1
|
Gama da Silva A, Constant C, Madeira S, Sousa AR, Bandeira T. A contribution towards a world without tobacco - The TabacoPed study. Pulmonology 2024; 30:307-309. [PMID: 37743170 DOI: 10.1016/j.pulmoe.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 08/06/2023] [Accepted: 08/07/2023] [Indexed: 09/26/2023] Open
Affiliation(s)
- A Gama da Silva
- Department of Paediatrics, Hospital de Santa Maria, CHULN, Portugal.
| | - C Constant
- Paediatric Respiratory Unit, Department of Paediatrics, Hospital de Santa Maria, CHULN, Portugal; Paediatric Lung Function Laboratory, Department of Paediatrics, Hospital de Santa Maria, CHULN, Portugal; Lisbon Academic Medical Centre, University of Lisbon, Portugal
| | - S Madeira
- Unidade de Cuidados de Saúde Personalizados de Azeitão, ACES Arrábida, Portugal; University Clinic of Family Medicine, Faculty of Medicine, University of Lisbon, Portugal
| | - A R Sousa
- Paediatric Cardiology Clinic, Department of Paediatrics, Hospital de Santa Maria, CHULN, Portugal
| | - T Bandeira
- Paediatric Respiratory Unit, Department of Paediatrics, Hospital de Santa Maria, CHULN, Portugal; Paediatric Lung Function Laboratory, Department of Paediatrics, Hospital de Santa Maria, CHULN, Portugal; Lisbon Academic Medical Centre, University of Lisbon, Portugal
| |
Collapse
|
2
|
Sousa AR, Cruz SS, Breda-Vázquez I. Understanding transformative capacity to boost urban climate adaptation: A Semi-Systematic Literature Review. Ambio 2024; 53:276-291. [PMID: 37957444 PMCID: PMC10774496 DOI: 10.1007/s13280-023-01940-2] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 08/11/2023] [Accepted: 09/19/2023] [Indexed: 11/15/2023]
Abstract
Transformative capacity (TC) is key for addressing climate change impacts. It refers to urban areas' ability for profound and intentional change to address current challenges and move towards a more desirable and resilient state. However, its varied applications across disciplines can lead to misunderstandings and implementation challenges. Thus, this Semi-Systematic Literature Review (SSLR) on TC within urban studies from 2016 to 2022 aims to overview and synthesise TC literature and its gaps to inform ongoing debates, intersecting it with climate-related research. The results show an increasing interest in TC within two fields of knowledge: resilience studies and transformative research. The review found TC as a catalyst for transformative actions, promoting sustainable pathways, enhancing resilience, and driving fundamental changes in urban climate adaptation. Finally, the prevailing literature gaps concern the TC concept's fragmentation, excessive research on governance features, and lack of joint research about TC and innovation.
Collapse
Affiliation(s)
- Ana R Sousa
- CITTA - Research Centre for Territory, Transports and Environment; Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias S/N, 4200-465, Porto, Portugal.
| | - Sara Santos Cruz
- CITTA - Research Centre for Territory, Transports and Environment; Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias S/N, 4200-465, Porto, Portugal
| | - Isabel Breda-Vázquez
- CITTA - Research Centre for Territory, Transports and Environment; Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias S/N, 4200-465, Porto, Portugal
| |
Collapse
|
3
|
Desrosiers M, Diamant Z, Castelnuovo P, Hellings PW, Han JK, Peters AT, Silver J, Smith SG, Fuller A, Sousa AR, Chan RH, Gevaert P. Sustained efficacy of mepolizumab in patients with severe chronic rhinosinusitis with nasal polyps: SYNAPSE 24-week treatment-free follow-up. Int Forum Allergy Rhinol 2024; 14:18-31. [PMID: 37345861 DOI: 10.1002/alr.23219] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 06/15/2023] [Accepted: 06/17/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND In the 52-week Phase III SYNAPSE study, mepolizumab given every 4 weeks (100 mg subcutaneously) reduced nasal polyp (NP) size, improved symptoms and quality of life (QoL), and reduced corticosteroid use and number of sinus surgeries in patients with severe chronic rhinosinusitis with nasal polyps (CRSwNP), versus placebo. Because the durability of mepolizumab's efficacy after discontinuation is poorly understood in CRSwNP, the efficacy of mepolizumab after discontinuation was analyzed in severe CRSwNP, over a 24-week follow-up. METHODS Changes from SYNAPSE baseline to end of treatment (week 52) and end of follow-up (week 76) were assessed for total endoscopic NP score, nasal obstruction and overall symptoms visual analog scale scores, and 22-item Sino-Nasal Outcome Test score. Time to first sinus surgery, time to first corticosteroid use, and geometric mean blood eosinophil counts (BECs) were also assessed. RESULTS Among 134 follow-up patients, clinical improvements observed with mepolizumab versus placebo were partially evident 24 weeks after discontinuation despite BEC returning to baseline. The mean (95% confidence interval [CI]) change from baseline in NP score (week 52: -1.3 [1.8 to -0.9] vs. -0.3 [-0.6 to 0.1]; week 76: -1.2 [-1.6 to -0.7] vs. -0.1 [-0.5 to 0.3]) and the proportion of patients having sinus surgery (week 52: 4% vs. 25%; week 76: 9% vs. 31%) remained substantially improved with mepolizumab versus placebo. Mepolizumab-associated improvements in overall symptoms, quality of life, and corticosteroid use versus placebo were partially sustained at week 76. CONCLUSION Fifty-two weeks of mepolizumab treatment is associated with sustained clinical benefits up to 24 weeks after discontinuation in patients with severe CRSwNP, which should be considered by physicians when making treatment decisions.
Collapse
Affiliation(s)
- Martin Desrosiers
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Québec, Canada
| | - Zuzana Diamant
- Department of Allergy and Clinical Immunology, KU Leuven, Catholic University of Leuven, Leuven, Belgium
- Department of Clinical Pharmacy & Pharmacology, University Medical Center Groningen, Groningen, The Netherlands
- Respiratory Medicine and Allergology, Skane University, Lund, Sweden
| | - Paolo Castelnuovo
- Department of Biotechnology and Life Science, University of Insubria, Varese, Italy
- Upload Research Centre, University of Insubiria, Varese, Italy
- Surgical Specialties Department, Ospedale di Circolo-Varese, Varese, Italy
| | - Peter W Hellings
- Department of Allergy and Clinical Immunology, KU Leuven, Catholic University of Leuven, Leuven, Belgium
| | - Joseph K Han
- Department of Otolaryngology Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Anju T Peters
- Division of Allergy-Immunology, Northwestern University, Chicago, Illinois, USA
| | - Jared Silver
- US Medical Affairs - Respiratory, GSK, Research Triangle Park, Durham, North Carolina, USA
| | - Steven G Smith
- Global Medical Affairs, GSK, Durham, North Carolina, USA
| | - Abigail Fuller
- Clinical Statistics, GSK, Brentford, Middlesex, UK
- Veramed, Ltd., Twickenham, UK
| | - Ana R Sousa
- Clinical Sciences, Respiratory, GSK, Brentford, UK
| | | | - Philippe Gevaert
- Upper Airways Research Laboratory, Department of Otorhinolaryngology, Ghent University, Ghent, Belgium
| |
Collapse
|
4
|
Casteleiro B, Rocha M, Sousa AR, Pereira AM, Martinho JMG, Pereira C, Farinha JPS. Multifunctional Nanoparticles with Superparamagnetic Mn(II) Ferrite and Luminescent Gold Nanoclusters for Multimodal Imaging. Polymers (Basel) 2023; 15:4392. [PMID: 38006116 PMCID: PMC10674285 DOI: 10.3390/polym15224392] [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: 09/29/2023] [Revised: 10/27/2023] [Accepted: 10/31/2023] [Indexed: 11/26/2023] Open
Abstract
Gold nanoclusters (AuNCs) with fluorescence in the Near Infrared (NIR) by both one- and two-photon electronic excitation were incorporated in mesoporous silica nanoparticles (MSNs) using a novel one-pot synthesis procedure where the condensation polymerization of alkoxysilane monomers in the presence of the AuNCs and a surfactant produced hybrid MSNs of 49 nm diameter. This method was further developed to prepare 30 nm diameter nanocomposite particles with simultaneous NIR fluorescence and superparamagnetic properties, with a core composed of superparamagnetic manganese (II) ferrite nanoparticles (MnFe2O4) coated with a thin silica layer, and a shell of mesoporous silica decorated with AuNCs. The nanocomposite particles feature NIR-photoluminescence with 0.6% quantum yield and large Stokes shift (290 nm), and superparamagnetic response at 300 K, with a saturation magnetization of 13.4 emu g-1. The conjugation of NIR photoluminescence and superparamagnetic properties in the biocompatible nanocomposite has high potential for application in multimodal bioimaging.
Collapse
Affiliation(s)
- Bárbara Casteleiro
- Centro de Química Estrutural, Institute of Molecular Sciences (IMS) and Departamento de Engenharia Química, Instituto Superior Técnico, Universidade de Lisboa, 1049-001 Lisboa, Portugal;
- REQUIMTE/LAQV, Departamento de Química e Bioquímica, Faculdade de Ciências, Universidade do Porto, Rua do Campo Alegre s/n, 4169-007 Porto, Portugal; (M.R.); (A.R.S.)
| | - Mariana Rocha
- REQUIMTE/LAQV, Departamento de Química e Bioquímica, Faculdade de Ciências, Universidade do Porto, Rua do Campo Alegre s/n, 4169-007 Porto, Portugal; (M.R.); (A.R.S.)
| | - Ana R. Sousa
- REQUIMTE/LAQV, Departamento de Química e Bioquímica, Faculdade de Ciências, Universidade do Porto, Rua do Campo Alegre s/n, 4169-007 Porto, Portugal; (M.R.); (A.R.S.)
- IFIMUP—Instituto de Física de Materiais Avançados, Nanotecnologia e Fotónica, Departamento de Física e Astronomia, Faculdade de Ciências, Universidade do Porto, Rua do Campo Alegre s/n, 4169-007 Porto, Portugal;
| | - André M. Pereira
- IFIMUP—Instituto de Física de Materiais Avançados, Nanotecnologia e Fotónica, Departamento de Física e Astronomia, Faculdade de Ciências, Universidade do Porto, Rua do Campo Alegre s/n, 4169-007 Porto, Portugal;
| | - José M. G. Martinho
- Centro de Química Estrutural, Institute of Molecular Sciences (IMS) and Departamento de Engenharia Química, Instituto Superior Técnico, Universidade de Lisboa, 1049-001 Lisboa, Portugal;
| | - Clara Pereira
- REQUIMTE/LAQV, Departamento de Química e Bioquímica, Faculdade de Ciências, Universidade do Porto, Rua do Campo Alegre s/n, 4169-007 Porto, Portugal; (M.R.); (A.R.S.)
| | - José P. S. Farinha
- Centro de Química Estrutural, Institute of Molecular Sciences (IMS) and Departamento de Engenharia Química, Instituto Superior Técnico, Universidade de Lisboa, 1049-001 Lisboa, Portugal;
| |
Collapse
|
5
|
Gago C, Lorenzo C, Pinto S, R Sousa A, Camilo C, Abecasis F. Extracorporeal Membrane Oxygenation in an Adolescent with Multisystem Inflammatory Syndrome in Children. ACTA MEDICA PORT 2023; 36:740-745. [PMID: 37185328 DOI: 10.20344/amp.19053] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 03/21/2023] [Indexed: 05/17/2023]
Abstract
Multisystem inflammatory syndrome in children is a rare and potentially life-threatening disease that is associated with SARS-CoV-2 infection, characterized by hyperinflammation and multiorgan involvement. Cardiovascular involvement is common, including myocardial dysfunction often leading to cardiogenic shock. We present the case of a 17-year-old boy with fever, odynophagia, maculopapular rash and abdominal pain who developed a cardiogenic shock. Due to progressive deterioration of cardiac function despite optimized vasoactive support, veno-arterial extracorporeal membrane oxygenation support was initiated 12 hours after admission, with successful decannulation after seven days and discharge after 23 days, with normal cardiac function. The patient received corticosteroids and intravenous immunoglobulin. Early recognition and intensive care support are crucial for ensuring a successful outcome in severe cases of multisystem inflammatory syndrome. In cases of severe cardiogenic shock, extracorporeal membrane oxygenation support can be critical for survival and rapid recovery.
Collapse
Affiliation(s)
- Cristina Gago
- Pediatric Intensive Care Unit. Department of Pediatrics. Hospital de Santa Maria. Centro Hospitalar Universitário Lisboa Norte. Lisboa.; Pediatric Functional Unit. Children Department. Hospital de Cascais Dr. José de Almeida. Cascais. Portugal
| | - Cristina Lorenzo
- Pediatric Intensive Care Unit. Department of Pediatrics. Hospital de Santa Maria. Centro Hospitalar Universitário Lisboa Norte. Lisbon. Portugal
| | - Sara Pinto
- Pediatric Intensive Care Unit; Pediatric Infectious Diseases and Immunodeficiencies Unit.. Department of Pediatrics. Hospital de Santa Maria. Centro Hospitalar Universitário Lisboa Norte. Portugal
| | - Ana R Sousa
- Pediatric Cardiology Unit. Department of Pediatrics. Hospital de Santa Maria. Centro Hospitalar Universitário Lisboa Norte. Lisbon. Portugal
| | - Cristina Camilo
- Pediatric Intensive Care Unit. Department of Pediatrics. Hospital de Santa Maria. Centro Hospitalar Universitário Lisboa Norte. Lisbon. Portugal
| | - Francisco Abecasis
- Pediatric Intensive Care Unit. Department of Pediatrics. Hospital de Santa Maria. Centro Hospitalar Universitário Lisboa Norte. Lisbon. Portugal
| |
Collapse
|
6
|
Chupp G, Alobid I, Lugogo NL, Kariyawasam HH, Bourdin A, Chaker AM, Smith SG, Sousa AR, Mayer B, Chan RH, Matucci A. Mepolizumab Reduces Systemic Corticosteroid Use in Chronic Rhinosinusitis With Nasal Polyps. J Allergy Clin Immunol Pract 2023; 11:3504-3512.e2. [PMID: 37586475 DOI: 10.1016/j.jaip.2023.08.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 07/28/2023] [Accepted: 08/06/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND Systemic corticosteroids (SCSs) are associated with short- and long-term adverse effects. OBJECTIVE To assess mepolizumab efficacy according to prior SCS use and characterize mepolizumab's SCS-sparing capabilities, in patients with severe chronic rhinosinusitis with nasal polyps. METHODS In the randomized, double-blind, phase III SYNAPSE trial (NCT03085797), adults with severe chronic rhinosinusitis with nasal polyps eligible for repeat sinus surgery despite standard of care treatment received mepolizumab (100 mg subcutaneously) or placebo every 4 weeks for 52 weeks. The impact of prior SCS courses (0/1/>1) on mepolizumab versus placebo treatment responses (changes from baseline in total endoscopic nasal polyp [week 52], nasal obstruction visual analog scale [weeks 49-52], and 22-item Sino-Nasal Outcome Test total [week 52] scores) was analyzed post hoc. To characterize mepolizumab's SCS-sparing capabilities, time-to-first SCS course for nasal polyps (prespecified) and total prednisolone-equivalent oral corticosteroid dose by patient baseline characteristics (post hoc, in patients with ≥1 SCS course during SYNAPSE) were assessed up to week 52. RESULTS Mepolizumab versus placebo improved treatment responses, irrespective of prior SCS use. By week 52, the probability of requiring SCSs for nasal polyps (Kaplan-Meier estimate [95% CI]) was lower with mepolizumab (25.4% [20.0-32.1]) versus placebo (37.5% [31.1-44.6]). In patients requiring 1 or more dose of SCSs, total (mean ± SD mg/y) prednisolone-equivalent oral corticosteroid dose was lower with mepolizumab (438.9 ± 350.40) versus placebo (505.2 ± 455.091), overall and irrespective of prior sinus surgeries, blood eosinophil count, or comorbidities. CONCLUSIONS Mepolizumab is associated with clinical benefits in patients with severe chronic rhinosinusitis with nasal polyps regardless of prior SCS use and has an SCS-sparing effect.
Collapse
Affiliation(s)
- Geoffrey Chupp
- Department of Internal Medicine, Yale School of Medicine, New Haven, Conn.
| | - Isam Alobid
- Department of Otorhinolaryngology, Universitat de Barcelona, Barcelona, Spain; Institut d Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigacion Biomedica en Red de Enfermedades Respiratorias (CIBERES), Barcelona, Spain; Unidad Alergo Rino, Centro Medico Teknon, Barcelona, Spain
| | - Njira L Lugogo
- Department of Medicine, University of Michigan, Ann Arbor, Mich
| | | | - Arnaud Bourdin
- Departement de Pneumologie et Addictologie, Hôpital Arnaud de Villeneuve, CHU Montpellier, Montpellier, France; University of Montpellier, Montpellier, France
| | - Adam M Chaker
- Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, Department of Otolaryngology and Center for Allergy and Environment, Munich, Germany
| | | | - Ana R Sousa
- Clinical Sciences, GSK R&D, Brentford, Middlesex, United Kingdom
| | - Bhabita Mayer
- Clinical Statistics, GSK, Brentford, Middlesex, United Kingdom
| | - Robert H Chan
- Clinical Sciences, GSK R&D, Brentford, Middlesex, United Kingdom
| | - Andrea Matucci
- Immunoallergology Unit, University Careggi Hospital of Florence, Florence, Italy
| |
Collapse
|
7
|
Gater A, Tolley C, Williams‐Hall R, Trennery C, Bradley H, Sikirica MV, Nelsen L, Sousa AR, Bratton DJ, Chan R, von Maltzahn R. Patient-Reported Outcome Measures for Severe Recurrent Bilateral Nasal Polyps: Psychometric Evaluation and Content Validity. OTO Open 2023; 7:e84. [PMID: 38130916 PMCID: PMC10733778 DOI: 10.1002/oto2.84] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 07/06/2023] [Accepted: 08/14/2023] [Indexed: 12/23/2023] Open
Abstract
Objective To date, no patient-reported outcome measures have been specifically developed to assess pharmacological treatment effect in participants with severe chronic rhinosinusitis (CRS) with recurrent bilateral nasal polyps (NP). These studies aimed to assess (1) the psychometric properties and (2) content validity of Visual Analogue Scales (VAS) assessing NP symptom severity. Study Design (1) Retrospective psychometric validation study using clinical trial data and (2) cross-sectional qualitative patient interview study. Setting (1) Multicentre trial; (2) real-world. Methods (1) Psychometric validation was performed using data from a randomized, double-blind, placebo-controlled, Phase II study (NCT01362244) investigating the effect of mepolizumab in 105 participants with severe, recurrent bilateral NP currently needing polypectomy surgery. (2) Content validity was explored through cognitive debriefing interviews in 27 adults with severe CRS with recurrent bilateral NP who had received NP surgery in the past 10 years (NCT03221192). Results (1) Acceptable reliability, validity, and responsiveness were shown for individual VAS items, although the loss of smell VAS item performed poorly in several analyses, suggesting further evaluation of this item is needed. (2) All individual VAS items were well understood, considered relevant and were consistently interpreted by most participants, providing evidence for their content validity. Conclusion These findings support the use of symptom VAS measures to evaluate disease experience and treatment effect in clinical trials of participants with severe CRS with recurrent bilateral NP.
Collapse
Affiliation(s)
- Adam Gater
- Patient‐Centered Outcomes, Adelphi ValuesBollingtonCheshireUK
| | - Chloe Tolley
- Patient‐Centered Outcomes, Adelphi ValuesBollingtonCheshireUK
| | | | - Claire Trennery
- Patient‐Centered Outcomes, Adelphi ValuesBollingtonCheshireUK
| | - Helena Bradley
- Patient‐Centered Outcomes, Adelphi ValuesBollingtonCheshireUK
| | - Mirko V. Sikirica
- Value Evidence and Outcomes, GSKPhiladelphiaPennsylvaniaUSA
- Present address:
Market Access, Janssen Global Services, LLC
| | - Linda Nelsen
- Value Evidence and Outcomes, GSKPhiladelphiaPennsylvaniaUSA
| | - Ana R. Sousa
- Clinical Sciences, Respiratory, GSKBrentfordMiddlesexUK
| | | | - Robert Chan
- Clinical Sciences, Respiratory, GSKBrentfordMiddlesexUK
| | - Robyn von Maltzahn
- Patient Centered Outcomes, Value Evidence and Outcomes, GSKBrentfordMiddlesexUK
| |
Collapse
|
8
|
Yasinska V, Gómez C, Kolmert J, Ericsson M, Pohanka A, James A, Andersson LI, Sparreman-Mikus M, Sousa AR, Riley JH, Bates S, Bakke PS, Zounemat Kermani N, Caruso M, Chanez P, Fowler SJ, Geiser T, Howarth PH, Horváth I, Krug N, Montuschi P, Sanak M, Behndig A, Shaw DE, Knowles RG, Dahlén B, Maitland-van der Zee AH, Sterk PJ, Djukanovic R, Adcock IM, Chung KF, Wheelock CE, Dahlén SE, Wikström Jonsson E. Low levels of endogenous anabolic androgenic steroids in females with severe asthma taking corticosteroids. ERJ Open Res 2023; 9:00269-2023. [PMID: 37868143 PMCID: PMC10588792 DOI: 10.1183/23120541.00269-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 06/21/2023] [Indexed: 10/24/2023] Open
Abstract
Rationale Patients with severe asthma are dependent upon treatment with high doses of inhaled corticosteroids (ICS) and often also oral corticosteroids (OCS). The extent of endogenous androgenic anabolic steroid (EAAS) suppression in asthma has not previously been described in detail. The objective of the present study was to measure urinary concentrations of EAAS in relation to exogenous corticosteroid exposure. Methods Urine collected at baseline in the U-BIOPRED (Unbiased Biomarkers for the Prediction of Respiratory Disease outcomes) study of severe adult asthmatics (SA, n=408) was analysed by quantitative mass spectrometry. Data were compared to that of mild-to-moderate asthmatics (MMA, n=70) and healthy subjects (HC, n=98) from the same study. Measurements and main results The concentrations of urinary endogenous steroid metabolites were substantially lower in SA than in MMA or HC. These differences were more pronounced in SA patients with detectable urinary OCS metabolites. Their dehydroepiandrosterone sulfate (DHEA-S) concentrations were <5% of those in HC, and cortisol concentrations were below the detection limit in 75% of females and 82% of males. The concentrations of EAAS in OCS-positive patients, as well as patients on high-dose ICS only, were more suppressed in females than males (p<0.05). Low levels of DHEA were associated with features of more severe disease and were more prevalent in females (p<0.05). The association between low EAAS and corticosteroid treatment was replicated in 289 of the SA patients at follow-up after 12-18 months. Conclusion The pronounced suppression of endogenous anabolic androgens in females might contribute to sex differences regarding the prevalence of severe asthma.
Collapse
Affiliation(s)
- Valentyna Yasinska
- Clinical Lung and Allergy Research, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
- Department of Respiratory Medicine, Karolinska University Hospital, Stockholm, Sweden
- The Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
| | - Cristina Gómez
- Department of Respiratory Medicine, Karolinska University Hospital, Stockholm, Sweden
- The Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
- Unit of Integrative Metabolomics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Johan Kolmert
- Department of Respiratory Medicine, Karolinska University Hospital, Stockholm, Sweden
- The Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
- Unit of Integrative Metabolomics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Ericsson
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
- Clinical Pharmacology, Karolinska University Hospital, Stockholm, Sweden
- Laboratoire AntiDopage Français, Université Paris-Saclay, Châtenay-Malabry, France
| | - Anton Pohanka
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
- Clinical Pharmacology, Karolinska University Hospital, Stockholm, Sweden
| | - Anna James
- Department of Respiratory Medicine, Karolinska University Hospital, Stockholm, Sweden
- The Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
- Unit of Integrative Metabolomics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Lars I. Andersson
- Clinical Lung and Allergy Research, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
- Department of Respiratory Medicine, Karolinska University Hospital, Stockholm, Sweden
- The Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
| | - Maria Sparreman-Mikus
- Clinical Lung and Allergy Research, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
- Department of Respiratory Medicine, Karolinska University Hospital, Stockholm, Sweden
- The Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
| | - Ana R. Sousa
- Respiratory and Speciality Group, GSK, Clinical Sciences, Stockley Park, UK
| | - John H. Riley
- Respiratory and Speciality Group, GSK, Clinical Sciences, Stockley Park, UK
| | - Stewart Bates
- Respiratory and Speciality Group, GSK, Clinical Sciences, Stockley Park, UK
| | - Per S. Bakke
- Institute of Clinical Science, University of Bergen, Bergen, Norway
| | - Nazanin Zounemat Kermani
- National Heart and Lung Institute and Data Science Institute, Imperial College London, London, UK
| | - Massimo Caruso
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - Pascal Chanez
- Assistance Publique des Hôpitaux de Marseille, Clinique des Bronches, Allergies et Sommeil, Aix Marseille Université, Marseille, France
| | - Stephen J. Fowler
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre and NIHR Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Thomas Geiser
- Department of Pulmonary Medicine, University Hospital, University of Bern, Bern, Switzerland
| | - Peter H. Howarth
- Faculty of Medicine, Southampton University, Southampton, UK
- NIHR Southampton Respiratory Biomedical Research Center, University Hospital Southampton, Southampton, UK
| | - Ildikó Horváth
- Department of Public Health, Semmelweis University, Budapest, Hungary
- National Koranyi Institute for Pulmonology, Budapest, Hungary
| | - Norbert Krug
- Fraunhofer Institute for Toxicology and Experimental Medicine, Hannover, Germany
| | - Paolo Montuschi
- National Heart and Lung Institute and Data Science Institute, Imperial College London, London, UK
- Department of Pharmacology, Faculty of Medicine, Catholic University of the Sacred Heart, Rome, Italy
| | - Marek Sanak
- Department of Internal Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Annelie Behndig
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Dominick E. Shaw
- Nottingham NIHR Biomedical Research Centre, University of Nottingham, Nottingham, UK
| | | | - Barbro Dahlén
- Clinical Lung and Allergy Research, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
- Department of Respiratory Medicine, Karolinska University Hospital, Stockholm, Sweden
- The Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
| | | | - Peter J. Sterk
- Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Ratko Djukanovic
- Faculty of Medicine, Southampton University, Southampton, UK
- NIHR Southampton Respiratory Biomedical Research Center, University Hospital Southampton, Southampton, UK
| | - Ian M. Adcock
- National Heart and Lung Institute and Data Science Institute, Imperial College London, London, UK
| | - Kian Fan Chung
- National Heart and Lung Institute and Data Science Institute, Imperial College London, London, UK
| | - Craig E. Wheelock
- Department of Respiratory Medicine, Karolinska University Hospital, Stockholm, Sweden
- The Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
- Unit of Integrative Metabolomics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Sven-Erik Dahlén
- Clinical Lung and Allergy Research, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
- Department of Respiratory Medicine, Karolinska University Hospital, Stockholm, Sweden
- The Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
- Unit of Integrative Metabolomics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Eva Wikström Jonsson
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
- Clinical Pharmacology, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
9
|
Bachert C, Luong AU, Gevaert P, Mullol J, Smith SG, Silver J, Sousa AR, Howarth PH, Benson VS, Mayer B, Chan RH, Busse WW. The Unified Airway Hypothesis: Evidence From Specific Intervention With Anti-IL-5 Biologic Therapy. J Allergy Clin Immunol Pract 2023; 11:2630-2641. [PMID: 37207831 DOI: 10.1016/j.jaip.2023.05.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 05/05/2023] [Accepted: 05/08/2023] [Indexed: 05/21/2023]
Abstract
The unified airway hypothesis proposes that upper and lower airway diseases reflect a single pathological process manifesting in different locations within the airway. Functional, epidemiological, and pathological evidence has supported this well-established hypothesis for some time. However, literature on the pathobiologic roles/therapeutic targeting of eosinophils and IL-5 in upper and lower airway diseases (including asthma, chronic rhinosinusitis with nasal polyps [CRSwNP], and nonsteroidal anti-inflammatory drug-exacerbated respiratory disease) has recently emerged. This narrative review revisits the unified airway hypothesis by searching the scientific literature for recent learnings and clinical trial/real-world data that provide a novel perspective on its relevance for clinicians. According to the available literature, eosinophils and IL-5 have important pathophysiological roles in both the upper and lower airways, although the impact of eosinophils and IL-5 may vary in asthma and CRSwNP. Some differential effects of anti-IL-5 and anti-IL-5-receptor therapies in CRSwNP have been observed, requiring further investigation. However, pharmaceutical targeting of eosinophils and IL-5 in patients with upper, lower, and comorbid upper and lower airway inflammation has led to clinical benefit, supporting the hypothesis that these are linked conditions manifesting in different locations. Consideration of this approach may improve patient care and aid clinical decision making.
