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Jang JH, Kim JH, Park HS. Current Issues in the Management of IgG Subclass Deficiencies in Adults With Chronic Respiratory Diseases. Allergy Asthma Immunol Res 2023; 15:562-579. [PMID: 37827977 PMCID: PMC10570785 DOI: 10.4168/aair.2023.15.5.562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 08/29/2023] [Accepted: 08/30/2023] [Indexed: 10/14/2023]
Abstract
Primary immunodeficiency diseases (PIDs) are uncommon in adults; however, immunoglobulin G subclass deficiency (IGGSCD) is often found in a subset of adult patients with chronic respiratory diseases. As quantitative laboratory tests are used to diagnose IGGSCD, the clinical significance of IGGSCD remains controversial. However, respiratory infection is a common presenting feature of IGGSCD, and respiratory complications are responsible for subsequent morbidities, such as severe asthma, bronchiectasis, chronic obstructive airway diseases, and mortality. This review summarizes the current epidemiological data for PIDs, focusing on IGGSCD in the adult population. In addition, the investigation, treatment, and management strategies are detailed, including distinct issues faced by patients with chronic airway disease and their physicians in the proper diagnosis and treatment of IGGSCD.
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Affiliation(s)
- Jae-Hyuk Jang
- Department of Allergy and Clinical Immunology, Ajou University Medical Center, Ajou University School of Medicine, Suwon, Korea
| | - Joo-Hee Kim
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Hae-Sim Park
- Department of Allergy and Clinical Immunology, Ajou University Medical Center, Ajou University School of Medicine, Suwon, Korea.
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Sharma S, Tasnim N, Agadi K, Asfeen U, Kanda J. Vulnerability for Respiratory Infections in Asthma Patients: A Systematic Review. Cureus 2022; 14:e28839. [PMID: 36225449 PMCID: PMC9536399 DOI: 10.7759/cureus.28839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2022] [Indexed: 11/30/2022] Open
Abstract
Asthma is a non-communicable and long-term condition affecting children and adults. The air passages in the lungs become narrow due to inflammation and tightening of the muscles around the small airways. Symptoms of asthma are intermittent and include cough, wheeze, shortness of breath, and chest tightness. Asthma is very often underdiagnosed and under-treated in many regions, especially in developing countries. While many studies show that viral infections can precipitate asthmatic attacks, very few studies have been conducted to see if history or current asthmatic attack increases the risk of viral infections. Our study aims to determine the predisposition of asthmatics to develop various viral infections and susceptibility toward certain viruses that cause upper respiratory tract infections. We performed a literature review of both published and unpublished articles. We included case reports, case series, reviews, clinical trials, cohort, and case-control studies, written only in English. Commentaries, letters to editors, and book chapters were excluded. Our initial search yielded 948 articles, of which 826 were rejected either because they were irrelevant or because they did not meet our inclusion criteria. We finally screened 122 abstracts and identified 24 relevant articles. People with a history of asthma have an abnormal innate immune response, making them potentially slower in clearing the infection and susceptible to both infections and virus-induced cell cytotoxicity. Also, in these studies, deficiencies in the interferon alpha response of peripheral blood mononuclear cells and plasmacytoid dendritic cells have been observed in asthmatics, both adults and children. Asthmatics with a viral infection usually present with an acute exacerbation of asthma, represented by dyspnea and cough, with other prodromal symptoms including vomiting and general malaise. The review includes an update on the relevance of dysregulated immune pathways in causing viral infections in asthmatic populations. It focuses on the evidence to suggest that people with asthma are at increased risk of viral infection, and viral infections in turn are known to precipitate and worsen the asthmatic status, making this a vicious cycle. The authors also suggest that further studies be undertaken to elucidate the pathophysiology and identify the critical therapeutic steps to break this vicious cycle and improve the quality of life for people with asthma.
