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Matsuda M, Shimora H, Nagatani Y, Nishikawa K, Takamori I, Haguchi T, Kitatani K, Kaminuma O, Nabe T. Involvement of CCR5 on interstitial macrophages in the development of lung fibrosis in severe asthma. Int Immunopharmacol 2024; 135:112331. [PMID: 38795597 DOI: 10.1016/j.intimp.2024.112331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Revised: 05/13/2024] [Accepted: 05/21/2024] [Indexed: 05/28/2024]
Abstract
CCR5 may be involved in the pathogenesis of asthma; however, the underlying mechanisms remain unclear. In comparison with a mild asthma model, subepithelial fibrosis was more severe and CCR5 gene expression in the lungs was significantly higher in our recently developed murine model of steroid-resistant severe asthma. Treatment with the CCR5 antagonist, maraviroc, significantly suppressed the development of subepithelial fibrosis in bronchi, whereas dexamethasone did not. On the other hand, increases in leukocytes related to type 2 inflammation, eosinophils, Th2 cells, and group 2 innate lymphoid cells in the lungs were not affected by the treatment with maraviroc. Increases in neutrophils and total macrophages were also not affected by the CCR5 antagonist. However, increases in transforming growth factor (TGF)-β-producing interstitial macrophages (IMs) were significantly reduced by maraviroc. The present results confirmed increases in CCR5-expressing IMs in the lungs of the severe asthma model. In conclusion, CCR5 on IMs plays significant roles in the development of subepithelial fibrosis in severe asthma through TGF-β production in the lungs.
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Affiliation(s)
- Masaya Matsuda
- Laboratory Immunopharmacology, Faculty of Pharmaceutical Sciences, Setsunan University, Osaka 573-0101, Japan
| | - Hayato Shimora
- Laboratory Immunopharmacology, Faculty of Pharmaceutical Sciences, Setsunan University, Osaka 573-0101, Japan
| | - Yukino Nagatani
- Laboratory Immunopharmacology, Faculty of Pharmaceutical Sciences, Setsunan University, Osaka 573-0101, Japan
| | - Keitaro Nishikawa
- Laboratory Immunopharmacology, Faculty of Pharmaceutical Sciences, Setsunan University, Osaka 573-0101, Japan
| | - Itomi Takamori
- Laboratory Immunopharmacology, Faculty of Pharmaceutical Sciences, Setsunan University, Osaka 573-0101, Japan
| | - Tenta Haguchi
- Laboratory Immunopharmacology, Faculty of Pharmaceutical Sciences, Setsunan University, Osaka 573-0101, Japan
| | - Kazuyuki Kitatani
- Laboratory Immunopharmacology, Faculty of Pharmaceutical Sciences, Setsunan University, Osaka 573-0101, Japan
| | - Osamu Kaminuma
- Department of Disease Model, Research Institute of Radiation Biology and Medicine, Hiroshima University, Hiroshima 734-8551, Japan
| | - Takeshi Nabe
- Laboratory Immunopharmacology, Faculty of Pharmaceutical Sciences, Setsunan University, Osaka 573-0101, Japan.
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Chang MT, Noel J, Ayoub NF, Qian ZJ, Dholakia S, Nayak JV, Patel ZM, Hwang PH. Oral Corticosteroids Following Endoscopic Sinus Surgery for Chronic Rhinosinusitis Without Nasal Polyposis: A Randomized Clinical Trial. JAMA Otolaryngol Head Neck Surg 2021; 147:434-441. [PMID: 33662124 DOI: 10.1001/jamaoto.2021.0011] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Although oral corticosteroids are commonly prescribed following endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS) without nasal polyposis, there are little data to suggest that this is a beneficial practice. Objective To assess the efficacy of oral corticosteroids following ESS in CRS without polyps. Design, Setting, and Participants This prospective double-blinded, placebo-controlled, randomized noninferiority clinical trial conducted in a single academic tertiary rhinology practice included adults with CRS without polyps undergoing ESS. Of 81 patients recruited, 72 completed the study. Interventions Patients were randomized into 2 treatment groups: a 12-day postoperative taper of oral prednisone vs matched placebo tablets. All study patients also received a uniform 2-week postoperative regimen of oral antibiotics, fluticasone nasal spray, and saline rinses. Main Outcomes and Measures The primary outcome measures were Sinonasal Outcome Test-22 (SNOT-22) scores and Lund-Kennedy endoscopy scores, collected preoperatively and postoperatively at 1 week, 1 month, 3 months, and 6 months. Scores were compared between treatment groups at each time point using longitudinal difference between treatment groups and analyzed using 2-way, repeated measures analysis of variance. Secondary outcome measures included treatment-related adverse effects. Results Overall, 72 patients (mean [SD] age, 49.4 [14.9] years; 36 men, 36 women) completed the study, with 33 in the prednisone arm and 39 in the placebo arm. When comparing longitudinal differences between treatment groups, there was no clinically meaningful difference observed in SNOT-22 total (F[4254] = 1.71, η2 = 0.01 [95% CI, 0.00-0.05]) or Lund-Kennedy scores (F[4247] = 1.23, η2 = 0.02 [95% CI, 0.00-0.50]). In SNOT-22 subdomain analyses, there was no clinically meaningful difference between treatment groups for rhinologic, extranasal rhinologic, ear/facial, or sleep subdomains. However, the prednisone group had worse longitudinal scores for psychological dysfunction compared with the placebo group (F[4254] = 3.18, η2 = 0.05 [95% CI, 0.02-0.09]). Reported adverse effects were similar between the 2 treatment groups. Conclusions and Relevance In this randomized clinical trial of patients with CRS without polyps, oral prednisone following ESS conferred no additional benefit over placebo in terms of SNOT-22 total scores, SNOT-22 rhinologic subscores, or Lund-Kennedy endoscopy scores up to 6 months after surgery. Patients receiving prednisone, however, did demonstrate worse SNOT-22 psychologic subdomain scores. These results suggest that the risks of oral corticosteroids may outweigh the benefits; thus use of oral corticosteroids after ESS for CRS without polyps should be carefully considered. Trial Registration ClinicalTrials.gov Identifier: NCT02748070.
