woodward KB, Liu Z, Islam JY, Hartert TV, Moore PE. β2-Adrenergic receptor promoter haplotype influences the severity of acute viral respiratory tract infection during infancy: a prospective cohort study. BMC MEDICAL GENETICS 2015; 16:82. [PMID: 26369942 PMCID: PMC4570703 DOI: 10.1186/s12881-015-0229-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 09/09/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Despite the significant interest in β2-Adrenergic receptor (ADRB2) polymorphisms related to asthma, whether ADRB2 genetic variants are similarly associated with acute respiratory tract infections have not been studied. We hypothesized that genetic variants in ADRB2 associated with a response to asthma therapy during an asthma exacerbation were also associated with severity of acute respiratory tract infections. METHODS To test this hypothesis, we genotyped 5 common polymorphisms in the promoter region and coding block of the ADRB2 gene (loci -2387, -2274, -1343, +46, and +79) from 374 Caucasian and African American term infants who were enrolled at the time of acute respiratory illness over four respiratory viral seasons. Severity of respiratory tract infections was measured using a bronchiolitis severity score (BSS; range = 0-12, clinically significant difference = 0.5) with a higher score indicating more severe disease. We assigned the promoter, coding and combined promoter and coding haplotypes to the unphased genotype data. The associations between each of these five single-nucleotide polymorphisms (SNPs) as well as the haplotypes and infant BSS were analyzed using nonparametric univariate analysis and multivariable proportional odds model separately in Caucasians and African Americans. RESULTS There was no significant association between infant BSS and each of the SNPs in both Caucasians and African Americans. However, promoter haplotype CCA was associated with a decreased BSS in African Americans in a dose dependent manner. The median (interquartile range) BSS of infants with no copies of the CCA haplotype, one copy, and two copies of the CCA haplotype were 5.5 (2.0, 8.0), 4.0 (1.0, 7.5), and 3.0 (1.0, 4.0), respectively. This dose dependent relationship persisted after adjusting for infant age, gender, daycare exposure, secondhand smoke exposure, prior history of breastfeeding, siblings at home, and enrollment season (adjusted odds ratio: 0.59, 95% confidence interval: 0.36, 0.98). There was no similar protective relationship of haplotype CCA on severity of respiratory tract infections identified in Caucasians. CONCLUSIONS ADRB2 genotype may be predictive of severity of acute respiratory tract infections in African Americans, and potentially identify a subset of infants who may respond to beta-agonist therapy.
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Affiliation(s)
- Pingsheng Wu
- Center for Asthma & Environmental Health Sciences Research, Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Suite 6100 Medical Center East, Nashville, TN, 37232, USA.
| | - Emma K Larkin
- Center for Asthma & Environmental Health Sciences Research, Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Suite 6100 Medical Center East, Nashville, TN, 37232, USA.
| | - Sara S Reiss
- Center for Asthma & Environmental Health Sciences Research, Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Suite 6100 Medical Center East, Nashville, TN, 37232, USA.
| | - Kecia N Carroll
- Department of Pediatrics, Vanderbilt University School of Medicine, 313 Oxford House, Nashville, TN, 37232, USA.
| | - Marshall L Summar
- Department of Genetics and Metabolism, Division of Genetics and Metabolism, Children's National Health System, 111 Michigan Avenue, NW, Washington, DC, 20010, USA.
| | - Patricia A Minton
- Center for Asthma & Environmental Health Sciences Research, Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Suite 6100 Medical Center East, Nashville, TN, 37232, USA.
| | - Kimberly B Woodward
- Center for Asthma & Environmental Health Sciences Research, Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Suite 6100 Medical Center East, Nashville, TN, 37232, USA.
| | - Zhouwen Liu
- Department of Biostatistics, Vanderbilt University School of Medicine, 2525 West end Ave, Suite 1100, Nashville, TN, 37203, USA.
| | - Jessica Y Islam
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, 27599, USA.
| | - Tina V Hartert
- Center for Asthma & Environmental Health Sciences Research, Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Suite 6100 Medical Center East, Nashville, TN, 37232, USA.
| | - Paul E Moore
- Division of Pediatric Allergy, Immunology and Pulmonary, Department of Pediatrics, Vanderbilt University School of Medicine, 2200 Children's Way, 11215 Doctor's Office Tower, Nashville, TN, 37232, USA.
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Thomsen SF. The contribution of twin studies to the understanding of the aetiology of asthma and atopic diseases. Eur Clin Respir J 2015; 2:27803. [PMID: 26672957 PMCID: PMC4653279 DOI: 10.3402/ecrj.v2.27803] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 08/11/2015] [Indexed: 01/17/2023] Open
Abstract
The prevalence of asthma and other atopic diseases has increased markedly during the past decades and the reasons for this are not fully understood. Asthma is still increasing in many parts of the world, notably in developing countries, and this emphasizes the importance of continuing research aimed at studying the aetiological factors of the disease and the causes of its increase in prevalence. Twin studies enable investigations into the genetic and environmental causes of individual variation in multifactorial diseases such as asthma. Thorough insight into these causes is important as this will ultimately guide the development of preventive strategies and targeted therapies. This review explores the contribution of twin studies to the understanding of the aetiology of asthma and atopic diseases.
