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1.  Allergen hybrids – next generation vaccines for Fagales pollen immunotherapy 
Summary
Background
Trees belonging to the order of Fagales show a distinct geographical distribution. While alder and birch are endemic in the temperate zones of the Northern Hemisphere, hazel, hornbeam and oak prefer a warmer climate. However, specific immunotherapy of Fagales pollen-allergic patients is mainly performed using birch pollen extracts, thus limiting the success of this intervention in birch-free areas.
Objectives
T cells are considered key players in the modification of an allergic immune response during specific immunotherapy (SIT), therefore we thought to combine linear T cell epitope-containing stretches of the five most important Fagales allergens from birch, hazel, alder, oak and hornbeam resulting in a Fagales pollen hybrid (FPH) molecule applicable for SIT.
Methods
A Fagales pollen hybrid was generated by PCR-based recombination of low IgE-binding allergen epitopes. Moreover, a structural-variant FPH4 was calculated by in silico mutagenesis, rendering the protein unable to adopt the Bet v 1-like fold. Both molecules were produced in Escherichia coli, characterized physico-chemically as well as immunologically, and tested in mouse models of allergic sensitization as well as allergy prophylaxis.
Results
Using spectroscopic analyses, both proteins were monomeric, and the secondary structure elements of FPH resemble the ones typical for Bet v 1-like proteins, whereas FPH4 showed increased amounts of unordered structure. Both molecules displayed reduced binding capacities of Bet v 1-specific IgE antibodies. However, in a mouse model, the proteins were able to induce high IgG titres cross-reactive with all parental allergens. Moreover, prophylactic treatment with the hybrid proteins prevented pollen extract-induced allergic lung inflammation in vivo.
Conclusion
The hybrid molecules showed a more efficient uptake and processing by dendritic cells resulting in a modified T cell response. The proteins had a lower IgE-binding capacity compared with the parental allergens, thus the high safety profile and increased efficacy emphasize clinical application for the treatment of Fagales multi-sensitization.
doi:10.1111/cea.12250
PMCID: PMC4041320  PMID: 24330218
allergen-specific immunotherapy; birch pollen allergy; Fagales pollen allergy; hybrid protein; immunomodulation; protein remodelling
2.  Vitamin D Supplementation Reduces Airway Hyperresponsiveness and Allergic Airway Inflammation in a Murine Model 
Background
Asthma is a chronic disease associated with airway hyperresponsiveness (AHR), airway obstruction, and airway remodeling. NF-κB is a transcriptional factor that regulates and co-ordinates the expression of various inflammatory genes. The NF-κB subunits, p50 and Rel-A, are translocated to the nucleus by importin α3 and importin α4. There is growing evidence that vitamin D is a potent immunomodulator. However, the evidence for beneficial or adverse effects of vitamin D in asthma is still unclear.
Objective
In this study, we examined the effect of vitamin D status on AHR, airway inflammation, and cytokines in the bronchoalveolar lavage fluid (BALF) in a murine model of allergic asthma.
Methods
Female BALB/c mice were fed with special vitamin D-deficient or vitamin D-sufficient (2,000 IU/kg) or vitamin D-supplemented (10,000 IU/kg) diet for 13 weeks. Mice were sensitized and challenged with ovalbumin. The effect of vitamin D on lung histology, AHR, T-regulatory cells and BALF cytokines was examined. The expression of importin-α3 and Rel-A in the lung of OVA-sensitized mice was analyzed using immunofluorescence.
Results
Vitamin D deficiency was associated with higher AHR in OVA-sensitized and challenged mice than those in vitamin D-sufficient mice. This was accompanied with marked signs of airway remodeling, high BALF eosinophilia, increased BALF pro-inflammatory cytokines, reduced BALF IL-10 levels, reduced blood T-regulatory cells, increased expression of importin-α3 and Rel-A in the lung tissue. Vitamin D supplementation attenuated the pro-inflammatory effects, but did not completely reverse the features of allergic airway inflammation.
Conclusion and Clinical Relevance
Vitamin D could be beneficial as an adjunct therapy in the treatment of allergic asthma.
doi:10.1111/cea.12102
PMCID: PMC3671499  PMID: 23711130
3.  ALOX5 Polymorphism Associates with Increased Leukotriene Production and Reduced Lung Function and Asthma Control in Children with Poorly Controlled Asthma 
Background
Identification of risk factors for reduced asthma control could improve the understanding and treatment of asthma. A promoter polymorphism in the 5-lipoxygenase gene affects gene expression and response to asthma therapy but its impact on disease control remains unclear.
Objective
We sought to determine if the ALOX5 promoter SP1 tandem repeat polymorphism was associated with changes in cysteinyl leukotriene production, lung function, airway inflammation and asthma control score.
Methods
We analyzed 270 children 6-17 years old with poorly controlled asthma enrolled in a 6-month clinical trial (NCT00604851). In secondary analysis, we associated the ALOX5 promoter SP1 tandem repeat polymorphism genotype (rs59439148) with asthma outcomes using both additive and recessive genetic models. We evaluated FEV1 percent predicted, symptom control, exhaled nitric oxide and urinary LTE4 levels.
Results
14.8% (40/270) of all children (and 28% (38/135) of African Americans) carried 2 non-5 repeat variant alleles of rs59439148. Children who were homozygous for variant alleles had significantly higher urinary LTE4 levels (38 versus 30 nmol/mol creatinine, p=.0134), significantly worse FEV1% predicted (84 versus 91, p=.017), and a trend toward worse asthma control. FEV1% predicted values were significantly negatively correlated with urinary LTE4 (r = -0.192, p=.009).