Collapse
Affiliation(s)
- Claus Bachert
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Muenster, Muenster, Germany; Department of Ear, Nose and Throat Diseases, Karolinska University Hospital, Stockholm, Sweden; Department of Otorhinolaryngology, The First Affiliated Hospital of Sun Yat-sen University, Sun Yat-sen University, Guangzhou, China; Upper Airway Research Laboratory, Ghent University Hospital, Ghent, Belgium.
| | - Amber U Luong
- McGovern Medical School of the University of Texas Health Science Center, Houston, Texas
| | - Philippe Gevaert
- Upper Airway Research Laboratory, Ghent University Hospital, Ghent, Belgium
| | - Joaquim Mullol
- Department of Otorhinolaryngology, Hospital Clínic, IDIBAPS, Universitat de Barcelona, CIBERES, Barcelona, Catalonia, Spain
| | | | - Jared Silver
- US Medical Affairs - Respiratory, GSK, Durham, NC
| | - Ana R Sousa
- Clinical Sciences - Respiratory, GSK, Brentford, United Kingdom
| | - Peter H Howarth
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton and NIHR Respiratory Biomedical Research Unit, Southampton General Hospital, Southampton, United Kingdom; Global Respiratory Franchise, GSK, Brentford, United Kingdom
| | - Victoria S Benson
- Epidemiology, Value Evidence and Outcomes, GSK, Brentford, United Kingdom
| | | | - Robert H Chan
- Clinical Sciences - Respiratory, GSK, Brentford, United Kingdom
| | - William W Busse
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, University of Wisconsin, Madison, Wis
| |
Collapse
|
10
|
Abdel-Aziz MI, Thorsen J, Hashimoto S, Vijverberg SJH, Neerincx AH, Brinkman P, van Aalderen W, Stokholm J, Rasmussen MA, Roggenbuck-Wedemeyer M, Vissing NH, Mortensen MS, Brejnrod AD, Fleming LJ, Murray CS, Fowler SJ, Frey U, Bush A, Singer F, Hedlin G, Nordlund B, Shaw DE, Chung KF, Adcock IM, Djukanovic R, Auffray C, Bansal AT, Sousa AR, Wagers SS, Chawes BL, Bønnelykke K, Sørensen SJ, Kraneveld AD, Sterk PJ, Roberts G, Bisgaard H, Maitland-van der Zee AH. Oropharyngeal Microbiota Clusters in Children with Asthma or Wheeze Associate with Allergy, Blood Transcriptomic Immune Pathways, and Exacerbation Risk. Am J Respir Crit Care Med 2023; 208:142-154. [PMID: 37163754 DOI: 10.1164/rccm.202211-2107oc] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 05/09/2023] [Indexed: 05/12/2023] Open
Abstract
Rationale: Children with preschool wheezing or school-age asthma are reported to have airway microbial imbalances. Objectives: To identify clusters in children with asthma or wheezing using oropharyngeal microbiota profiles. Methods: Oropharyngeal swabs from the U-BIOPRED (Unbiased Biomarkers for the Prediction of Respiratory Disease Outcomes) pediatric asthma or wheezing cohort were characterized using 16S ribosomal RNA gene sequencing, and unsupervised hierarchical clustering was performed on the Bray-Curtis β-diversity. Enrichment scores of the Molecular Signatures Database hallmark gene sets were computed from the blood transcriptome using gene set variation analysis. Children with severe asthma or severe wheezing were followed up for 12-18 months, with assessment of the frequency of exacerbations. Measurements and Main Results: Oropharyngeal samples from 241 children (age range, 1-17 years; 40% female) revealed four taxa-driven clusters dominated by Streptococcus, Veillonella, Rothia, and Haemophilus. The clusters showed significant differences in atopic dermatitis, grass pollen sensitization, FEV1% predicted after salbutamol, and annual asthma exacerbation frequency during follow-up. The Veillonella cluster was the most allergic and included the highest percentage of children with two or more exacerbations per year during follow-up. The oropharyngeal clusters were different in the enrichment scores of TGF-β (transforming growth factor-β) (highest in the Veillonella cluster) and Wnt/β-catenin signaling (highest in the Haemophilus cluster) transcriptomic pathways in blood (all q values <0.05). Conclusions: Analysis of the oropharyngeal microbiota of children with asthma or wheezing identified four clusters with distinct clinical characteristics (phenotypes) that associate with risk for exacerbation and transcriptomic pathways involved in airway remodeling. This suggests that further exploration of the oropharyngeal microbiota may lead to novel pathophysiologic insights and potentially new treatment approaches.
Collapse
Affiliation(s)
- Mahmoud I Abdel-Aziz
- Department of Pulmonary Medicine and
- Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
- Amsterdam Public Health, Amsterdam, the Netherlands
- Department of Clinical Pharmacy, Faculty of Pharmacy, Assiut University, Assiut, Egypt
| | - Jonathan Thorsen
- Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, and
| | - Simone Hashimoto
- Department of Pulmonary Medicine and
- Department of Paediatric Pulmonary Medicine, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
- Amsterdam Public Health, Amsterdam, the Netherlands
| | - Susanne J H Vijverberg
- Department of Pulmonary Medicine and
- Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
- Amsterdam Public Health, Amsterdam, the Netherlands
| | - Anne H Neerincx
- Department of Pulmonary Medicine and
- Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
- Amsterdam Public Health, Amsterdam, the Netherlands
| | - Paul Brinkman
- Department of Pulmonary Medicine and
- Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
- Amsterdam Public Health, Amsterdam, the Netherlands
| | - Wim van Aalderen
- Department of Paediatric Pulmonary Medicine, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Jakob Stokholm
- Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital
- Department of Food Science, University of Copenhagen, Frederiksberg, Denmark
| | - Morten Arendt Rasmussen
- Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital
- Department of Food Science, University of Copenhagen, Frederiksberg, Denmark
| | - Michael Roggenbuck-Wedemeyer
- Section of Microbiology, Department of Biology, University of Copenhagen, Copenhagen, Denmark
- Novozymes, Bagsvaerd, Denmark
| | - Nadja H Vissing
- Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital
| | - Martin Steen Mortensen
- Section of Microbiology, Department of Biology, University of Copenhagen, Copenhagen, Denmark
| | - Asker Daniel Brejnrod
- Section of Bioinformatics, Department of Health Technology, Technical University of Denmark, Lyngby, Denmark
| | - Louise J Fleming
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Royal Brompton and Harefield NHS Trust, London, United Kingdom
| | - Clare S Murray
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
- Manchester Academic Health Science Centre and National Institute for Health and Care Research Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - Stephen J Fowler
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
- Manchester Academic Health Science Centre and National Institute for Health and Care Research Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - Urs Frey
- University Children's Hospital Basel, University of Basel, Basel, Switzerland
| | - Andrew Bush
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Royal Brompton and Harefield NHS Trust, London, United Kingdom
| | - Florian Singer
- Division of Paediatric Pulmonology and Allergology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
- Division of Paediatric Respiratory Medicine and Allergology, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Gunilla Hedlin
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Björn Nordlund
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Dominick E Shaw
- National Institute for Health and Care Research Respiratory Biomedical Research Unit, University of Nottingham, Nottingham, United Kingdom
| | - Kian Fan Chung
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Royal Brompton and Harefield NHS Trust, London, United Kingdom
| | - Ian M Adcock
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Royal Brompton and Harefield NHS Trust, London, United Kingdom
| | - Ratko Djukanovic
- National Institute for Health and Care Research Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and Clinical and Experimental Sciences and Human Development and Health, University of Southampton, Southampton, United Kingdom
| | - Charles Auffray
- European Institute for Systems Biology and Medicine, CIRI UMR5308, CNRS-ENS-UCBL-INSERM, Lyon, France
| | - Aruna T Bansal
- Acclarogen Ltd., St. John's Innovation Centre, Cambridge, United Kingdom
| | - Ana R Sousa
- Respiratory Therapeutic Unit, GlaxoSmithKline, Stockley Park, United Kingdom
| | | | - Bo Lund Chawes
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, and
| | - Klaus Bønnelykke
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, and
| | - Søren Johannes Sørensen
- Section of Microbiology, Department of Biology, University of Copenhagen, Copenhagen, Denmark
| | - Aletta D Kraneveld
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, the Netherlands
| | - Peter J Sterk
- Department of Pulmonary Medicine and
- Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
| | - Graham Roberts
- National Institute for Health and Care Research Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and Clinical and Experimental Sciences and Human Development and Health, University of Southampton, Southampton, United Kingdom
| | - Hans Bisgaard
- Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital
| | - Anke H Maitland-van der Zee
- Department of Pulmonary Medicine and
- Department of Paediatric Pulmonary Medicine, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
- Amsterdam Public Health, Amsterdam, the Netherlands
| |
Collapse
|
11
|
Hou R, Ye G, Cheng X, Shaw DE, Bakke PS, Caruso M, Dahlen B, Dahlen SE, Fowler SJ, Horváth I, Howarth P, Krug N, Montuschi P, Sanak M, Sandström T, Auffray C, De Meulder B, Sousa AR, Adcock IM, Fan Chung K, Sterk PJ, Skipp PJ, Schofield J, Djukanović R. The role of inflammation in anxiety and depression in the European U-BIOPRED asthma cohorts. Brain Behav Immun 2023; 111:249-258. [PMID: 37146653 DOI: 10.1016/j.bbi.2023.04.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 04/13/2023] [Accepted: 04/23/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND Growing evidence indicates high comorbid anxiety and depression in patients with asthma. However, the mechanisms underlying this comorbid condition remain unclear. The aim of this study was to investigate the role of inflammation in comorbid anxiety and depression in three asthma patient cohorts of the Unbiased Biomarkers for the Prediction of Respiratory Disease Outcomes (U-BIOPRED) project. METHODS U-BIOPRED was conducted by a European Union consortium of 16 academic institutions in 11 European countries. A subset dataset from subjects with valid anxiety and depression measures and a large blood biomarker dataset were analysed, including 198 non-smoking patients with severe asthma (SAn), 65 smoking patients with severe asthma (SAs), 61 non-smoking patients with mild-to-moderate asthma (MMA), and 20 healthy non-smokers (HC). The Hospital Anxiety and Depression Scale was used to measure anxiety and depression and a series of inflammatory markers were analysed by the SomaScan v3 platform (SomaLogic, Boulder, Colo). ANOVA and the Kruskal-Wallis test were used for multiple-group comparisons as appropriate. RESULTS There were significant group effects on anxiety and depression among the four cohort groups (p < 0.05). Anxiety and depression of SAn and SAs groups were significantly higher than that of MMA and HC groups (p < 0.05. There were significant differences in serum IL6, MCP1, CCL18, CCL17, IL8, and Eotaxin among the four groups (p < 0.05). Depression was significantly associated with IL6, MCP1, CCL18 level, and CCL17; whereas anxiety was associated with CCL17 only (p < 0.05). CONCLUSIONS The current study suggests that severe asthma patients are associated with higher levels of anxiety and depression, and inflammatory responses may underlie this comorbid condition.
Collapse
Affiliation(s)
- Ruihua Hou
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, UK.
| | - Gang Ye
- Suzhou Guangji Hospital, Suzhou, Jiangsu, China
| | | | - Dominick E Shaw
- Respiratory Research Unit, University of Nottingham, Nottingham, UK
| | - Per S Bakke
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Massimo Caruso
- Dept of Clinical and Experimental Medicine Hospital University, University of Catania, Catania, Italy
| | - Barbro Dahlen
- The Centre for Allergy Research, The Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Sven-Erik Dahlen
- The Centre for Allergy Research, The Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Stephen J Fowler
- Faculty of Biology, Medicine and Health, School of Biological Sciences, Division of Infection, Immunity & Respiratory Medicine, The University of Manchester and Manchester Academic Health Science Centre and NIHR Manchester Biomedical Research Unit and Manchester University NHS Foundation Trust, UK
| | - Ildikó Horváth
- Dept of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Peter Howarth
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, UK
| | - Norbert Krug
- Fraunhofer Institute for Toxicology and Experimental Medicine Hannover, Hannover, Germany
| | - Paolo Montuschi
- Pharmacology, Faculty of Medicine, Catholic University of the Sacred Heart, Rome, Italy
| | - Marek Sanak
- Department of Internal Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Thomas Sandström
- Department of Medicine, Department of Public Health and Clinical Medicine Respiratory Medicine Unit, Umea University, Sweden
| | - Charles Auffray
- European Institute for Systems Biology and Medicine, CNRS-ENS-UCBL-INSERM, Université de Lyon, France
| | - Bertrand De Meulder
- European Institute for Systems Biology and Medicine, CNRS-ENS-UCBL-INSERM, Université de Lyon, France
| | - Ana R Sousa
- Respiratory Therapeutic Unit, GlaxoSmithKline, Stockley Park, UK
| | - Ian M Adcock
- National Heart and Lung Institute, Imperial College London, UK
| | - Kian Fan Chung
- National Heart and Lung Institute, Imperial College London, UK
| | - Peter J Sterk
- Amsterdam UMC, University of Amsterdam, Holland, Netherlands
| | - Paul J Skipp
- Biological Sciences, University of Southampton, Southampton, UK
| | - James Schofield
- Biological Sciences, University of Southampton, Southampton, UK; NIHR Southampton Respiratory Biomedical Research Centre, UK
| | - Ratko Djukanović
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, UK; NIHR Southampton Respiratory Biomedical Research Centre, UK
| |
Collapse
|
12
|
Brandsma J, Schofield JPR, Yang X, Strazzeri F, Barber C, Goss VM, Koster G, Bakke PS, Caruso M, Chanez P, Dahlén SE, Fowler SJ, Horváth I, Krug N, Montuschi P, Sanak M, Sandström T, Shaw DE, Chung KF, Singer F, Fleming LJ, Adcock IM, Pandis I, Bansal AT, Corfield J, Sousa AR, Sterk PJ, Sánchez-García RJ, Skipp PJ, Postle AD, Djukanović R. Stratification of asthma by lipidomic profiling of induced sputum supernatant. J Allergy Clin Immunol 2023; 152:117-125. [PMID: 36918039 DOI: 10.1016/j.jaci.2023.02.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 02/07/2023] [Accepted: 02/14/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND Asthma is a chronic respiratory disease with significant heterogeneity in its clinical presentation and pathobiology. There is need for improved understanding of respiratory lipid metabolism in asthma patients and its relation to observable clinical features. OBJECTIVE We performed a comprehensive, prospective, cross-sectional analysis of the lipid composition of induced sputum supernatant obtained from asthma patients with a range of disease severities, as well as from healthy controls. METHODS Induced sputum supernatant was collected from 211 adults with asthma and 41 healthy individuals enrolled onto the U-BIOPRED (Unbiased Biomarkers for the Prediction of Respiratory Disease Outcomes) study. Sputum lipidomes were characterized by semiquantitative shotgun mass spectrometry and clustered using topologic data analysis to identify lipid phenotypes. RESULTS Shotgun lipidomics of induced sputum supernatant revealed a spectrum of 9 molecular phenotypes, highlighting not just significant differences between the sputum lipidomes of asthma patients and healthy controls, but also within the asthma patient population. Matching clinical, pathobiologic, proteomic, and transcriptomic data helped inform the underlying disease processes. Sputum lipid phenotypes with higher levels of nonendogenous, cell-derived lipids were associated with significantly worse asthma severity, worse lung function, and elevated granulocyte counts. CONCLUSION We propose a novel mechanism of increased lipid loading in the epithelial lining fluid of asthma patients resulting from the secretion of extracellular vesicles by granulocytic inflammatory cells, which could reduce the ability of pulmonary surfactant to lower surface tension in asthmatic small airways, as well as compromise its role as an immune regulator.
Collapse
Affiliation(s)
- Joost Brandsma
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom; National Institute for Health Research Southampton Biomedical Research Centre, Southampton, United Kingdom.
| | - James P R Schofield
- National Institute for Health Research Southampton Biomedical Research Centre, Southampton, United Kingdom; Centre for Proteomic Research, Biological Sciences, University of Southampton, Southampton, United Kingdom
| | - Xian Yang
- Data Science Institute, Imperial College, London, United Kingdom
| | - Fabio Strazzeri
- Mathematical Sciences, University of Southampton, Southampton, United Kingdom
| | - Clair Barber
- National Institute for Health Research Southampton Biomedical Research Centre, Southampton, United Kingdom
| | - Victoria M Goss
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom; National Institute for Health Research Southampton Biomedical Research Centre, Southampton, United Kingdom
| | - Grielof Koster
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom; National Institute for Health Research Southampton Biomedical Research Centre, Southampton, United Kingdom
| | - Per S Bakke
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Massimo Caruso
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - Pascal Chanez
- Department of Respiratory Diseases, Aix-Marseille University, Marseille, France
| | - Sven-Erik Dahlén
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Stephen J Fowler
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, University of Manchester, Manchester, United Kingdom; Manchester Academic Health Centre and NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - Ildikó Horváth
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Norbert Krug
- Fraunhofer Institute for Toxicology and Experimental Medicine, Hannover, Germany
| | - Paolo Montuschi
- Department of Pharmacology, Faculty of Medicine, Catholic University of the Sacred Heart, Rome, Italy; National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Marek Sanak
- Department of Medicine, Jagiellonian University, Krakow, Poland
| | - Thomas Sandström
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Dominick E Shaw
- National Institute for Health Research Biomedical Research Unit, University of Nottingham, Nottingham, United Kingdom
| | - Kian Fan Chung
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Florian Singer
- Division of Paediatric Respiratory Medicine and Allergology, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Paediatrics and Adolescent Medicine, Division of Paediatric Pulmonology and Allergology, Medical University of Graz, Graz, Austria
| | - Louise J Fleming
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Ian M Adcock
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Ioannis Pandis
- Data Science Institute, Imperial College, London, United Kingdom
| | - Aruna T Bansal
- Acclarogen Ltd, St John's Innovation Centre, Cambridge, United Kingdom
| | | | - Ana R Sousa
- Respiratory Therapy Unit, GlaxoSmithKline, London, United Kingdom
| | - Peter J Sterk
- Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Paul J Skipp
- Centre for Proteomic Research, Biological Sciences, University of Southampton, Southampton, United Kingdom
| | - Anthony D Postle
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Ratko Djukanović
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom; National Institute for Health Research Southampton Biomedical Research Centre, Southampton, United Kingdom
| |
Collapse
|
13
|
Benson VS, Fu Q, Yang S, Sousa AR, Chan RH, Howarth P, Hopkins C. Real-world characterisation of patients with chronic rhinosinusitis with nasal polyps with and without surgery in England. Clin Otolaryngol 2023. [PMID: 37129235 DOI: 10.1111/coa.14070] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 03/16/2023] [Accepted: 04/18/2023] [Indexed: 05/03/2023]
Abstract
OBJECTIVES To characterise the real-world burden of chronic rhinosinusitis with nasal polyps (CRSwNP) in the UK, stratified by number of surgeries. DESIGN Retrospective cohort study. SETTING UK Clinical Practice Research Datalink Aurum database with Hospital Episodes Statistics linkage (2007-2019). PARTICIPANTS Adults ≥18 years of age with a first NP diagnosis (index) and 365 days of baseline and ≥180 days of follow-up data. Follow-up continued until disenrollment, death or end of data collection. MAIN OUTCOME MEASURES Primary: primary care physician prescribed CRSwNP-related treatments, and all-cause healthcare resource utilisation (HCRU) in 90 days post-index, stratified by surgeries during follow-up. Secondary: rate of surgery and CRSwNP point prevalence. Baseline patient demographics, clinical characteristics and comorbidities were also assessed. RESULTS Of the 33 107 patients included, 23.5% and 2.2% had ≥1 and ≥2 surgeries during follow-up, respectively (mean follow-up: 5.3 years). Patients with more surgeries (≥2/≥1/0) during follow-up were more likely to be male (67.3%/69.0%/58.0%), have asthma (37.8%/28.2%/20.2%) and have baseline blood eosinophil counts ≥300 cells/μL (68.5%/66.0%/51.5%). During the first 90-days post-index as surgery number increased, the proportion of patients using oral corticosteroids (25.8%/20.7%/14.2%) and mean (SD) number of all-cause healthcare visits (5.9 [4.2]/5.4 [4.0]/4.9 [4.2]) increased. Time between surgeries was shorter among patients with more surgeries. CRSwNP prevalence on 31 December 2018 was 476 cases per 100 000 persons. CONCLUSION A small proportion of patients in the UK required multiple surgeries for CRSwNP and this was associated with increasing comorbidity burden, baseline blood eosinophil counts, CRSwNP-related treatment and HCRU use.
Collapse
Affiliation(s)
- Victoria S Benson
- Epidemiology, Value Evidence and Outcomes, GSK, GSK House, Brentford, Middlesex, UK
| | - Qinggong Fu
- Value Evidence and Outcomes, GSK, Collegeville, Pennsylvania, USA
| | - Shibing Yang
- Value Evidence and Outcomes, GSK, Collegeville, Pennsylvania, USA
| | - Ana R Sousa
- Respiratory Clinical Sciences R&D, GSK House, Brentford, Middlesex, UK
| | - Robert H Chan
- Respiratory Clinical Sciences R&D, GSK House, Brentford, Middlesex, UK
| | - Peter Howarth
- Global Medical Affairs, GSK, Brentford, Middlesex, UK
| | - Claire Hopkins
- ENT Department, Guys and St Thomas's Hospital, London, UK
- King's College Hospital, London, UK
| |
Collapse
|
14
|
Fokkens WJ, Mullol J, Kennedy D, Philpott C, Seccia V, Kern RC, Coste A, Sousa AR, Howarth PH, Benson VS, Mayer B, Yancey SW, Chan R, Gane SB. Mepolizumab for chronic rhinosinusitis with nasal polyps (SYNAPSE): In-depth sinus surgery analysis. Allergy 2023; 78:812-821. [PMID: 35822924 DOI: 10.1111/all.15434] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [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: 03/10/2022] [Revised: 06/10/2022] [Accepted: 06/18/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Patients with severe chronic rhinosinusitis with nasal polyps (CRSwNP) often require repeat sinus surgery. Mepolizumab reduced the need for sinus surgery in the SYNAPSE trial; this analysis sought to provide a more in-depth assessment of surgery endpoints in SYNAPSE. METHODS SYNAPSE was a double-blind Phase III trial (NCT03085797) in adults with recurrent, refractory, severe, CRSwNP eligible for repeat sinus surgery despite standard of care treatments and previous surgery. Patients were randomized (1:1) to mepolizumab 100 mg subcutaneously or placebo, plus standard of care, every 4 weeks for 52 weeks. Time to first inclusion on a waiting list for sinus surgery and time to first actual sinus surgery (both up to week 52) were assessed; the latter endpoint was also analyzed post hoc according to time since last sinus surgery before study screening and baseline blood eosinophil count. RESULTS Among 407 patients (mepolizumab: 206; placebo: 201), mepolizumab versus placebo reduced the risk of being included on a waiting list for sinus surgery (week 52 Kaplan-Meier probability estimate [95% confidence interval]: 13.9% [9.8%, 19.5%] vs. 28.5% [22.7%, 35.4%]). Mepolizumab versus placebo reduced the risk of sinus surgery irrespective of time (<3 vs ≥3 years) since patients' last sinus surgery prior to study screening (hazard ratios [95% confidence intervals] 0.28 [0.09, 0.84] and 0.50 [0.26, 0.98], respectively) and baseline blood eosinophil count. CONCLUSIONS Mepolizumab reduced the risk of further sinus surgery in patients with recurrent, refractory, severe CRSwNP, irrespective of the patient baseline characteristics assessed.