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Lauret S, Noel-Savina E, Prévot G, Guibert N, Reber L, Brouquières D, Didier A, Guilleminault L. Are serum immunoglobulin concentrations a predictive biomarker of response to anti-IL5/IL5Rα therapies? Respir Med Res 2022; 81:100882. [PMID: 34983012 DOI: 10.1016/j.resmer.2021.100882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 12/13/2021] [Accepted: 12/14/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Approval of biologics has recently revolutionized T2 severe asthma management. However, predictive biomarkers remain highly needed to improve patient's selection. OBJECTIVE This study aims to determine whether serum immunoglobulins (Igs) levels might be predictive biomarkers of response to anti-interleukin-5 (IL5)/IL5Rα therapies. METHODS Severe asthma patients eligible for mepolizumab or benralizumab were included herein. Serum immunoglobulin quantification was performed at baseline before mepolizumab or benralizumab initiation. After a 6-month treatment of mepolizumab or benralizumab, patients presented a second serum immunoglobulin quantification. The treatment response was evaluated by the GETE (Global Evaluation of Treatment Effectiveness) score at 6 months. RESULTS A total of 50 patients were included. Median age was 56 [IQR 48.8-65.3] and 50% were females. Compared to baseline, a significant increase in IgG was observed at 6 months (9.2 [7.8-10.2] g/l vs 10.1 [8.8-11.1] g/l, p = 0.04). The area under the ROC curve was 0.58 [95%IC 0.40-0.77] for blood eosinophil count (p = 0.37), 0.75 [95%IC: 0.58-0.92] for serum IgG concentration (p = 0.009) for predicting the treatment response. According to the Youden index, serum IgG concentration ≥ 9.2 g/l predicts the response to anti-IL5 therapies with a sensitivity of 76.9% and a specificity of 75.7%. CONCLUSION Baseline serum IgG concentrations may be a useful tool to predict the response to anti-IL5/IL5Rα therapies but should be confirmed in larger clinical trials. Interestingly, anti-IL5/IL5Rα therapies are associated with a significant increase in serum IgG concentrations at 6 months.
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Affiliation(s)
- Simon Lauret
- Department of respiratory medicine, Toulouse University Hospital Centre, Toulouse, France
| | - Elise Noel-Savina
- Department of respiratory medicine, Toulouse University Hospital Centre, Toulouse, France
| | - Grégoire Prévot
- Department of respiratory medicine, Toulouse University Hospital Centre, Toulouse, France
| | - Nicolas Guibert
- Department of respiratory medicine, Toulouse University Hospital Centre, Toulouse, France
| | - Laurent Reber
- Toulouse Institute for Infectious and Inflammatory Diseases (Infinity),Inserm U1291, University of Toulouse, CNRS U5282
| | - Danièle Brouquières
- Department of respiratory medicine, Toulouse University Hospital Centre, Toulouse, France
| | - Alain Didier
- Department of respiratory medicine, Toulouse University Hospital Centre, Toulouse, France; Toulouse Institute for Infectious and Inflammatory Diseases (Infinity),Inserm U1291, University of Toulouse, CNRS U5282
| | - Laurent Guilleminault
- Department of respiratory medicine, Toulouse University Hospital Centre, Toulouse, France; Toulouse Institute for Infectious and Inflammatory Diseases (Infinity),Inserm U1291, University of Toulouse, CNRS U5282.
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Özkan M, Eskiocak YC, Wingender G. Macrophage and dendritic cell subset composition can distinguish endotypes in adjuvant-induced asthma mouse models. PLoS One 2021; 16:e0250533. [PMID: 34061861 PMCID: PMC8168852 DOI: 10.1371/journal.pone.0250533] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 05/18/2021] [Indexed: 12/27/2022] Open
Abstract
Asthma is a heterogeneous disease with neutrophilic and eosinophilic asthma as the main endotypes that are distinguished according to the cells recruited to the airways and the related pathology. Eosinophilic asthma is the treatment-responsive endotype, which is mainly associated with allergic asthma. Neutrophilic asthma is a treatment-resistant endotype, affecting 5-10% of asthmatics. Although eosinophilic asthma is well-studied, a clear understanding of the endotypes is essential to devise effective diagnosis and treatment approaches for neutrophilic asthma. To this end, we directly compared adjuvant-induced mouse models of neutrophilic (CFA/OVA) and eosinophilic (Alum/OVA) asthma side-by-side. The immune response in the inflamed lung was analyzed by multi-parametric flow cytometry and immunofluorescence. We found that eosinophilic asthma was characterized by a preferential recruitment of interstitial macrophages and myeloid dendritic cells, whereas in neutrophilic asthma plasmacytoid dendritic cells, exudate macrophages, and GL7+ activated B cells predominated. This differential distribution of macrophage and dendritic cell subsets reveals important aspects of the pathophysiology of asthma and holds the promise to be used as biomarkers to diagnose asthma endotypes.