Conclusion and Clinical Relevance
Carrying two copies of a minor variant ALOX5 promoter SP1 tandem repeat allele contributes to increased cysLT exposure as determined by urinary LTE4 levels, reduced lung function, and potentially worse asthma control. ALOX5 promoter SP1 tandem repeat genotype may be a risk factor for worse asthma outcomes.
doi:10.1111/cea.12076
PMCID: PMC3633142  PMID: 23600541
Asthma; Children; ALOX5; 5-Lipoxygenase; Leukotriene; Asthma Control; FEV1; Exhaled Nitric Oxide; Genetic Association
4.  Glutathione S-transferase P1 Ile105Val polymorphism modulates allergen-induced airway inflammation in human atopic asthmatics in vivo 
Background
Glutathione S-transferase P1 is a Phase II cytoprotective and detoxifying enzyme that is widely expressed in human airways. The glutathione S-transferase P1 Ile105Val polymorphism has been linked with atopic disorders and asthma. Yet, little is known about the regulation of allergic inflammation by glutathione S-transferase P1 in human asthmatics.
Objective
To establish the effect of the glutathione S-transferase P1 Ile105Val polymorphism on allergen-induced airway inflammation and oxidant stress, and nonspecific bronchial hyperresponsiveness to methacholine and reactivity to specific allergen in mild human atopic asthmatics in vivo.
Methods
Five Val105/Val105, twelve Val105/Ile105, and twenty Ile105/Ile105 mild atopic asthmatics underwent methacholine challenge, inhaled allergen challenge, and endobronchial allergen provocation through a bronchoscope. A panel of inflammatory cytokines and chemokines, F2-isoprostanes and isofuranes, markers of oxidative stress, thromboxane B2, and immunoglobulin E were measured in bronchoalveolar lavage fluid at baseline and 24 hrs after allergen instillation.
Results
Asthmatics with glutathione S-transferase P1 Val105/Val105 compared to asthmatics with the glutathione S-transferase P1 Val105/Ile105 and Ile105/Ile105 had greater generation of acute phase cytokines (TNF-α, IL-6, CXCL8), IL-12, CCL11, thromboxane B2, and immunoglobulin E at 24 hrs after local allergen challenge. The GSTP1 genotype had no effect on airway hyperresponsiveness to methacholine and the reactivity to specific allergen.
Conclusion
The glutathione S-transferase P1 Ile105Val polymorphism markedly modifies allergen-provoked airway inflammation in atopic asthmatics in vivo. Modulation of the biochemical milieu in response to allergen provides a mechanistic explanation for regulatory effects of glutathione S-transferase P1 polymorphism on airway pathophysiology, and may guide improvement of future therapeutic methods in human atopic asthmatics. These findings must me confirmed in a larger study population of asthmatics with various ethnicities.
doi:10.1111/cea.12086
PMCID: PMC3633143  PMID: 23600543
Glutathione S-transferase P1; Ile105Val polymorphism; atopic asthma; allergen challenge; methacholine challenge; allergic inflammation; oxidant stress
5.  Age-dependent interaction between atopy and eosinophils in asthma cases: Results from NHANES 2005–2006 
Background
Atopy is an established risk factor for asthma, and an elevated eosinophil level is a hallmark of atopic and non-atopic asthma. Whether atopy and eosinophils act independently or interact to influence asthma has clinical and public health implications.
Objective
To investigate the relationship between atopy and eosinophils in asthma.
Methods
Data on current asthma, atopy (IgE positive to ≥ 1 allergen), and blood eosinophil percent (dichotomized at the median) were obtained for persons aged ≥ 6 years from NHANES 2005–2006. Interaction on an additive scale was evaluated by estimating the prevalences of asthma for combinations of atopy (yes or no) and eosinophil percent (high or low) and calculating the excess prevalence due to interaction.
Results
For all ages combined, the adjusted prevalences of asthma were 4.6%, 7.6%, 6.9%, and 17.2% for persons with neither factor, atopy alone, a high eosinophil percent alone, and both factors, respectively. The excess prevalence of asthma due to interaction was 7.2%, indicating synergism. The excess prevalence was greatest in children aged 6–17 years (15.3%), and it decreased with each older age category until it was absent in adults aged ≥ 55 years (−0.2%). In children, 94% of asthma cases attributable to the 2 factors were attributable to their interaction, whereas in the oldest adults, no cases were attributable to their interaction.
Conclusions and Clinical Relevance
Interaction between atopy and an elevated eosinophil level in asthma cases was very strong in children but absent in the oldest adults, which suggests different mechanistic pathways for these factors by age and supports the notion that asthma is a heterogeneous disease. In addition, the age-dependent interaction between the factors has potential implications for the selection of asthma patients for treatments that would target either IgE or a high eosinophil level.
doi:10.1111/cea.12069
PMCID: PMC3633144  PMID: 23600545
Asthma; atopy; eosinophils; epidemiology; immunoglobulin E; survey
6.  Interleukin-13: prospects for new treatments 
Summary
IL-13 is a T-helper type 2 cytokine. Animal models have implicated IL-13 as a critical cytokine in the development of asthma and chronic obstructive pulmonary disease (COPD). In vitro IL-13 exerts important effects on both structural and inflammatory cells within the airway and has the capacity to drive the clinical features of airways disease. In asthma, this view is strongly supported by associations with IL-13 genetic polymorphisms and increased mRNA and protein expression in blood, sputum and bronchial submucosa. In particular, IL-13 up-regulation is associated with severe disease. Current evidence in COPD is conflicting, with some reports supporting and others refuting a role for IL-13. Early clinical trials of anti-IL-13 therapies in asthma have shown promise, and the results of further efficacy studies are eagerly awaited.
doi:10.1111/j.1365-2222.2009.03383.x
PMCID: PMC3992377  PMID: 19878194
7.  Association of polymorphisms in CASP10 and CASP8 with FEV1/FVC and bronchial hyperresponsiveness in ethnically diverse asthmatics 
Summary
Background
Several chromosomal regions have been identified using family-based linkage analysis to contain genes contributing to the development of asthma and allergic disorders. One of these regions, chromosome 2q32-q33, contains a gene cluster containing CFLAR, CASP10 and CASP8. These genes regulate the extrinsic apoptosis pathway utilized by several types of immune and structural cells that have been implicated in the pathogenesis of asthma.