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Affiliation(s)
- Michael T Chang
- Stanford University School of Medicine, Department of Otolaryngology-Head & Neck Surgery, Stanford, California
| | - Julia Noel
- Stanford University School of Medicine, Department of Otolaryngology-Head & Neck Surgery, Stanford, California
| | - Noel F Ayoub
- Stanford University School of Medicine, Department of Otolaryngology-Head & Neck Surgery, Stanford, California
| | - Zhen Jason Qian
- Stanford University School of Medicine, Department of Otolaryngology-Head & Neck Surgery, Stanford, California
| | - Sachi Dholakia
- Stanford University School of Medicine, Department of Otolaryngology-Head & Neck Surgery, Stanford, California
| | - Jayakar V Nayak
- Stanford University School of Medicine, Department of Otolaryngology-Head & Neck Surgery, Stanford, California
| | - Zara M Patel
- Stanford University School of Medicine, Department of Otolaryngology-Head & Neck Surgery, Stanford, California
| | - Peter H Hwang
- Stanford University School of Medicine, Department of Otolaryngology-Head & Neck Surgery, Stanford, California
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Hox V, Lourijsen E, Jordens A, Aasbjerg K, Agache I, Alobid I, Bachert C, Boussery K, Campo P, Fokkens W, Hellings P, Hopkins C, Klimek L, Mäkelä M, Mösges R, Mullol J, Pujols L, Rondon C, Rudenko M, Toppila-Salmi S, Scadding G, Scheire S, Tomazic PV, Van Zele T, Wagemann M, van Boven JFM, Gevaert P. Benefits and harm of systemic steroids for short- and long-term use in rhinitis and rhinosinusitis: an EAACI position paper. Clin Transl Allergy 2020; 10:1. [PMID: 31908763 PMCID: PMC6941282 DOI: 10.1186/s13601-019-0303-6] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 12/02/2019] [Indexed: 02/05/2023] Open
Abstract
Because of the inflammatory mechanisms of most chronic upper airway diseases such as rhinitis and chronic rhinosinusitis, systemic steroids have been used for their treatment for decades. However, it has been very well documented that—potentially severe—side-effects can occur with the accumulation of systemic steroid courses over the years. A consensus document summarizing the benefits of systemic steroids for each upper airway disease type, as well as highlighting the potential harms of this treatment is currently lacking. Therefore, a panel of international experts in the field of Rhinology reviewed the available literature with the aim of providing recommendations for the use of systemic steroids in treating upper airway disease.
