Fazila Chouiali

Genetic and histologic evidence for autophagy in asthma pathogenesis

To the Editor: Asthma affects all age groups and presents itself as a spectrum of severity and symptoms. Reactive oxidative species (ROS) play a pivotal role in asthma pathogenesis. Exhaled levels of mediators associated with ROS positively correlate with asthma severity.(1) Autophagy, the process of cellular waste disposal through lysosomal -dependent pathways, is induced by ROS to remove oxidized proteins or organelles to minimize tissue damage.(2) Although autophagy is augmented in the lungs of COPD patients compared to healthy control subjects (3), evidence for autophagy in asthma, particularly moderate-to-severe asthma, has not been reported. We hypothesize that autophagy is associated with asthma pathogenesis, and sought to detect its presence using both genetic and histological approaches. We conducted a genetic association study to investigate whether single nucleotide polymorphisms (SNPs) in genes of the autophagy pathway are associated with asthma. We selected 5 genes of the autophagy pathway (unc-51-like kinase 1(ULK1), sequestosome 1 (SQSTM1), microtubule-associated protein 1 light chain 3 beta (MAP1LC3B), beclin 1 (BECN1) and autophagy related 5 homolog (ATG5)). (2) We tested for genetic associations in an asthma family-based study from northeastern Quebec, Canada (The Saguenay-Lac-Saint-Jean (SLSJ) asthma Study) using the family based association test (FBAT) statistic and UNPHASED software for an odds ratio estimate.(4, 5) Patient recruitment has previously been described.(6) These SNPs have been genotyped previously in a genome-wide association study.(6) To reduce the likelihood of false positive findings, we reset the statistical significance threshold from p=0.05 to p=0.001 according to the Bonferroni method. To confirm our positive findings, we tested the association in a second family based population; the non-Hispanic Caucasian participants of the Childhood Asthma Management Program (CAMP), and patient recruitment has previously been described. (7) The SLSJ local ethics committee and the Institutional Review Board for CAMP approved the study, and all subjects gave informed consents. In the SLSJ asthma study a total of 1338 individuals (483 nuclear families) with known asthma status were included in the analysis, and 336 individuals were either probands or affected siblings. Of this group, the male:female ratio was 0.83. The mean age was 16.45 (standard deviation (SD) +/− 9.43) years. 77.1% were atopic. The mean (SD) forced expiratory volume in 1 second (FEV1)% predicted was 94.1(20.1)%. A total of 39 SNPs were tested, and after Bonferroni correction, SNP rs12212740 G>A of ATG5 remained statistically significant (Table 1). Allele G with allele frequency of 0.88 is over - transmitted to asthmatic offspring (p=0.0002), (Odds ratio = 1.35, (95% confidence interval = 1.01 and 1.89). SNP rs12212740 was not associated with asthma in CAMP, however, it was associated with pre - bronchodilator FEV1 (pre-FEV1) (adjusted for age, sex and height) (p=0.04). In the SLSJ cohort, rs12212740 was associated with pre-FEV1 (p=0.007). In both populations, allele G was negatively associated with adjusted pre-FEV1. SNP rs12212740 is located in intron 3 of ATG5, 7kb downstream and 8kb upstream of exon 3 and 4, respectively. At present, the functional consequence of SNP rs12212740 is unknown, and it is probable that the association is due to the linkage disequilibrium between SNP rs12212740 and the true causative variant. Nevertheless, the association between a genetic variant of ATG5 and pre-FEV1 in both study populations suggest that autophagy is associated with reduced lung function in asthmatic subjects. Table 1 Association of SNPs and asthma in the SLSJ asthma study To determine if autophagy is present in the airways of asthmatic individuals, bronchial biopsy stored at the Tissue Bank of the Respiratory Health Network of the Fonds de la Recherche en Sante du Quebec (McGill University Health Centre site) were obtained. Patient recruitment and bronchoscopy have previously been described.(8) Bronchial biopsy tissue from a moderately severe asthma patient and a healthy control were viewed by electron microscopy (EM) for double membrane autophagosomes. Here, we demonstrated by EM in a tissue sample from a moderately severe asthma subject evidence of autophagy in asthma pathogenesis. Using EM, double membrane autophagosomes were detected in fibroblasts and epithelial cells. A representative fibroblast from a bronchial biopsy tissue of a moderate asthma subject is depicted in Figures 1A-C, and epithelial cells in figures 2A-C. Corresponding fibroblast and epithelial cells from a healthy control are depicted in figures 1D-F and figures 2D-F, respectively, where fewer or no autophagosome was detected. Fig 1 A double membrane autophagosome was detected in a fibroblast from a bronchial biopsy tissue sample of a moderate asthma subject. Tissue was viewed at magnifications of (A) 1480x, (B) 16100x and (C) 62200x. Boxed areas were viewed under higher magnification ... Fig 2 Autophagosomes were detected in bronchial epithelial cells from a moderate asthma subject. Tissue was viewed at magnifications of (A) 4030x, (B) 9760x and (C) 37000x, respectively. Corresponding epithelial cells of a healthy subject was viewed at magnifications ... This is the first report to present genetic and histological evidence of autophagy in asthma pathogenesis. ATG5 is involved in the elongation step of the autophagosome formation. ATG5 forms a complex with ATG12 and ATG16L1 and the complexes are found on the outer membrane of the forming autophagosome.(2) We speculate that the positive association of allele G with asthma and the negative association with pre-FEV1 in asthmatics may be due to the inverse relationship between pre-FEV1 and asthma severity(9). If allele G is a risk factor for low pre-FEV1, given that pre-FEV1 tends to be lower in those with more severe forms of asthma, the allele would also increase the risk of developing moderate-to-severe asthma. The genetic association of ATG with pre-FEV1 in asthmatics and the detection of autophagosomes in fibroblasts and epithelial cells in tissues from a moderately severe asthma patient suggest an association between autophagy and reduced lung function in asthmatic subjects. At present the mechanistic pathway of autophagy in asthma is unclear, but it opens up a new avenue to explore the mechanism of the chronic nature of asthma pathogenesis.