Objective
To assess the role of genetic variation in CFLAR, CASP10 and CASP8 in asthma and related phenotypes in individuals of diverse ethnic backgrounds.
Methods
We tested 26 single nucleotide polymorphisms (SNPs) in the CFLAR, CASP10 and CASP8 gene cluster for association with asthma and related phenotypes in African-American, non-Hispanic whites, and Hispanic case–control populations (cases, N = 517, controls, N = 644).
Results
Five CASP10 SNPS were associated with forced expiratory volume in 1 s (FEV1)/forced expiration volume capacity (FVC) in the African-American subjects with asthma (P = 0.0009–0.047). Nine SNPs, seven in CASP10 and two in CASP8, were also associated with the degree of bronchial hyperresponsiveness (BHR) (as determined by PC20) in race-specific analysis, predominately in the Non-Hispanic white cases. Two SNPs, rs6750157 in CASP10 and rs1045485 in CASP8 were modestly associated with asthma in the African-American (P = 0.025) and Hispanic (P = 0.033) populations, respectively.
Conclusion
These data suggest a role for CASP10 as a potential modifier of the asthma phenotype, specifically with measures of airway obstruction and BHR.
doi:10.1111/j.1365-2222.2008.03095.x
PMCID: PMC3979622  PMID: 18823309
asthma; bronchial hyperresponsiveness; CASP10; chromosome 2q; FEV1/FVC
8.  Genome-wide association study of body mass index in 23,000 individuals with and without asthma 
Background
Both asthma and obesity are complex disorders that are influenced by environmental and genetic factors. Shared genetic factors between asthma and obesity have been proposed to partly explain epidemiological findings of co-morbidity between these conditions.
Objective
To identify genetic variants that are associated with body mass index (BMI) in asthmatic children and adults, and to evaluate if there are differences between the genetics of BMI in asthmatics and healthy individuals.
Methods
In total, 19 studies contributed with genome-wide analysis study (GWAS) data from more than 23,000 individuals with predominantly European descent, of whom 8,165 are asthmatics.
Results
We report associations between several DENND1B variants (p=2.2×10−7 for rs4915551) on chromosome 1q31 and BMI from a meta-analysis of GWAS data using 2,691 asthmatic children (screening data). The top DENND1B SNPs were next evaluated in seven independent replication data sets comprising 2,014 asthmatics, and rs4915551 was nominally replicated (p<0.05) in two of the seven studies and of borderline significance in one (p=0.059). However, strong evidence of effect heterogeneity was observed and overall, the association between rs4915551 and BMI was not significant in the total replication data set, p=0.71. Using a random effects model, BMI was overall estimated to increase by 0.30 kg/m2 (p=0.01 for combined screening and replication data sets, N=4,705) per additional G allele of this DENND1B SNP. FTO was confirmed as an important gene for adult and childhood BMI regardless of asthma status.
Conclusions and Clinical Relevance
DENND1B was recently identified as an asthma susceptibility gene in a GWAS on children, and here we find evidence that DENND1B variants may also be associated with BMI in asthmatic children. However, the association was overall not replicated in the independent data sets and the heterogeneous effect of DENND1B points to complex associations with the studied diseases that deserve further study.
doi:10.1111/cea.12054
PMCID: PMC3608930  PMID: 23517042
Association; Asthma; BMI; Genetics; Genome-wide; Obesity
9.  Copy number variation prevalence in known asthma genes and their impact on asthma susceptibility 
Background
Genetic studies have identified numerous genes reproducibly associated with asthma, yet these studies have focused almost entirely on single nucleotide polymorphisms (SNPs), and virtually ignored another highly prevalent form of genetic variation: Copy Number Variants (CNVs).
Objective
To survey the prevalence of CNVs in genes previously associated with asthma, and to assess whether CNVs represent the functional asthma-susceptibility variants at these loci.
Methods
We genotyped 383 asthmatic trios participating in the Childhood Asthma Management Program (CAMP) using a competitive genomic hybridization (CGH) array designed to interrogate 20,092 CNVs. To ensure comprehensive assessment of all potential asthma candidate genes, we purposely used liberal asthma gene inclusion criteria, resulting in consideration of 270 candidate genes previously implicated in asthma. We performed statistical testing using FBAT-CNV.
Results
Copy number variation in asthma candidate genes was prevalent, with 21% of tested genes residing near or within one of 69 CNVs. In 6 instances, the complete candidate gene sequence resides within the CNV boundaries. On average, asthmatic probands carried 6 asthma-candidate CNVs (range 1–29). However, the vast majority of identified CNVs were of rare frequency (< 5%), and were not statistically associated with asthma. Modest evidence for association with asthma was observed for 2 CNVs near NOS1 and SERPINA3. Linkage disequilibrium analysis suggests that CNV effects are unlikely to explain previously detected SNP associations with asthma.
Conclusions
Although a substantial proportion of asthma-susceptibility genes harbor polymorphic CNVs, the majority of these variants do not confer increased asthma risk. The lack of linkage disequilibrium (LD) between CNVs and asthma-associated SNPs suggests that these CNVs are unlikely to represent the functional variant responsible for most known asthma associations.
doi:10.1111/cea.12060
PMCID: PMC3609036  PMID: 23517041
10.  Anti-IL-5 attenuates activation and surface density of β2-integrins on circulating eosinophils after segmental antigen challenge 
Background
IL-5 activates αMβ2 integrin on blood eosinophils in vitro. Eosinophils in bronchoalveolar lavage (BAL) following segmental antigen challenge have activated β2-integrins.
Objective
To identify roles for IL-5 in regulating human eosinophil integrins in vivo.
Methods
Blood and BAL eosinophils were analyzed by flow cytometry in ten subjects with allergic asthma who underwent a segmental antigen challenge protocol before and after anti-IL-5 administration.