Collapse
Affiliation(s)
- Wytske J Fokkens
- Department of Otolaryngology, University of Amsterdam, Amsterdam, Netherlands
| | - Joaquim Mullol
- Department of Otorhinolaryngology, Hospital Clinic, IDIBAPS, Universitat de Barcelona, CIBERES, Barcelona, Catalonia, Spain
| | - David Kennedy
- Department of Otorhinolaryngology: Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Carl Philpott
- Norwich Medical School, University of East Anglia, Norwich, UK.,Norfolk and Waveney Ear Nose and Throat Service, James Paget University Hospitals NHS Foundation Trust, Great Yarmouth, UK
| | - Veronica Seccia
- ENT Unit, Department of Neuroscience, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Robert C Kern
- Department of Medicine and Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - André Coste
- Service d'ORL et de Chirurgie Cervico-faciale Centre, Hospitalier Intercommunal de Creteil, et APHP, Groupe Hospitalier Henri Mondor-Albert Chenevier, Universite Paris-Est Creteil, Creteil, France
| | - Ana R Sousa
- Clinical Sciences, Respiratory, GSK, GSK House, Brentford, Middlesex, UK
| | - Peter H Howarth
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton and NIHR Respiratory Biomedical Research Unit, Southampton General Hospital, Southampton, UK.,Global Respiratory Franchise, GSK House, Brentford, Middlesex, UK
| | - Victoria S Benson
- Epidemiology, Value Evidence and Outcomes, GSK House, Brentford, Middlesex, UK
| | - Bhabita Mayer
- Clinical Statistics, GSK House, Brentford, Middlesex, UK
| | - Steve W Yancey
- Respiratory Medical Franchise, GSK, Research Triangle Park, North Carolina, USA
| | - Robert Chan
- Clinical Sciences, Respiratory, GSK, GSK House, Brentford, Middlesex, UK
| | - Simon B Gane
- Department of Rhinology, Royal National ENT Hospital, University College London Hospitals NHS Foundation Trust, London, UK.,UCL Ear Institute, University College London, London, UK
| |
Collapse
|
15
|
Hopkins C, Han JK, Lund VJ, Bachert C, Fokkens WJ, Diamant Z, Mullol J, Sousa AR, Smith SG, Yang S, Mayer B, Yancey SW, Chan RH, Lee SE. Evaluating treatment response to mepolizumab in patients with severe CRSwNP. Rhinology 2023; 61:108-117. [PMID: 36716382 DOI: 10.4193/rhin22.200] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The SYNAPSE study (NCT03085797) demonstrated that mepolizumab decreased nasal polyp (NP) size and nasal obstruction in patients with chronic rhinosinusitis with NP (CRSwNP). METHODS SYNAPSE, a randomized, double-blind study, included patients with recurrent, refractory, severe CRSwNP, eligible for repeated surgery despite receiving standard of care (SoC). Patients received 4-weekly mepolizumab 100 mg or placebo subcutaneously plus SoC for 52 weeks. This post hoc analysis further characterized treatment responses and association with patient characteristics. The proportion of patients meeting any and each of five response criteria indicating improvement in disease-specific quality of life, NP size, nasal obstruction, loss of smell, and overall symptoms at Weeks 24 and 52, were assessed in subgroups: 1) no surgery; 2) neither surgery nor systemic corticosteroids (SCS). RESULTS Of 407 patients in the intention-to-treat population, 381 and 343 patients had no sinus surgery by Weeks 24 and 52, respectively. More mepolizumab- versus placebo-treated patients without surgery by Weeks 24 and 52 met each response criteria. Of the mepolizumab-treated patients without surgery by Week 24, 109 (55%) responded across ≥ 3 criteria, increasing to 126 (67%) by Week 52. Similar response trends were seen for patients with neither surgery nor SCS by Weeks 24 and 52. At either timepoint, there were no major differences in baseline characteristics between mepolizumab-treated full- (5/5 categories) and non-responders (0/5 categories). CONCLUSIONS Most patients who completed SYNAPSE required neither surgery nor SCS use and in addition achieved a progressive and sustained clinical response to mepolizumab underscoring the therapeutic benefits of mepolizumab in severe CRSwNP.
Collapse
Affiliation(s)
- C Hopkins
- Department of ENT, Guy's Hospital and St Thomas' Hospital, King's College London, UK
| | - J K Han
- Department of Otolaryngology Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, VA, USA
| | - V J Lund
- Royal National Throat, Nose and Ear Hospital, UCLH NHS Trust, London, UK
| | - C Bachert
- Upper Airways Research Laboratory, Faculty of Medicine, Ghent University, Ghent, Belgium
| | - W J Fokkens
- Department of Otolaryngology, Amsterdam University Medical Center, Location AMC, Amsterdam, Netherlands
| | - Z Diamant
- Department of Microbiology Immunology and Transplantation, KU Leuven, Catholic University of Leuven, Belgium.,Department of Respiratory Medicine and Allergology, Institute for Clinical Science, Skane University Hospital, Lund University, Lund, Sweden.,Department of Clinical Pharmacy and Pharmacololgy, University Medical Center Groningen, Groningen, the Netherlands
| | - J Mullol
- Department of Otorhinolaryngology, Hospital Clinic, IDIBAPS, Universitat de Barcelona, CIBERES, Barcelona, Catalonia, Spain
| | - A R Sousa
- Clinical Sciences, Respiratory, GSK, GSK House, Brentford, UK
| | - S G Smith
- Respiratory Therapeutic Area Unit, GSK, Research Triangle Park, NC, USA
| | - S Yang
- Value Evidence and Outcomes, GSK, Collegeville, PA, USA
| | - B Mayer
- Clinical Statistics, GSK, GSK House, Brentford, Middlesex, UK
| | - S W Yancey
- Respiratory Therapeutic Area Unit, GSK, Research Triangle Park, NC, USA
| | - R H Chan
- Clinical Sciences, Respiratory, GSK, GSK House, Brentford, UK
| | - S E Lee
- Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| |
Collapse
|
16
|
Fokkens W, Trigg A, Lee SE, Chan RH, Diamant Z, Hopkins C, Howarth P, Lund V, Mayer B, Sousa AR, Yancey S, Tabberer M. Mepolizumab improvements in health-related quality of life and disease symptoms in a patient population with very severe chronic rhinosinusitis with nasal polyps: psychometric and efficacy analyses from the SYNAPSE study. J Patient Rep Outcomes 2023; 7:4. [PMID: 36662344 PMCID: PMC9859976 DOI: 10.1186/s41687-023-00543-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 01/04/2023] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Although the psychometric properties of patient-reported outcome measures (e.g. the 22-item Sino-nasal Outcomes Test [SNOT-22]) in chronic rhinosinusitis with nasal polyps (CRSwNP) have been defined, these definitions have not been extensively studied in patients with very severe CRSwNP, as defined by recurrent disease despite ≥ 1 previous surgery and a current need for further surgery. Therefore, the psychometric properties of the symptoms visual analogue scales (VAS) were evaluated, and meaningful within-patient change thresholds were calculated for VAS and SNOT-22. METHODS SYNAPSE (NCT03085797), a randomized, double-blind, placebo-controlled, 52-week trial, assessed the efficacy and safety of 4-weekly mepolizumab 100 mg subcutaneously added to standard of care in very severe CRSwNP. Enrolled patients (n = 407) completed symptom VAS (six items) daily and SNOT-22 every 4 weeks from baseline until Week 52. Blinded psychometric assessment of individual and composite VAS was performed post hoc, including anchor-based thresholds for meaningful within-patient changes for VAS and SNOT-22, supported by cumulative distribution function and probability density function plots. The effect of mepolizumab versus placebo for 52 weeks on VAS and SNOT-22 scores was then determined using these thresholds using unblinded data. RESULTS Internal consistency was acceptable for VAS and SNOT-22 scores (Cronbach's α-coefficients ≥ 0.70). Test-retest reliability was demonstrated for all symptom VAS (Intra-Class Correlation coefficients > 0.75). Construct validity was acceptable between individual and composite VAS and SNOT-22 total score (r = 0.461-0.598) and between individual symptom VAS and corresponding SNOT-22 items (r = 0.560-0.780), based upon pre-specified ranges. Known-groups validity assessment demonstrated generally acceptable validity based on factors associated with respiratory health, with all VAS responsive to change. Mepolizumab treatment was associated with significantly increased odds of meeting or exceeding meaningful within-patient change thresholds, derived for this very severe cohort using six anchor groups for individual VAS (odds ratio [OR] 2.19-2.68) at Weeks 49-52, and SNOT-22 (OR 1.61-2.96) throughout the study. CONCLUSIONS Symptoms VAS and SNOT-22 had acceptable psychometric properties for use in very severe CRSwNP. Mepolizumab provided meaningful within-patient improvements in symptom severity and health-related quality of life versus placebo, indicating mepolizumab provides substantial clinical benefits in very severe CRSwNP.
Collapse
Affiliation(s)
- Wytske Fokkens
- grid.7177.60000000084992262Department of Otolaryngology, University of Amsterdam, Amsterdam, The Netherlands
| | - Andrew Trigg
- Patient-Centred Outcomes, Adelphi Values, Bollington, Cheshire, UK
| | - Stella E. Lee
- grid.38142.3c000000041936754XDivision of Otolaryngology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
| | - Robert H. Chan
- grid.418236.a0000 0001 2162 0389Clinical Sciences, Respiratory, GSK, GSK House, Brentford, Middlesex, UK
| | - Zuzana Diamant
- grid.5596.f0000 0001 0668 7884Department of Microbiology Immunology and Transplantation, KU Leuven, Catholic University of Leuven, Leuven, Belgium ,grid.4494.d0000 0000 9558 4598Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, The Netherlands ,Respiratory Medicine and Allergology, Skane University, Lund, Sweden
| | - Claire Hopkins
- grid.13097.3c0000 0001 2322 6764ENT Department, Guys and St Thomas’s Hospital, King’s College, London, UK
| | - Peter Howarth
- grid.418236.a0000 0001 2162 0389Global Medical Affairs, GSK, Brentford, Middlesex, UK
| | - Valerie Lund
- grid.439749.40000 0004 0612 2754Royal National Throat, Nose and Ear Hospital, University College London Hospitals, London, UK
| | - Bhabita Mayer
- grid.418236.a0000 0001 2162 0389Clinical Statistics, GSK, GSK House, Brentford, Middlesex, UK
| | - Ana R. Sousa
- grid.418236.a0000 0001 2162 0389Clinical Sciences, Respiratory, GSK, GSK House, Brentford, Middlesex, UK
| | - Steve Yancey
- grid.418019.50000 0004 0393 4335Respiratory Therapeutic Area Unit, GSK, Research Triangle Park, NC USA
| | - Maggie Tabberer
- Respiratory Patient Centered Outcomes, Value Evidence and Outcomes GSK, GSK House, Brentford, Middlesex, UK
| | | |
Collapse
|
17
|
Daley-Yates PT, Deans A, Mehta R, Sousa AR. Comparative clinical pharmacology of mometasone furoate, fluticasone propionate and fluticasone furoate. Pulm Pharmacol Ther 2022; 77:102171. [DOI: 10.1016/j.pupt.2022.102171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 10/07/2022] [Accepted: 10/07/2022] [Indexed: 11/06/2022]
|
18
|
Gevaert P, Han JK, Smith SG, Sousa AR, Howarth PH, Yancey SW, Chan R, Bachert C. The roles of eosinophils and interleukin-5 in the pathophysiology of chronic rhinosinusitis with nasal polyps. Int Forum Allergy Rhinol 2022; 12:1413-1423. [PMID: 35243803 PMCID: PMC9790271 DOI: 10.1002/alr.22994] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 02/10/2022] [Accepted: 03/01/2022] [Indexed: 12/30/2022]
Abstract
Chronic rhinosinusitis with nasal polyps (CRSwNP) is generally associated with eosinophilic tissue infiltration linked to type 2 inflammation and characterized by elevated levels of interleukin (IL)-5 and other type 2 inflammatory mediators. Although distinct and overlapping contributions of eosinophils and IL-5 to CRSwNP pathology are still being explored, they are both known to play an important role in NP inflammation. Eosinophils secrete numerous type 2 inflammatory mediators including granule proteins, enzymes, cytokines, chemokines, growth factors, lipids, and oxidative products. IL-5 is critical for the differentiation, migration, activation, and survival of eosinophils but is also implicated in the biological functions of mast cells, basophils, innate lymphoid cells, B cells, and epithelial cells. Results from clinical trials of therapeutics that target type 2 inflammatory mediators (including but not limited to anti-IL-5, anti-immunoglobulin-E, and anti-IL-4/13) may provide further evidence of how eosinophils and IL-5 contribute to CRSwNP. Finally, the association between eosinophilia/elevated IL-5 and greater rates of NP recurrence after endoscopic sinus surgery (ESS) suggests that these mediators may have utility as biomarkers of NP recurrence in diagnosing and assessing the severity of CRSwNP. This review provides an overview of eosinophil and IL-5 biology and explores the literature regarding the role of these mediators in CRSwNP pathogenesis and NP recurrence following ESS. Based on current published evidence, we suggest that although eosinophils play a key role in CRSwNP pathophysiology, IL-5, a cytokine that activates these cells, also represents a pertinent and effective treatment target in patients with CRSwNP.
Collapse
Affiliation(s)
- Philippe Gevaert
- Upper Airway Research LaboratoryDepartment of OtorhinolaryngologyGhent University HospitalGhentBelgium
| | | | - Steven G. Smith
- Respiratory Medical Franchise, GSKResearch Triangle ParkNorth CarolinaUSA
| | - Ana R. Sousa
- Clinical Sciences, Respiratory, GSKBrentfordMiddlesexUK
| | - Peter H. Howarth
- Clinical and Experimental SciencesFaculty of Medicine, University of Southampton and NIHR Respiratory Biomedical Research UnitSouthampton General HospitalSouthamptonUK,Global Respiratory Franchise, GSKBrentfordMiddlesexUK
| | - Steven W. Yancey
- Respiratory Medical Franchise, GSKResearch Triangle ParkNorth CarolinaUSA
| | - Robert Chan
- Clinical Sciences, Respiratory, GSKBrentfordMiddlesexUK
| | - Claus Bachert
- Upper Airway Research LaboratoryDepartment of OtorhinolaryngologyGhent University HospitalGhentBelgium,Division of ENT DiseasesCLINTECKarolinska InstituteStockholmSweden
| |
Collapse
|
19
|
Benson VS, Germain G, Chan RH, Sousa AR, Yang S, Silver J, Duh MS, Laliberté F, Chang R, Han JK. Elucidating the Real-World Burden of Chronic Rhinosinusitis With Nasal Polyps in Patients in the USA. OTO Open 2022; 6:2473974X221128930. [PMID: 36247655 PMCID: PMC9558883 DOI: 10.1177/2473974x221128930] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 09/04/2022] [Indexed: 11/16/2022] Open
Abstract
Objective To characterize healthcare burden, treatment patterns, and clinical characteristics associated with chronic rhinosinusitis with nasal polyps (CRSwNP). Study Design Retrospective cohort. Setting Real-world study using US health insurance claims database. Methods Adults with ≥1 CRSwNP diagnosis (index date: first claim for nasal polyps [NPs] between January 1, 2008, and March 31, 2019) and continuous health insurance coverage for ≥180 days preindex (baseline) and postindex were included. Follow-up spanned from index to the earliest of disenrollment, death, or data end. Assessments included patient demographics, comorbidities, and blood eosinophil count at baseline, healthcare resource utilization (HCRU), and costs during follow-up in the overall population and stratified by number of surgeries. Results Of the 119,357 patients who met the inclusion criteria, 33,748 (28%) had ≥1 surgery during follow-up, among whom 3262 (9.7%) had ≥2 surgeries. At baseline, patients with ≥1 vs no NP surgeries had a greater comorbidity burden; a higher proportion of patients had comorbid asthma (37.8% vs 21.8%) and blood eosinophil count ≥300 cells/µL (42.6% vs 38.1%). During follow-up, patients with NP surgeries had higher all-cause and CRSwNP-related HCRU and costs than patients without NP surgery. All-cause healthcare costs per person per year increased with the number of surgeries during follow-up (no surgery, $10,628; ≥1 surgery, $20,747; ≥2 surgeries, $26,969). Conclusion Patients with CRSwNP and surgery had a greater disease burden than those without surgery, with higher HCRU and costs, and were more likely to have comorbid conditions (most commonly asthma) and elevated blood eosinophil count, indicating a subset of patients with recalcitrant CRSwNP.
Collapse
Affiliation(s)
- Victoria S. Benson
- Epidemiology, Value Evidence and
Outcomes, GSK, Brentford, Middlesex, UK,Victoria S. Benson, PhD, Epidemiology,
Value Evidence and Outcomes, GSK, 90 Great West Road, Brentford, Middlesex, TW8
9GS, UK.
| | | | - Robert H. Chan
- Clinical Sciences, Respiratory, GSK,
Brentford, Middlesex, UK
| | - Ana R. Sousa
- Clinical Sciences, Respiratory, GSK,
Brentford, Middlesex, UK
| | - Shibing Yang
- Value Evidence and Outcomes, GSK,
Collegeville, Pennsylvania, USA
| | - Jared Silver
- US Medical Affairs–Respiratory, GSK,
Research Triangle Park, North Carolina, USA
| | | | | | - Rose Chang
- Analysis Group, Inc., Boston,
Massachusetts, USA
| | - Joseph K. Han
- Eastern Virginia Medical School,
Norfolk, Virginia, USA
| |
Collapse
|
20
|
Hoda U, Pavlidis S, Bansal AT, Takahashi K, Hu S, Ng Kee Kwong F, Rossios C, Sun K, Bhavsar P, Loza M, Baribaud F, Chanez P, Fowler SJ, Horvath I, Montuschi P, Singer F, Musial J, Dahlen B, Krug N, Sandstrom T, Shaw DE, Lutter R, Fleming LJ, Howarth PH, Caruso M, Sousa AR, Corfield J, Auffray C, De Meulder B, Lefaudeux D, Dahlen SE, Djukanovic R, Sterk PJ, Guo Y, Adcock IM, Chung KF. Clinical and transcriptomic features of persistent exacerbation-prone severe asthma in U-BIOPRED cohort. Clin Transl Med 2022; 12:e816. [PMID: 35474304 PMCID: PMC9043117 DOI: 10.1002/ctm2.816] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 03/24/2022] [Accepted: 03/29/2022] [Indexed: 01/28/2023] Open
Abstract
Background Exacerbation‐prone asthma is a feature of severe disease. However, the basis for its persistency remains unclear. Objectives To determine the clinical and transcriptomic features of frequent exacerbators (FEs) and persistent FEs (PFEs) in the U‐BIOPRED cohort. Methods We compared features of FE (≥2 exacerbations in past year) to infrequent exacerbators (IE, <2 exacerbations) and of PFE with repeat ≥2 exacerbations during the following year to persistent IE (PIE). Transcriptomic data in blood, bronchial and nasal epithelial brushings, bronchial biopsies and sputum cells were analysed by gene set variation analysis for 103 gene signatures. Results Of 317 patients, 62.4% had FE, of whom 63.6% had PFE, while 37.6% had IE, of whom 61.3% had PIE. Using multivariate analysis, FE was associated with short‐acting beta‐agonist use, sinusitis and daily oral corticosteroid use, while PFE was associated with eczema, short‐acting beta‐agonist use and asthma control index. CEA cell adhesion molecule 5 (CEACAM5) was the only differentially expressed transcript in bronchial biopsies between PE and IE. There were no differentially expressed genes in the other four compartments. There were higher expression scores for type 2, T‐helper type‐17 and type 1 pathway signatures together with those associated with viral infections in bronchial biopsies from FE compared to IE, while there were higher expression scores of type 2, type 1 and steroid insensitivity pathway signatures in bronchial biopsies of PFE compared to PIE. Conclusion The FE group and its PFE subgroup are associated with poor asthma control while expressing higher type 1 and type 2 activation pathways compared to IE and PIE, respectively.
Collapse
Affiliation(s)
- Uruj Hoda
- National Heart and Lung Institute, Imperial College London, and Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, UK
| | - Stelios Pavlidis
- Department of Computing & Data Science Institute, Imperial College London
| | | | - Kentaro Takahashi
- National Heart and Lung Institute, Imperial College London, and Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, UK.,Research Centre for Allergy and Clinical Immunology, Asahi General Hospital, Asahi, Japan
| | | | - Francois Ng Kee Kwong
- National Heart and Lung Institute, Imperial College London, and Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, UK
| | - Christos Rossios
- National Heart and Lung Institute, Imperial College London, and Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, UK
| | | | - Pankaj Bhavsar
- National Heart and Lung Institute, Imperial College London, and Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, UK
| | - Matthew Loza
- Janssen Research and Development, High Wycombe, Buckinghamshire, UK
| | | | - Pascal Chanez
- Assistance Publique des Hôpitaux de Marseille, Clinique des Bronches, Allergies et Sommeil, Aix Marseille Université, Marseille, France
| | - Stephen J Fowler
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, School of Biological Sciences, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, and NIHR Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Ildiko Horvath
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | | | - Florian Singer
- Department of Respiratory Medicine, University Children's Hospital Zurich and Childhood Research Center, Zurich, and Department of Paediatrics, Inselspital, University of Bern, Switzerland
| | - Jacek Musial
- Department of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Barbro Dahlen
- Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
| | - Norbert Krug
- Fraunhofer Institute for Toxicology and Experimental Medicine, Hannover, Germany
| | - Thomas Sandstrom
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | | | - Rene Lutter
- Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Louise J Fleming
- National Heart and Lung Institute, Imperial College London, and Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, UK
| | - Peter H Howarth
- NIHR Southampton Biomedical Research Centre, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, UK
| | - Massimo Caruso
- Department of Biochemical and Biotechnological Medicine, University of Catania, Catania, Italy
| | - Ana R Sousa
- Respiratory Therapeutic Unit, GSK, Stockley Park, UK
| | - Julie Corfield
- AstraZeneca R&D, Molndal, Sweden, and Areteva R&D, Nottingham, UK
| | - Charles Auffray
- European Institute for Systems Biology and Medicine, CNRS-ENS-UCBL-INSERM, Lyon, France
| | - Bertrand De Meulder
- European Institute for Systems Biology and Medicine, CNRS-ENS-UCBL-INSERM, Lyon, France
| | - Diane Lefaudeux
- European Institute for Systems Biology and Medicine, CNRS-ENS-UCBL-INSERM, Lyon, France
| | - Sven-Erik Dahlen
- Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
| | - Ratko Djukanovic
- NIHR Southampton Biomedical Research Centre, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, UK
| | - Peter J Sterk
- Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Ian M Adcock
- National Heart and Lung Institute, Imperial College London, and Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, UK
| | - Kian Fan Chung
- National Heart and Lung Institute, Imperial College London, and Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, UK
| | | |
Collapse
|
21
|
Borish L, Cohen NA, Chupp G, Hopkins C, Wagenmann M, Sousa AR, Smith SG, Silver J, Yang S, Mayer B, Yancey SW, Chan RH, Fokkens W. Evaluating enrollment and outcome criteria in trials of biologics for chronic rhinosinusitis with nasal polyps. Ann Allergy Asthma Immunol 2022; 129:160-168. [PMID: 35398492 DOI: 10.1016/j.anai.2022.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 03/30/2022] [Accepted: 04/04/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Treatment for chronic rhinosinusitis with nasal polyps (CRSwNP) generally involves intranasal corticosteroids (INCS) and saline irrigation, followed by short courses of systemic corticosteroids (SCS) or surgery with postoperative medical therapy for patients who do not respond to INCS. However, both SCS use and surgery are associated with a range of adverse effects or complications, have a high recurrence rate, and are unsuitable for some patients. Biologics targeting the underlying pathophysiology are promising treatment alternatives for these patients. Dupilumab, omalizumab, and mepolizumab are approved for use in patients with severe, uncontrolled CRSwNP. However, the lack of a consistent definition of severe CRSwNP makes the decision to initiate biologic treatment particularly complex. Furthermore, the position of each biologic in the overall management of CRSwNP remains to be clarified. DATA SOURCES Publications reporting results of phase III trials of dupilumab, omalizumab, mepolizumab, and benralizumab in the treatment of CRSwNP. STUDY SELECTIONS Randomized, controlled phase III trials of biologics approved for CRSwNP. RESULTS These trials all used different enrollment criteria. We discuss the complexities of assessing CRSwNP disease severity and highlight how these impact comparisons of the populations and outcomes of the phase III biologic trials. CONCLUSION To position biologic agents appropriately within the existing CRSwNP treatment paradigm, future trials will need to include comparable patient populations and standardized outcome measures. Such trials will help to ensure that biologic treatment is targeted appropriately to support optimal clinical outcomes.
Collapse
Affiliation(s)
- Larry Borish
- Departments of Medicine and Microbiology, University of Virginia Health System, Charlottesville, Virginia.
| | - Noam A Cohen
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania
| | - Geoffrey Chupp
- Yale Center for Asthma and Airways Disease, Yale School of Medicine, New Haven, Connecticut
| | - Claire Hopkins
- ENT Department, Guy's and St Thomas NHS Foundation Trust, London, UK and King's College London, London, United Kingdom
| | - Martin Wagenmann
- Department of Otorhinolaryngology, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Ana R Sousa
- Respiratory Clinical Sciences, R&D, GSK House, Brentford, Middlesex, United Kingdom
| | - Steven G Smith
- Respiratory Therapeutic Area Unit, GSK, Research Triangle Park, North Carolina
| | - Jared Silver
- US Value Evidence & Outcomes, US Medical Affairs-Respiratory, GSK, Research Triangle Park, North Carolina
| | - Shibing Yang
- Value Evidence and Outcomes, GSK, Collegeville, Pennsylvania
| | - Bhabita Mayer
- Clinical Statistics, GSK, GSK House, Brentford, Middlesex, United Kingdom
| | - Steven W Yancey
- Respiratory Therapeutic Area Unit, GSK, Research Triangle Park, North Carolina
| | - Robert H Chan
- Respiratory Clinical Sciences, R&D, GSK House, Brentford, Middlesex, United Kingdom
| | - Wytske Fokkens
- Department of Otolaryngology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| |
Collapse
|
22
|
Ataíde Silva R, R Sousa A, de Carvalho MSL, Anjos R. Congenital long QT syndrome presenting as unexplained bradycardia. BMJ Case Rep 2022; 15:e242362. [PMID: 35236671 PMCID: PMC8895896 DOI: 10.1136/bcr-2021-242362] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2022] [Indexed: 11/03/2022] Open
Abstract
Congenital long QT syndrome (LQTS) is a genetically autosomal heterogeneous disorder of the ion channels and causes about 10% of sudden death infant syndrome in newborns. Its estimated prevalence is approximately 1 in 2500, probably underestimated because of its clinical heterogenicity. Few cases of neonatal LQTS have been reported. In 4% of them, life-threatening arrhythmic events can be the first manifestation of LQTS. The authors report two cases of neonatal LQTS with heterogeneous genetic mutations. Both manifested by bradycardia, one since fetal life. One case had serious arrhythmias during beta blocker therapeutic establishment needing a pacemaker implantation. Genetic mutations found were not the most frequently described in association with neonatal bradycardia, thus the importance of this report. Presentation with bradycardia is relatively frequent in neonatal period, thus LQTS should be actively investigated in neonates with unexplained bradycardia. Beta blocker therapy reduces QTc and avoids arrhythmic events and sudden death.