Genetic deletion of IL-17A reduces cigarette smoke-induced inflammation and alveolar type II cell apoptosis

Chronic obstructive pulmonary disease (COPD) is an inflammatory disorder marked by relative resistance to steroids. Inflammation and apoptosis have been suggested to be important mechanisms for COPD. Interleukin (IL)-17 superfamily has been associated with chronic inflammation and diminished responses to steroids. It is reasonable to consider that IL-17 may play a role in the pathogenesis of COPD. In this study, we examined IL-17 expression in mice exposed to cigarette smoke (CS) and investigated the contribution of IL-17 to CS-induced inflammation and alveolar cell apoptosis in IL-17(-/-) mice. After exposing wild-type and IL-17(-/-) mice to mainstream CS for 4 wk, IL-17A, but not IL-17F, expression was increased in mice upon CS exposure. Neutrophil infiltration in the lungs of IL-17(-/-) mice was significantly decreased. In IL-17(-/-) mice, there is reduced expression of IL-6, macrophage inflammatory protein-2, and matrix metalloproteinase-12 compared with wild-type mice after CS exposure. The number of apoptotic type II alveolar cells was significantly increased in CS-exposed wild-type mice but not in IL-17(-/-) mice. The effect of IL-17A on type II alveolar cell apoptosis was confirmed in vitro through either addition of IL-17A or transient knockdown of IL-17A by small-interfering RNA transfection in type II alveolar cells. These findings suggest that IL-17A plays an important role in the inflammatory response to CS exposure through increased multiple inflammatory mediators. Moreover, IL-17 may also contribute to type II alveolar cell apoptosis. This study opens a new option in targeting IL-17A to modulate inflammatory response to CS and may be the bases for new therapy for COPD.

GSDMB induces an asthma phenotype characterized by increased airway responsiveness and remodeling without lung inflammation