Results
Blood eosinophil reactivity with monoclonal antibody (mAb) KIM-127, which recognizes partially activated β2-integrins, was decreased after anti-IL-5. Before anti-IL-5, surface densities of blood eosinophil β2, αM, and αL integrin subunits increased modestly post-challenge. After anti-IL-5, such increases did not occur. Before or after anti-IL-5, surface densities of β2,αM, αL, and αD and reactivity with KIM-127 and mAb CBRM1/5, which recognizes high-activity αMβ2, were similarly high on BAL eosinophils 48 h post-challenge. Density and activation state of β1-integrins on blood and BAL eosinophils were not impacted by anti-IL-5, even though anti-IL-5 ablated a modest post-challenge increase on blood or BAL eosinophils of P-selectin glycoprotein ligand-1 (PSGL-1), a receptor for P-selectin that causes activation of β1-integrins. Forward scatter of blood eosinophils post-challenge was less heterogeneous and on the average decreased after anti-IL-5; however, anti-IL-5 had no effect on the decreased forward scatter of eosinophils in post-challenge BAL compared to eosinophils in blood. Blood eosinophil KIM-127 reactivity at the time of challenge correlated with the percentage of eosinophils in BAL post-challenge.
Conclusion and Clinical Relevance
IL-5 supports a heterogeneous population of circulating eosinophils with partially activated β2-integrins and is responsible for upregulation of β2-integrins and PSGL-1 on circulating eosinophils following segmental antigen challenge but has minimal effects on properties of eosinophils in BAL. Dampening of β2-integrin function of eosinophils in transit to inflamed airway may contribute to the decrease in lung inflammation caused by anti-IL-5.
doi:10.1111/j.1365-2222.2012.04065.x
PMCID: PMC3579563  PMID: 23414537
eosinophils; integrins; PSGL-1; forward scatter; IL-5; blood; bronchoalveolar lavage; segmental lung antigen challenge
12.  Airway generation-specific differences in the spatial distribution of immune cells and cytokines in allergen-challenged rhesus monkeys 
Summary
Background
Accumulation of immune cell populations and their cytokine products within tracheobronchial airways contributes to the pathogenesis of allergic asthma. It has been postulated that peripheral regions of the lung play a more significant role than proximal airways with regard to inflammatory events and airflow obstruction.
Objective
To determine whether immune cell populations and associated cytokines are uniformly distributed throughout the conducting airway tree in a non-human primate model of allergic asthma.
Methods
We used a stereologic approach with a stratified sampling scheme to measure the volume density of immune cells within the epithelium and interstitium of trachea and 4–5 intrapulmonary airway generations from house dust mite (HDM) (Dermatophagoides farinae)-challenged adult monkeys. In conjunction with immune cell distribution profiles, mRNA levels for 21 cytokines/ chemokines and three chemokine receptors were evaluated at four different airway generations from microdissected lungs.
Results
In HDM-challenged monkeys, the volume of CD1a+ dendritic cells, CD4+ T helper lymphocytes, CD25+ cells, IgE+ cells, eosinophils, and proliferating cells were significantly increased within airways. All five immune cell types accumulated within airways in unique patterns of distribution, suggesting compartmentalized responses with regard to trafficking. Although cytokine mRNA levels were elevated throughout the conducting airway tree of HDM-challenged animals, the distal airways (terminal and respiratory bronchioles) exhibited the most pronounced up-regulation.
Conclusion
These findings demonstrate that key effector immune cell populations and cytokines associated with asthma differentially accumulate within distinct regions and compartments of tracheobronchial airways from allergen-challenged primates.
doi:10.1111/j.1365-2222.2005.02271.x
PMCID: PMC3918236  PMID: 16008676
CD25; dendritic cell; dermatophagoides farinae; eosinophil; IgE; lung; primate; T lymphocyte
13.  Lung effects of inhaled corticosteroids in a rhesus monkey model of childhood asthma 
Summary
Background
The risks for infants and young children receiving inhaled corticosteroid (ICS) therapy are largely unknown. Recent clinical studies indicate that ICS therapy in pre-school children with symptoms of asthma result in decreased symptoms without influencing the clinical disease course, but potentially affect postnatal growth and development. The current study employs a primate experimental model to identify the risks posed by ICS therapy.
Objective
To (1) establish whether ICS therapy in developing primate lungs reverses pulmonary pathobiology associated with allergic airway disease (AAD) and (2) define the impact of ICS on postnatal lung growth and development in primates.
Methods
Infant rhesus monkeys were exposed, from 1 through 6 months, to filtered air (FA) with house dust mite allergen and ozone using a protocol that produces AAD (AAD monkeys), or to FA alone (Control monkeys). From three through 6 months, the monkeys were treated daily with ICS (budesonide) or saline.
Results
Several AAD manifestations (airflow restrictions, lavage eosinophilia, basement membrane zone thickening, epithelial mucin composition) were reduced with ICS treatment, without adverse effects on body growth or adrenal function; however, airway branching abnormalities and intraepithelial innervation were not reduced. In addition, several indicators of postnatal lung growth and differentiation: vital capacity, inspiratory capacity, compliance, non-parenchymal lung volume and alveolarization, were increased in both AAD and Control monkeys that received ICS treatment.
Conclusions and Clinical Relevance
Incomplete prevention of pathobiological changes in the airways and disruption of postnatal growth and differentiation of airways and lung parenchyma in response to ICS pose risks for developing primate lungs. These responses also represent two mechanisms that could compromise ICS therapy’s ability to alter clinical disease course in young children.
doi:10.1111/j.1365-2222.2012.04005.x
PMCID: PMC3913647  PMID: 22702509
allergic asthma; animal models; gender; immune response
14.  Segmental Allergen Challenge Enhances Chitinase Activity and Levels of CCL18 in Mild Atopic Asthma 
Background
Allergic airway inflammation contributes to the airway remodeling that has been linked to increased obstruction and morbidity in asthma. However, the mechanisms by which allergens contribute to airway remodeling in humans are not fully established. CCL18, chitotriosidase (CHIT1) and YKL-40 are readily detectable in the lungs and contribute to remodeling in other fibrotic diseases, but their involvement in allergic asthma is unclear.