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Affiliation(s)
- Valerie Hox
- 1Cliniques Universitaires Saint-Luc Brussels, Av. Hippocrate 10, 1200 Brussels, Belgium
| | - Evelijn Lourijsen
- 2Department of Otorhinolaryngology, Amsterdam University Medical Centres, AMC, Amsterdam, The Netherlands
| | - Arnout Jordens
- 3Upper Airway Research Laboratory, Dep. of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
| | | | - Ioana Agache
- Faculty of Medicine, Transsylvania University, Brasov, Romania
| | - Isam Alobid
- 6Hospital Clínic, IDIBAPS, CEBERES Universitat de Barcelona, Catalonia, Spain.,7Centro Medico Teknon, Barcelona, Spain
| | - Claus Bachert
- 3Upper Airway Research Laboratory, Dep. of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium.,8Department of Ear, Nose and Throat Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Koen Boussery
- 9Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Paloma Campo
- 10Allergy Unit, Hospital Regional Universitario of Málaga, IBIMA, ARADyAL, Malaga, Spain
| | - Wytske Fokkens
- 2Department of Otorhinolaryngology, Amsterdam University Medical Centres, AMC, Amsterdam, The Netherlands
| | - Peter Hellings
- 11Department of Ear, Nose and Throat Disease, University Hospitals, Louvain, Belgium
| | - Claire Hopkins
- 12ENT Department, Guy's & St Thomas' Hospital, London, UK
| | - Ludger Klimek
- Center of Rhinology and Allergology, Wiesbaden, Germany
| | - Mika Mäkelä
- 14Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | | | - Joaquim Mullol
- 6Hospital Clínic, IDIBAPS, CEBERES Universitat de Barcelona, Catalonia, Spain
| | - Laura Pujols
- 6Hospital Clínic, IDIBAPS, CEBERES Universitat de Barcelona, Catalonia, Spain
| | - Carmen Rondon
- 10Allergy Unit, Hospital Regional Universitario of Málaga, IBIMA, ARADyAL, Malaga, Spain
| | | | - Sanna Toppila-Salmi
- 14Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | | | - Sophie Scheire
- 9Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | | | - Thibaut Van Zele
- 3Upper Airway Research Laboratory, Dep. of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
| | | | - Job F M van Boven
- 20Department of Clinical Pharmacy & Pharmacology, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, Groningen, The Netherlands
| | - Philippe Gevaert
- 3Upper Airway Research Laboratory, Dep. of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
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Gendron DR, Lecours PB, Lemay AM, Beaulieu MJ, Huppé CA, Lee-Gosselin A, Flamand N, Don AS, Bissonnette É, Blanchet MR, Laplante M, Bourgoin SG, Bossé Y, Marsolais D. A Phosphorylatable Sphingosine Analog Induces Airway Smooth Muscle Cytostasis and Reverses Airway Hyperresponsiveness in Experimental Asthma. Front Pharmacol 2017; 8:78. [PMID: 28270767 PMCID: PMC5318459 DOI: 10.3389/fphar.2017.00078] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 02/07/2017] [Indexed: 11/13/2022] Open
Abstract
In asthma, excessive bronchial narrowing associated with thickening of the airway smooth muscle (ASM) causes respiratory distress. Numerous pharmacological agents prevent experimental airway hyperresponsiveness (AHR) when delivered prophylactically. However, most fail to resolve this feature after disease is instated. Although sphingosine analogs are primarily perceived as immune modulators with the ability to prevent experimental asthma, they also influence processes associated with tissue atrophy, supporting the hypothesis that they could interfere with mechanisms sustaining pre-established AHR. We thus assessed the ability of a sphingosine analog (AAL-R) to reverse AHR in a chronic model of asthma. We dissected the pharmacological mechanism of this class of agents using the non-phosphorylatable chiral isomer AAL-S and the pre-phosphorylated form of AAL-R (AFD-R) in vivo and in human ASM cells. We found that a therapeutic course of AAL-R reversed experimental AHR in the methacholine challenge test, which was not replicated by dexamethasone or the non-phosphorylatable isomer AAL-S. AAL-R efficiently interfered with ASM cell proliferation in vitro, supporting the concept that immunomodulation is not necessary to interfere with cellular mechanisms sustaining AHR. Moreover, the sphingosine-1-phosphate lyase inhibitor SM4 and the sphingosine-1-phosphate receptor antagonist VPC23019 failed to inhibit proliferation, indicating that intracellular accumulation of sphingosine-1-phosphate or interference with cell surface S1P1/S1P3 activation, are not sufficient to induce cytostasis. Potent AAL-R-induced cytostasis specifically related to its ability to induce intracellular AFD-R accumulation. Thus, a sphingosine analog that possesses the ability to be phosphorylated in situ interferes with cellular mechanisms that beget AHR.