Collapse
Affiliation(s)
- Rita Ataíde Silva
- Department of Pediatric Cardiology, Centro Hospitalar de Lisboa Ocidental EPE, Lisboa, Carnaxide, Portugal
| | - Ana R Sousa
- Department of Pediatric Cardiology, Centro Hospitalar de Lisboa Ocidental EPE, Lisboa, Carnaxide, Portugal
| | | | - Rui Anjos
- Department of Pediatric Cardiology, Centro Hospitalar de Lisboa Ocidental EPE, Lisboa, Carnaxide, Portugal
| |
Collapse
|
23
|
Bachert C, Sousa AR, Han JK, Schlosser RJ, Sowerby LJ, Hopkins C, Maspero JF, Smith SG, Kante O, Karidi-Andrioti DE, Mayer B, Chan RH, Yancey SW, Chaker AM. Mepolizumab for chronic rhinosinusitis with nasal polyps: treatment efficacy by comorbidity and blood eosinophil count. J Allergy Clin Immunol 2022; 149:1711-1721.e6. [PMID: 35007624 DOI: 10.1016/j.jaci.2021.10.040] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [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: 06/27/2021] [Revised: 10/12/2021] [Accepted: 10/28/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND In the Phase III SYNAPSE study, mepolizumab reduced nasal polyp (NP) size and nasal obstruction in chronic rhinosinusitis with NP (CRSwNP). OBJECTIVE To assess the efficacy of mepolizumab in patients from SYNAPSE grouped by comorbid asthma, aspirin-exacerbated respiratory disease (AERD), and baseline blood eosinophil count (BEC). METHODS SYNAPSE, a randomized, double-blind, 52-week study (NCT03085797), included patients with severe bilateral CRSwNP eligible for surgery despite intranasal corticosteroid treatment. Patients received 4-weekly subcutaneous mepolizumab 100 mg or placebo plus standard of care for 52 weeks. Co-primary endpoints were change in total endoscopic NP score (Week 52) and nasal obstruction visual analog scale (VAS) score (Weeks 49-52). Subgroup analyses by comorbid asthma and AERD status, and post hoc by BEC, were exploratory. RESULTS Analyses included 407 patients (289 with asthma; 108 with AERD; 371 and 278 with BEC counts ≥150 or ≥300 cells/μL, respectively). The proportion of patients with ≥1-point improvement from baseline in NP score was higher with mepolizumab versus placebo across comorbid diseases (asthma: 52.9% vs 29.5%; AERD: 51.1% vs 20.6%) and baseline BEC subgroups (<150 cells/μL: 55.0% vs 31.3%; ≥150 cells/μL: 49.5% vs 28.1%; <300 cells/μL: 50.7% vs 29.0%; ≥300 cells/μL: 50.4% vs 28.1%). A similar trend was observed in patients without comorbid asthma or AERD. More patients had >3-point improvement in nasal obstruction VAS score with mepolizumab versus placebo across comorbid subgroups. CONCLUSION Mepolizumab reduced polyp size and nasal obstruction in CRSwNP regardless of the presence of comorbid asthma or AERD. CLINICAL IMPLICATION Mepolizumab should be considered for the treatment of CRSwNP, particularly in patients with comorbid asthma or AERD.
Collapse
Affiliation(s)
- Claus Bachert
- Upper Airways Research Laboratory and Department of Oto-Rhino-Laryngology, Ghent University and Ghent University Hospital, Ghent, Belgium; Division of ENT Diseases, CLINTEC, Karolinska Institute, University of Stockholm, Stockholm, Sweden; First Affiliated Hospital, Sun Yat-sen University, International Airway Research Center, Guangzhou, China
| | - Ana R Sousa
- Clinical Sciences, GSK R&D, Brentford, Middlesex, UK
| | - Joseph K Han
- Department of Otolaryngology, Head & Neck Surgery, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Rodney J Schlosser
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Leigh J Sowerby
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, ON, Canada
| | - Claire Hopkins
- ENT Department, Guys and St Thomas's Hospital, and King's College, London, UK
| | - Jorge F Maspero
- Allergy and Respiratory Research Unit, Fundación CIDEA, Buenos Aires, Argentina
| | - Steven G Smith
- Respiratory Therapeutic Area Unit, GSK, Research Triangle Park, NC, USA
| | - Oliver Kante
- Global Clinical Sciences and Delivery, GSK Munich, Germany
| | | | | | - Robert H Chan
- Clinical Sciences, GSK R&D, Brentford, Middlesex, UK
| | | | - Adam M Chaker
- Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, Department of Otolaryngology and Center for Allergy and Environment, Munich, Germany.
| |
Collapse
|
24
|
Abdel-Aziz MI, Vijverberg SJH, Neerincx AH, Brinkman P, Wagener AH, Riley JH, Sousa AR, Bates S, Wagers SS, De Meulder B, Auffray C, Wheelock ÅM, Bansal AT, Caruso M, Chanez P, Uddin M, Corfield J, Horvath I, Krug N, Musial J, Sun K, Shaw DE, Sandström T, Montuschi P, Fowler SJ, Lutter R, Djukanovic R, Howarth P, Skipp P, Sanak M, Adcock IM, Chung KF, Sterk PJ, Kraneveld AD, Maitland-van der Zee PharmD AH. A multi-omics approach to delineate sputum microbiome-associated asthma inflammatory phenotypes. Eur Respir J 2021; 59:13993003.02603-2021. [PMID: 34824056 DOI: 10.1183/13993003.02603-2021] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 10/11/2021] [Indexed: 12/06/2022]
Affiliation(s)
- Mahmoud I Abdel-Aziz
- Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands .,Department of Clinical Pharmacy, Faculty of Pharmacy, Assiut University, Assiut, Egypt
| | - Susanne J H Vijverberg
- Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Anne H Neerincx
- Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Paul Brinkman
- Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Ariane H Wagener
- Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - John H Riley
- Respiratory Therapeutic Unit, GlaxoSmithKline, Stockley Park, United Kingdom
| | - Ana R Sousa
- Respiratory Therapeutic Unit, GlaxoSmithKline, Stockley Park, United Kingdom
| | - Stewart Bates
- Respiratory Therapeutic Unit, GlaxoSmithKline, Stockley Park, United Kingdom
| | | | - Bertrand De Meulder
- European Institute for Systems Biology and Medicine, CIRI UMR5308, CNRS-ENS-UCBL-INSERM, Lyon, France
| | - Charles Auffray
- European Institute for Systems Biology and Medicine, CIRI UMR5308, CNRS-ENS-UCBL-INSERM, Lyon, France
| | - Åsa M Wheelock
- Respiratory Medicine Unit, Department of Medicine and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm, Sweden
| | - Aruna T Bansal
- Acclarogen Ltd, St John's Innovation Centre, Cambridge, United Kingdom
| | - Massimo Caruso
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - Pascal Chanez
- Département des Maladies Respiratoires APHM, U1067 INSERM, Aix Marseille Université Marseille, Marseille, France
| | - Mohib Uddin
- AstraZeneca BioPharmaceuticals R&D, Gothenburg, Sweden
| | - Julie Corfield
- AstraZeneca R&D, Mölndal, Sweden.,Areteva R&D, Nottingham, United Kingdom
| | - Ildiko Horvath
- Department of Public Health, Semmelweis University; National Koranyi Institute for Pulmonology, Budapest, Hungary
| | - Norbert Krug
- Fraunhofer Institute for Toxicology and Experimental Medicine Hannover, Hannover, Germany
| | - Jacek Musial
- Department of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Kai Sun
- Data Science Institute, South Kensington Campus, Imperial College London, London, United Kingdom
| | - Dominick E Shaw
- Respiratory Research Unit, University of Nottingham, Nottingham, United Kingdom
| | - Thomas Sandström
- Department of Public Health and Clinical Medicine, Department of Medicine, Respiratory Medicine Unit, Umeå University, Umeå, Sweden
| | - Paolo Montuschi
- Pharmacology, Faculty of Medicine, Catholic University of the Sacred Heart, Rome, Italy
| | - Stephen J Fowler
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, and Manchester Academic Health Science Centre and NIHR Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - René Lutter
- Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Experimental Immunology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Ratko Djukanovic
- NIHR Southampton Respiratory Biomedical Research Unit, Clinical and Experimental Sciences, and Human Development and Health, University of Southampton, Southampton, United Kingdom
| | - Peter Howarth
- NIHR Southampton Respiratory Biomedical Research Unit, Clinical and Experimental Sciences, and Human Development and Health, University of Southampton, Southampton, United Kingdom
| | - Paul Skipp
- Centre for Proteomic Research, Biological Sciences, University of Southampton, Southampton, United Kingdom
| | - Marek Sanak
- Department of Internal Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Ian M Adcock
- National Heart and Lung Institute, Imperial College London, and Royal Brompton and Harefield NHS Trust, London, United Kingdom
| | - Kian Fan Chung
- National Heart and Lung Institute, Imperial College London, and Royal Brompton and Harefield NHS Trust, London, United Kingdom
| | - Peter J Sterk
- Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Aletta D Kraneveld
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, the Netherlands
| | - Anke H Maitland-van der Zee PharmD
- Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Pediatric Respiratory Medicine, Emma Children's Hospital, Amsterdam UMC, Amsterdam, The Netherlands
| | | |
Collapse
|
25
|
Reinke SN, Naz S, Chaleckis R, Gallart-Ayala H, Kolmert J, Kermani NZ, Tiotiu A, Broadhurst DI, Lundqvist A, Olsson H, Ström M, Wheelock ÅM, Gómez C, Ericsson M, Sousa AR, Riley JH, Bates S, Scholfield J, Loza M, Baribaud F, Bakke PS, Caruso M, Chanez P, Fowler SJ, Geiser T, Howarth P, Horváth I, Krug N, Montuschi P, Behndig A, Singer F, Musial J, Shaw DE, Dahlén B, Hu S, Lasky-Su J, Sterk PJ, Chung KF, Djukanovic R, Dahlén SE, Adcock IM, Wheelock CE. Urinary metabotype of severe asthma evidences decreased carnitine metabolism independent of oral corticosteroid treatment in the U-BIOPRED study. Eur Respir J 2021; 59:13993003.01733-2021. [PMID: 34824054 PMCID: PMC9245194 DOI: 10.1183/13993003.01733-2021] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 10/28/2021] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Asthma is a heterogeneous disease with poorly defined phenotypes. Severe asthmatics often receive multiple treatments including oral corticosteroids (OCS). Treatment may modify the observed metabotype, rendering it challenging to investigate underlying disease mechanisms. Here, we aimed to identify dysregulated metabolic processes in relation to asthma severity and medication. METHODS Baseline urine was collected prospectively from healthy participants (n=100), mild-to-moderate asthmatics (n=87) and severe asthmatics (n=418) in the cross-sectional U-BIOPRED cohort; 12-18-month longitudinal samples were collected from severe asthmatics (n=305). Metabolomics data were acquired using high-resolution mass spectrometry and analysed using univariate and multivariate methods. RESULTS Ninety metabolites were identified, with 40 significantly altered (p<0.05, FDR<0.05) in severe asthma and 23 by OCS use. Multivariate modelling showed that observed metabotypes in healthy participants and mild-to-moderate asthmatics differed significantly from severe asthmatics (p=2.6×10-20), OCS-treated asthmatics differed significantly from non-treated (p=9.5×10-4), and longitudinal metabotypes demonstrated temporal stability. Carnitine levels evidenced the strongest OCS-independent decrease in severe asthma. Reduced carnitine levels were associated with mitochondrial dysfunction via decreases in pathway enrichment scores of fatty acid metabolism and reduced expression of the carnitine transporter SLC22A5 in sputum and bronchial brushings. CONCLUSIONS This is the first large-scale study to delineate disease- and OCS-associated metabolic differences in asthma. The widespread associations with different therapies upon the observed metabotypes demonstrate the necessity to evaluate potential modulating effects on a treatment- and metabolite-specific basis. Altered carnitine metabolism is a potentially actionable therapeutic target that is independent of OCS treatment, highlighting the role of mitochondrial dysfunction in severe asthma.
Collapse
Affiliation(s)
- Stacey N Reinke
- Division of Physiological Chemistry 2, Department of Medical Biochemistry and Biophysics, Karolinska Institute, Stockholm, Sweden.,Centre for Integrative Metabolomics & Computational Biology, School of Science, Edith Cowan University, Perth, Australia.,equal contribution
| | - Shama Naz
- Division of Physiological Chemistry 2, Department of Medical Biochemistry and Biophysics, Karolinska Institute, Stockholm, Sweden.,equal contribution
| | - Romanas Chaleckis
- Division of Physiological Chemistry 2, Department of Medical Biochemistry and Biophysics, Karolinska Institute, Stockholm, Sweden.,Gunma Initiative for Advanced Research (GIAR), Gunma University, Maebashi, Japan
| | - Hector Gallart-Ayala
- Division of Physiological Chemistry 2, Department of Medical Biochemistry and Biophysics, Karolinska Institute, Stockholm, Sweden
| | - Johan Kolmert
- Division of Physiological Chemistry 2, Department of Medical Biochemistry and Biophysics, Karolinska Institute, Stockholm, Sweden.,The Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | - Angelica Tiotiu
- National Heart and Lung Institute, Imperial College, London, U.K.,Department of Pulmonology, University Hospital of Nancy, Nancy, France
| | - David I Broadhurst
- Centre for Integrative Metabolomics & Computational Biology, School of Science, Edith Cowan University, Perth, Australia
| | - Anders Lundqvist
- Respiratory & Immunology, BioPharmaceuticals R&D, DMPK, Research and Early Development, AstraZeneca, Gothenburg, Sweden
| | - Henric Olsson
- Translational Science and Experimental Medicine, Research and Early Development, AstraZeneca, Gothenburg, Sweden
| | - Marika Ström
- Respiratory Medicine Unit, K2 Department of Medicine Solna and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm, Sweden
| | - Åsa M Wheelock
- Respiratory Medicine Unit, K2 Department of Medicine Solna and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm, Sweden
| | - Cristina Gómez
- Division of Physiological Chemistry 2, Department of Medical Biochemistry and Biophysics, Karolinska Institute, Stockholm, Sweden.,The Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Ericsson
- Department of Clinical Pharmacology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | | | | | | | - James Scholfield
- Faculty of Medicine, Southampton University and NIHR Southampton Respiratory Biomedical Research Center, University Hospital Southampton, Southampton, U.K
| | - Matthew Loza
- Janssen Research and Development, High Wycombe, U.K
| | | | - Per S Bakke
- Institute of Medicine, University of Bergen, Bergen, Norway
| | - Massimo Caruso
- Department of Biomedical and Biotechnological Sciences and Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Pascal Chanez
- Assistance Publique des Hôpitaux de Marseille, Clinique des Bronches, Allergies et Sommeil, Aix Marseille Université, Marseille, France
| | - Stephen J Fowler
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, School of Biological Sciences, Medicine and Health, University of Manchester, and Manchester Academic Health Science Centre and NIHR Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, U.K
| | - Thomas Geiser
- Department of Pulmonary Medicine, University Hospital, University of Bern, Switzerland
| | - Peter Howarth
- Faculty of Medicine, Southampton University and NIHR Southampton Respiratory Biomedical Research Center, University Hospital Southampton, Southampton, U.K
| | - Ildikó Horváth
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Norbert Krug
- Fraunhofer Institute for Toxicology and Experimental Medicine, Hannover, Germany
| | - Paolo Montuschi
- Pharmacology, Catholic University of the Sacred Heart, Rome, Italy
| | - Annelie Behndig
- Department of Public Health and Clinical Medicine, Section of Medicine, Umeå University, Umeå, Sweden
| | - Florian Singer
- Division of Paediatric Respiratory Medicine and Allergology, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Jacek Musial
- Dept of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Dominick E Shaw
- Nottingham NIHR Biomedical Research Centre, University of Nottingham, U.K
| | - Barbro Dahlén
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm, Sweden
| | - Sile Hu
- Data Science Institute, Imperial College, London, U.K
| | - Jessica Lasky-Su
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Peter J Sterk
- Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Kian Fan Chung
- National Heart and Lung Institute, Imperial College, London, U.K
| | - Ratko Djukanovic
- Faculty of Medicine, Southampton University and NIHR Southampton Respiratory Biomedical Research Center, University Hospital Southampton, Southampton, U.K
| | - Sven-Erik Dahlén
- The Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm, Sweden
| | - Ian M Adcock
- National Heart and Lung Institute, Imperial College, London, U.K
| | - Craig E Wheelock
- Division of Physiological Chemistry 2, Department of Medical Biochemistry and Biophysics, Karolinska Institute, Stockholm, Sweden .,Gunma Initiative for Advanced Research (GIAR), Gunma University, Maebashi, Japan.,Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm, Sweden
| | | |
Collapse
|
26
|
Han JK, Bachert C, Fokkens W, Desrosiers M, Wagenmann M, Lee SE, Smith SG, Martin N, Mayer B, Yancey SW, Sousa AR, Chan R, Hopkins C. Mepolizumab for chronic rhinosinusitis with nasal polyps (SYNAPSE): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Respir Med 2021; 9:1141-1153. [PMID: 33872587 DOI: 10.1016/s2213-2600(21)00097-7] [Citation(s) in RCA: 226] [Impact Index Per Article: 75.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/29/2021] [Accepted: 02/11/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Chronic rhinosinusitis with nasal polyps affects approximately 2-4% of the general population, and long-term use of systemic corticosteroids is associated with adverse effects. The aim of this study was to assess the efficacy and safety of mepolizumab in adults with recurrent, refractory severe bilateral chronic rhinosinusitis with nasal polyps. METHODS SYNAPSE was a randomised, double-blind, placebo-controlled, parallel-group, phase 3 trial done at 93 centres, mainly hospitals, in 11 countries. Eligible patients were aged 18 years or older with recurrent, refractory, severe, bilateral nasal polyp symptoms (nasal obstruction symptom visual analogue scale [VAS] score of >5), were eligible for repeat nasal surgery (overall symptoms VAS score >7 and endoscopic nasal polyps score of ≥5, with a minimum score of 2 in each nasal cavity) despite standard of care treatment, and had to have at least one nasal surgery in the past 10 years. Patients were randomly assigned (1:1), using permuted block design, to receive either 100 mg mepolizumab subcutaneously or placebo once every 4 weeks, in addition to standard of care (mometasone furoate intranasal spray for at least 8 weeks before screening and during the study, saline nasal irrigations, systemic corticosteroids or antibiotics, or both), as required, for 52 weeks. Site staff, the central study team, and patients were masked to study treatment and absolute blood eosinophil counts. The coprimary endpoints were change from baseline in total endoscopic nasal polyp score at week 52 and in mean nasal obstruction VAS score during weeks 49-52, assessed in the intention-to-treat population (ITT). This study is registered with ClinicalTrials.gov, NCT03085797. FINDINGS From May 25, 2017, to Dec 12, 2018, 854 patients were screened for eligibility. 414 patients were randomly assigned with 407 included in the ITT population; 206 received mepolizumab and 201 received placebo. Total endoscopic nasal polyp score significantly improved at week 52 from baseline with mepolizumab versus placebo (adjusted difference in medians -0·73, 95% CI -1·11 to -0·34; p<0·0001) and nasal obstruction VAS score during weeks 49-52 also significantly improved (-3·14, -4·09 to -2·18; p<0·0001). Adverse events considered related to study treatment were reported in 30 (15%) of 206 patients receiving mepolizumab and 19 (9%) of 201 receiving placebo. On-treatment serious adverse events occurred in 12 (6%) patients receiving mepolizumab and 13 (6%) receiving placebo; none were considered related to treatment in those receiving mepolizumab. One death was reported in the placebo group (myocardial infarction; death occurred 99 days after the last dose) and was considered unrelated to the treatment. INTERPRETATION Mepolizumab treatment improved nasal polyp size and nasal obstruction compared with placebo, with no new safety indications, in patients with recurrent, refractory severe chronic rhinosinusitis with nasal polyps. These findings suggest that mepolizumab provides an effective add-on treatment option to standard of care in this population. FUNDING GlaxoSmithKline.
Collapse
Affiliation(s)
- Joseph K Han
- Department of Otolaryngology, Eastern Virginia Medical School, Norfolk, VA, USA.
| | - Claus Bachert
- Department of Oto-Rhino-Laryngology, Upper Airways Research Laboratory, Ghent University Hospital, Ghent University, Ghent, Belgium; Division of ENT Diseases, CLINTEC, Karolinska Institutet, University of Stockholm, Stockholm, Sweden
| | - Wytske Fokkens
- Department of Otolaryngology, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Martin Desrosiers
- Division of Otolaryngology-Head and Neck Surgery, Centre Hospitalier de l'University de Montreal, Montreal, QC, Canada
| | - Martin Wagenmann
- Department of Otorhinolaryngology, HNO-Klinik, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Stella E Lee
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Steven G Smith
- Respiratory Therapeutic Area Unit, GlaxoSmithKline, Research Triangle Park, NC, USA
| | | | | | - Steven W Yancey
- Respiratory Therapeutic Area Unit, GlaxoSmithKline, Research Triangle Park, NC, USA
| | | | | | - Claire Hopkins
- Department of ENT, Guy's Hospital, London, UK; St Thomas' Hospital, King's College London, London, UK
| |
Collapse
|
27
|
Alahmadi FH, Simpson AJ, Gomez C, Ericsson M, Thörngren JO, Wheelock CE, Shaw DE, Fleming LJ, Roberts G, Riley J, Bates S, Sousa AR, Knowles R, Bansal AT, Corfield J, Pandis I, Sun K, Bakke PS, Caruso M, Chanez P, Dahlén B, Horvath I, Krug N, Montuschi P, Singer F, Wagers S, Adcock IM, Djukanovic R, Chung KF, Sterk PJ, Dahlen SE, Fowler SJ. Medication Adherence in Patients With Severe Asthma Prescribed Oral Corticosteroids in the U-BIOPRED Cohort. Chest 2021; 160:53-64. [PMID: 33610577 DOI: 10.1016/j.chest.2021.02.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 01/22/2021] [Accepted: 02/02/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Although estimates of suboptimal adherence to oral corticosteroids in asthma range from 30% to 50%, no ideal method for measurement exists; the impact of poor adherence in severe asthma is likely to be particularly high. RESEARCH QUESTIONS What is the prevalence of suboptimal adherence detected by self-reporting and direct measures? Is suboptimal adherence associated with disease activity? STUDY DESIGN AND METHODS Data were included from individuals with severe asthma taking part in the U-BIOPRED (Unbiased Biomarkers for the Prediction of Respiratory Disease Outcomes) study and prescribed daily oral corticosteroids. Participants completed the Medication Adherence Report Scale, a five-item questionnaire used to grade adherence on a scale from 1 to 5, and provided a urine sample for analysis of prednisolone and metabolites by liquid chromatography-mass spectrometry. RESULTS Data from 166 participants were included in this study: mean (SD) age, 54.2 (± 11.9) years; FEV1, 65.1% (± 20.5%) predicted; female, 58%; 37% completing the Medication Adherence Report Scale reported suboptimal adherence; and 43% with urinary corticosteroid data did not have detectable prednisolone or metabolites in their urine. Good adherence by both methods was detected in 49 of the 142 (35%) of participants in whom both methods were performed; adherence detection did not match between methods in 53%. Self-reported high adherers had better asthma control and quality of life, whereas directly measured high adherers had lower blood eosinophil levels. INTERPRETATION Low adherence is a common problem in severe asthma, whether measured directly or self-reported. We report poor agreement between the two methods, suggesting some disassociation between self-assessment of medication adherence and regular oral corticosteroid use, which suggests that each approach may provide complementary information in clinical practice.