Objective
We hypothesized that CCL18, YKL-40, and CHIT1 bioactivity are enhanced in allergic asthma subjects after segmental allergen challenge and are related to increased profibrotic and Th2-associated mediators in the lungs.
Methods
Levels of CCL18 and YKL-40 protein and CHIT1 bioactivity in bronchoalveolar lavage (BAL) fluid, as well as CCL18, YKL-40, and CHIT1 mRNA levels in BAL cells, were evaluated in patients with asthma at baseline and 48 h after segmental allergen challenge. We also examined the correlation between CCL18 and YKL-40 levels and CHIT1 activity with the levels of other profibrotic factors and chemokines previously shown to be up-regulated after allergen challenge.
Results
CHIT1 activity and YKL-40 and CCL18 levels were elevated after segmental allergen challenge and these levels correlated with those of other profibrotic factors, T cell chemokines, and inflammatory cells after allergen challenge. CCL18 and YKL-40 mRNA levels also increased in BAL cells after allergen challenge.
Conclusions & Clinical Relevance
Our results suggest that CCL18 and YKL-40 levels and CHIT1 activity are enhanced in allergic airway inflammation and thus may contribute to airway remodeling in asthma.
doi:10.1111/cea.12032
PMCID: PMC3623278  PMID: 23331560
asthma; segmental bronchoprovocation; CHIT1; YKL-40; CCL18
15.  Specific Patterns of Allergic Sensitization in Early Childhood and Asthma & Rhinitis Risk 
BACKGROUND
Specific patterns of allergic sensitization as well as quantification of the in vitro IgE response in early life may provide relevant clinical insight into future rhinitis and asthma risk.
OBJECTIVE
To define relationships among established sensitization to particular aeroallergens, quantitative analyses of allergen-specific IgE levels, pet exposure and sensitization, and asthma and rhinitis risk.
METHODS
Children at high-risk for the development of asthma and allergic diseases were enrolled at birth into the Childhood Origins of ASThma (COAST) study. Allergen-specific IgE was assessed at ages 1, 3, 6, and 9 years by fluoroenzyme immunoassay (Unicap® 100, Pharmacia Diagnostics). Current asthma and rhinitis were diagnosed at age 6 and 8 years.
RESULTS
Sensitization to dog was strongly associated with increased asthma risk (p < 0.0001). Sensitization to perennial compared to seasonal allergens was more strongly associated with asthma risk, while sensitization to seasonal allergens was more closely associated with rhinitis risk. Increased levels of specific IgE to perennial allergens were associated with an increased asthma risk (p = 0.05), while any detectable level of IgE to seasonal allergens was associated with increased rhinitis risk (p = 0.0009). While dog and cat sensitization were both independently associated with increased asthma and rhinitis risk, dog exposure at birth was associated with a reduced risk of asthma, regardless of dog sensitization status during the first 6 years of life (p = 0.05).
CONCLUSIONS & CLINICAL RELEVANCE
Analyzing specific patterns of an individual’s allergic sensitization profile reveals additional relevant associations with asthma and rhinitis risk as opposed to the information gained from characterizing an individual as “atopic” by the presence of any demonstrable sensitization alone. Further, protective mechanisms of dog exposure with regards to asthma risk appear to be unrelated to the prevention of sensitization.
doi:10.1111/cea.12050
PMCID: PMC3557802  PMID: 23331564
asthma; rhinitis; children; IgE; allergic sensitization; pet exposure
16.  A mechanism of benefit of soy genistein in asthma: inhibition of eosinophil p38-dependent leukotriene synthesis 
Summary
Background
Dietary intake of the soy isoflavone genistein is associated with reduced severity of asthma, but the mechanisms responsible for this effect are unknown.
Objective
To determine whether genistein blocks eosinophil leukotriene C4 (LTC4) synthesis and to evaluate the mechanism of this effect, and to assess the impact of a 4-week period of soy isoflavone dietary supplementation on indices of eosinophilic inflammation in asthma patients.
Methods
Human peripheral blood eosinophils were stimulated in the absence and presence of genistein, and LTC4 synthesis was measured. 5-lipoxygenase (5-LO) nuclear membrane translocation was assessed by confocal immunofluorescence microscopy. Mitogen-activated protein (MAP) kinase activation was determined by immunoblot. Human subjects with mild-to-moderate persistent asthma and minimal or no soy intake were given a soy isoflavone supplement (100 mg/day) for 4 weeks. The fraction of exhaled nitric oxide (FENO) and ex vivo eosinophil LTC4 production were assessed before and after the soy isoflavone treatment period.
Results
Genistein inhibited eosinophil LTC4 synthesis (IC50 80 nm), blocked phosphorylation of p38 MAP kinase and its downstream target MAPKAP-2, and reduced translocation of 5-LO to the nuclear membrane. In patients with asthma, following 4 weeks of dietary soy isoflavone supplementation, ex vivo eosinophil LTC4 synthesis decreased by 33% (N = 11, P = 0.02) and FENO decreased by 18% (N = 13, P = 0.03).
Conclusion
At physiologically relevant concentrations, genistein inhibits eosinophil LTC4 synthesis in vitro, probably by blocking p38- and MAPKAP-2-dependent activation of 5-LO. In asthma patients, dietary soy isoflavone supplementation reduces eosinophil LTC4 synthesis and eosinophilic airway inflammation. These results support a potential role for soy isoflavones in the treatment of asthma.
doi:10.1111/j.1365-2222.2007.02862.x
PMCID: PMC3873088  PMID: 17979994
asthma; eosinophils; genistein; 5-lipoxygenase; soy isoflavones
17.  Human Eosinophils Release IL-1β and Increase Expression of IL-17A in Activated CD4+ T Lymphocytes 
Background
Differentiation and activation of CD4+ T cells is controlled by various cytokines produced by innate immune cells. We have shown that eosinophils (EOS) have the potential to influence Th1 and Th2 cytokine generation by CD4+ cells, but their influence on IL-17A (IL-17) has not been established.