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Affiliation(s)
- David R Gendron
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec QC, Canada
| | - Pascale B Lecours
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec QC, Canada
| | - Anne-Marie Lemay
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec QC, Canada
| | - Marie-Josée Beaulieu
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec QC, Canada
| | - Carole-Ann Huppé
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec QC, Canada
| | - Audrey Lee-Gosselin
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec QC, Canada
| | - Nicolas Flamand
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, QuébecQC, Canada; Faculty of Medicine, Université Laval, QuébecQC, Canada
| | - Anthony S Don
- Centenary Institute and NHMRC Clinical Trials Centre, University of Sydney, Camperdown NSW, Australia
| | - Élyse Bissonnette
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, QuébecQC, Canada; Faculty of Medicine, Université Laval, QuébecQC, Canada
| | - Marie-Renée Blanchet
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, QuébecQC, Canada; Faculty of Medicine, Université Laval, QuébecQC, Canada
| | - Mathieu Laplante
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, QuébecQC, Canada; Faculty of Medicine, Université Laval, QuébecQC, Canada
| | - Sylvain G Bourgoin
- Faculty of Medicine, Université Laval, QuébecQC, Canada; Division of Infectious Diseases and Immunology, CHU de Québec Research Center, QuébecQC, Canada
| | - Ynuk Bossé
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, QuébecQC, Canada; Faculty of Medicine, Université Laval, QuébecQC, Canada
| | - David Marsolais
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, QuébecQC, Canada; Faculty of Medicine, Université Laval, QuébecQC, Canada
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5
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Wang FP, Fan YQ, Li SY, Mao H. Biomarkers of in vivo fluorescence imaging in allergic airway inflammation. Mol Cell Probes 2016; 30:100-5. [PMID: 26902991 DOI: 10.1016/j.mcp.2016.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 02/17/2016] [Accepted: 02/17/2016] [Indexed: 02/05/2023]
Abstract
Airway inflammation is a central component of the manifestation of asthma but is relatively inaccessible to study. Current imaging techniques such as X-ray CT, MRI, and PET, have advanced noninvasive research on pulmonary diseases. However, these techniques mainly facilitate the anatomical or structural assessment of the diseased lung and/or typically use radioactive agents. In vivo fluorescence imaging is a novel method for noninvasive, real-time, and specific monitoring of lung airway inflammation, which is particularly important to gain a further understanding asthma. Compared to conventional techniques, fluorescent imaging has the advantages of rapid feedback, as well as high sensitivity and resolution. Recently, there has been an increase in the identification of biomarkers, including matrix metalloproteinases, cathepsins, selectins, folate receptor-beta, nanoparticles, as well as sialic acid-binding immunoglobulin-like lectin-F to assess the level of airway inflammation in asthma. Recent advances in our understanding of these biomarkers as molecular probes for in vivo imaging are discussed in this review.
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Affiliation(s)
- Fa-Ping Wang
- Department of Respiratory Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Ying-Qi Fan
- Department of Respiratory Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Su-Yun Li
- Department of Respiratory Medicine, First Affiliated Hospital of Henan College of Traditional Chinese Medicine, Zhengzhou 450000, China
| | - Hui Mao
- Department of Respiratory Medicine, West China Hospital, Sichuan University, Chengdu 610041, China.
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6
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Kononowa N, Michel S, Miedinger D, Pichler CE, Chhajed PN, Helbling A, Leuppi JD. Effects of add-on montelukast on airway hyperresponsiveness in patients with well-controlled asthma - a pilot study. J Drug Assess 2013; 2:49-57. [PMID: 27536437 PMCID: PMC4937661 DOI: 10.3109/21556660.2013.791300] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2013] [Indexed: 11/13/2022] Open
Abstract
Objective Control of airway inflammation is the cornerstone of asthma management. The aim of the present pilot study was to assess the effects of a leukotriene receptor antagonist (LTRA) added to a basic treatment of inhaled corticosteroids (ICS) and long-acting beta-agonist (LABA) on airway hyperresponsiveness, inflammation, and quality of life in well-controlled patients with asthma. Research design and methods Seventeen patients (age 18–65, 11 women) with well-controlled asthma presenting airway hyperresponsiveness to mannitol and methacholine challenge were given add-on montelukast on a stable ICS + LABA for 4 weeks. Quality of life and selected parameters of airway inflammation were measured at baseline and at study end. (ClinicalTrials.gov (NCT01725360)). Results Adding montelukast to ICS + LABA resulted in an increase in mean FEV1 (+4.5%, p = 0.057), cumulated higher dose of mannitol (+32.5%, p = 0.023) and methacholine (+17.2%, 0.237) in the provocation test, lower airway reactivity with mannitol and methacholine (response dose ratio (RDR) –50.0%, p = 0.024 and –44.3%, p = 0.006, respectively), and improved airway sensitivity to mannitol and methacholine (+12.1%, p = 0.590 and +48.0%, p = 0.129 for PD15 and PD20 FEV1, respectively). Changes in inflammation parameters (blood eosinophil count, serum eosinophil cationic protein, and exhaled nitric oxide) were consistent with these findings. Asthma-related quality of life improved significantly in all domains and overall (from 5.3 at baseline to 6.1 at the final visit, p < 0.001). The main limitation was the absence of a control group. Conclusion The consistency of the changes in airway hyperresponsiveness and inflammation as well as in quality of life observed with an add-on therapy with montelukast in well-controlled asthma patients during 4 weeks suggests that residual inflammation may represent an area for further improvement of asthma control to be explored in adequately powered randomized controlled trials.