Significance Because the SNP linking chromosome 17q21 to asthma is associated with increased gasdermin B (GSDMB) expression, we generated transgenic mice expressing increased levels of the human GSDMB transgene (hGSDMBZp3-Cre), which develop an asthma phenotype characterized by a spontaneous increase in airway responsiveness and airway remodeling (increased peribronchial smooth muscle) in the absence of the development of airway inflammation. These results challenge the current paradigm in asthma that airway inflammation induces smooth muscle remodeling and airway responsiveness, as these hGSDMBZp3-Cre mice develop increased airway-hyperresponsiveness and smooth muscle in the absence of airway inflammation. Furthermore, this study adds to our understanding of gene networks in asthma that we have identified can act in sequential pathways (i.e., GSDMB induces 5-lipoxygenase to induce TGF-β1). Gasdermin B (GSDMB) on chromosome 17q21 demonstrates a strong genetic linkage to asthma, but its function in asthma is unknown. Here we identified that GSDMB is highly expressed in lung bronchial epithelium in human asthma. Overexpression of GSDMB in primary human bronchial epithelium increased expression of genes important to both airway remodeling [TGF-β1, 5-lipoxygenase (5-LO)] and airway-hyperresponsiveness (AHR) (5-LO). Interestingly, hGSDMBZp3-Cre mice expressing increased levels of the human GSDMB transgene showed a significant spontaneous increase in AHR and a significant spontaneous increase in airway remodeling, with increased smooth muscle mass and increased fibrosis in the absence of airway inflammation. In addition, hGSDMBZp3-Cre mice showed increases in the same remodeling and AHR mediators (TGF-β1, 5-LO) observed in vitro in GSDMB-overexpressing epithelial cells. GSDMB induces TGF-β1 expression via induction of 5-LO, because knockdown of 5-LO in epithelial cells overexpressing GSDMB inhibited TGF-β1 expression. These studies demonstrate that GSDMB, a gene highly linked to asthma but whose function in asthma is previously unknown, regulates AHR and airway remodeling without airway inflammation through a previously unrecognized pathway in which GSDMB induces 5-LO to induce TGF-β1 in bronchial epithelium.

Fstl1 Promotes Asthmatic Airway Remodeling by Inducing Oncostatin M

Chronic asthma is associated with airway remodeling and decline in lung function. In this article, we show that follistatin-like 1 (Fstl1), a mediator not previously associated with asthma, is highly expressed by macrophages in the lungs of humans with severe asthma. Chronic allergen-challenged Lys-Cretg /Fstl1Δ/Δ mice in whom Fstl1 is inactivated in macrophages/myeloid cells had significantly reduced airway remodeling and reduced levels of oncostatin M (OSM), a cytokine previously not known to be regulated by Fstl1. The importance of the Fstl1 induction of OSM to airway remodeling was demonstrated in murine studies in which administration of Fstl1 induced airway remodeling and increased OSM, whereas administration of an anti-OSM Ab blocked the effect of Fstl1 on inducing airway remodeling, eosinophilic airway inflammation, and airway hyperresponsiveness, all cardinal features of asthma. Overall, these studies demonstrate that the Fstl1/OSM pathway may be a novel pathway to inhibit airway remodeling in severe human asthma.

Induction of GITRL expression in human keratinocytes by Th2 cytokines and TNF‐α: implications for atopic dermatitis

Glucocorticoid‐induced TNF receptor‐related protein ligand (GITRL), a ligand for the T cell co‐stimulatory molecule GITR, is expressed by keratinocytes and involved in chemokine production. The expression of GITRL in skin inflammation remains unknown.

Increased autophagy-related 5 gene expression is associated with collagen expression in the airways of refractory asthmatics

Background Fibrosis, particularly excessive collagen deposition, presents a challenge for treating asthmatic individuals. At present, no drugs can remove or reduce excessive collagen in asthmatic airways. Hence, the identification of pathways involved in collagen deposition would help to generate therapeutic targets to interfere with the airway remodeling process. Autophagy, a cellular degradation process, has been shown to be dysregulated in various fibrotic diseases, and genetic association studies in independent human populations have identified autophagy-related 5 (ATG5) to be associated with asthma pathogenesis. Hence, the dysregulation of autophagy may contribute to fibrosis in asthmatic airways. Objective This study aimed to determine if (1) collagen deposition in asthmatic airways is associated with ATG5 expression and (2) ATG5 protein expression is associated with asthma per se and severity. Methods Gene expression of transforming growth factor beta 1, various asthma-related collagen types [collagen, type I, alpha 1; collagen, type II, alpha 1; collagen, type III, alpha 1; collagen, type V, alpha 1 (COL5A1) and collagen, type V, alpha 2], and ATG5 were measured using mRNA isolated from bronchial biopsies of refractory asthmatic subjects and assessed for pairwise associations. Protein expression of ATG5 in the airways was measured and associations were assessed for asthma per se, severity, and lung function. Main results In refractory asthmatic individuals, gene expression of ATG5 was positively associated with COL5A1 in the airways. No association was detected between ATG5 protein expression and asthma per se, severity, and lung function. Conclusion and clinical relevance Positive correlation between the gene expression patterns of ATG5 and COL5A1 suggests that dysregulated autophagy may contribute to subepithelial fibrosis in the airways of refractory asthmatic individuals. This finding highlights the therapeutic potential of ATG5 in ameliorating airway remodeling in the difficult-to-treat refractory asthmatic individuals.