Objective
The purpose of the study is to determine the effect of EOS on IL-17 production by lymphocytes.
Methods
Preactivated CD4+ T cells were cultured in the presence of either autologous EOS or EOS culture supernatants. Expression of IL-17 was determined by real-time quantitative PCR (qPCR) after 5 h and protein level was measured after 48 h. To determine the effect of allergen-induced airway EOS on IL-17, subjects with mild allergic asthma underwent bronchoscopic segmental bronchoprovocation with allergen (SBP-Ag) after a treatment with an anti-IL-5 neutralizing antibody (mepolizumab) to reduce airway eosinophilia. IL-17 mRNA was measured in bronchoalveolar lavage (BAL) cells by qPCR.
Results
In vitro, EOS significantly increased IL-17 production by CD4+ T cells. Addition of exogenous IL-1β increased expression of IL-17 mRNA by CD4+ T cells. EOS expressed and released IL-1β. Furthermore, levels of IL-1β in EOS supernatants highly correlated with their ability to increase IL-17 expression by CD4+ T cells, and neutralizing antibody to IL-1β reduced expression of IL-17 mRNA. In vivo, reduction of EOS in the airway using mepolizumab was associated with diminished IL-17 expression after SBP-Ag.
Conclusions & Clinical Relevance
Our data demonstrate that EOS can promote IL-17 production through the release of IL-1β. Enhanced IL-17 cytokine production is another mechanism by which EOS may participate in pathogenesis of allergic airway inflammation in asthma.
doi:10.1111/j.1365-2222.2012.04060.x
PMCID: PMC3612975  PMID: 23181791
Human; Eosinophils; Lymphocytes; Asthma; Allergy; Cytokines; IL-17A; IL-1β
18.  FcRn-mediated intestinal absorption of IgG anti-IgE/IgE immune complexes in mice 
Background
The mechanism(s) responsible for the acquisition of maternal antibody isotypes other than IgG are not fully understood.
Objective
To define the ability of the neonatal Fc receptor for IgG uptake (FcRn) to mediate intestinal absorption of IgG1 anti-IgE/IgE immune complexes.
Methods
C57BL/6 allergic ovalbumin (OVA)-immune foster mothers were generated to nurse naïve FcRn+/− or FcRn−/− progeny. At the time of weaning, serum levels of OVA-specific antibodies and IgG1 anti-IgE/IgE immune complexes were determined in allergic foster mothers and FcRn+/+, FcRn+/−, or FcRn−/− breastfed offspring. In separate experiments, FcRn+/− or FcRn−/− neonatal mice were gavage fed TNP-specific IgE as IgG1 anti-IgE/IgE immune complexes, IgG1 isotype control and IgE, or IgE alone. Mice were sacrificed 2 hours after feeding to determine serum levels and biologic activity of absorbed TNP-specific IgE.
Results
As expected, the absorption of maternal OVA-specific IgG1 in FcRn−/− offspring was at levels 103–104 less than observed in FcRn+/+ or FcRn+/− offspring. Surprisingly, FcRn expression also influenced the absorption of maternal IgE. OVA-specific IgE was detected in FcRn+/+ and FcRn+/− offspring, but not in FcRn−/− offspring. IgG1 anti-IgE/IgE immune complexes were detected in allergic foster mothers and correlated strongly with levels in FcRn+/+ and FcRn+/− offspring (rho=0.88, P <0.0001). Furthermore, FcRn expression was required for neonatal mice to absorb TNP-specific IgE when fed as IgG1 anti-IgE/IgE immune complexes. When immune complexes were generated with IgG1 anti-IgE directed against the Cε4 domain, the absorbed IgE was able to function in antigen-dependent basophil degranulation.
Conclusions and Clinical Relevance
These data demonstrate a novel mechanism by which FcRn may facilitate absorption of maternal antibodies other than IgG. These findings are clinically relevant because FcRn mediates the transplacental passage of maternal IgG to the fetus. This raises the possibility that FcRn could mediate the transplacental passage of maternal IgE as IgG anti-IgE/IgE immune complexes.
doi:10.1111/j.1365-2222.2012.04043.x
PMCID: PMC3508740  PMID: 23181795
Allergy; sensitization; autoantibodies; placenta; maternal transmission
19.  Impact of allergy treatment on the association between allergies and mood and anxiety in a population sample 
Background
Previous studies have suggested an association between allergy and mood and anxiety disorders. Yet, extant work suffers from methodologic limitations.
Objective
To investigate the association between physician diagnosed allergy and DSM-IV mood and anxiety disorders in the general population, and to examine the role of allergy treatment in this relationship.
Methods
Data were drawn from the German National Health Interview and Examination Survey, a population-based, representative sample of 4,181 adults aged 18-65 in Germany. Allergy was diagnosed by physicians during medical examination and mental disorders were diagnosed using the CIDI.
Results
Allergy was associated with an increased prevalence of any anxiety disorder (OR=1.3 (1.1, 1.6)), panic attacks (OR=1.6 (1.1, 2.1)), panic disorder (OR=1.6 (1.01, 2.3)), GAD (OR=1.8 (1.1, 3.0)), any mood disorder (OR= 1.4 (1.1, 1.7)), depression (OR=1.4 (1.1, 1.7)), and bipolar disorder (OR=2.0, (1.0, 3.8)). After adjusting for desensitization treatment status, these relationships were no longer significant. Those treated for allergy were significantly less likely to have any mood or anxiety disorder (OR=0.65 (0.4, 0.96)), compared to those untreated. All relationships were adjusted for age, sex and socioeconomic status (SES).