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Affiliation(s)
- Nina Kononowa
- Clinic of Internal Medicine, University Hospital BaselSwitzerland
| | - Sandra Michel
- Clinic of Allergology, University Hospital Basel, Switzerland; University Clinic of Rheumatology, Clinical Immunology and Allergology, University Hospital BernSwitzerland
| | - David Miedinger
- Medical Faculty, University of Basel and Clinic of Internal Medicine, Canton Hospital Baselland, LiestalSwitzerland
| | - Christiane E Pichler
- University Clinic of Rheumatology, Clinical Immunology and Allergology, University Hospital BernSwitzerland
| | - Prashant N Chhajed
- Medical Faculty, University of Basel and Clinic of Internal Medicine, Canton Hospital Baselland, LiestalSwitzerland
| | - Arthur Helbling
- University Clinic of Rheumatology, Clinical Immunology and Allergology, University Hospital BernSwitzerland
| | - Jörg D Leuppi
- Medical Faculty, University of Basel and Clinic of Internal Medicine, Canton Hospital Baselland, LiestalSwitzerland
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7
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Malik S, Saravanan V, Kelly C. Interstitial lung disease in rheumatoid arthritis: an update on diagnosis and management. ACTA ACUST UNITED AC 2012. [DOI: 10.2217/ijr.12.24] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Helyes Z, Hajna Z. Endotoxin-Induced Airway Inflammation and Asthma Models. METHODS IN PHARMACOLOGY AND TOXICOLOGY 2012. [DOI: 10.1007/978-1-62703-077-9_16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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9
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Montuschi P, Barnes PJ. New perspectives in pharmacological treatment of mild persistent asthma. Drug Discov Today 2011; 16:1084-91. [PMID: 21930234 DOI: 10.1016/j.drudis.2011.09.005] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Revised: 09/02/2011] [Accepted: 09/05/2011] [Indexed: 10/17/2022]
Abstract
Until the relationship between symptoms, lung function tests, airway inflammation, airway hyper-responsiveness (AHR), exacerbations and remodelling is clarified, regular treatment seems to enable a greater disease control than on-demand therapy in most patients with mild persistent asthma. Current guideline classification based on disease severity remains a cornerstone in asthma management. However, the heterogeneity of asthma, the growing emphasis on subphenotypes, including molecular phenotypes identified by -omics technologies, and their possible implications in terms of different asthma severity, progression and therapeutic response, are changing current asthma treatment mainly based on disease severity classification to a pharmacological strategy more focused on the individual patient.
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Affiliation(s)
- Paolo Montuschi
- Department of Pharmacology, Faculty of Medicine, Catholic University of Sacred Heart, Largo Francesco Vito, 1-00168 Rome, Italy.
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10
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Abstract
Airway remodeling is a central feature of asthma. It is exemplified by thickening of the lamina reticularis and structural changes to the epithelium, submucosa, smooth muscle, and vasculature of the airway wall. Airway remodeling may result from persistent airway inflammation. Immunoglobulin E (IgE) is an important mediator of allergic reactions and has a central role in airway inflammation and asthma-related symptoms. Anti-IgE therapies (such as omalizumab) have the potential to block an early step in the allergic cascade and therefore have the potential to reduce airway remodeling. The reduction in free IgE levels following anti-IgE therapy leads to reductions in high-affinity IgE receptor (FcεRI) expression on mast cells, basophils, and dendritic cells. This combined effect results in attenuation of several markers of inflammation, including peripheral and bronchial tissue eosinophilia and levels of granulocyte macrophage colony-stimulating factor, interleukin (IL)-2, IL-4, IL-5, and IL-13. Considering the previously demonstrated anti-inflammatory effects of anti-IgE therapy, along with results from a small study showing continued benefit after discontinuation of long-term treatment, a larger study to assess its effect on markers of airway remodeling is underway.
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Affiliation(s)
- K F Rabe
- Department of Medicine, University Kiel, Kiel, Germany and Krankenhaus Grosshansdorf, Center for Pulmonology and Thoracic Surgery, Wöhrendamm 80, Grosshansdorf, Germany.