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Affiliation(s)
- Simon F Thomsen
- Department of Respiratory Medicine, Bispebjerg Hospital, Copenhagen, Denmark;
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Ozyigit LP, Morita H, Akdis M. Innate lymphocyte cells in asthma phenotypes. Clin Transl Allergy 2015; 5:23. [PMID: 26150907 PMCID: PMC4491887 DOI: 10.1186/s13601-015-0068-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 05/25/2015] [Indexed: 01/12/2023] Open
Abstract
T helper type 2 (TH2) cells were previously thought to be the main initiating effector cell type in asthma; however, exaggerated TH2 cell activities alone were insufficient to explain all aspects of asthma. Asthma is a heterogeneous syndrome comprising different phenotypes that are characterized by their different clinical features, treatment responses, and inflammation patterns. The most-studied subgroups of asthma include TH2-associated early-onset allergic asthma, late-onset persistent eosinophilic asthma, virus-induced asthma, obesity-related asthma, and neutrophilic asthma. The recent discovery of human innate lymphoid cells capable of rapidly producing large amounts of cytokines upon activation and the mouse data pointing to an essential role for these cells in asthma models have emphasized the important role of the innate immune system in asthma and have provided a new means of better understanding asthma mechanisms and differentiating its phenotypes.
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Affiliation(s)
- Leyla Pur Ozyigit
- Department of Allergy and Immunology, Koç University, School of Medicine, Istanbul, Turkey
| | - Hideaki Morita
- Swiss Institute of Allergy and Asthma Research, University of Zurich, Zurich, Switzerland ; Christine Kühne-Center for Allergy Research and Education, Davos, Switzerland
| | - Mubeccel Akdis
- Swiss Institute of Allergy and Asthma Research, University of Zurich, Zurich, Switzerland ; Christine Kühne-Center for Allergy Research and Education, Davos, Switzerland
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48
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Larkin EK, Hartert TV. Genes associated with RSV lower respiratory tract infection and asthma: the application of genetic epidemiological methods to understand causality. Future Virol 2015; 10:883-897. [PMID: 26478738 DOI: 10.2217/fvl.15.55] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Infants with respiratory syncytial virus (RSV) lower respiratory tract infections (LRIs) are at increased risk for childhood asthma. The objectives of this article are to review the genes associated with both RSV LRI and asthma, review analytic approaches to assessing shared genetic risk and propose a future perspective on how these approaches can help us to understand the role of infant RSV infection as both an important risk factor for asthma and marker of shared genetic etiology between the two conditions. The review of shared genes and thus pathways associated with severity of response to RSV infection and asthma risk can help us to understand mechanisms of disease and ultimately propose new and novel targets for primary prevention of both diseases.
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Affiliation(s)
- Emma K Larkin
- Department of Medicine, Division of Allergy, Pulmonary & Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Tina V Hartert
- Department of Medicine, Division of Allergy, Pulmonary & Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USA
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Variability in Asthma Inflammatory Phenotype in Induced Sputum. Frequency and Causes. Arch Bronconeumol 2015; 52:76-81. [PMID: 25953707 DOI: 10.1016/j.arbres.2015.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Revised: 03/13/2015] [Accepted: 03/16/2015] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Recent studies have found variability in asthma inflammatory phenotypes determined by the inflammatory cells in induced sputum (IS). The aim of this study was to determine the frequency and factors affecting inflammatory phenotype variability in IS. METHODS Retrospective observational study that included 61 asthmatic patients who underwent at least two IS tests over a period of 5 years. They were classified according to their baseline inflammatory phenotype and subsequently grouped according to phenotype variability (persistent eosinophilic, persistent non-eosinophilic and intermittent eosinophilic). Demographic, clinical and functional data and factors potentially influencing IS variability were collected in all cases. RESULTS Of the 61 patients, 31 (50.8%) had a change with respect to baseline inflammatory phenotype. Of these, 16 (51.6%) were eosinophilic, 5 (16.1%) neutrophilic, 1 (3.2%) mixed and 9 (29.1%) paucigranulocytic. According to phenotype variability, 18 patients (29.5%) were classified as persistent eosinophilic, 17 (27.9%) non-persistent eosinophilic, and 26 (42.6%) intermittent eosinophilic. Smoking and recent asthma exacerbation were significantly associated with increased risk of variability of the IS inflammatory phenotype (OR=6.44; p=.013; 95% CI=1.49-27.80 and OR=5.84; p=.022; 95% CI=1.29-26.37, respectively). CONCLUSION Half of asthma patients, predominantly those with eosinophilic phenotype, present a change in IS inflammatory phenotype. This variability is associated with smoking and recent asthma exacerbation. Data suggest these factors can modify the classification of IS inflammatory phenotype in clinical practice.
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50
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Thomsen SF. Epidemiology and natural history of atopic diseases. Eur Clin Respir J 2015; 2:24642. [PMID: 26557262 PMCID: PMC4629767 DOI: 10.3402/ecrj.v2.24642] [Citation(s) in RCA: 166] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 02/01/2015] [Indexed: 01/17/2023] Open
Abstract
The atopic diseases – atopic dermatitis, asthma, and hay fever – pose a great burden to the individual and society, not least, since these diseases have reached epidemic proportions during the past decades in industrialized and, more recently, in developing countries. Whereas the prevalence of the atopic diseases now seems to have reached a plateau in many Western countries, they are still on the increase in the developing world. This emphasizes continuing research aimed at identifying the causes, risk factors, and natural history of these diseases. Herein, the fundamental aspects of the natural history and epidemiology of the atopic diseases are reviewed.
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Affiliation(s)
- Simon F Thomsen
- Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark
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