Conclusions & Clinical Relevance
These findings provide the first evidence of a link between physician diagnosed allergy and DSM-IV mood and anxiety disorders in a representative sample. Treatment for allergy may mitigate much of this relationship.
doi:10.1111/j.1365-2222.2012.04042.x
PMCID: PMC3701302  PMID: 23181792
allergy; asthma; epidemiology; anxiety; depression; mood
20.  An environmental epigenetic study of ADRB2 5'-UTR methylation and childhood asthma severity 
Summary
Background
Beta-2 adrenergic receptor (ADRB2) is the primary target of both short- and long-acting beta-agonist asthma medications. ADRB2 5'-UTR methylation changes in blood have the potential to act as a surrogate biomarker of responsiveness to beta-agonist treatment and childhood asthma severity.
Objective
To study the association between ADRB2 5'-UTR methylation, NO2 exposure and childhood asthma severity.
Methods
We compared ADRB2 5'-UTR methylation levels in blood between 60 children with mild asthma and 122 children with severe asthma using methylation-specific PCR. We also investigated potential joint effects between NO2 exposure and ADRB2 5'-UTR methylation.
Results
We found a significant association between intermediate (OR: 4.11, 95% CI: 1.58–10.73) and high levels (OR: 7.63, 95% CI: 3.02–19.26) of ADRB2 methylation and severe childhood asthma. In addition, we found a significant association between indoor exposure to NO2, an air pollutant and known asthmogen, and severe asthma among children exhibiting high ADRB2 methylation (OR: 4.59, 95% CI: 1.03–20.55) but no association among children exhibiting low levels of ADRB2 methylation (OR: 0.35, 95% CI: 0.01–14.13).
Conclusions and Clinical Relevance
These findings support the potential use of ADRB2 5'-UTR methylation as a biomarker of both asthma severity and risk for NO2-associated asthma exacerbations in children, and present the first evidence of an epigenetic link between an important environmental exposure and childhood asthma severity.
doi:10.1111/j.1365-2222.2012.04055.x
PMCID: PMC3673701  PMID: 22862293
ADRB2; methylation; asthma severity; epigenetic; NO2
21.  Toll-like receptors 2, 3 and 4 and thymic stromal lymphopoietin expression in fatal asthma 
Background
Airway inflammation in asthma involves innate immune responses. Toll-like receptors (TLRs) and thymic stromal lymphopoietin (TSLP) are thought to be involved in airway inflammation, but their expression in asthmatics’ both large and small airways has not been investigated.
Objective
To analyze the expression of TLR2, TLR3, TLR4 and TSLP in large and small airways of asthmatics and compare their expression in smoking and nonsmoking asthmatics; to investigate whether TLR expression is associated with eosinophilic or neutrophilic airway inflammation and with Mycoplasma pneumoniae and Chlamydophila pneumoniae infection.
Methods
Using immunohistochemistry and image analysis, we investigated TLR2, TLR3, TLR4 and TSLP expression in large and small airways of 24 victims of fatal asthma, FA, (13 nonsmokers, 11 smokers) and 9 deceased control subjects (DCtrl). TLRs were also measured in 18 mild asthmatics (MA) and 12 healthy controls (HCtrl). Mycoplasma pneumoniae and Chlamydophila pneumoniae in autopsy lung tissue was analyzed using real-time polymerase chain reaction. Airway eosinophils and neutrophils were measured in all subjects.
Results
Fatal asthma patients had higher TLR2 in the epithelial and outer layers of large and small airways compared with DCtrls. Smoking asthmatics had lower TLR2 levels in the inner and outer layers of the small airways than nonsmoking asthmatics. TSLP was increased in the epithelial and outer layers of the large airways of FA. FA patients had greater TLR3 expression in the outer layer of large airways and greater TLR4 expression in the outer layer of small airways. Eosinophilic airway inflammation was associated with TLR expression in the epithelium of FA. No bacterial DNA was detected in FA or DCtrls. MA and HCtrls had only a small difference in TLR3 expression.
Conclusions and Clinical Relevance
Increased expression of TLR 2, 3 and 4 and TSLP in fatal asthma may contribute to the acute inflammation surrounding asthma deaths.
doi:10.1111/j.1365-2222.2012.04047.x
PMCID: PMC3459227  PMID: 22994343
lung; innate immunity; immunohistochemistry
22.  Presence of functional, autoreactive human milk-specific IgE in infants with cow’s milk allergy 
Summary
Background
Occasionally, exclusively breastfed infants with cow’s milk allergy (CMA) remain symptomatic despite strict maternal milk avoidance.
Objective
To determine whether or not persistence of symptoms could be due to sensitization against endogenous human milk proteins with a high degree of similarity to bovine allergens.
Methods
Ten peptides representing known bovine milk IgE-binding epitopes [α-lactalbumin (ALA), β- and κ-casein] and the corresponding, highly homologous human milk peptides were labelled with sera from 15 breastfed infants with CMA, aged 3 weeks to 12 months, and peptide (epitope)-specific IgE antibodies were assessed. Nine of the 15 breastfed infants became asymptomatic during strict maternal avoidance of milk and other major food allergens; six infants remained symptomatic until weaned. Ten older children, aged 5–15 years, with CMA were also assessed. The functional capacity of specific IgE antibodies was assessed by measuring β-hexosaminidase release from rat basophilic leukaemia cells passively sensitized and stimulated with human and bovine ALA. Results A minimum of one human milk peptide was recognized by IgE antibodies from 9 of 15 (60%) milk-allergic infants, and the majority of older children with CMA. Genuine sensitization to human milk peptides in the absence of IgE to bovine milk was occasionally seen. There was a trend towards specific IgE being detected to more human milk peptides in those infants who did not respond to the maternal milk elimination diet than in those who did (P = 0.099). Functional IgE antibody to human ALA was only detected in infants not responding to the maternal diet.