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11
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Guidotti TL, Prezant D, de la Hoz RE, Miller A. The evolving spectrum of pulmonary disease in responders to the World Trade Center tragedy. Am J Ind Med 2011; 54:649-60. [PMID: 23236631 DOI: 10.1002/ajim.20987] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
On September 11, 2001, events at the World Trade Center (WTC) exposed residents ofNew York City to WTC dust and products of combustion and pyrolysis. The majority ofWTC-exposed fire department rescue workers experienced a substantial decline in airflowover the first 12 months post-9/11, in addition to the normal age-related declinethat affected all responders, followed by a persistent plateau in pulmonary function inthe 6 years thereafter. The spectrum of the resulting pulmonary diseases consists ofchronic inflammation, characterized by airflow obstruction, and expressing itself indifferent ways in large and small airways. These conditions include irritant-inducedasthma, non-specific chronic bronchitis, aggravated pre-existing obstructive lung disease(asthma or COPD), and bronchiolitis. Conditions concomitant with airwaysobstruction, particularly chronic rhinosinusitis and upper airway disease, and gastroesophagealreflux, have been prominent in this population. Less common have beenreports of sarcoidosis or interstitial pulmonary fibrosis. Pulmonary fibrosis and bronchiolitisare generally characterized by long latency, relatively slow progression, and asilent period with respect to pulmonary function during its evolution. For these reasons,the incidence of these outcomes may be underestimated and may increase overtime. The spectrum of chronic obstructive airways disease is broad in this populationand may importantly include involvement at the bronchiolar level, manifested as smallairways disease. Protocols that go beyond conventional screening pulmonary functiontesting and imaging may be necessary to identify these diseases in order to understandthe underlying pathologic processes so that treatment can be most effective.
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Affiliation(s)
- Tee L Guidotti
- Medical Advisory Services (A Division of The NMAS Group), Rockville, Maryland 20850, USA.
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12
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Montuschi P. Pharmacotherapy of patients with mild persistent asthma: strategies and unresolved issues. Front Pharmacol 2011; 2:35. [PMID: 21808620 PMCID: PMC3139104 DOI: 10.3389/fphar.2011.00035] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Accepted: 06/21/2011] [Indexed: 12/22/2022] Open
Abstract
In studies comparing regular versus on-demand treatment for patients with mild persistent asthma, on-demand treatment seems to have a similar efficacy on clinical and functional outcomes, but it does not suppress chronic airway inflammation or airway hyper-responsiveness (AHR) associated with asthma. Data on the efficacy of a continuous treatment with inhaled corticosteroids (ICS) in preventing the progression of asthma are conflicting. There is the possibility that patients without a regular treatment with ICS may develop a more severe asthma associated with airway structural changes (remodeling) and a progressive loss of lung function. However, the possible clinical and functional consequences of persistent, not controlled, airway inflammation in patients with asthma have to be established. Assessment of asthma control should include inflammatory outcomes, such as fraction of exhaled nitric oxide and sputum eosinophil counts. Until the relationships between symptoms, lung function tests, AHR, airway inflammation, exacerbations, and airway remodeling are clarified, regular treatment seems to be generally more appropriate than on-demand treatment to warrant a greater control of asthma. Select subgroups of patients with mild asthma who are well controlled by regular treatment might adopt the on-demand treatment plan as an intermediate step toward the suspension of controller medication. The increasing evidence for heterogeneity of asthma, the growing emphasis on asthma subphenotypes, including molecular phenotypes identified by omics technologies, and their possible implications for different asthma severity and progression and therapeutic response, are changing the paradigm of treating patients with asthma only based on classification of their disease severity to a pharmacological strategy more focused on the individual asthmatic patient. Pharmacological treatment of asthma is going toward a personalized approach.
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Affiliation(s)
- Paolo Montuschi
- Department of Pharmacology, Faculty of Medicine, Catholic University of the Sacred HeartRome, Italy
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13
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Lower sensitivity of nasal polyp fibroblasts to glucocorticoid anti-proliferative effects. Respir Med 2010; 105:218-25. [PMID: 20829014 DOI: 10.1016/j.rmed.2010.08.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2010] [Revised: 07/09/2010] [Accepted: 08/03/2010] [Indexed: 12/31/2022]
Abstract
BACKGROUND Treatment with glucocorticoids (GCs) is the cornerstone of nasal polyp (NP) therapy, but some patients respond poorly to them. Fibroblasts are involved in both inflammation and remodelling of NP. We aimed to evaluate whether NP fibroblasts are less sensitive to GCs' anti-proliferative and anti-inflammatory effects, compared to nasal mucosa (NM) fibroblasts. METHODS Fibroblasts were obtained from NP (n = 8) from asthmatic patients undergoing endoscopic surgery and NM (n = 8) from patients undergoing nasal corrective surgery. Fibroblasts were stimulated with DMEM at 0.5% or 5% FBS, or TGF-β (5 ng/ml), with or without dexamethasone (10(-11) to 10(-5)M) for different times. Cell proliferation, collagen mRNA expression and IL-6 and IL-8 release were measured. RESULTS After 3-days, dexamethasone dose-dependently inhibited proliferation of NM (p < 0.001) but not that of NP fibroblasts. Dexamethasone (10(-6)M) reduced by 25% the proliferation of NM fibroblasts. Dexamethasone also inhibited proliferation of NM (p < 0.01) but not that of NP fibroblasts at 5-days. TGF-β induced collagen-1α1, -1α2, and -3α1 mRNA levels in both NM and NP fibroblasts (p < 0.05), and dexamethasone did not alter TGF-β-induced collagen mRNA levels in either fibroblast type at 24 h. Dexamethasone dose-dependently decreased (p < 0.05) FBS-induced IL-6 and IL-8 release in both NM and NP fibroblasts at 4 h, although at 10(-8)M, dexamethasone inhibited cytokine production in NM (p < 0.05) but not in NP fibroblasts. CONCLUSIONS This impaired sensitivity of nasal polyp fibroblasts to in vitro glucocorticoid effects concurs in part with the poor clinical response that these nasal polyp patients show to glucocorticoid treatment.