Collapse
Affiliation(s)
- Fahad H Alahmadi
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, University of Manchester, and Manchester Academic Health Science Centre and NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, England; Respiratory Therapy Department, College of Medical Rehabilitation Sciences, Taibah University, Medina, Saudi Arabia
| | - Andrew J Simpson
- Division of Sport, Health and Exercise Science, University of Hull, Hull, England
| | - Cristina Gomez
- The Centre for Allergy Research, The Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Division of Physiological Chemistry II, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Ericsson
- The Doping Laboratory, The Department of Laboratory Medicine at the Karolinska University Hospital Huddinge, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - John-Olof Thörngren
- The Doping Laboratory, The Department of Laboratory Medicine at the Karolinska University Hospital Huddinge, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Craig E Wheelock
- Division of Physiological Chemistry II, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm, Sweden; Department of Respiratory Medicine and Allergy, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Dominic E Shaw
- Respiratory Research Unit, University of Nottingham, Nottingham, England
| | - Louise J Fleming
- National Heart and Lung Institute, Imperial College London, London, England
| | - Graham Roberts
- NIHR Southampton Respiratory Biomedical Research Unit, Clinical and Experimental Sciences and Human Development and Health, Southampton, England
| | - John Riley
- Respiratory Therapeutic Unit, GlaxoSmithKline, Stockley Park, London, England
| | - Stewart Bates
- Respiratory Therapeutic Unit, GlaxoSmithKline, Stockley Park, London, England
| | - Ana R Sousa
- Respiratory Therapeutic Unit, GlaxoSmithKline, Stockley Park, London, England
| | | | - Aruna T Bansal
- Acclarogen Ltd, St John's Innovation Centre, Cambridge, England
| | | | - Ioannis Pandis
- Data Science Institute, South Kensington Campus, Imperial College London, London, England
| | - Kai Sun
- Data Science Institute, South Kensington Campus, Imperial College London, London, England
| | - Per S Bakke
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Massimo Caruso
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Pascal Chanez
- Assistance Publique-Hôpitaux de Marseille, Clinique des Bronches, de l'Allergie et du Sommeil CIC Nord, Aix-Marseille Université, Marseille, France
| | - Barbro Dahlén
- Division of Respiratory Medicine and Allergy, Department of Medicine, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Ildiko Horvath
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Norbert Krug
- Fraunhofer Institute for Toxicology and Experimental Medicine, Hannover, Germany
| | | | - Florian Singer
- Division of Respiratory Medicine, Department of Pediatrics, Inselspital University Hospital Bern, University of Bern, Switzerland
| | | | - Ian M Adcock
- National Heart and Lung Institute, Imperial College London, London, England
| | - Ratko Djukanovic
- NIHR Southampton Respiratory Biomedical Research Unit, Clinical and Experimental Sciences and Human Development and Health, Southampton, England
| | - Kian Fan Chung
- National Heart and Lung Institute, Imperial College London, London, England
| | - Peter J Sterk
- Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Sven-Erik Dahlen
- The Centre for Allergy Research, The Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Stephen J Fowler
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, University of Manchester, and Manchester Academic Health Science Centre and NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, England.
| |
Collapse
|
28
|
Kermani NZ, Pavlidis S, Xie J, Sun K, Loza M, Baribaud F, Fowler SJ, Shaw DE, Fleming LJ, Howarth PH, Sousa AR, Corfield J, Auffray C, De Meulder B, Sterk PJ, Guo Y, Uddin M, Djukanovic R, Adcock IM, Chung KF. Instability of sputum molecular phenotypes in U-BIOPRED severe asthma. Eur Respir J 2021; 57:13993003.01836-2020. [PMID: 33008937 PMCID: PMC7859503 DOI: 10.1183/13993003.01836-2020] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 08/27/2020] [Indexed: 11/24/2022]
Abstract
The Unbiased Biomarkers for the Prediction of Respiratory Disease Outcomes (U-BIOPRED) project has described phenotypic differences of severe asthma using a systems biology approach. We obtained three molecular phenotypes termed transcription-associated clusters (TACs) using hierarchical clustering of differentially expressed transcripts between T2-high and T2-low [1]. TAC1 was characterised by receptors IL33R, CCR3 and TSLPR, with the highest enrichment of gene signatures for IL-13/type-2 (T2) inflammation with sputum eosinophilia; TAC2 by inflammasome-associated genes, interferon-α (IFN-α) and tumour necrosis factor-α (TNF-α)-associated genes with sputum neutrophilia; and TAC3 by metabolic and mitochondrial function genes with pauci-granulocytic inflammation. Given that sputum eosinophilia may vary with time in many asthmatic subjects [2, 3], we hypothesised that TAC status may also change with time. At 1 year, 45% of severe asthma change molecular phenotype as determined by sputum transcriptomic analysis. Together with concomitant shift in sputum granulocytic markers, this may indicate variability of driving mechanisms in this unstable group.https://bit.ly/35aj489
Collapse
Affiliation(s)
- Nazanin Z Kermani
- Dept of Computing and Data Science Institute, Imperial College London, London, UK
| | - Stelios Pavlidis
- Dept of Computing and Data Science Institute, Imperial College London, London, UK.,National Heart and Lung Institute, Imperial College London, and Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, UK
| | - Jiaxing Xie
- National Heart and Lung Institute, Imperial College London, and Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, UK
| | - Kai Sun
- Dept of Computing and Data Science Institute, Imperial College London, London, UK
| | - Matthew Loza
- Janssen Research and Development, High Wycombe, UK
| | | | - Steve J Fowler
- Centre for Respiratory Medicine and Allergy, Institute of Inflammation and Repair, University of Manchester and University Hospital of South Manchester, Manchester, UK
| | - Dominic E Shaw
- Respiratory Research Unit, University of Nottingham, Nottingham, UK
| | - Louise J Fleming
- National Heart and Lung Institute, Imperial College London, and Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, UK
| | - Peter H Howarth
- NIHR Southampton Respiratory Biomedical Research Unit, Clinical and Experimental Sciences and Human Development and Health, Southampton, UK
| | - Ana R Sousa
- Respiratory Therapeutic Unit, GSK, Stockley Park, UK
| | - Julie Corfield
- AstraZeneca R&D, Molndal, Sweden.,Areteva R&D, Nottingham, UK
| | - Charles Auffray
- European Institute for Systems Biology and Medicine, CNRS-ENS-UCBL-INSERM, Lyon, France
| | - Bertrand De Meulder
- European Institute for Systems Biology and Medicine, CNRS-ENS-UCBL-INSERM, Lyon, France
| | - Peter J Sterk
- Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Yike Guo
- Dept of Computing and Data Science Institute, Imperial College London, London, UK
| | - Mohib Uddin
- Respiratory Global Medicines Development, AstraZeneca, Gothenburg, Sweden
| | - Ratko Djukanovic
- NIHR Southampton Respiratory Biomedical Research Unit, Clinical and Experimental Sciences and Human Development and Health, Southampton, UK
| | - Ian M Adcock
- Dept of Computing and Data Science Institute, Imperial College London, London, UK.,National Heart and Lung Institute, Imperial College London, and Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, UK
| | - Kian Fan Chung
- Dept of Computing and Data Science Institute, Imperial College London, London, UK.,National Heart and Lung Institute, Imperial College London, and Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, UK
| | | |
Collapse
|
29
|
Gorlanova O, Tischhauser E, Adcock IM, Chung KF, Fleming L, Meier D, Sterk PJ, Roberts G, Roberts A, Singer F, Sousa AR, Uddin M, Frey U. Discordant use of short-acting β 2 agonists in children and adults with severe, uncontrolled asthma from the U-BIOPRED cohort. Pediatr Pulmonol 2021; 56:338-340. [PMID: 33231935 DOI: 10.1002/ppul.25171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 09/27/2020] [Accepted: 11/03/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Olga Gorlanova
- Department of Pulmonology, University Children's Hospital (UKBB), University of Basel, Basel, Switzerland
| | - Eveline Tischhauser
- Department of Pulmonology, University Children's Hospital (UKBB), University of Basel, Basel, Switzerland
| | - Ian M Adcock
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Kian Fan Chung
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Louise Fleming
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Delphine Meier
- Department of Pulmonology, University Children's Hospital (UKBB), University of Basel, Basel, Switzerland
| | - Peter J Sterk
- Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Graham Roberts
- Clinical and Experimental Sciences and Human Development and Health, Faculty of Medicine, University of Southampton, UK and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - Florian Singer
- Department of Paediatric Respiratory Medicine, Children's University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Ana R Sousa
- Respiratory Therapeutic Unit, GSK, London, UK
| | - Mohib Uddin
- Respiratory Global Medicines Development, AstraZeneca BioPharmaceuticals R&D, Gothenburg, Sweden
| | - Urs Frey
- Department of Pulmonology, University Children's Hospital (UKBB), University of Basel, Basel, Switzerland
| | | |
Collapse
|
30
|
Kolmert J, Gómez C, Balgoma D, Sjödin M, Bood J, Konradsen JR, Ericsson M, Thörngren JO, James A, Mikus M, Sousa AR, Riley JH, Bates S, Bakke PS, Pandis I, Caruso M, Chanez P, Fowler SJ, Geiser T, Howarth P, Horváth I, Krug N, Montuschi P, Sanak M, Behndig A, Shaw DE, Knowles RG, Holweg CTJ, Wheelock ÅM, Dahlén B, Nordlund B, Alving K, Hedlin G, Chung KF, Adcock IM, Sterk PJ, Djukanovic R, Dahlén SE, Wheelock CE. Urinary Leukotriene E 4 and Prostaglandin D 2 Metabolites Increase in Adult and Childhood Severe Asthma Characterized by Type 2 Inflammation. A Clinical Observational Study. Am J Respir Crit Care Med 2021; 203:37-53. [PMID: 32667261 PMCID: PMC7781128 DOI: 10.1164/rccm.201909-1869oc] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [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: 01/09/2023] Open
Abstract
Rationale: New approaches are needed to guide personalized treatment of asthma.Objectives: To test if urinary eicosanoid metabolites can direct asthma phenotyping.Methods: Urinary metabolites of prostaglandins (PGs), cysteinyl leukotrienes (CysLTs), and isoprostanes were quantified in the U-BIOPRED (Unbiased Biomarkers for the Prediction of Respiratory Diseases Outcomes) study including 86 adults with mild-to-moderate asthma (MMA), 411 with severe asthma (SA), and 100 healthy control participants. Validation was performed internally in 302 participants with SA followed up after 12-18 months and externally in 95 adolescents with asthma.Measurement and Main Results: Metabolite concentrations in healthy control participants were unrelated to age, body mass index, and sex, except for the PGE2 pathway. Eicosanoid concentrations were generally greater in participants with MMA relative to healthy control participants, with further elevations in participants with SA. However, PGE2 metabolite concentrations were either the same or lower in male nonsmokers with asthma than in healthy control participants. Metabolite concentrations were unchanged in those with asthma who adhered to oral corticosteroid treatment as documented by urinary prednisolone detection, whereas those with SA treated with omalizumab had lower concentrations of LTE4 and the PGD2 metabolite 2,3-dinor-11β-PGF2α. High concentrations of LTE4 and PGD2 metabolites were associated with lower lung function and increased amounts of exhaled nitric oxide and eosinophil markers in blood, sputum, and urine in U-BIOPRED participants and in adolescents with asthma. These type 2 (T2) asthma associations were reproduced in the follow-up visit of the U-BIOPRED study and were found to be as sensitive to detect T2 inflammation as the established biomarkers.Conclusions: Monitoring of urinary eicosanoids can identify T2 asthma and introduces a new noninvasive approach for molecular phenotyping of adult and adolescent asthma.Clinical trial registered with www.clinicaltrials.gov (NCT01976767).
Collapse
Affiliation(s)
- Johan Kolmert
- The Institute of Environmental Medicine.,Division of Physiological Chemistry II, Department of Medical Biochemistry and Biophysics.,The Center for Allergy Research
| | - Cristina Gómez
- The Institute of Environmental Medicine.,Division of Physiological Chemistry II, Department of Medical Biochemistry and Biophysics.,The Center for Allergy Research
| | - David Balgoma
- The Institute of Environmental Medicine.,Division of Physiological Chemistry II, Department of Medical Biochemistry and Biophysics.,The Center for Allergy Research
| | - Marcus Sjödin
- The Institute of Environmental Medicine.,Division of Physiological Chemistry II, Department of Medical Biochemistry and Biophysics.,The Center for Allergy Research
| | - Johan Bood
- The Institute of Environmental Medicine.,The Center for Allergy Research.,Department of Women's and Children's Health, and
| | - Jon R Konradsen
- The Center for Allergy Research.,Respiratory Medicine Unit, Department of Medicine, Solna Campus, and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Medicine and
| | - Magnus Ericsson
- Department of Clinical Pharmacology, Huddinge Campus, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - John-Olof Thörngren
- Department of Clinical Pharmacology, Huddinge Campus, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Anna James
- The Institute of Environmental Medicine.,The Center for Allergy Research
| | - Maria Mikus
- The Institute of Environmental Medicine.,The Center for Allergy Research
| | - Ana R Sousa
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - John H Riley
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Stewart Bates
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | | | - Ioannis Pandis
- Institute of Medicine, University of Bergen, Bergen, Norway
| | - Massimo Caruso
- National Heart and Lung Institute and Department of Computing & Data Science Institute, Imperial College London, London, United Kingdom.,Department of Clinical and Experimental Medicine and
| | - Pascal Chanez
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - Stephen J Fowler
- Clinique des Bronches, Allergies et Sommeil, Aix Marseille Université, Assistance Publique des Hôpitaux de Marseille, Marseille, France
| | - Thomas Geiser
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, and Manchester Academic Health Science Centre and National Institute for Health Research Biomedical Research Centre, Manchester University Hospitals National Health Service Foundation Trust, Manchester, United Kingdom
| | - Peter Howarth
- Department of Pulmonary Medicine, University Hospital Bern, Bern, Switzerland
| | - Ildikó Horváth
- Faculty of Medicine, Southampton University, and National Institute for Health Research Southampton Respiratory Biomedical Research Center, University Hospital Southampton, Southampton, United Kingdom
| | - Norbert Krug
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Paolo Montuschi
- Fraunhofer Institute for Toxicology and Experimental Medicine, Hannover, Germany
| | - Marek Sanak
- Department of Pharmacology, Catholic University of the Sacred Heart, and Agostino Gemelli University Hospital Foundation, IRCCS, Rome, Italy
| | - Annelie Behndig
- Department of Internal Medicine, Medical College, Jagiellonian University, Cracow, Poland
| | - Dominick E Shaw
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Richard G Knowles
- Nottingham National Institute for Health Research Biomedical Research Centre, University of Nottingham, United Kingdom
| | - Cécile T J Holweg
- Knowles Consulting, Stevenage Bioscience Catalyst, Stevenage, United Kingdom
| | | | - Barbro Dahlén
- The Center for Allergy Research.,Department of Women's and Children's Health, and
| | - Björn Nordlund
- Respiratory Medicine Unit, Department of Medicine, Solna Campus, and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Medicine and
| | - Kjell Alving
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; and
| | - Gunilla Hedlin
- The Center for Allergy Research.,Respiratory Medicine Unit, Department of Medicine, Solna Campus, and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Medicine and
| | - Kian Fan Chung
- Institute of Medicine, University of Bergen, Bergen, Norway
| | - Ian M Adcock
- Institute of Medicine, University of Bergen, Bergen, Norway
| | - Peter J Sterk
- Department of Respiratory Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Ratko Djukanovic
- Department of Pulmonary Medicine, University Hospital Bern, Bern, Switzerland
| | - Sven-Erik Dahlén
- The Institute of Environmental Medicine.,The Center for Allergy Research
| | - Craig E Wheelock
- Division of Physiological Chemistry II, Department of Medical Biochemistry and Biophysics.,The Center for Allergy Research
| | | |
Collapse
|
31
|
Wilson SJ, Ward JA, Pickett HM, Baldi S, Sousa AR, Sterk PJ, Chung KF, Djukanovic R, Dahlen B, Billing B, Shaw D, Krug N, Sandstrӧm T, Brightling C, Howarth PH. Airway Elastin is increased in severe asthma and relates to proximal wall area: histological and computed tomography findings from the U-BIOPRED severe asthma study. Clin Exp Allergy 2021; 51:296-304. [PMID: 33342006 DOI: 10.1111/cea.13813] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 12/08/2020] [Accepted: 12/15/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Airway remodelling, which may include goblet cell hyperplasia / hypertrophy, changes in epithelial integrity, accumulation of extracellular matrix components, smooth muscle hypertrophy and thickening of the lamina reticularis, is a feature of severe asthma and contributes to the clinical phenotype. OBJECTIVE Within the U-BIOPRED severe asthma study, we have assessed histological elements of airway remodelling and their relationship to computed tomography (CT) measures of proximal airway dimensions. METHODS Bronchial biopsies were collected from two severe asthma groups, one non-smoker (SAn, n = 28) and one current/ex-smoker (SAs/ex, n = 13), and a mild-moderate asthma group (MMA, n = 28) classified and treated according to GINA guidelines, plus a healthy control group (HC, n = 33). Movat's pentachrome technique was used to identify mucin, elastin and total collagen in these biopsies. The number of goblet cells (mucin+) was counted as a percentage of the total number of epithelial cells and the percentage mucin epithelial area measured. The percentage area of elastic fibres and total collagen within the submucosa was also measured, and the morphology of the elastic fibres classified. Participants in the asthma groups also had a CT scan to assess large airway morphometry. RESULTS The submucosal tissue elastin percentage was higher in both severe asthma groups (16.1% SAn, 18.9% SAs/ex) compared with the HC (9.7%) but did not differ between asthma groups. There was a positive relationship between elastin and airway wall area measured by CT (n = 18-20, rho=0.544, p = 0.024), which also related to an increase in elastic fibres with a thickened lamellar morphological appearance. Mucin epithelial area and total collagen were not different between the four groups. Due to small numbers of suitable CT scans, it was not feasible to compare airway morphometry between the asthma groups. CONCLUSION These findings identify a link between extent of elastin deposition and airway wall thickening in severe asthma.
Collapse
Affiliation(s)
- Susan J Wilson
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Jonathan A Ward
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Helen M Pickett
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Simonetta Baldi
- Department of Respiratory Science, University of Leicester, Leicester, UK
| | - Ana R Sousa
- Respiratory Therapy Unit, GlaxoSmithKline, Stevenage, UK
| | - Peter J Sterk
- Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Kian Fan Chung
- National Heart & Lung Institute, Imperial College London, London, UK
| | | | - Barbro Dahlen
- Department of Respiratory Medicine and Allergy, The Centre for Allergy Research, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Bo Billing
- Department of Respiratory Medicine and Allergy, The Centre for Allergy Research, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Dominick Shaw
- Nottingham Respiratory Research, University of Nottingham, Nottingham, UK
| | - Norbert Krug
- Fraunhofer Institute of Toxicology & Experimental Medicine, Hannover, Germany
| | - Thomas Sandstrӧm
- Department of Respiratory Medicine, Umea University, Stockholm, Sweden
| | | | - Peter H Howarth
- Faculty of Medicine, University of Southampton, Southampton, UK
| | | |
Collapse
|
32
|
Zounemat Kermani N, Saqi M, Agapow P, Pavlidis S, Kuo C, Tan KS, Mumby S, Sun K, Loza M, Baribaud F, Sousa AR, Riley J, Wheelock AM, Wheelock CE, De Meulder B, Schofield J, Sánchez‐Ovando S, Simpson JL, Baines KJ, Wark PA, Auffray C, Dahlen S, Sterk PJ, Djukanovic R, Adcock IM, Guo Y, Chung KF. Type 2-low asthma phenotypes by integration of sputum transcriptomics and serum proteomics. Allergy 2021; 76:380-383. [PMID: 32865817 DOI: 10.1111/all.14573] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 08/17/2020] [Accepted: 08/20/2020] [Indexed: 12/27/2022]
Affiliation(s)
| | - Mansoor Saqi
- Department of Computing & Data Science Institute Imperial College London London UK
| | - Paul Agapow
- Department of Computing & Data Science Institute Imperial College London London UK
| | - Stelios Pavlidis
- Department of Computing & Data Science Institute Imperial College London London UK
| | - Chihhsi Kuo
- Department of Computing & Data Science Institute Imperial College London London UK
- National Heart & Lung Institute Imperial College London London UK
| | - Kai Sen Tan
- Department of Otolaryngology National University of Singapore Singapore Singapore
| | - Sharon Mumby
- National Heart & Lung Institute Imperial College London London UK
| | - Kai Sun
- Department of Computing & Data Science Institute Imperial College London London UK
| | - Matthew Loza
- Janssen Research and Development High Wycombe UK
| | | | - Ana R. Sousa
- Respiratory Therapeutic Unit, GSK Stockley Park UK
| | - John Riley
- Respiratory Therapeutic Unit, GSK Stockley Park UK
| | - Asa M. Wheelock
- Department of Medicine Solna & Center for Molecular Medicine & Department of Medical Biochemistry and Biophysics Karolinska Institute Stockholm Sweden
| | - Craig E. Wheelock
- Department of Medicine Solna & Center for Molecular Medicine & Department of Medical Biochemistry and Biophysics Karolinska Institute Stockholm Sweden
| | - Bertrand De Meulder
- European Institute for Systems Biology and Medicine CNRS‐ENS‐UCBL‐INSERM Lyon France
| | - Jim Schofield
- Faculty of Medicine Southampton University Southampton UK
- NIHR Southampton Respiratory Biomedical Research Unit University Hospital Southampton Southampton UK
| | - Stephany Sánchez‐Ovando
- Priority Research Centre for Healthy Lungs Faculty of Health and Medicine University of Newcastle Newcastle NSW Australia
| | - Jodie Louise Simpson
- Priority Research Centre for Healthy Lungs Faculty of Health and Medicine University of Newcastle Newcastle NSW Australia
| | - Katherine Joanne Baines
- Priority Research Centre for Healthy Lungs Faculty of Health and Medicine University of Newcastle Newcastle NSW Australia
| | - Peter A. Wark
- Priority Research Centre for Healthy Lungs Faculty of Health and Medicine University of Newcastle Newcastle NSW Australia
| | - Charles Auffray
- European Institute for Systems Biology and Medicine CNRS‐ENS‐UCBL‐INSERM Lyon France
| | - Sven‐Erik Dahlen
- Department of Medicine Solna & Center for Molecular Medicine & Department of Medical Biochemistry and Biophysics Karolinska Institute Stockholm Sweden
| | - Peter J. Sterk
- Amsterdam University Medical Centers University of Amsterdam Amsterdam The Netherlands
| | - Ratko Djukanovic
- Faculty of Medicine Southampton University Southampton UK
- NIHR Southampton Respiratory Biomedical Research Unit University Hospital Southampton Southampton UK
| | - Ian M. Adcock
- Department of Computing & Data Science Institute Imperial College London London UK
- National Heart & Lung Institute Imperial College London London UK
| | - Yi‐ke Guo
- Department of Computing & Data Science Institute Imperial College London London UK
| | - Kian Fan Chung
- Department of Computing & Data Science Institute Imperial College London London UK
- National Heart & Lung Institute Imperial College London London UK
| | | |
Collapse
|
33
|
Hall R, Trennery C, Chan R, Gater A, Bradley H, Sikirica MV, von Maltzahn R, Sousa AR, Nelsen LM. Understanding the Patient Experience of Severe, Recurrent, Bilateral Nasal Polyps: A Qualitative Interview Study in the United States and Germany. Value Health 2020; 23:632-641. [PMID: 32389229 DOI: 10.1016/j.jval.2019.11.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 10/17/2019] [Accepted: 11/07/2019] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To qualitatively explore patient experiences of severe, recurrent, bilateral nasal polyps (NP). METHODS A targeted literature review of published qualitative studies and online blogs describing patient experiences of NP was conducted. Semistructured concept elicitation interviews were conducted in the United States and Germany with participants ≥18 years with severe, recurrent, bilateral NP to explore their symptom experience and impacts on health-related quality of life (HRQoL; NCT03221192). A subset of 10 participants reported symptoms and impacts using a smartphone or tablet application (app) over a 10-day period. RESULTS A paucity of qualitative evidence regarding patient experience of NP was identified from the literature or blog review. Twenty-seven participant interviews were conducted. Thirty-six symptoms were identified, including 7 primary symptoms (nasal congestion [n = 27 of 27], breathing difficulties [n = 27 of 27], postnasal drip [n = 25 of 27], runny nose [n = 24 of 27], head/facial pressure [n = 23 of 27], loss of smell [n = 23 of 27], loss of taste [n = 22 of 27]) and 29 secondary symptoms (the most common were mucus/catarrh and nose bleeds [both n = 20 of 27]). Most symptoms were reported to vary both within and between days. Sixty impacts of severe NP were reported, including impacts on sleep (n = 22 of 27), physical functioning (n = 21 of 27), activities of daily living (n = 21 of 27), emotional well-being (n = 27 of 27), treatment (n = 23 of 27), social life (n = 26 of 27), and work (n = 19 of 27). Symptoms/impacts reported using the app were consistent with interview findings, although new symptoms were identified (ear pain, throat pain, nasal scabs, and nasal burning). These results supported the development of a conceptual model outlining concepts related to symptoms, impacts, and treatment of NP. CONCLUSIONS Severe, recurrent, bilateral NP are associated with a range of symptoms that have significant detrimental impact on HRQoL.
Collapse
Affiliation(s)
- Rebecca Hall
- Patient-Centered Outcomes, Adelphi Values, Bollington, Cheshire, England, UK
| | - Claire Trennery
- Patient-Centered Outcomes, Adelphi Values, Bollington, Cheshire, England, UK
| | - Robert Chan
- Clinical Sciences, GlaxoSmithKline R&D, Stockley Park, Uxbridge, England, UK
| | - Adam Gater
- Patient-Centered Outcomes, Adelphi Values, Bollington, Cheshire, England, UK
| | - Helena Bradley
- Patient-Centered Outcomes, Adelphi Values, Bollington, Cheshire, England, UK
| | - Mirko V Sikirica
- Value Evidence and Outcomes, GlaxoSmithKline, Philadelphia, PA, USA
| | - Robyn von Maltzahn
- Patient Centred Outcomes, Value Evidence and Outcomes, GlaxoSmithKline, London, England, UK.
| | - Ana R Sousa
- Clinical Sciences, GlaxoSmithKline R&D, Stockley Park, Uxbridge, England, UK
| | - Linda M Nelsen
- Patient Centred Outcomes, Value Evidence and Outcomes, GlaxoSmithKline, Philadelphia, PA, USA
| |
Collapse
|
34
|
Rato J, R Sousa A, Teixeira A, Anjos R. Ebstein's anomaly with 'reversible' functional pulmonary atresia. BMJ Case Rep 2019; 12:12/12/e229809. [PMID: 31888914 DOI: 10.1136/bcr-2019-229809] [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] [Indexed: 11/04/2022] Open
Abstract
We present the case of an infant with prenatal diagnosis, at 32 weeks gestation, of Ebstein's anomaly without anterograde flow from right ventricular to pulmonary atresia (PA)-functional PA with flow reversal in the ductus arteriosus. Prostaglandin E1 was started after birth. Chest X-ray showed severe cardiomegaly and echocardiogram confirmed Ebstein's anomaly with a thickened non-opening pulmonary valve without anterograde flow but with mild regurgitation. Multidisciplinary team decision was to progressively reduce prostaglandins and have an expectant attitude. Peripheral oxygen saturation above 85% was maintained and serial echocardiograms documented progressive reduction of the ductus arteriosus and the opening of the pulmonic valve cusps, with the development of anterograde flow. The newborn was discharged at day 19 of life without the need for any intervention, and at last follow-up remains asymptomatic, with anterograde normal flow in the pulmonary valve.