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Affiliation(s)
- Müge Özkan
- Department of Genome Sciences and Molecular Biotechnology, Izmir International Biomedicine and Genome Institute, Dokuz Eylul University, Balcova/Izmir, Turkey
| | | | - Gerhard Wingender
- Izmir Biomedicine and Genome Center (IBG), Balcova/Izmir, Turkey
- Department of Biomedicine and Health Technologies, Izmir International Biomedicine and Genome Institute, Dokuz Eylul University, Balcova/Izmir, Turkey
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Dai J, Chen J, Qi J, Ding M, Liu W, Shao T, Han J, Wang G. Konjac Glucomannan from Amorphophallus konjac enhances immunocompetence of the cyclophosphamide-induced immunosuppressed mice. Food Sci Nutr 2021; 9:728-735. [PMID: 33598158 PMCID: PMC7866624 DOI: 10.1002/fsn3.2038] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 10/24/2020] [Accepted: 11/13/2020] [Indexed: 01/19/2023] Open
Abstract
This present study was designed to evaluate the immunomodulatory activity of Konjac glucomannan (KGM) on immunosuppressed mice induced by cyclophosphamide (CTX) treatment. The mice immunodeficiency model was established by CTX. KGM was used to modulate the activities of immunosuppressive mice. It was proved that KGM could promote the proliferation of lymphocyte, thymus, and spleen indices, and alleviate the atrophy of immune organs and weight loss. Besides, in mice serum, the levels of cytokines including TNF-α, IgG, IL-2, and the contents of hemolysin were also increased after treatment with KGM. Furtherly, in nonspecific immunity, KGM could enhance natural killer (NK) cell lethality and pinocytic activity of mouse peritoneal macrophages. Therefore, all of these results revealed that KGM could improve the reduced immunity of CTX-induced mice via modulation innate immunity and adaptive immunity.
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Affiliation(s)
- Jiajia Dai
- School of Public HealthWannan Medical CollegeWuhuChina
- Anhui Provincial Engineering Research Center for Polysaccharide Drugs, Provincial Engineering Laboratory for Screening and Re‐evaluation of Active Compounds of Herbal Medicines in Southern Anhui, Anhui Province Key Laboratory of Active Biological MacromoleculesWuhuChina
| | - Jian Chen
- School of Public HealthWannan Medical CollegeWuhuChina
| | - Jun Qi
- College of Tea & Food Science and TechnologyAnhui Engineering Laboratory for Agro‐products ProcessingAnhui Agricultural UniversityHefeiChina
| | - Mengru Ding
- Anhui Provincial Engineering Research Center for Polysaccharide Drugs, Provincial Engineering Laboratory for Screening and Re‐evaluation of Active Compounds of Herbal Medicines in Southern Anhui, Anhui Province Key Laboratory of Active Biological MacromoleculesWuhuChina
- School of Pharmacy, Drug Research & Development CenterWannan Medical CollegeWuhuChina
| | - Wei Liu
- Anhui Provincial Engineering Research Center for Polysaccharide Drugs, Provincial Engineering Laboratory for Screening and Re‐evaluation of Active Compounds of Herbal Medicines in Southern Anhui, Anhui Province Key Laboratory of Active Biological MacromoleculesWuhuChina
- School of Pharmacy, Drug Research & Development CenterWannan Medical CollegeWuhuChina
| | - Taili Shao
- Anhui Provincial Engineering Research Center for Polysaccharide Drugs, Provincial Engineering Laboratory for Screening and Re‐evaluation of Active Compounds of Herbal Medicines in Southern Anhui, Anhui Province Key Laboratory of Active Biological MacromoleculesWuhuChina
- School of Pharmacy, Drug Research & Development CenterWannan Medical CollegeWuhuChina
| | - Jun Han
- Anhui Provincial Engineering Research Center for Polysaccharide Drugs, Provincial Engineering Laboratory for Screening and Re‐evaluation of Active Compounds of Herbal Medicines in Southern Anhui, Anhui Province Key Laboratory of Active Biological MacromoleculesWuhuChina