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Diamant Z, Mantzouranis E, Bjermer L. Montelukast in the treatment of asthma and beyond. Expert Rev Clin Immunol 2010; 5:639-58. [PMID: 20477688 DOI: 10.1586/eci.09.62] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Asthma is a chronic inflammatory disease affecting over 300 million people worldwide. The common association with allergic rhinitis and the presence of proinflammatory cells and mediators in the circulation of patients qualify asthma as a systemic disease. This characteristic and the fact that the gold-standard therapy for persistent asthma, inhaled corticosteroids, cannot suppress all components of airway inflammation and fail to adequately penetrate into the small airways, warrant the quest for effective systemic anti-asthma therapies. This review describes the most important controlled studies of montelukast, a once-daily leukotriene receptor antagonist, in asthma and allergic rhinitis in both adults and children. Montelukast is a systemically active drug with a targeted, dual mechanism of action, acting both as a bronchodilator and anti-inflammatory. In patients of all ages, montelukast has shown a favorable safety profile and was well-tolerated. Both as monotherapy or in combination with inhaled corticosteroids, montelukast produced clinically relevant improvements in asthma-related parameters, including symptoms, lung function parameters, quality of life and the number of asthma exacerbations. Furthermore, bronchoprotective effects have been reported both against specific and nonspecific bronchoactive stimuli. Similarly, in patients with allergic rhinitis, montelukast produced substantial improvements in symptoms and quality of life. Long-term studies aimed to determine its effects on airway remodeling are still lacking.
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Affiliation(s)
- Zuzana Diamant
- Department of Allergology, Erasmus Medical Center, Rotterdam, The Netherlands.
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15
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Hagedorn PH, Burton CM, Carlsen J, Steinbrüchel D, Andersen CB, Sahar E, Domany E, Cohen IR, Flyvbjerg H, Iversen M. Chronic rejection of a lung transplant is characterized by a profile of specific autoantibodies. Immunology 2010; 130:427-35. [PMID: 20201985 DOI: 10.1111/j.1365-2567.2010.03246.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
SUMMARY Obliterative bronchiolitis (OB) continues to be the major limitation to long-term survival after lung transplantation. The specific aetiology and pathogenesis of OB are not well understood. To explore the role of autoreactivity in OB, we spotted 751 different self molecules onto glass slides, and used these antigen microarrays to profile 48 human serum samples for immunoglobulin G (IgG) and IgM autoantibodies; 27 patients showed no or mild bronchiolitis obliterans syndrome (BOS; a clinical correlate of OB) and 15 patients showed medium to severe BOS. We now report that these BOS grades could be differentiated by a profile of autoantibodies binding to 28 proteins or their peptides. The informative autoantibody profile included down-regulation as well as up-regulation of both IgM and IgG specific reactivities. This profile was evaluated for robustness using a panel of six independent test patients. Analysis of the functions of the 28 informative self antigens showed that eight of them are connected in an interaction network involved in apoptosis and protein metabolism. Thus, a profile of autoantibodies may reflect pathological processes in the lung allograft, suggesting a role for autoimmunity in chronic rejection leading to OB.
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Affiliation(s)
- Peter H Hagedorn
- Biosystems Department, Risø National Laboratory, Technical University of Denmark, Roskilde, Denmark.
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Riesenfeld EP, Sullivan MJ, Thompson-Figueroa JA, Haverkamp HC, Lundblad LK, Bates JHT, Irvin CG. Inhaled salmeterol and/or fluticasone alters structure/function in a murine model of allergic airways disease. Respir Res 2010; 11:22. [PMID: 20181256 PMCID: PMC2841146 DOI: 10.1186/1465-9921-11-22] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2009] [Accepted: 02/24/2010] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The relationship between airway structural changes (remodeling) and airways hyperresponsiveness (AHR) is unclear. Asthma guidelines suggest treating persistent asthma with inhaled corticosteroids and long acting beta-agonists (LABA). We examined the link between physiological function and structural changes following treatment fluticasone and salmeterol separately or in combination in a mouse model of allergic asthma. METHODS BALB/c mice were sensitized to intraperitoneal ovalbumin (OVA) followed by six daily inhalation exposures. Treatments included 9 daily nebulized administrations of fluticasone alone (6 mg/ml), salmeterol (3 mg/ml), or the combination fluticasone and salmeterol. Lung impedance was measured following methacholine inhalation challenge. Airway inflammation, epithelial injury, mucus containing cells, and collagen content were assessed 48 hours after OVA challenge. Lungs were imaged using micro-CT. RESULTS AND DISCUSSION Treatment of allergic airways disease with fluticasone alone or in combination with salmeterol reduced AHR to approximately naüve levels while salmeterol alone increased elastance by 39% compared to control. Fluticasone alone and fluticasone in combination with salmeterol both reduced inflammation to near naive levels. Mucin containing cells were also reduced with fluticasone and fluticasone in combination with salmeterol. CONCLUSIONS Fluticasone alone and in combination with salmeterol reduces airway inflammation and remodeling, but salmeterol alone worsens AHR: and these functional changes are consistent with the concomitant changes in mucus metaplasia.