Collapse
Affiliation(s)
- João Rato
- Pediatric Cardiology, Centro Hospitalar de Lisboa Ocidental EPE, Carnaxide, Lisboa, Portugal
| | - Ana R Sousa
- Pediatric Cardiology, Centro Hospitalar de Lisboa Ocidental EPE, Carnaxide, Lisboa, Portugal
| | - Ana Teixeira
- Pediatric Cardiology, Centro Hospitalar de Lisboa Ocidental EPE, Carnaxide, Lisboa, Portugal
| | - Rui Anjos
- Pediatric Cardiology, Hospital Santa Cruz, Carnaxide, Portugal
| |
Collapse
|
35
|
Perotin JM, Schofield JPR, Wilson SJ, Ward J, Brandsma J, Strazzeri F, Bansal A, Yang X, Rowe A, Corfield J, Lutter R, Shaw DE, Bakke PS, Caruso M, Dahlén B, Fowler SJ, Horváth I, Howarth P, Krug N, Montuschi P, Sanak M, Sandström T, Sun K, Pandis I, Auffray C, De Meulder B, Lefaudeux D, Riley JH, Sousa AR, Dahlen SE, Adcock IM, Chung KF, Sterk PJ, Skipp PJ, Collins JE, Davies DE, Djukanović R. Epithelial dysregulation in obese severe asthmatics with gastro-oesophageal reflux. Eur Respir J 2019; 53:13993003.00453-2019. [PMID: 31023846 DOI: 10.1183/13993003.00453-2019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 03/20/2019] [Indexed: 02/02/2023]
Affiliation(s)
- Jeanne-Marie Perotin
- NIHR Southampton Biomedical Research Centre, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - James P R Schofield
- NIHR Southampton Biomedical Research Centre, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,Centre for Proteomic Research, Biological Sciences, University of Southampton, Southampton, UK
| | - Susan J Wilson
- The Histochemistry Research Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Jonathan Ward
- The Histochemistry Research Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Joost Brandsma
- NIHR Southampton Biomedical Research Centre, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Fabio Strazzeri
- Mathematical Sciences, University of Southampton, Southampton, UK
| | | | - Xian Yang
- Data Science Institute, Imperial College London, London, UK
| | - Anthony Rowe
- Janssen Research and Development, High Wycombe, UK
| | | | - Rene Lutter
- Amsterdam UMC, Dept of Experimental Immunology (Amsterdam Infection and Immunity Institute), University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam UMC, Dept of Respiratory Medicine, University of Amsterdam, Amsterdam, The Netherlands
| | - Dominick E Shaw
- NIHR Biomedical Respiratory Research Centre, University of Nottingham, Nottingham, UK
| | - Per S Bakke
- Institute of Medicine, University of Bergen, Bergen, Norway
| | - Massimo Caruso
- Dept of Clinical and Experimental Medicine Hospital University, University of Catania, Catania, Italy.,Dept of Biomedical and Biotechnological Sciences (Biometec), University of Catania, Catania, Italy
| | - Barbro Dahlén
- Dept of Respiratory Diseases and Allergy, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Stephen J Fowler
- Respiratory and Allergy Research Group, University of Manchester, Manchester, UK
| | - Ildikó Horváth
- Dept of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Peter Howarth
- NIHR Southampton Biomedical Research Centre, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Norbert Krug
- Fraunhofer Institute for Toxicology and Experimental Medicine Hannover, Hannover, Germany
| | - Paolo Montuschi
- Faculty of Medicine, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario, Agostino Gemelli IRCCS, Rome, Italy
| | - Marek Sanak
- Laboratory of Molecular Biology and Clinical Genetics, Medical College, Jagiellonian University, Krakow, Poland
| | - Thomas Sandström
- Dept of Medicine, Dept of Public Health and Clinical Medicine Respiratory Medicine Unit, Umeå University, Umeå, Sweden
| | - Kai Sun
- Janssen Research and Development, High Wycombe, UK
| | | | - Charles Auffray
- European Institute for Systems Biology and Medicine, CNRS-ENS-UCBL-INSERM, Université de Lyon, Lyons, France
| | - Bertrand De Meulder
- European Institute for Systems Biology and Medicine, CNRS-ENS-UCBL-INSERM, Université de Lyon, Lyons, France
| | - Diane Lefaudeux
- European Institute for Systems Biology and Medicine, CNRS-ENS-UCBL-INSERM, Université de Lyon, Lyons, France
| | | | - Ana R Sousa
- Respiratory Therapeutic Unit, GSK, Uxbridge, UK
| | - Sven-Erik Dahlen
- The Centre for Allergy Research, The Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Ian M Adcock
- Cell and Molecular Biology Group, Airways Disease Section, National Heart and Lung Institute, Imperial College London, London, UK
| | - Kian Fan Chung
- Cell and Molecular Biology Group, Airways Disease Section, National Heart and Lung Institute, Imperial College London, London, UK
| | - Peter J Sterk
- NIHR Biomedical Respiratory Research Centre, University of Nottingham, Nottingham, UK
| | - Paul J Skipp
- Centre for Proteomic Research, Biological Sciences, University of Southampton, Southampton, UK
| | - Jane E Collins
- NIHR Southampton Biomedical Research Centre, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Donna E Davies
- NIHR Southampton Biomedical Research Centre, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Ratko Djukanović
- NIHR Southampton Biomedical Research Centre, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | | | | |
Collapse
|
36
|
Östling J, van Geest M, Schofield JPR, Jevnikar Z, Wilson S, Ward J, Lutter R, Shaw DE, Bakke PS, Caruso M, Dahlen SE, Fowler SJ, Horváth I, Krug N, Montuschi P, Sanak M, Sandström T, Sun K, Pandis I, Auffray C, Sousa AR, Guo Y, Adcock IM, Howarth P, Chung KF, Bigler J, Sterk PJ, Skipp PJ, Djukanović R, Vaarala O. IL-17-high asthma with features of a psoriasis immunophenotype. J Allergy Clin Immunol 2019; 144:1198-1213. [PMID: 30998987 DOI: 10.1016/j.jaci.2019.03.027] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 03/06/2019] [Accepted: 03/18/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND The role of IL-17 immunity is well established in patients with inflammatory diseases, such as psoriasis and inflammatory bowel disease, but not in asthmatic patients, in whom further study is required. OBJECTIVE We sought to undertake a deep phenotyping study of asthmatic patients with upregulated IL-17 immunity. METHODS Whole-genome transcriptomic analysis was performed by using epithelial brushings, bronchial biopsy specimens (91 asthmatic patients and 46 healthy control subjects), and whole blood samples (n = 498) from the Unbiased Biomarkers for the Prediction of Respiratory Disease Outcomes (U-BIOPRED) cohort. Gene signatures induced in vitro by IL-17 and IL-13 in bronchial epithelial cells were used to identify patients with IL-17-high and IL-13-high asthma phenotypes. RESULTS Twenty-two of 91 patients were identified with IL-17, and 9 patients were identified with IL-13 gene signatures. The patients with IL-17-high asthma were characterized by risk of frequent exacerbations, airway (sputum and mucosal) neutrophilia, decreased lung microbiota diversity, and urinary biomarker evidence of activation of the thromboxane B2 pathway. In pathway analysis the differentially expressed genes in patients with IL-17-high asthma were shared with those reported as altered in psoriasis lesions and included genes regulating epithelial barrier function and defense mechanisms, such as IL1B, IL6, IL8, and β-defensin. CONCLUSION The IL-17-high asthma phenotype, characterized by bronchial epithelial dysfunction and upregulated antimicrobial and inflammatory response, resembles the immunophenotype of psoriasis, including activation of the thromboxane B2 pathway, which should be considered a biomarker for this phenotype in further studies, including clinical trials targeting IL-17.
Collapse
Affiliation(s)
- Jörgen Östling
- Respiratory, Inflammation, Autoimmunity IMED Biotech Unit, AstraZeneca, Gothenburg, Sweden
| | - Marleen van Geest
- Respiratory, Inflammation, Autoimmunity IMED Biotech Unit, AstraZeneca, Gothenburg, Sweden
| | - James P R Schofield
- Centre for Proteomic Research, University of Southampton, Southampton, United Kingdom; NIHR Southampton Biomedical Research Centre, Clinical and Experimental Sciences, Faculty of Research, University of Southampton, Southampton, United Kingdom
| | - Zala Jevnikar
- Respiratory, Inflammation, Autoimmunity IMED Biotech Unit, AstraZeneca, Gothenburg, Sweden
| | - Susan Wilson
- NIHR Southampton Biomedical Research Centre, Clinical and Experimental Sciences, Faculty of Research, University of Southampton, Southampton, United Kingdom; Histochemistry Research Unit, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Jonathan Ward
- NIHR Southampton Biomedical Research Centre, Clinical and Experimental Sciences, Faculty of Research, University of Southampton, Southampton, United Kingdom
| | - Rene Lutter
- AUMC, Department of Experimental Immunology, University of Amsterdam, Amsterdam, The Netherlands; AUMC, Department of Respiratory Medicine, University of Amsterdam, Amsterdam, The Netherlands
| | - Dominick E Shaw
- Respiratory Research Unit, University of Nottingham, Nottingham, United Kingdom
| | - Per S Bakke
- Institute of Medicine, University of Bergen, Bergen, Norway
| | - Massimo Caruso
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Sven-Erik Dahlen
- Centre for Allergy Research, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Stephen J Fowler
- Respiratory and Allergy Research Group, University of Manchester, Manchester, United Kingdom
| | - Ildikó Horváth
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Norbert Krug
- Fraunhofer Institute for Toxicology and Experimental Medicine Hannover, Hannover, Germany
| | - Paolo Montuschi
- Faculty of Medicine, Catholic University of the Sacred Heart, Fondazione Policlinico Agostino Gemelli IRCCS, Rome, Italy
| | - Marek Sanak
- Laboratory of Molecular Biology and Clinical Genetics, Medical College, Jagiellonian University, Krakow, Poland
| | - Thomas Sandström
- Department of Medicine, Department of Public Health and Clinical Medicine Respiratory Medicine Unit, Umeå University, Umeå, Sweden
| | - Kai Sun
- Data Science Institute, Imperial College, London, United Kingdom
| | - Ioannis Pandis
- Data Science Institute, Imperial College, London, United Kingdom
| | - Charles Auffray
- European Institute for Systems Biology and Medicine, CNRS-ENS-UCBL-INSERM, Université de Lyon, Lyon, France
| | - Ana R Sousa
- Respiratory Therapeutic Unit, GlaxoSmithKline, Stockley Park, United Kingdom
| | - Yike Guo
- Data Science Institute, Imperial College, London, United Kingdom
| | - Ian M Adcock
- Experimental Studies, Airways Disease Section, National Heart & Lung institute, Imperial College London, London, United Kingdom
| | - Peter Howarth
- NIHR Southampton Biomedical Research Centre, Clinical and Experimental Sciences, Faculty of Research, University of Southampton, Southampton, United Kingdom
| | - Kian Fan Chung
- Experimental Studies, Airways Disease Section, National Heart & Lung institute, Imperial College London, London, United Kingdom
| | | | - Peter J Sterk
- AUMC, Department of Respiratory Medicine, University of Amsterdam, Amsterdam, The Netherlands
| | - Paul J Skipp
- Centre for Proteomic Research, University of Southampton, Southampton, United Kingdom; NIHR Southampton Biomedical Research Centre, Clinical and Experimental Sciences, Faculty of Research, University of Southampton, Southampton, United Kingdom
| | - Ratko Djukanović
- NIHR Southampton Biomedical Research Centre, Clinical and Experimental Sciences, Faculty of Research, University of Southampton, Southampton, United Kingdom.
| | - Outi Vaarala
- Respiratory, Inflammation, Autoimmunity IMED Biotech Unit, AstraZeneca, Gothenburg, Sweden
| | | |
Collapse
|
37
|
Schofield JPR, Burg D, Nicholas B, Strazzeri F, Brandsma J, Staykova D, Folisi C, Bansal AT, Xian Y, Guo Y, Rowe A, Corfield J, Wilson S, Ward J, Lutter R, Shaw DE, Bakke PS, Caruso M, Dahlen SE, Fowler SJ, Horváth I, Howarth P, Krug N, Montuschi P, Sanak M, Sandström T, Sun K, Pandis I, Riley J, Auffray C, De Meulder B, Lefaudeux D, Sousa AR, Adcock IM, Chung KF, Sterk PJ, Skipp PJ, Djukanović R. Stratification of asthma phenotypes by airway proteomic signatures. J Allergy Clin Immunol 2019; 144:70-82. [PMID: 30928653 DOI: 10.1016/j.jaci.2019.03.013] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 02/14/2019] [Accepted: 03/08/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Stratification by eosinophil and neutrophil counts increases our understanding of asthma and helps target therapy, but there is room for improvement in our accuracy in prediction of treatment responses and a need for better understanding of the underlying mechanisms. OBJECTIVE We sought to identify molecular subphenotypes of asthma defined by proteomic signatures for improved stratification. METHODS Unbiased label-free quantitative mass spectrometry and topological data analysis were used to analyze the proteomes of sputum supernatants from 246 participants (206 asthmatic patients) as a novel means of asthma stratification. Microarray analysis of sputum cells provided transcriptomics data additionally to inform on underlying mechanisms. RESULTS Analysis of the sputum proteome resulted in 10 clusters (ie, proteotypes) based on similarity in proteomic features, representing discrete molecular subphenotypes of asthma. Overlaying granulocyte counts onto the 10 clusters as metadata further defined 3 of these as highly eosinophilic, 3 as highly neutrophilic, and 2 as highly atopic with relatively low granulocytic inflammation. For each of these 3 phenotypes, logistic regression analysis identified candidate protein biomarkers, and matched transcriptomic data pointed to differentially activated underlying mechanisms. CONCLUSION This study provides further stratification of asthma currently classified based on quantification of granulocytic inflammation and provided additional insight into their underlying mechanisms, which could become targets for novel therapies.
Collapse
Affiliation(s)
- James P R Schofield
- Centre for Proteomic Research, Biological Sciences, University of Southampton, Southampton, United Kingdom; NIHR Southampton Biomedical Research Centre, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Dominic Burg
- Centre for Proteomic Research, Biological Sciences, University of Southampton, Southampton, United Kingdom; NIHR Southampton Biomedical Research Centre, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Ben Nicholas
- NIHR Southampton Biomedical Research Centre, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Fabio Strazzeri
- Centre for Proteomic Research, Biological Sciences, University of Southampton, Southampton, United Kingdom; Mathematical Sciences, University of Southampton, Southampton, United Kingdom
| | - Joost Brandsma
- NIHR Southampton Biomedical Research Centre, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Doroteya Staykova
- Centre for Proteomic Research, Biological Sciences, University of Southampton, Southampton, United Kingdom
| | - Caterina Folisi
- Centre for Proteomic Research, Biological Sciences, University of Southampton, Southampton, United Kingdom
| | | | - Yang Xian
- Data Science Institute, Imperial College, London, United Kingdom
| | - Yike Guo
- Data Science Institute, Imperial College, London, United Kingdom
| | - Anthony Rowe
- Janssen Research & Development, High Wycombe, United Kingdom
| | | | - Susan Wilson
- NIHR Southampton Biomedical Research Centre, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Jonathan Ward
- NIHR Southampton Biomedical Research Centre, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Rene Lutter
- AMC, Department of Experimental Immunology, University of Amsterdam, Amsterdam, The Netherlands; Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Dominick E Shaw
- Respiratory Research Unit, University of Nottingham, Nottingham, United Kingdom
| | - Per S Bakke
- Institute of Medicine, University of Bergen, Bergen, Norway
| | - Massimo Caruso
- Department of Clinical and Experimental Medicine Hospital University, University of Catania, Catania, Italy
| | - Sven-Erik Dahlen
- Centre for Allergy Research, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Stephen J Fowler
- Respiratory and Allergy Research Group, University of Manchester, Manchester, United Kingdom
| | - Ildikó Horváth
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Peter Howarth
- NIHR Southampton Biomedical Research Centre, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Norbert Krug
- Fraunhofer Institute for Toxicology and Experimental Medicine Hannover, Hannover, Germany
| | - Paolo Montuschi
- Faculty of Medicine, Catholic University of the Sacred Heart, Rome, Italy
| | - Marek Sanak
- Laboratory of Molecular Biology and Clinical Genetics, Medical College, Jagiellonian University, Krakow, Poland
| | - Thomas Sandström
- Department of Medicine, Department of Public Health and Clinical Medicine Respiratory Medicine Unit, Umeå University, Umeå, Sweden
| | - Kai Sun
- Data Science Institute, Imperial College, London, United Kingdom
| | - Ioannis Pandis
- Data Science Institute, Imperial College, London, United Kingdom
| | - John Riley
- Respiratory Therapeutic Unit, GlaxoSmithKline, Stockley Park, United Kingdom
| | - Charles Auffray
- European Institute for Systems Biology and Medicine, CNRS-ENS-UCBL-INSERM, Université de Lyon, Lyon, France
| | - Bertrand De Meulder
- European Institute for Systems Biology and Medicine, CNRS-ENS-UCBL-INSERM, Université de Lyon, Lyon, France
| | - Diane Lefaudeux
- European Institute for Systems Biology and Medicine, CNRS-ENS-UCBL-INSERM, Université de Lyon, Lyon, France
| | - Ana R Sousa
- Respiratory Therapeutic Unit, GlaxoSmithKline, Stockley Park, United Kingdom
| | - Ian M Adcock
- Cell and Molecular Biology Group, Airways Disease Section, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Kian Fan Chung
- Cell and Molecular Biology Group, Airways Disease Section, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Peter J Sterk
- Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Paul J Skipp
- Centre for Proteomic Research, Biological Sciences, University of Southampton, Southampton, United Kingdom
| | - Ratko Djukanović
- NIHR Southampton Biomedical Research Centre, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom.
| | | |
Collapse
|
38
|
Tariq K, Schofield JPR, Nicholas BL, Burg D, Brandsma J, Bansal AT, Wilson SJ, Lutter R, Fowler SJ, Bakke, Caruso M, Dahlen B, Horváth I, Krug N, Montuschi P, Sanak M, Sandström T, Geiser T, Pandis I, Sousa AR, Adcock IM, Shaw DE, Auffray C, Howarth PH, Sterk PJ, Chung KF, Skipp PJ, Dimitrov B, Djukanović R. Sputum proteomic signature of gastro-oesophageal reflux in patients with severe asthma. Respir Med 2019; 150:66-73. [PMID: 30961953 DOI: 10.1016/j.rmed.2019.02.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 01/30/2019] [Accepted: 02/04/2019] [Indexed: 01/08/2023]
Abstract
Gastro-oesophageal reflux disease (GORD) has long been associated with poor asthma control without an established cause-effect relationship. 610 asthmatics (421 severe/88 mild-moderate) and 101 healthy controls were assessed clinically and a subset of 154 severe asthmatics underwent proteomic analysis of induced sputum using untargeted mass spectrometry, LC-IMS-MSE. Univariate and multiple logistic regression analyses (MLR) were conducted to identify proteins associated with GORD in this cohort. When compared to mild/moderate asthmatics and healthy individuals, respectively, GORD was three- and ten-fold more prevalent in severe asthmatics and was associated with increased asthma symptoms and oral corticosteroid use, poorer quality of life, depression/anxiety, obesity and symptoms of sino-nasal disease. Comparison of sputum proteomes in severe asthmatics with and without active GORD showed five differentially abundant proteins with described roles in anti-microbial defences, systemic inflammation and epithelial integrity. Three of these were associated with active GORD by multiple linear regression analysis: Ig lambda variable 1-47 (p = 0·017) and plasma protease C1 inhibitor (p = 0·043), both in lower concentrations, and lipocalin-1 (p = 0·034) in higher concentrations in active GORD. This study provides evidence which suggests that reflux can cause subtle perturbation of proteins detectable in the airways lining fluid and that severe asthmatics with GORD may represent a distinct phenotype of asthma.
Collapse
Affiliation(s)
- K Tariq
- NIHR Southampton Respiratory Biomedical Research Centre, University Hospital Southampton, Southampton, UK; Clinical Experimental Sciences Unit, Faculty of Medicine, University of Southampton, University Hospital Southampton, South Academic Block, Southampton, UK
| | - J P R Schofield
- NIHR Southampton Respiratory Biomedical Research Centre, University Hospital Southampton, Southampton, UK; Centre for Proteomic Research, University of Southampton, Highfield, Southampton, UK
| | - B L Nicholas
- NIHR Southampton Respiratory Biomedical Research Centre, University Hospital Southampton, Southampton, UK; Clinical Experimental Sciences Unit, Faculty of Medicine, University of Southampton, University Hospital Southampton, South Academic Block, Southampton, UK
| | - D Burg
- NIHR Southampton Respiratory Biomedical Research Centre, University Hospital Southampton, Southampton, UK; Centre for Proteomic Research, University of Southampton, Highfield, Southampton, UK
| | - J Brandsma
- NIHR Southampton Respiratory Biomedical Research Centre, University Hospital Southampton, Southampton, UK
| | | | - S J Wilson
- NIHR Southampton Respiratory Biomedical Research Centre, University Hospital Southampton, Southampton, UK
| | - R Lutter
- AMC, Department of Experimental Immunology, University of Amsterdam, Amsterdam, the Netherlands; AMC, Department of Respiratory Medicine, University of Amsterdam, Amsterdam, the Netherlands
| | - S J Fowler
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester and University Hospital of South Manchester, NHS Foundation Trust, Manchester, UK
| | - Bakke
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - M Caruso
- Dept. of Clinical and Experimental Medicine Hospital University, Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy
| | - B Dahlen
- Division of Respiratory Medicine and Allergy, Department of Medicine, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - I Horváth
- Dept. of Pulmonology, Semmelweis University, Budapest, Hungary
| | - N Krug
- Fraunhofer Institute for Toxicology and Experimental Medicine Hannover, Hannover, Germany
| | - P Montuschi
- Dept. of Pharmacology, Faculty of Medicine, Catholic University of the Sacred Heart, Rome, Italy
| | - M Sanak
- Division of Molecular Biology and Clinical Genetics, Medical College, Jagiellonian University Medical College, Krakow, Poland
| | - T Sandström
- Dept. of Medicine, Dept of Public Health and Clinical Medicine Respiratory Medicine Unit, Umeå University, Umeå, Sweden
| | - T Geiser
- University Hospital Bern, Bern, Switzerland
| | - I Pandis
- Data Science Institute, Imperial College, London, UK
| | - A R Sousa
- Respiratory Therapeutic Unit, GSK, Stockley Park, UK
| | - I M Adcock
- Cell and Molecular Biology Group, Airways Disease Section, National Heart and Lung Institute, Imperial College London, Dovehouse Street, London, UK
| | - D E Shaw
- Respiratory Research Unit, University of Nottingham, Nottingham, UK
| | - C Auffray
- European Institute for Systems Biology and Medicine, CNRS-ENS-UCBL-INSERM, Lyon, France
| | - P H Howarth
- NIHR Southampton Respiratory Biomedical Research Centre, University Hospital Southampton, Southampton, UK; Clinical Experimental Sciences Unit, Faculty of Medicine, University of Southampton, University Hospital Southampton, South Academic Block, Southampton, UK
| | - P J Sterk
- AMC, Department of Respiratory Medicine, University of Amsterdam, Amsterdam, the Netherlands
| | - K F Chung
- Airways Disease, National Heart and Lung Institute, Imperial College, London & Royal Brompton NIHR Biomedical Research Unit, London, United Kingdom
| | - P J Skipp
- Centre for Proteomic Research, University of Southampton, Highfield, Southampton, UK
| | - B Dimitrov
- NIHR Southampton Respiratory Biomedical Research Centre, University Hospital Southampton, Southampton, UK
| | - R Djukanović
- NIHR Southampton Respiratory Biomedical Research Centre, University Hospital Southampton, Southampton, UK; Clinical Experimental Sciences Unit, Faculty of Medicine, University of Southampton, University Hospital Southampton, South Academic Block, Southampton, UK.
| | | |
Collapse
|
39
|
Simpson AJ, Hekking PP, Shaw DE, Fleming LJ, Roberts G, Riley JH, Bates S, Sousa AR, Bansal AT, Pandis I, Sun K, Bakke PS, Caruso M, Dahlén B, Dahlén SE, Horvath I, Krug N, Montuschi P, Sandstrom T, Singer F, Adcock IM, Wagers SS, Djukanovic R, Chung KF, Sterk PJ, Fowler SJ. Treatable traits in the European U-BIOPRED adult asthma cohorts. Allergy 2019; 74:406-411. [PMID: 30307629 PMCID: PMC6587719 DOI: 10.1111/all.13629] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Andrew J. Simpson
- University of Manchester, and Manchester University NHS Foundation Trust; Manchester Academic Health Science Centre; Manchester UK
- Department of Sport, Health and Exercise Science; School of Life Sciences; The University of Hull; Hull UK
| | | | - Dominick E. Shaw
- Respiratory Research Unit; University of Nottingham; Nottingham UK
| | - Louise J. Fleming
- National Heart and Lung Institute; Imperial College; London UK
- Royal Brompton and Harefield NHS Trust; London UK
| | - Graham Roberts
- NIHR Southampton Respiratory Biomedical Research Unit; Clinical and Experimental Sciences and Human Development and Health; Southampton UK
| | | | | | | | | | | | - Kai Sun
- Data Science Institute; Imperial College; London UK
| | - Per S. Bakke
- Department of Clinical Science; University of Bergen; Bergen Norway
| | - Massimo Caruso
- Department of Clinical and Experimental Medicine; University of Catania; Catania Italy
| | - Barbro Dahlén
- Centre for Allergy Research; Karolinska Institutet; Stockholm Sweden
| | - Sven-Erik Dahlén
- Centre for Allergy Research; Karolinska Institutet; Stockholm Sweden
| | - Ildiko Horvath
- Department of Pulmonology; Semmelweis University; Budapest Hungary
| | - Norbert Krug
- Fraunhofer Institute for Toxicology and Experimental Medicine; Hannover Germany
| | | | - Thomas Sandstrom
- Department of Public Health and Clinical Medicine; Umeå University; Umeå Sweden
| | - Florian Singer
- Inselspital; Bern University Hospital; University of Bern; Bern Switzerland
| | - Ian M. Adcock
- National Heart and Lung Institute; Imperial College; London UK
- Royal Brompton and Harefield NHS Trust; London UK
| | | | - Ratko Djukanovic
- NIHR Southampton Respiratory Biomedical Research Unit; Clinical and Experimental Sciences and Human Development and Health; Southampton UK
| | - Kian Fan Chung
- National Heart and Lung Institute; Imperial College; London UK
- Royal Brompton and Harefield NHS Trust; London UK
| | - Peter J. Sterk
- Respiratory Medicine; Academic Medical Centre; Amsterdam The Netherlands
| | - Stephen J. Fowler
- University of Manchester, and Manchester University NHS Foundation Trust; Manchester Academic Health Science Centre; Manchester UK
| | | |
Collapse
|
40
|
Pavlidis S, Takahashi K, Ng Kee Kwong F, Xie J, Hoda U, Sun K, Elyasigomari V, Agapow P, Loza M, Baribaud F, Chanez P, Fowler SJ, Shaw DE, Fleming LJ, Howarth PH, Sousa AR, Corfield J, Auffray C, De Meulder B, Knowles R, Sterk PJ, Guo Y, Adcock IM, Djukanovic R, Fan Chung K. "T2-high" in severe asthma related to blood eosinophil, exhaled nitric oxide and serum periostin. Eur Respir J 2019; 53:13993003.00938-2018. [PMID: 30578390 DOI: 10.1183/13993003.00938-2018] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 10/26/2018] [Indexed: 11/05/2022]
Abstract
Type-2 (T2) immune responses in airway epithelial cells (AECs) classifies mild-moderate asthma into a T2-high phenotype. We examined whether currently available clinical biomarkers can predict AEC-defined T2-high phenotype within the U-BIOPRED cohort.The transcriptomic profile of AECs obtained from brushings of 103 patients with asthma and 44 healthy controls was obtained and gene set variation analysis used to determine the relative expression score of T2 asthma using a signature from interleukin (IL)-13-exposed AECs.37% of asthmatics (45% nonsmoking severe asthma, n=49; 33% of smoking or ex-smoking severe asthma, n=18; and 28% mild-moderate asthma, n=36) were T2-high using AEC gene expression. They were more symptomatic with higher exhaled nitric oxide fraction (F eNO) and blood and sputum eosinophils, but not serum IgE or periostin. Sputum eosinophilia correlated best with the T2-high signature. F eNO (≥30 ppb) and blood eosinophils (≥300 cells·µL-1) gave a moderate prediction of T2-high asthma. Sputum IL-4, IL-5 and IL-13 protein levels did not correlate with gene expression.T2-high severe asthma can be predicted to some extent from raised levels of F eNO, blood and sputum eosinophil counts, but serum IgE or serum periostin were poor predictors. Better bedside biomarkers are needed to detect T2-high.