Conclusions and Clinical Relevance
Endogenous human milk epitopes are recognized by specific IgE from the majority of infants and children with CMA. Such autoreactive, human milk-specific IgE antibodies appear to have functional properties in vitro. Their role in provoking allergic symptoms in infants exclusively breastfed by mothers strictly avoiding dietary milk remains unclear.
doi:10.1111/j.1365-2222.2011.03864.x
PMCID: PMC3780604  PMID: 22092935
atopic eczema; autoreactivity; cow’s milk allergy; cross-reactivity; endogenous protein; human milk; IgE antibodies; infants; RBL assay; sensitization; SPOT method
23.  Evidence of pathway-specific basophil anergy induced by peanut oral immunotherapy in peanut-allergic children 
Background
In Westernized countries, over 1% of the population is allergic to peanuts or tree nuts, which carries a risk of severe allergic reactions. Several studies support the efficacy of peanut oral immunotherapy (OIT) for reducing the clinical sensitivity of affected individuals; however, the mechanisms of this effect are still being characterized. One mechanism that may contribute is the suppression of effector cells, such as basophils. Basophil anergy has been characterized in vitro as a pathway-specific hyporesponsiveness; however, this has not been demonstrated to occur in vivo.
Objective
To evaluate the hypothesis that basophil anergy occurs in vivo due to chronic allergen exposure in the setting of a clinical oral immunotherapy trial.
Methods
Samples of peripheral blood were obtained from subjects during a placebo-controlled clinical trial of peanut OIT. Basophil reactivity to in vitro stimulation with peanut allergen and controls was assessed by the upregulation of activation markers, CD63 and CD203c, measured by flow cytometry.
Results
The upregulation of CD63 following stimulation of the IgE receptor, either specifically with peanut allergen or non-specifically with anti-IgE antibody, was strongly suppressed by active OIT. However, OIT did not significantly suppress this response in basophils stimulated by the distinct fMLP receptor pathway. In the subset of subjects with egg sensitization, active peanut OIT also suppressed CD63 upregulation in response to stimulation with egg allergen. Allergen OIT also suppressed the upregulation of CD203c including in response to stimulation with IL-3 alone.
Conclusion
Peanut OIT induces a hyporesponsive state in basophils that is consistent with pathway-specific anergy previously described in vitro. This suggests the hypothesis that effector cell anergy could contribute to clinical desensitization.
doi:10.1111/j.1365-2222.2012.04028.x
PMCID: PMC3779434  PMID: 22805467
human basophils; desensitization; basophil anergy; CD63; CD203c; oral immunotherapy; peanut allergy
24.  Cysteinyl leukotriene receptors, old and new; implications for asthma 
Summary
The cysteinyl leukotrienes (cys-LTs) are three structurally similar, but functionally distinct lipid mediators of inflammation. The parent cys-LT, LTC4, is synthesized by and released from mast cells, eosinophils, basophils, and macrophages, and is converted to the potent constrictor LTD4 and the stable metabolite, LTE4. While only two cys-LT-selective receptors (CysLTRs) have been identified, cloned, and characterized, studies dating back three decades predicted the existence of at least three functional CysLTRs, each with a characteristic physiological function in airways and other tissues. The recent demonstration that mice lacking both known CysLTRs exhibit full (and in some instances, augmented) physiological responses to cys-LTs verifies the existence of unidentified CysLTRs. Moreover, the ability to manipulate receptor expression in both whole animal and cellular systems reveals that the functions of CysLTRs are controlled at multiple levels, including receptor-receptor interactions. Finally, studies in transgenic mice have uncovered a potentially major role for cys-LTs in controlling the induction of Th2 responses to common allergens. This review focuses on these recent findings and their potential clinical implications.
doi:10.1111/j.1365-2222.2012.03982.x
PMCID: PMC3773244  PMID: 22925317
25.  EFFECT OF INHALED DUST-MITE ALLERGEN ON REGIONAL PARTICLE DEPOSITION AND MUCOCILIARY CLEARANCE IN ALLERGIC ASTHMATICS 
Background
Acute exacerbations in allergic asthmatics may lead to impaired ability to clear mucus from the airways, a key factor in asthma morbidity.
Objective
The purpose of this study was to determine the effect of inhaled house dust mite challenge on regional deposition of inhaled particles and mucociliary clearance (MCC) in allergic asthmatics.
Methods
We used gamma scintigraphy (inhalation of 99mTc -sulfur colloid particles) to measure regional particle deposition and MCC in allergic asthmatics (n=12) 4hr following an inhaled dust mite allergen challenge (Dermatophagoides farinae extract; PDmax = fall in FEV1 of 10%) for comparison to baseline non-challenge measures.
Results
In responders (n=9 PDmax dose), lung function returned to pre-challenge values by 3 hours but was significantly decreased at 6 and 24 hours in 3 of the responders (i.e. late phase response) and induced sputum eosinophils were increased at 24 hours post-challenge (p < 0.05). Responders showed enhanced bronchial airway deposition of inhaled particles (p < 0.05) and slowed clearance from the central lung zone (p < 0.01) at 4 hrs post-challenge compared to baseline (no allergen challenge) that was predicted by the PDmax allergen concentration (r = − 0.70, p < 0.05). The fall in lung function at 24 hours post challenge correlated with reduced MCC from the central lung zone (r = − 0.78, p < 0.02) and PDmax. Non-responders (n=3) had no change in lung function, regional deposition or MCC post-challenge vs. baseline.
Conclusions and clinical relevance
These data suggest that regional deposition and clearance of inhaled particles may be sensitive for detecting mild airway obstruction associated with early and late-phase allergen-induced effects on mucus secretions. The study was listed on clinicaltrials.gov (NCT00448851).
doi:10.1111/j.1365-2222.2011.03814.x
PMCID: PMC3750994  PMID: 21729182
dust-mite allergen; particle inhalation; airway deposition; mucus

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