- School of Pharmacy, Drug Research & Development CenterWannan Medical CollegeWuhuChina
| | - Guodong Wang
- Anhui Provincial Engineering Research Center for Polysaccharide Drugs, Provincial Engineering Laboratory for Screening and Re‐evaluation of Active Compounds of Herbal Medicines in Southern Anhui, Anhui Province Key Laboratory of Active Biological MacromoleculesWuhuChina
- School of Pharmacy, Drug Research & Development CenterWannan Medical CollegeWuhuChina
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Lyly A, Laulajainen-Hongisto A, Gevaert P, Kauppi P, Toppila-Salmi S. Monoclonal Antibodies and Airway Diseases. Int J Mol Sci 2020; 21:E9477. [PMID: 33322143 PMCID: PMC7763928 DOI: 10.3390/ijms21249477] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 12/09/2020] [Accepted: 12/10/2020] [Indexed: 12/19/2022] Open
Abstract
Monoclonal antibodies, biologics, are a relatively new treatment option for severe chronic airway diseases, asthma, allergic rhinitis, and chronic rhinosinusitis (CRS). In this review, we focus on the physiological and pathomechanisms of monoclonal antibodies, and we present recent study results regarding their use as a therapeutic option against severe airway diseases. Airway mucosa acts as a relative barrier, modulating antigenic stimulation and responding to environmental pathogen exposure with a specific, self-limited response. In severe asthma and/or CRS, genome-environmental interactions lead to dysbiosis, aggravated inflammation, and disease. In healthy conditions, single or combined type 1, 2, and 3 immunological response pathways are invoked, generating cytokine, chemokine, innate cellular and T helper (Th) responses to eliminate viruses, helminths, and extracellular bacteria/fungi, correspondingly. Although the pathomechanisms are not fully known, the majority of severe airway diseases are related to type 2 high inflammation. Type 2 cytokines interleukins (IL) 4, 5, and 13, are orchestrated by innate lymphoid cell (ILC) and Th subsets leading to eosinophilia, immunoglobulin E (IgE) responses, and permanently impaired airway damage. Monoclonal antibodies can bind or block key parts of these inflammatory pathways, resulting in less inflammation and improved disease control.
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Affiliation(s)
- Annina Lyly
- Inflammation Centre, Skin and Allergy Hospital, Helsinki University Hospital, University of Helsinki, P.O. Box 160, 00029 HUS Helsinki, Finland;
- Department of Otorhinolaryngology—Head and Neck Surgery, Helsinki University Hospital, University of Helsinki, 00029 HUS Helsinki, Finland;
| | - Anu Laulajainen-Hongisto
- Department of Otorhinolaryngology—Head and Neck Surgery, Helsinki University Hospital, University of Helsinki, 00029 HUS Helsinki, Finland;
| | - Philippe Gevaert
- Department of Otorhinolaryngology, Upper Airway Research Laboratory, Ghent University Hospital, 9000 Ghent, Belgium;
| | - Paula Kauppi
- Heart and Lung Center, Pulmonary Department, University of Helsinki and Helsinki University Hospital, 00029 HUS Helsinki, Finland;
| | - Sanna Toppila-Salmi
- Inflammation Centre, Skin and Allergy Hospital, Helsinki University Hospital, University of Helsinki, P.O. Box 160, 00029 HUS Helsinki, Finland;
- Medicum, Haartman Institute, University of Helsinki, 00029 HUS Helsinki, Finland
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Teague WG, Borish LC. Low Serum IgG: A Novel Predictor of Virus-Induced Asthma Exacerbations? J Allergy Clin Immunol Pract 2020; 7:1514-1515. [PMID: 31076061 DOI: 10.1016/j.jaip.2019.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 03/04/2019] [Indexed: 10/26/2022]
Affiliation(s)
- W Gerald Teague
- Division of Respiratory Medicine, Allergy, and Immunology, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Va.