Collapse
Affiliation(s)
- Stelios Pavlidis
- National Heart and Lung Institute, Imperial College London, and Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, UK.,Dept of Computing and Data Science Institute, Imperial College London, London, UK
| | - Kentaro Takahashi
- National Heart and Lung Institute, Imperial College London, and Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, UK.,Research Centre for Allergy and Clinical Immunology, Asahi General Hospital, Asahi, Japan
| | - Francois Ng Kee Kwong
- National Heart and Lung Institute, Imperial College London, and Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, UK
| | - Jiaxing Xie
- National Heart and Lung Institute, Imperial College London, and Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, UK
| | - Uruj Hoda
- National Heart and Lung Institute, Imperial College London, and Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, UK
| | - Kai Sun
- Dept of Computing and Data Science Institute, Imperial College London, London, UK
| | - Vahid Elyasigomari
- Dept of Computing and Data Science Institute, Imperial College London, London, UK
| | - Paul Agapow
- Dept of Computing and Data Science Institute, Imperial College London, London, UK
| | - Matthew Loza
- Janssen Research and Development, High Wycombe, UK
| | | | - Pascal Chanez
- Assistance Publique des Hôpitaux de Marseille - Clinique des bronches, allergies et sommeil, Aix Marseille Université, Marseille, France
| | - Steve J Fowler
- Centre for Respiratory Medicine and Allergy, Institute of Inflammation and Repair, University of Manchester and University Hospital of South Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Dominic E Shaw
- Respiratory Research Unit, University of Nottingham, Nottingham, UK
| | - Louise J Fleming
- National Heart and Lung Institute, Imperial College London, and Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, UK
| | - Peter H Howarth
- NIHR Southampton Respiratory Biomedical Research Unit, Clinical and Experimental Sciences and Human Development and Health, Southampton, UK
| | - Ana R Sousa
- Respiratory Therapeutic Unit, GSK, Stockley Park, UK
| | - Julie Corfield
- AstraZeneca R&D, Molndal, Sweden.,Areteva R&D, Nottingham, UK
| | - Charles Auffray
- European Institute for Systems Biology and Medicine, CNRS-ENS-UCBL-INSERM, Lyon, France
| | - Bertrand De Meulder
- European Institute for Systems Biology and Medicine, CNRS-ENS-UCBL-INSERM, Lyon, France
| | | | - Peter J Sterk
- Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Yike Guo
- Dept of Computing and Data Science Institute, Imperial College London, London, UK
| | - Ian M Adcock
- National Heart and Lung Institute, Imperial College London, and Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, UK.,Dept of Computing and Data Science Institute, Imperial College London, London, UK
| | - Ratko Djukanovic
- NIHR Southampton Respiratory Biomedical Research Unit, Clinical and Experimental Sciences and Human Development and Health, Southampton, UK
| | - Kian Fan Chung
- National Heart and Lung Institute, Imperial College London, and Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, UK.,Dept of Computing and Data Science Institute, Imperial College London, London, UK
| | | |
Collapse
|
41
|
Brinkman P, Wagener AH, Hekking PP, Bansal AT, Maitland-van der Zee AH, Wang Y, Weda H, Knobel HH, Vink TJ, Rattray NJ, D'Amico A, Pennazza G, Santonico M, Lefaudeux D, De Meulder B, Auffray C, Bakke PS, Caruso M, Chanez P, Chung KF, Corfield J, Dahlén SE, Djukanovic R, Geiser T, Horvath I, Krug N, Musial J, Sun K, Riley JH, Shaw DE, Sandström T, Sousa AR, Montuschi P, Fowler SJ, Sterk PJ. Identification and prospective stability of electronic nose (eNose)-derived inflammatory phenotypes in patients with severe asthma. J Allergy Clin Immunol 2018; 143:1811-1820.e7. [PMID: 30529449 DOI: 10.1016/j.jaci.2018.10.058] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 10/04/2018] [Accepted: 10/22/2018] [Indexed: 01/24/2023]
Abstract
BACKGROUND Severe asthma is a heterogeneous condition, as shown by independent cluster analyses based on demographic, clinical, and inflammatory characteristics. A next step is to identify molecularly driven phenotypes using "omics" technologies. Molecular fingerprints of exhaled breath are associated with inflammation and can qualify as noninvasive assessment of severe asthma phenotypes. OBJECTIVES We aimed (1) to identify severe asthma phenotypes using exhaled metabolomic fingerprints obtained from a composite of electronic noses (eNoses) and (2) to assess the stability of eNose-derived phenotypes in relation to within-patient clinical and inflammatory changes. METHODS In this longitudinal multicenter study exhaled breath samples were taken from an unselected subset of adults with severe asthma from the U-BIOPRED cohort. Exhaled metabolites were analyzed centrally by using an assembly of eNoses. Unsupervised Ward clustering enhanced by similarity profile analysis together with K-means clustering was performed. For internal validation, partitioning around medoids and topological data analysis were applied. Samples at 12 to 18 months of prospective follow-up were used to assess longitudinal within-patient stability. RESULTS Data were available for 78 subjects (age, 55 years [interquartile range, 45-64 years]; 41% male). Three eNose-driven clusters (n = 26/33/19) were revealed, showing differences in circulating eosinophil (P = .045) and neutrophil (P = .017) percentages and ratios of patients using oral corticosteroids (P = .035). Longitudinal within-patient cluster stability was associated with changes in sputum eosinophil percentages (P = .045). CONCLUSIONS We have identified and followed up exhaled molecular phenotypes of severe asthma, which were associated with changing inflammatory profile and oral steroid use. This suggests that breath analysis can contribute to the management of severe asthma.
Collapse
Affiliation(s)
- Paul Brinkman
- Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - Ariane H Wagener
- Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Pieter-Paul Hekking
- Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Aruna T Bansal
- Acclarogen, St John's Innovation Centre, Cambridge, United Kingdom
| | | | | | - Hans Weda
- Philips Research, Eindhoven, The Netherlands
| | | | | | - Nicholas J Rattray
- Department of Environmental Health Sciences, Yale School of Public Health, Yale University, New Haven, Conn
| | - Arnaldo D'Amico
- Department of Electronic Engineering, University of Rome "Tor Vergata," Rome, Italy
| | - Giorgio Pennazza
- Center for Integrated Research-CIR, Unit for Electronics for Sensor Systems, Campus Bio-Medico U, Rome, Italy
| | - Marco Santonico
- Center for Integrated Research-CIR, Unit for Electronics for Sensor Systems, Campus Bio-Medico U, Rome, Italy
| | - Diane Lefaudeux
- European Institute for Systems Biology and Medicine, CIRI UMR5308, CNRS-ENS-UCBL-INSERM, Lyon, France
| | - Bertrand De Meulder
- European Institute for Systems Biology and Medicine, CIRI UMR5308, CNRS-ENS-UCBL-INSERM, Lyon, France
| | - Charles Auffray
- European Institute for Systems Biology and Medicine, CIRI UMR5308, CNRS-ENS-UCBL-INSERM, Lyon, France
| | - Per S Bakke
- Institute of Medicine, University of Bergen, Bergen, Norway
| | - Massimo Caruso
- Department of Clinical and Experimental Medicine Hospital University, University of Catania, Catania, Italy
| | - Pascal Chanez
- Département des Maladies Respiratoires APHM,U1067 INSERM, Aix Marseille Université Marseille, Marseille, Italy
| | - Kian F Chung
- National Heart and Lung Institute, Imperial College, London, UK Biomedical Research Unit, Royal Brompton & Harefield NHS Trust, London, United Kingdom
| | - Julie Corfield
- AstraZeneca R&D, Mölndal, Sweden; Areteva R&D, Nottingham, United Kingdom
| | - Sven-Erik Dahlén
- Centre for Allergy Research, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Ratko Djukanovic
- NIHR Southampton Respiratory Biomedical Research Unit, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Thomas Geiser
- the Department of Pulmonary Medicine, University Hospital Bern, Bern, Switzerland
| | - Ildiko Horvath
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Nobert Krug
- Fraunhofer Institute for Toxicology and Experimental Medicine Hannover, Hannover, Germany
| | - Jacek Musial
- Department of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Kai Sun
- Data Science Institute, South Kensington Campus, Imperial College Londont, London, United Kingdom
| | - John H Riley
- Respiratory Therapeutic Unit, GlaxoSmithKline, Stockley Park, United Kingdom
| | - Dominic E Shaw
- Respiratory Research Unit, University of Nottingham, Nottingham, United Kingdom
| | - Thomas Sandström
- Department of Public Health and Clinical Medicine, Department of Medicine, Respiratory Medicine Unit, Umeå University, Umeå, Sweden
| | - Ana R Sousa
- Respiratory Therapeutic Unit, GlaxoSmithKline, Stockley Park, United Kingdom
| | - Paolo Montuschi
- Department of Pharmacology, Faculty of Medicine, Catholic University of the Sacred Heart, Rome, Italy
| | - Stephen J Fowler
- Respiratory Research Group, Faculty of Medical and Human Sciences, University of Manchester, Manchester Academic Healthy Science Centre, and NIHR Translational Research Faculty in Respiratory Medicine, University Hospital of South Manchester, Manchester, United Kingdom; Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom
| | - Peter J Sterk
- Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | | |
Collapse
|
42
|
Alcázar Navarrete B, Boucot I, Naya I, Tombs L, Lipson DA, Compton C, Sousa AR, Feldman G. Umeclidinium/Vilanterol Versus Tiotropium/Olodaterol in Maintenance-Naïve Patients with Moderate Symptomatic Chronic Obstructive Pulmonary Disease: A Post Hoc Analysis. Pulm Ther 2018; 4:171-183. [PMID: 32026389 PMCID: PMC6967227 DOI: 10.1007/s41030-018-0057-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 04/16/2018] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Appropriate timing for dual bronchodilator therapy initiation in chronic obstructive pulmonary disease (COPD) management is uncertain. Combination therapy is recommended as step-up from monotherapy or first-line treatment in patients with persistent symptoms. In this setting, umeclidinium/vilanterol (UMEC/VI) demonstrated improved lung function and reduced rescue medication use over tiotropium/olodaterol (TIO/OLO). This subgroup analysis explored efficacy differences between these combinations in patients naïve to COPD maintenance therapy before study entry. METHODS Post hoc analysis of an 8-week, randomized, open-label, assessor-blind, two-period crossover study (204990; NCT02799784) comparing UMEC/VI 62.5/25 mcg and TIO/OLO 5/5 mcg, focused on maintenance-naïve (MN) patients with moderate COPD and persistent symptoms (modified Medical Research Council dyspnea score ≥ 2). Change from baseline (CFB) in trough forced expiratory volume in 1 s (FEV1), percentage of FEV1 responders (CFB ≥ 100 ml), rescue medication use and safety were evaluated. RESULTS The MN population comprised 63% of the intent-to-treat (ITT) population (148/236 patients) and had similar baseline demographics. At week 8, adjusted mean (standard error) improvements in trough FEV1 from baseline were clinically meaningful for both combinations (UMEC/VI: 167 [17] ml; TIO/OLO 110 [18] ml; adjusted mean difference [95% confidence interval (CI)]: 57 [23-92] ml; p = 0.001; %CFB: 11 vs. 8%). Proportion of FEV1 responders was greater with UMEC/VI versus TIO/OLO at week 8 (60 vs. 42%; odds ratio [95% CI] 1.90 [1.12-3.22]; p = 0.018). Reduction in rescue medication use was 0.20 (95% CI 0.07-0.34) puffs/day greater with UMEC/VI versus TIO/OLO over weeks 1-8 (p = 0.003). Adverse events incidence was similar (UMEC/VI: 24%; TIO/OLO: 29%). CONCLUSIONS These results highlight that the efficacy difference between UMEC/VI and TIO/OLO demonstrated in the ITT population is maintained in MN patients. Greater lung function improvements with UMEC/VI versus TIO/OLO were accompanied by symptom improvements, as reflected in a significantly lower need for supplemental rescue medication. FUNDING GSK. TRIAL REGISTRATION NCT02799784.
Collapse
Affiliation(s)
| | | | - Ian Naya
- Global Respiratory Franchise, GSK, Brentford, Middlesex, UK
| | - Lee Tombs
- Precise Approach Ltd, Contingent Worker on Assignment at GSK, Stockley Park West, Uxbridge, Middlesex, UK
| | - David A Lipson
- Respiratory Research and Development, GSK, Collegeville, PA, USA
| | - Chris Compton
- Global Respiratory Franchise, GSK, Brentford, Middlesex, UK
| | - Ana R Sousa
- Discovery Medicine, GSK, Stockley Park West, Uxbridge, Middlesex, UK
| | - Gregory Feldman
- South Carolina Pharmaceutical Research, Spartanburg, SC, USA
| |
Collapse
|
43
|
Emma R, Bansal AT, Kolmert J, Wheelock CE, Dahlen SE, Loza MJ, De Meulder B, Lefaudeux D, Auffray C, Dahlen B, Bakke PS, Chanez P, Fowler SJ, Horvath I, Montuschi P, Krug N, Sanak M, Sandstrom T, Shaw DE, Fleming LJ, Djukanovic R, Howarth PH, Singer F, Sousa AR, Sterk PJ, Corfield J, Pandis I, Chung KF, Adcock IM, Lutter R, Fabbella L, Caruso M. Enhanced oxidative stress in smoking and ex-smoking severe asthma in the U-BIOPRED cohort. PLoS One 2018; 13:e0203874. [PMID: 30240401 PMCID: PMC6150501 DOI: 10.1371/journal.pone.0203874] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 08/29/2018] [Indexed: 12/20/2022] Open
Abstract
Oxidative stress is believed to be a major driver of inflammation in smoking asthmatics. The U-BIOPRED project recruited a cohort of Severe Asthma smokers/ex-smokers (SAs/ex) and non-smokers (SAn) with extensive clinical and biomarker information enabling characterization of these subjects. We investigated oxidative stress in severe asthma subjects by analysing urinary 8-iso-PGF2α and the mRNA-expression of the main pro-oxidant (NOX2; NOSs) and anti-oxidant (SODs; CAT; GPX1) enzymes in the airways of SAs/ex and SAn. All the severe asthma U-BIOPRED subjects were further divided into current smokers with severe asthma (CSA), ex-smokers with severe asthma (ESA) and non-smokers with severe asthma (NSA) to deepen the effect of active smoking. Clinical data, urine and sputum were obtained from severe asthma subjects. A bronchoscopy to obtain bronchial biopsy and brushing was performed in a subset of subjects. The main clinical data were analysed for each subset of subjects (urine-8-iso-PGF2α; IS-transcriptomics; BB-transcriptomics; BBr-transcriptomics). Urinary 8-iso-PGF2α was quantified using mass spectrometry. Sputum, bronchial biopsy and bronchial brushing were processed for mRNA expression microarray analysis. Urinary 8-iso-PGF2α was increased in SAs/ex, median (IQR) = 31.7 (24.5-44.7) ng/mmol creatinine, compared to SAn, median (IQR) = 26.6 (19.6-36.6) ng/mmol creatinine (p< 0.001), and in CSA, median (IQR) = 34.25 (24.4-47.7), vs. ESA, median (IQR) = 29.4 (22.3-40.5), and NSA, median (IQR) = 26.5 (19.6-16.6) ng/mmol creatinine (p = 0.004). Sputum mRNA expression of NOX2 was increased in SAs/ex compared to SAn (probe sets 203922_PM_s_at fold-change = 1.05 p = 0.006; 203923_PM_s_at fold-change = 1.06, p = 0.003; 233538_PM_s_at fold-change = 1.06, p = 0.014). The mRNA expression of antioxidant enzymes were similar between the two severe asthma cohorts in all airway samples. NOS2 mRNA expression was decreased in bronchial brushing of SAs/ex compared to SAn (fold-change = -1.10; p = 0.029). NOS2 mRNA expression in bronchial brushing correlated with FeNO (Kendal's Tau = 0.535; p< 0.001). From clinical and inflammatory analysis, FeNO was lower in CSA than in ESA in all the analysed subject subsets (p< 0.01) indicating an effect of active smoking. Results about FeNO suggest its clinical limitation, as inflammation biomarker, in severe asthma active smokers. These data provide evidence of greater systemic oxidative stress in severe asthma smokers as reflected by a significant changes of NOX2 mRNA expression in the airways, together with elevated urinary 8-iso-PGF2α in the smokers/ex-smokers group. Trial registration ClinicalTrials.gov-Identifier: NCT01976767.
Collapse
Affiliation(s)
- Rosalia Emma
- Department of Clinical and Experimental Medicine - University of Catania, Catania, Italy
| | - Aruna T Bansal
- Acclarogen Ltd, St John's Innovation Centre, Cambridge, United Kingdom
| | - Johan Kolmert
- Division of Physiological Chemistry 2, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm, Sweden.,Centre for Allergy Research, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Craig E Wheelock
- Division of Physiological Chemistry 2, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm, Sweden
| | - Swen-Erik Dahlen
- Centre for Allergy Research, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Matthew J Loza
- Janssen Research & Development, LLC, Springhouse, Pennsylvania, United States of America
| | - Bertrand De Meulder
- European Institute for Systems Biology and Medicine, CNRS-ENS-UCBL-INSERM, CIRI-UMR5308, Lyon, France
| | - Diane Lefaudeux
- European Institute for Systems Biology and Medicine, CNRS-ENS-UCBL-INSERM, CIRI-UMR5308, Lyon, France
| | - Charles Auffray
- European Institute for Systems Biology and Medicine, CNRS-ENS-UCBL-INSERM, CIRI-UMR5308, Lyon, France
| | - Barbro Dahlen
- Karolinska University Hospital & Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
| | - Per S Bakke
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Pascal Chanez
- Département des Maladies Respiratoires, CIC Nord, INSERM U1067 Aix Marseille Université Marseille, Marseille, France
| | - Stephen J Fowler
- Centre for Respiratory Medicine and Allergy, The University of Manchester, Manchester Academic Health Science Centre, University Hospital of South Manchester NHS Foundation Trust, Clinic, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom
| | - Ildiko Horvath
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Paolo Montuschi
- Faculty of Medicine, Catholic University of the Sacred Heart, Rome, Italy
| | - Norbert Krug
- Fraunhofer Institute for Toxicology and Experimental Medicine Hannover, Germany
| | - Marek Sanak
- Department of Medicine, Jagiellonian University Medical School, Krakow, Poland
| | - Thomas Sandstrom
- Dept of Public Health and Clinical Medicine, Medicine, Umeå University, Umeå, Sweden
| | - Dominick E Shaw
- Respiratory Research Unit, University of Nottingham, Nottingham, United Kingdom
| | - Louise J Fleming
- National Heart & Lung Institute, Imperial College, London, United Kingdom
| | - Ratko Djukanovic
- NIHR Southampton Respiratory Biomedical Research Unit, Clinical and Experimental Sciences, University of Southampton Faculty of Medicine, Southampton, United Kingdom
| | - Peter H Howarth
- NIHR Southampton Respiratory Biomedical Research Unit, Clinical and Experimental Sciences, University of Southampton Faculty of Medicine, Southampton, United Kingdom
| | - Florian Singer
- University Children's Hospital Bern, Bern, Switzerland.,University Children's Hospital Zurich, Zurich, Switzerland
| | - Ana R Sousa
- Respiratory Therapy Unit, GlaxoSmithKline, London, United Kingdom
| | - Peter J Sterk
- Dept of Respiratory Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Julie Corfield
- AstraZeneca R&D, Mölndal, Sweden.,Areteva R&D, Nottingham, United Kingdom
| | - Ioannis Pandis
- Data Science Institute, South Kensington Campus, Imperial College London, London, United Kingdom
| | - Kian F Chung
- National Heart & Lung Institute, Imperial College, London, United Kingdom
| | - Ian M Adcock
- National Heart & Lung Institute, Imperial College, London, United Kingdom
| | - René Lutter
- Dept of Respiratory Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Lorena Fabbella
- Department of Clinical and Experimental Medicine - University of Catania, Catania, Italy
| | - Massimo Caruso
- Department of Clinical and Experimental Medicine - University of Catania, Catania, Italy.,Department of Biomedical and Biotechnological Sciences (BIOMETEC), University of Catania, Catania, Italy
| | | |
Collapse
|
44
|
Brandsma J, Goss VM, Yang X, Bakke PS, Caruso M, Chanez P, Dahlén SE, Fowler SJ, Horvath I, Krug N, Montuschi P, Sanak M, Sandström T, Shaw DE, Chung KF, Singer F, Fleming LJ, Sousa AR, Pandis I, Bansal AT, Sterk PJ, Djukanović R, Postle AD. Lipid phenotyping of lung epithelial lining fluid in healthy human volunteers. Metabolomics 2018; 14:123. [PMID: 30830396 PMCID: PMC6153688 DOI: 10.1007/s11306-018-1412-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 08/12/2018] [Indexed: 01/20/2023]
Abstract
BACKGROUND Lung epithelial lining fluid (ELF)-sampled through sputum induction-is a medium rich in cells, proteins and lipids. However, despite its key role in maintaining lung function, homeostasis and defences, the composition and biology of ELF, especially in respect of lipids, remain incompletely understood. OBJECTIVES To characterise the induced sputum lipidome of healthy adult individuals, and to examine associations between different ELF lipid phenotypes and the demographic characteristics within the study cohort. METHODS Induced sputum samples were obtained from 41 healthy non-smoking adults, and their lipid compositions analysed using a combination of untargeted shotgun and liquid chromatography mass spectrometry methods. Topological data analysis (TDA) was used to group subjects with comparable sputum lipidomes in order to identify distinct ELF phenotypes. RESULTS The induced sputum lipidome was diverse, comprising a range of different molecular classes, including at least 75 glycerophospholipids, 13 sphingolipids, 5 sterol lipids and 12 neutral glycerolipids. TDA identified two distinct phenotypes differentiated by a higher total lipid content and specific enrichments of diacyl-glycerophosphocholines, -inositols and -glycerols in one group, with enrichments of sterols, glycolipids and sphingolipids in the other. Subjects presenting the lipid-rich ELF phenotype also had significantly higher BMI, but did not differ in respect of other demographic characteristics such as age or gender. CONCLUSIONS We provide the first evidence that the ELF lipidome varies significantly between healthy individuals and propose that such differences are related to weight status, highlighting the potential impact of (over)nutrition on lung lipid metabolism.
Collapse
Affiliation(s)
- Joost Brandsma
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.
| | - Victoria M Goss
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Xian Yang
- Data Science Institute, Imperial College, London, UK
| | - Per S Bakke
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Massimo Caruso
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Pascal Chanez
- Department of Respiratory Diseases, Aix-Marseille University, Marseille, France
| | - Sven-Erik Dahlén
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Stephen J Fowler
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, University Hospital of South Manchester, Manchester, UK
| | - Ildiko Horvath
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Norbert Krug
- Fraunhofer Institute for Toxicology and Experimental Medicine, Hannover, Germany
| | - Paolo Montuschi
- Department of Pharmacology, Faculty of Medicine, Catholic University of the Sacred Heart, Rome, Italy
| | - Marek Sanak
- Department of Medicine, Jagiellonian University, Krakow, Poland
| | - Thomas Sandström
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Dominick E Shaw
- Respiratory Research Unit, University of Nottingham, Nottingham, UK
| | - Kian Fan Chung
- National Heart and Lung Institute, Imperial College, London, UK
| | | | | | - Ana R Sousa
- Respiratory Therapy Unit, GlaxoSmithKline, London, UK
| | | | - Aruna T Bansal
- Acclarogen Ltd, St John's Innovation Centre, Cambridge, UK
| | - Peter J Sterk
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Ratko Djukanović
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- National Institute for Health Research Southampton Biomedical Research Centre, Southampton, UK
| | - Anthony D Postle
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | | |
Collapse
|
45
|
Jevnikar Z, Östling J, Ax E, Calvén J, Thörn K, Israelsson E, Öberg L, Singhania A, Lau LCK, Wilson SJ, Ward JA, Chauhan A, Sousa AR, De Meulder B, Loza MJ, Baribaud F, Sterk PJ, Chung KF, Sun K, Guo Y, Adcock IM, Payne D, Dahlen B, Chanez P, Shaw DE, Krug N, Hohlfeld JM, Sandström T, Djukanovic R, James A, Hinks TSC, Howarth PH, Vaarala O, van Geest M, Olsson H. Epithelial IL-6 trans-signaling defines a new asthma phenotype with increased airway inflammation. J Allergy Clin Immunol 2018; 143:577-590. [PMID: 29902480 DOI: 10.1016/j.jaci.2018.05.026] [Citation(s) in RCA: 118] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 04/15/2018] [Accepted: 05/04/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Although several studies link high levels of IL-6 and soluble IL-6 receptor (sIL-6R) to asthma severity and decreased lung function, the role of IL-6 trans-signaling (IL-6TS) in asthmatic patients is unclear. OBJECTIVE We sought to explore the association between epithelial IL-6TS pathway activation and molecular and clinical phenotypes in asthmatic patients. METHODS An IL-6TS gene signature obtained from air-liquid interface cultures of human bronchial epithelial cells stimulated with IL-6 and sIL-6R was used to stratify lung epithelial transcriptomic data (Unbiased Biomarkers in Prediction of Respiratory Disease Outcomes [U-BIOPRED] cohorts) by means of hierarchical clustering. IL-6TS-specific protein markers were used to stratify sputum biomarker data (Wessex cohort). Molecular phenotyping was based on transcriptional profiling of epithelial brushings, pathway analysis, and immunohistochemical analysis of bronchial biopsy specimens. RESULTS Activation of IL-6TS in air-liquid interface cultures reduced epithelial integrity and induced a specific gene signature enriched in genes associated with airway remodeling. The IL-6TS signature identified a subset of patients with IL-6TS-high asthma with increased epithelial expression of IL-6TS-inducible genes in the absence of systemic inflammation. The IL-6TS-high subset had an overrepresentation of frequent exacerbators, blood eosinophilia, and submucosal infiltration of T cells and macrophages. In bronchial brushings Toll-like receptor pathway genes were upregulated, whereas expression of cell junction genes was reduced. Sputum sIL-6R and IL-6 levels correlated with sputum markers of remodeling and innate immune activation, in particular YKL-40, matrix metalloproteinase 3, macrophage inflammatory protein 1β, IL-8, and IL-1β. CONCLUSIONS Local lung epithelial IL-6TS activation in the absence of type 2 airway inflammation defines a novel subset of asthmatic patients and might drive airway inflammation and epithelial dysfunction in these patients.