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Affiliation(s)
- Erik P Riesenfeld
- Vermont Lung Center, University of Vermont, Burlington, Vermont, USA
| | | | | | - Hans C Haverkamp
- Vermont Lung Center, University of Vermont, Burlington, Vermont, USA
| | | | - Jason HT Bates
- Vermont Lung Center, University of Vermont, Burlington, Vermont, USA
| | - Charles G Irvin
- Vermont Lung Center, University of Vermont, Burlington, Vermont, USA
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Ulrik CS, Diamant Z. Add-on montelukast to inhaled corticosteroids protects against excessive airway narrowing. Clin Exp Allergy 2010; 40:576-81. [PMID: 20128823 DOI: 10.1111/j.1365-2222.2010.03447.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
RATIONALE Excessive airway narrowing in response to broncho-active stimuli is a predictor for severe exacerbations in asthma. Leukotriene receptor antagonists (LTRAs) have complementary properties to inhaled corticosteroids (ICS) on asthma control. OBJECTIVES The LTRA montelukast may provide an additional protection against excessive airway narrowing. We tested the add-on effects of montelukast on the maximal response plateau and PD(20) to inhaled methacholine in asthmatics on a stable dose of ICS. METHODS Thirty-one patients with allergic asthma [14M/17F, 19-50 years, forced expiratory volume in 1 s (FEV(1)) >70% pred., PD(20) <3.9 micromol methacholine], with a twice documented response plateau to methacholine, were randomized in a double-blind (montelukast 10 mg or matching placebo once daily), 12-week parallel study. Bronchoprovocation tests with methacholine (0.03-256 micromol or > or =40% decline in FEV(1)) were repeated every 4 weeks and after wash-out. The main study objectives were changes from baseline in maximal FEV(1) decline at the response plateau (i.e. >2 post-dose FEV(1) values within 5%) and PD(20) to methacholine after 12 weeks' treatment. RESULTS Neither treatment affected baseline FEV(1) (P=0.62). Compared with placebo, montelukast significantly decreased the maximal response plateau to methacholine (mean difference 9.4%; 95% confidence interval 3.9-15.7; P<0.005), improved the FEV(1) decline (mean change in FEV(1) decline was 2.1% [montelukast] and -0.8% [placebo], respectively, P<0.05), and increased PD(20) methacholine (mean change in PD(20) of 5.3 [montelukast] and 1.4 [placebo] doubling doses, respectively, P<0.001). CONCLUSION Add-on montelukast to ICS has disease-modifying effects in adults with persistent asthma, and hence reduces the risk of excessive airway narrowing (NCT 00913328).
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Affiliation(s)
- C S Ulrik
- Department of Respiratory Diseases, Hvidovre Hospital, Copenhagen, Denmark
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Allen JE, Bischof RJ, Sucie Chang HY, Hirota JA, Hirst SJ, Inman MD, Mitzner W, Sutherland TE. Animal models of airway inflammation and airway smooth muscle remodelling in asthma. Pulm Pharmacol Ther 2009; 22:455-65. [PMID: 19393759 DOI: 10.1016/j.pupt.2009.04.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2008] [Revised: 12/28/2008] [Accepted: 04/14/2009] [Indexed: 10/24/2022]
Abstract
Asthma is a complex disease that involves chronic inflammation and subsequent decline in airway function. The widespread use of animal models has greatly contributed to our understanding of the cellular and molecular pathways underlying human allergic asthma. Animal models of allergic asthma include smaller animal models which offer 'ease of use' and availability of reagents, and larger animal models that may be used to address aspects of allergic airways disease not possible in humans or smaller animal models. This review examines the application and suitability of various animal models for studying mechanisms of airway inflammation and tissue remodelling in allergic asthma, with a specific focus on airway smooth muscle.
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Affiliation(s)
- Judith E Allen
- Ashworth Laboratory, Institute of Infection and Immunology, School of Biological Sciences, University of Edinburgh, Edinburgh, UK
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