| | - Larry C Borish
- Division of Allergy, Asthma, Immunology, Department of Medicine, Carter Immunology Center, University of Virginia School of Medicine, Charlottesville, Va; Departments of Medicine and Microbiology, University of Virginia School of Medicine, Charlottesville, Va
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Schatz M, Sicherer SH, Khan DA, Zeiger RS. The Journal of Allergy and Clinical Immunology: In Practice 2019 Highlights. J Allergy Clin Immunol Pract 2020; 8:912-936. [PMID: 31980411 DOI: 10.1016/j.jaip.2020.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 01/03/2020] [Indexed: 10/25/2022]
Abstract
This article provides highlights of the clinically impactful original studies and reviews published in The Journal of Allergy and Clinical Immunology: In Practice in 2019 on the subjects of anaphylaxis, asthma, dermatitis, drug allergy, food allergy, immunodeficiency, immunotherapy, rhinitis/sinusitis, and urticaria/angioedema/mast cell disorders. Within each topic, practical aspects of diagnosis and management are emphasized. Treatments discussed include lifestyle modifications, allergen avoidance therapy, positive and negative effects of pharmacologic therapy, and various forms of immunologic and desensitization management. We designed this review to help readers consolidate and use this extensive and practical knowledge for the benefit of their patients.
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Affiliation(s)
- Michael Schatz
- Department of Allergy, Kaiser Permanente Southern California, San Diego, Calif.
| | - Scott H Sicherer
- Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - David A Khan
- Department of Internal Medicine, Division of Allergy & Immunology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Robert S Zeiger
- Department of Allergy, Kaiser Permanente Southern California, San Diego, Calif; Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, Calif
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Howard E, Orhurhu V, Huang L, Guthrie B, Phipatanakul W. The Impact of Ambient Environmental Exposures to Microbial Products on Asthma Outcomes from Birth to Childhood. Curr Allergy Asthma Rep 2019; 19:59. [PMID: 31781873 PMCID: PMC7088961 DOI: 10.1007/s11882-019-0890-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Purpose of Review Asthma is a chronic respiratory condition with increasing domestic and worldwide prevalence that burdens individuals and the healthcare system with high costs associated with long-term treatments and acute emergency room (ER) visits. It can be triggered by ambient microbes, including bacteria, viruses, and fungi. In this review, we examine the outcomes of asthma patients in relation to environmental exposures to ambient microbe products, focusing on whether exposure leads to asthma development from birth to childhood and if particular microbes are associated with worsened asthma exacerbations. Recent Findings Bacterial endotoxin is more prominent in homes with pets and may cause cytokine cascades that lead to asthma exacerbation. However, some studies have demonstrated a protective effect with early exposure. Patients with positive Aspergillus skin testing are more prone to moderate-severe or severe-uncontrolled asthma. Fungal sensitization is also associated with earlier onset of asthma and demonstrates a dose-dependent relationship of symptom severity and duration. Among viruses, rhinovirus has the greatest association with decreased lung function, severe asthma, and asthma-related hospital admissions. Distribution of microbial products and associated asthma symptoms depends on the geographical climate. Genetic variations among individuals also mitigate the effects of microbial products on asthma development and symptom severity. Summary Microbial products of bacteria, fungi, and viruses are associated with the development of asthma, more severe asthma symptoms, and worse outcomes. However, some early exposure studies have also demonstrated a protective effect. Bacterial and fungal products are related to decreased lung function and earlier onset of asthma. Viral products are related to asthma-associated hospital admissions; and the climate and patient genetics can also temper or intensify the relationships between microbial products, asthma development, and asthma symptom severity. Further research should focus on the effects of early microbe exposure and its interaction with human immune systems and asthma-related outcomes.
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Affiliation(s)
- Evin Howard
- Bouvé College of Health Sciences, Graduate School of Nursing, Northeastern University, Boston, MA, USA
| | - Vwaire Orhurhu
- Department of Anesthesia, Critical Care, & Pain Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Lisa Huang
- Department of Anesthesia, Critical Care, & Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Barbara Guthrie
- Bouvé College of Health Sciences, Graduate School of Nursing, Northeastern University, Boston, MA, USA
| | - Wanda Phipatanakul
- Division of Asthma, Allergy, & Immunology, Harvard Medical School, Children's Hospital Boston, Boston, MA, USA.
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