Collapse
Affiliation(s)
- Zala Jevnikar
- Department of Bioscience, Respiratory, Inflammation and Autoimmunity, IMED Biotech Unit, AstraZeneca, Gothenburg, Sweden.
| | - Jörgen Östling
- Department of Bioscience, Respiratory, Inflammation and Autoimmunity, IMED Biotech Unit, AstraZeneca, Gothenburg, Sweden
| | - Elisabeth Ax
- Department of Bioscience, Respiratory, Inflammation and Autoimmunity, IMED Biotech Unit, AstraZeneca, Gothenburg, Sweden; Department of Internal Medicine and Clinical Nutrition, Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Jenny Calvén
- Department of Bioscience, Respiratory, Inflammation and Autoimmunity, IMED Biotech Unit, AstraZeneca, Gothenburg, Sweden
| | - Kristofer Thörn
- Department of Bioscience, Respiratory, Inflammation and Autoimmunity, IMED Biotech Unit, AstraZeneca, Gothenburg, Sweden
| | - Elisabeth Israelsson
- Department of Bioscience, Respiratory, Inflammation and Autoimmunity, IMED Biotech Unit, AstraZeneca, Gothenburg, Sweden
| | - Lisa Öberg
- Department of Bioscience, Respiratory, Inflammation and Autoimmunity, IMED Biotech Unit, AstraZeneca, Gothenburg, Sweden
| | - Akul Singhania
- Clinical and Experimental Sciences, University of Southampton Faculty of Medicine, Southampton University Hospital, Southampton, United Kingdom
| | - Laurie C K Lau
- Clinical and Experimental Sciences, University of Southampton Faculty of Medicine, Southampton University Hospital, Southampton, United Kingdom
| | - Susan J Wilson
- Clinical and Experimental Sciences, University of Southampton Faculty of Medicine, Southampton University Hospital, Southampton, United Kingdom; Histochemistry Research Unit, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Jonathan A Ward
- Clinical and Experimental Sciences, University of Southampton Faculty of Medicine, Southampton University Hospital, Southampton, United Kingdom; Histochemistry Research Unit, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Anoop Chauhan
- Portsmouth Hospitals NHS Trust, Portsmouth, United Kingdom
| | - Ana R Sousa
- Discovery Medicine, GlaxoSmithKline, Brentford, United Kingdom
| | - Bertrand De Meulder
- European Institute for Systems Biology and Medicine, CIRI UMR5308, CNRS-ENS-UCBL-INSERM, Université de Lyon, Lyon, France
| | | | | | - Peter J Sterk
- Department of Respiratory Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Kian Fan Chung
- National Heart and Lung Institute, Imperial College London, London UK & Royal Brompton Biomedical Research Unit at Royal Brompton and Harefield NHS Foundation Trust and Imperial College London, London, United Kingdom
| | - Kai Sun
- Department of Computing & Data Science Institute, Imperial College London, London, United Kingdom
| | - Yike Guo
- Department of Computing & Data Science Institute, Imperial College London, London, United Kingdom
| | - Ian M Adcock
- National Heart and Lung Institute, Imperial College London, London UK & Royal Brompton Biomedical Research Unit at Royal Brompton and Harefield NHS Foundation Trust and Imperial College London, London, United Kingdom
| | - Debbie Payne
- Centre for Integrated Genomic Medical Research, University of Manchester, Manchester, United Kingdom
| | - Barbro Dahlen
- Karolinska University Hospital & Centre for Allergy Research, Karolinska Institute, Stockholm, Sweden
| | | | - Dominick E Shaw
- Respiratory Biomedical Research Unit, University of Nottingham, Nottingham, United Kingdom
| | - Norbert Krug
- Fraunhofer Institute of Toxicology and Experimental Medicine, Member of the German Center for Lung Research, Hannover, Germany
| | - Jens M Hohlfeld
- Fraunhofer Institute of Toxicology and Experimental Medicine, Member of the German Center for Lung Research, Hannover, Germany; Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Thomas Sandström
- Department of Public Health and Clinical Medicine, Medicine, Umeå University, Umeå, Sweden
| | - Ratko Djukanovic
- NIHR Southampton Respiratory Biomedical Research Unit, Southampton University Hospital, Southampton, United Kingdom
| | - Anna James
- Experimental Asthma and Allergy Research, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Timothy S C Hinks
- Clinical and Experimental Sciences, University of Southampton Faculty of Medicine, Southampton University Hospital, Southampton, United Kingdom; NIHR Southampton Respiratory Biomedical Research Unit, Southampton University Hospital, Southampton, United Kingdom; Respiratory Medicine Unit, NDM Experimental Medicine, University of OxfordJohn Radcliffe Hospital, Oxford, United Kingdom
| | - Peter H Howarth
- Clinical and Experimental Sciences, University of Southampton Faculty of Medicine, Southampton University Hospital, Southampton, United Kingdom; NIHR Southampton Respiratory Biomedical Research Unit, Southampton University Hospital, Southampton, United Kingdom
| | - Outi Vaarala
- Department of Bioscience, Respiratory, Inflammation and Autoimmunity, IMED Biotech Unit, AstraZeneca, Gothenburg, Sweden
| | - Marleen van Geest
- Department of Bioscience, Respiratory, Inflammation and Autoimmunity, IMED Biotech Unit, AstraZeneca, Gothenburg, Sweden
| | - Henric Olsson
- Department of Bioscience, Respiratory, Inflammation and Autoimmunity, IMED Biotech Unit, AstraZeneca, Gothenburg, Sweden
| | | |
Collapse
|
46
|
Burg D, Schofield JPR, Brandsma J, Staykova D, Folisi C, Bansal A, Nicholas B, Xian Y, Rowe A, Corfield J, Wilson S, Ward J, Lutter R, Fleming L, Shaw DE, Bakke PS, Caruso M, Dahlen SE, Fowler SJ, Hashimoto S, Horváth I, Howarth P, Krug N, Montuschi P, Sanak M, Sandström T, Singer F, Sun K, Pandis I, Auffray C, Sousa AR, Adcock IM, Chung KF, Sterk PJ, Djukanović R, Skipp PJ, The U-Biopred Study Group. Large-Scale Label-Free Quantitative Mapping of the Sputum Proteome. J Proteome Res 2018; 17:2072-2091. [PMID: 29737851 DOI: 10.1021/acs.jproteome.8b00018] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Analysis of induced sputum supernatant is a minimally invasive approach to study the epithelial lining fluid and, thereby, provide insight into normal lung biology and the pathobiology of lung diseases. We present here a novel proteomics approach to sputum analysis developed within the U-BIOPRED (unbiased biomarkers predictive of respiratory disease outcomes) international project. We present practical and analytical techniques to optimize the detection of robust biomarkers in proteomic studies. The normal sputum proteome was derived using data-independent HDMSE applied to 40 healthy nonsmoking participants, which provides an essential baseline from which to compare modulation of protein expression in respiratory diseases. The "core" sputum proteome (proteins detected in ≥40% of participants) was composed of 284 proteins, and the extended proteome (proteins detected in ≥3 participants) contained 1666 proteins. Quality control procedures were developed to optimize the accuracy and consistency of measurement of sputum proteins and analyze the distribution of sputum proteins in the healthy population. The analysis showed that quantitation of proteins by HDMSE is influenced by several factors, with some proteins being measured in all participants' samples and with low measurement variance between samples from the same patient. The measurement of some proteins is highly variable between repeat analyses, susceptible to sample processing effects, or difficult to accurately quantify by mass spectrometry. Other proteins show high interindividual variance. We also highlight that the sputum proteome of healthy individuals is related to sputum neutrophil levels, but not gender or allergic sensitization. We illustrate the importance of design and interpretation of disease biomarker studies considering such protein population and technical measurement variance.
Collapse
Affiliation(s)
- Dominic Burg
- Centre for Proteomic Research, Biological Sciences , University of Southampton , Southampton SO17 1BJ , U.K.,NIHR Southampton Biomedical Research Centre, Clinical and Experimental Sciences, Faculty of Medicine , University of Southampton , Southampton SO16 6YD , U.K
| | - James P R Schofield
- Centre for Proteomic Research, Biological Sciences , University of Southampton , Southampton SO17 1BJ , U.K.,NIHR Southampton Biomedical Research Centre, Clinical and Experimental Sciences, Faculty of Medicine , University of Southampton , Southampton SO16 6YD , U.K
| | - Joost Brandsma
- NIHR Southampton Biomedical Research Centre, Clinical and Experimental Sciences, Faculty of Medicine , University of Southampton , Southampton SO16 6YD , U.K
| | - Doroteya Staykova
- Centre for Proteomic Research, Biological Sciences , University of Southampton , Southampton SO17 1BJ , U.K
| | - Caterina Folisi
- Centre for Proteomic Research, Biological Sciences , University of Southampton , Southampton SO17 1BJ , U.K
| | | | - Ben Nicholas
- NIHR Southampton Biomedical Research Centre, Clinical and Experimental Sciences, Faculty of Medicine , University of Southampton , Southampton SO16 6YD , U.K
| | - Yang Xian
- Data Science Institute , Imperial College London , London SW7 2AZ , U.K
| | - Anthony Rowe
- Janssen Research & Development , Buckinghamshire HP12 4DP , U.K
| | | | - Susan Wilson
- NIHR Southampton Biomedical Research Centre, Clinical and Experimental Sciences, Faculty of Medicine , University of Southampton , Southampton SO16 6YD , U.K
| | - Jonathan Ward
- NIHR Southampton Biomedical Research Centre, Clinical and Experimental Sciences, Faculty of Medicine , University of Southampton , Southampton SO16 6YD , U.K
| | - Rene Lutter
- AMC, Department of Experimental Immunology , University of Amsterdam , 1012 WX Amsterdam , The Netherlands.,AMC, Department of Respiratory Medicine , University of Amsterdam , 1012 WX Amsterdam , The Netherlands
| | - Louise Fleming
- Airways Disease , National Heart and Lung Institute, Imperial College, London & Royal Brompton NIHR Biomedical Research Unit , London SW7 2AZ , United Kingdom
| | - Dominick E Shaw
- Respiratory Research Unit , University of Nottingham , Nottingham NG7 2RD , U.K
| | - Per S Bakke
- Institute of Medicine , University of Bergen , 5007 Bergen , Norway
| | - Massimo Caruso
- Department of Clinical and Experimental Medicine Hospital University , University of Catania , 95124 Catania , Italy
| | - Sven-Erik Dahlen
- The Centre for Allergy Research , The Institute of Environmental Medicine, Karolinska Institutet , SE-171 77 Stockholm , Sweden
| | - Stephen J Fowler
- Respiratory and Allergy Research Group , University of Manchester , Manchester M13 9PL , U.K
| | - Simone Hashimoto
- Department of Respiratory Medicine, Academic Medical Centre , University of Amsterdam , 1012 WX Amsterdam , The Netherlands
| | - Ildikó Horváth
- Department of Pulmonology , Semmelweis University , Budapest 1085 , Hungary
| | - Peter Howarth
- NIHR Southampton Biomedical Research Centre, Clinical and Experimental Sciences, Faculty of Medicine , University of Southampton , Southampton SO16 6YD , U.K
| | - Norbert Krug
- Fraunhofer Institute for Toxicology and Experimental Medicine Hannover , 30625 Hannover , Germany
| | - Paolo Montuschi
- Faculty of Medicine , Catholic University of the Sacred Heart , 00168 Rome , Italy
| | - Marek Sanak
- Laboratory of Molecular Biology and Clinical Genetics, Medical College , Jagiellonian University , 31-007 Krakow , Poland
| | - Thomas Sandström
- Department of Medicine, Department of Public Health and Clinical Medicine Respiratory Medicine Unit , Umeå University , 901 87 Umeå , Sweden
| | - Florian Singer
- University Children's Hospital Zurich , 8032 Zurich , Switzerland
| | - Kai Sun
- Data Science Institute , Imperial College London , London SW7 2AZ , U.K
| | - Ioannis Pandis
- Data Science Institute , Imperial College London , London SW7 2AZ , U.K
| | - Charles Auffray
- European Institute for Systems Biology and Medicine, CNRS-ENS-UCBL-INSERM , Université de Lyon , 69007 Lyon , France
| | - Ana R Sousa
- Respiratory Therapeutic Unit, GSK , Stockley Park , Uxbridge UB11 1BT , U.K
| | - Ian M Adcock
- Cell and Molecular Biology Group, Airways Disease Section , National Heart and Lung Institute, Imperial College London , Dovehouse Street , London SW3 6LR , U.K
| | - Kian Fan Chung
- Airways Disease , National Heart and Lung Institute, Imperial College, London & Royal Brompton NIHR Biomedical Research Unit , London SW7 2AZ , United Kingdom
| | - Peter J Sterk
- AMC, Department of Experimental Immunology , University of Amsterdam , 1012 WX Amsterdam , The Netherlands
| | - Ratko Djukanović
- NIHR Southampton Biomedical Research Centre, Clinical and Experimental Sciences, Faculty of Medicine , University of Southampton , Southampton SO16 6YD , U.K
| | - Paul J Skipp
- Centre for Proteomic Research, Biological Sciences , University of Southampton , Southampton SO17 1BJ , U.K
| | | |
Collapse
|
47
|
Takahashi K, Pavlidis S, Ng Kee Kwong F, Hoda U, Rossios C, Sun K, Loza M, Baribaud F, Chanez P, Fowler SJ, Horvath I, Montuschi P, Singer F, Musial J, Dahlen B, Dahlen SE, Krug N, Sandstrom T, Shaw DE, Lutter R, Bakke P, Fleming LJ, Howarth PH, Caruso M, Sousa AR, Corfield J, Auffray C, De Meulder B, Lefaudeux D, Djukanovic R, Sterk PJ, Guo Y, Adcock IM, Chung KF. Sputum proteomics and airway cell transcripts of current and ex-smokers with severe asthma in U-BIOPRED: an exploratory analysis. Eur Respir J 2018; 51:13993003.02173-2017. [PMID: 29650557 DOI: 10.1183/13993003.02173-2017] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 02/22/2018] [Indexed: 12/14/2022]
Abstract
Severe asthma patients with a significant smoking history have airflow obstruction with reported neutrophilia. We hypothesise that multi-omic analysis will enable the definition of smoking and ex-smoking severe asthma molecular phenotypes.The U-BIOPRED cohort of severe asthma patients, containing current-smokers (CSA), ex-smokers (ESA), nonsmokers and healthy nonsmokers was examined. Blood and sputum cell counts, fractional exhaled nitric oxide and spirometry were obtained. Exploratory proteomic analysis of sputum supernatants and transcriptomic analysis of bronchial brushings, biopsies and sputum cells was performed.Colony-stimulating factor (CSF)2 protein levels were increased in CSA sputum supernatants, with azurocidin 1, neutrophil elastase and CXCL8 upregulated in ESA. Phagocytosis and innate immune pathways were associated with neutrophilic inflammation in ESA. Gene set variation analysis of bronchial epithelial cell transcriptome from CSA showed enrichment of xenobiotic metabolism, oxidative stress and endoplasmic reticulum stress compared to other groups. CXCL5 and matrix metallopeptidase 12 genes were upregulated in ESA and the epithelial protective genes, mucin 2 and cystatin SN, were downregulated.Despite little difference in clinical characteristics, CSA were distinguishable from ESA subjects at the sputum proteomic level, with CSA patients having increased CSF2 expression and ESA patients showing sustained loss of epithelial barrier processes.
Collapse
Affiliation(s)
- Kentaro Takahashi
- National Heart and Lung Institute, Imperial College London, and Biomedical Research Unit, Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, UK.,Research Centre for Allergy and Clinical Immunology, Asahi General Hospital, Matsudo, Japan
| | - Stelios Pavlidis
- Dept of Computing and Data Science Institute, Imperial College London, London, UK
| | - Francois Ng Kee Kwong
- National Heart and Lung Institute, Imperial College London, and Biomedical Research Unit, Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, UK
| | - Uruj Hoda
- National Heart and Lung Institute, Imperial College London, and Biomedical Research Unit, Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, UK
| | - Christos Rossios
- National Heart and Lung Institute, Imperial College London, and Biomedical Research Unit, Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, UK
| | - Kai Sun
- Dept of Computing and Data Science Institute, Imperial College London, London, UK
| | - Matthew Loza
- Janssen Research and Development, High Wycombe, UK
| | | | - Pascal Chanez
- Assistance Publique des Hôpitaux de Marseille, Clinique des Bronches, Allergies et Sommeil, Aix Marseille Université, Marseille, France
| | - Steve J Fowler
- Centre for Respiratory Medicine and Allergy, Institute of Inflammation and Repair, University of Manchester and University Hospital of South Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
| | | | | | - Florian Singer
- Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jacek Musial
- Dept of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Barbro Dahlen
- Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
| | - Sven-Eric Dahlen
- Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
| | - Norbert Krug
- Fraunhofer Institute for Toxicology and Experimental Medicine, Hannover, Germany
| | - Thomas Sandstrom
- Dept of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Dominic E Shaw
- Respiratory Research Unit, University of Nottingham, Nottingham, UK
| | - Rene Lutter
- Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Per Bakke
- Dept of Clinical Science, University of Bergen, Bergen, Norway
| | - Louise J Fleming
- National Heart and Lung Institute, Imperial College London, and Biomedical Research Unit, Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, UK
| | - Peter H Howarth
- NIHR Southampton Respiratory Biomedical Research Unit, Clinical and Experimental Sciences and Human Development and Health, Southampton, UK
| | - Massimo Caruso
- Dept Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Ana R Sousa
- Respiratory Therapeutic Unit, GSK, Stockley Park, UK
| | - Julie Corfield
- AstraZeneca R&D, Molndal, Sweden.,Areteva R&D, Nottingham, UK
| | - Charles Auffray
- European Institute for Systems Biology and Medicine, CNRS-ENS-UCBL-INSERM, Lyon, France
| | - Bertrand De Meulder
- European Institute for Systems Biology and Medicine, CNRS-ENS-UCBL-INSERM, Lyon, France
| | - Diane Lefaudeux
- European Institute for Systems Biology and Medicine, CNRS-ENS-UCBL-INSERM, Lyon, France
| | - Ratko Djukanovic
- NIHR Southampton Respiratory Biomedical Research Unit, Clinical and Experimental Sciences and Human Development and Health, Southampton, UK
| | - Peter J Sterk
- Dept of Clinical Science, University of Bergen, Bergen, Norway
| | - Yike Guo
- Dept of Computing and Data Science Institute, Imperial College London, London, UK
| | - Ian M Adcock
- National Heart and Lung Institute, Imperial College London, and Biomedical Research Unit, Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, UK.,Dept of Computing and Data Science Institute, Imperial College London, London, UK
| | - Kian Fan Chung
- National Heart and Lung Institute, Imperial College London, and Biomedical Research Unit, Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, UK.,Dept of Computing and Data Science Institute, Imperial College London, London, UK
| | | |
Collapse
|
48
|
Abstract
Fetuses exposed to warfarin during pregnancy are at an increased risk of developing an embryopathy known as fetal warfarin syndrome or warfarin embryopathy. The most consistent anomalies are nasal hypoplasia and stippling of vertebrae or bony epiphyses. Management of pregnant patients on anticoagulation is challenging. Current guidelines suggest the use of warfarin if the therapeutic dose is ≤5 mg/day. We report the case of a newborn with signs of warfarin embryopathy born from a mother anticoagulated with warfarin due to mechanical mitral and aortic heart valves. Warfarin was required at the dose of 5 mg/day and was withheld without medical advice between weeks 8 and 10 with no other anticoagulation. The newborn presented with skeletal abnormalities and a ventricular septal defect that have not required specific treatment during the first year of life. Low-dose warfarin is associated with a lower risk of warfarin-related fetopathy but the risk of embryopathy seems unchanged.
Collapse
Affiliation(s)
- Ana R Sousa
- Department of Pediatric Cardiology, Centro Hospitalar de Lisboa Ocidental EPE, Lisbon, Portugal.,Department of Neonatology, Centro Hospitalar de Lisboa Ocidental EPE, Lisbon, Portugal
| | - Rita Barreira
- Department of Pediatrics, Centro Hospitalar de Lisboa Ocidental EPE, Lisbon, Portugal
| | - Edmundo Santos
- Department of Neonatology, Centro Hospitalar de Lisboa Ocidental EPE, Lisbon, Portugal
| |
Collapse
|
49
|
Loymans RJB, Debray TPA, Honkoop PJ, Termeer EH, Snoeck-Stroband JB, Schermer TRJ, Assendelft WJJ, Timp M, Chung KF, Sousa AR, Sont JK, Sterk PJ, Reddel HK, Ter Riet G. Exacerbations in Adults with Asthma: A Systematic Review and External Validation of Prediction Models. J Allergy Clin Immunol Pract 2018; 6:1942-1952.e15. [PMID: 29454163 DOI: 10.1016/j.jaip.2018.02.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 01/11/2018] [Accepted: 02/05/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Several prediction models assessing future risk of exacerbations in adult patients with asthma have been published. Applicability of these models is uncertain because their predictive performance has often not been assessed beyond the population in which they were derived. OBJECTIVE This study aimed to identify and critically appraise prediction models for asthma exacerbations and validate them in 2 clinically distinct populations. METHODS PubMed and EMBASE were searched to April 2017 for reports describing adult asthma populations in which multivariable models were constructed to predict exacerbations during any time frame. After critical appraisal, the models' predictive performances were assessed in a primary and a secondary care population for author-defined exacerbations and for American Thoracic Society/European Respiratory Society-defined severe exacerbations. RESULTS We found 12 reports from which 24 prediction models were evaluated. Three predictors (previous health care utilization, symptoms, and spirometry values) were retained in most models. Assessment was hampered by suboptimal methodology and reporting, and by differences in exacerbation outcomes. Discrimination (area under the receiver-operating characteristic curve [c-statistic]) of models for author-defined exacerbations was better in the primary care population (mean, 0.71) than in the secondary care population (mean, 0.60) and similar (0.65 and 0.62, respectively) for American Thoracic Society/European Respiratory Society-defined severe exacerbations. Model calibration was generally poor, but consistent between the 2 populations. CONCLUSIONS The preservation of 3 predictors in models derived from variable populations and the fairly consistent predictive properties of most models in 2 distinct validation populations suggest the feasibility of a generalizable model predicting severe exacerbations. Nevertheless, improvement of the models is warranted because predictive performances are below the desired level.
Collapse
Affiliation(s)
- Rik J B Loymans
- Department of General Practice, Academic Medical Center, Amsterdam, The Netherlands.
| | - Thomas P A Debray
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands; Cochrane Netherlands, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Persijn J Honkoop
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Evelien H Termeer
- Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Jiska B Snoeck-Stroband
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Tjard R J Schermer
- Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Willem J J Assendelft
- Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Merel Timp
- Department of General Practice, Academic Medical Center, Amsterdam, The Netherlands
| | - Kian Fan Chung
- Experimental Airway Disease, National Heart and Lung Institute, Imperial College, London, United Kingdom; Royal Brompton NIHR Biomedical Research Unit, London, United Kingdom
| | - Ana R Sousa
- Respiratory Therapeutic Unit, GlaxoSmithKline, Uxbridge, United Kingdom
| | - Jacob K Sont
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Peter J Sterk
- Department of Respiratory Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Helen K Reddel
- Clinical Management Group, Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
| | - Gerben Ter Riet
- Department of General Practice, Academic Medical Center, Amsterdam, The Netherlands
| |
Collapse
|
50
|
Feldman GJ, Sousa AR, Lipson DA, Tombs L, Barnes N, Riley JH, Patel S, Naya I, Compton C, Alcázar Navarrete B. Comparative Efficacy of Once-Daily Umeclidinium/Vilanterol and Tiotropium/Olodaterol Therapy in Symptomatic Chronic Obstructive Pulmonary Disease: A Randomized Study. Adv Ther 2017; 34:2518-2533. [PMID: 29094315 PMCID: PMC5702366 DOI: 10.1007/s12325-017-0626-4] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Indexed: 11/03/2022]
Abstract
INTRODUCTION We report the results of the first direct comparison of the once-daily fixed-dose long-acting muscarinic antagonist/long-acting β2-agonist (LAMA/LABA) combinations umeclidinium/vilanterol (UMEC/VI) and tiotropium/olodaterol (TIO/OLO) in patients with COPD. METHODS This was a randomized, two-period crossover open-label study in symptomatic patients with COPD [age 40 years or older, postbronchodilator forced expiratory volume in 1 s (FEV1) of 70% or less and 50% or more of predicted normal values, and modified Medical Research Council Dyspnoea Scale score of 2 or greater] not receiving inhaled corticosteroid therapy. Patients were randomized to receive UMEC/VI (62.5/25 µg once daily) via a multidose dry powder inhaler (ELLIPTA) followed by TIO/OLO (5/5 µg once daily) via a soft mist inhaler (Respimat), each for 8 weeks with an interim 3-week washout or vice versa. The primary end point was the change from baseline in trough FEV1 at week 8 with a noninferiority margin of - 50 mL in the per-protocol (PP) population. The incidence of adverse events was also assessed. RESULTS In total, 236 patients (mean age 64.4 years, 60% male) were included in the intent-to-treat population and 227 were included in the PP population. UMEC/VI treatment was noninferior in the PP population and superior in the intent-to-treat population to TIO/OLO treatment with regard to trough FEV1 at week 8 [FEV1 change from baseline 180 mL vs 128 mL; difference 52 mL (95% confidence interval 28-77 mL); p < 0.001]. Patients receiving UMEC/VI had twofold increased odds of experiencing a clinically meaningful increase (100 mL or more) from baseline in trough FEV1 at week 8 compared with patients receiving TIO/OLO (odds ratio 2.05; 95% confidence interval 1.34-3.14). Adverse events occurred in 25% of patients in the UMEC/VI group and in 31% of patients in the TIO/OLO group. CONCLUSION In this first direct comparison of two once-daily fixed-dose LAMA/LABA combinations, superiority was observed for the primary end point of trough FEV1 at week 8 with UMEC/VI compared with TIO/OLO in patients with symptomatic COPD. Both treatments had similar safety profiles. These findings confirm the results of previous indirect LAMA/LABA comparisons, and show that an efficacy gradient exists within the LAMA/LABA class. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT02799784. FUNDING GlaxoSmithKline.
Collapse
Affiliation(s)
| | - Ana R Sousa
- Respiratory Research and Development, GlaxoSmithKline, Stockley Park West, Uxbridge, Middlesex, UK
| | - David A Lipson
- Respiratory Research and Development, GlaxoSmithKline, King of Prussia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Lee Tombs
- Precise Approach Ltd, Birmingham, West Midlands, UK
| | - Neil Barnes
- Global Respiratory Franchise, GlaxoSmithKline, Brentford, Middlesex, UK
| | - John H Riley
- Respiratory Therapy Area Unit, GlaxoSmithKline Medicines Research Centre, GlaxoSmithKline, Stevenage, Hertfordshire, UK
| | - Sadhana Patel
- Global Respiratory Franchise, GlaxoSmithKline, Brentford, Middlesex, UK
| | - Ian Naya
- Respiratory Medicine, GlaxoSmithKline, Brentford, Middlesex, UK
| | - Chris Compton
- Global Respiratory Franchise, GlaxoSmithKline, Brentford, Middlesex, UK
| | | |
Collapse
|