Gm Gauvreau

Myeloid and plasmacytoid dendritic cells in induced sputum after allergen inhalation in subjects with asthma

BACKGROUND Dendritic cells are professional antigen presenting cells that mediate the response to inhaled allergens. In animal models, the induction and maintenance of allergic airway inflammation is primarily a function of myeloid dendritic cells, whereas the tolerization to inhaled allergens is likely a function of plasmacytoid dendritic cells. OBJECTIVE To investigate changes in sputum myeloid and plasmacytoid dendritic cells after allergen inhalation in subjects with asthma. Also, the number of myeloid and plasmacytoid dendritic cells expressing both CCR6 and 7 and their chemokine ligands macrophage inflammatory protein (MIP)-3alpha and 3beta were measured in sputum supernatants. METHODS Sputum was induced from 12 dual-responder subjects with allergic asthma before and 7 hours, 24 hours, and 72 hours after inhalation of diluent and allergen. Dendritic cells were enumerated via flow cytometry and the chemokines by using ELISAs. RESULTS The number of sputum myeloid dendritic cells was significantly higher 24 hours after allergen challenge compared with diluent. Similarly, sputum plasmacytoid dendritic cells increased significantly at 24 hours after allergen challenge. Also, a significant increase in CCR6(+) myeloid dendritic cells numbers occurred 72 hours after allergen challenge. In contrast, CCR7(+) myeloid dendritic cells, as well as the number of CCR6(+) and CCR7(+) plasmacytoid dendritic cells, were not different between challenges. Finally, allergen challenge increased sputum levels of MIP-3alpha, but not MIP-3beta, compared with baseline. CONCLUSIONS Both myeloid and plasmacytoid dendritic cells increase in the sputum of subjects with asthma after allergen challenge, suggesting that both subsets are involved in the pathogenesis of allergen responses in asthma.

Severe asthma: future treatments

Patients with severe refractory asthma have not achieved asthma control, even with high doses of ICS, usually in combination with LABAs and other maintenance treatments.

Single-dose desloratadine and montelukast and allergen-induced late airway responses

Montelukast and desloratadine synergistically inhibit the allergen-induced early asthmatic response. Montelukast also suppresses the allergen-induced late asthmatic response, but there are no reports on the effect of desloratadine or the combination on the allergen-induced late asthmatic response. Atopic asthmatics (n = 10) completed a multicentric randomised double-blind crossover study comparing single-dose placebo, 5 mg desloratadine, 10 mg montelukast and the combination administered 2 h prior to allergen inhalation challenge. Methacholine challenges were performed 24 h before and after allergen challenge. Exhaled nitric oxide measurements and sputum inflammatory cell counts were also carried out. All active treatments significantly decreased the late asthmatic response area under the curve. Combination therapy provided the greatest inhibition compared to desloratadine and montelukast. Montelukast was nonsignificantly better than desloratadine but not as effective as the combination. There was a trend towards a decrease in airway responsiveness following montelukast and combination. Montelukast, but not desloratadine or the combination, decreased exhaled NO levels 24 h after allergen. The allergen-induced increase in sputum eosinophil numbers was significantly suppressed at 7 h with desloratadine and combination therapy, and at 24 h with montelukast and combination therapy. Single-dose co-administration of desloratadine and montelukast 2 h prior to allergen inhalation clinically abolished the late asthmatic response and eosinophil recruitment.

Interleukin-18 and interleukin-18 receptor-α expression in allergic asthma

To the Editors: The inflammatory process in allergic asthma is initiated by T-helper (Th) type-2 cells, which produce a repertoire of cytokines, including interleukin (IL)-4, IL-5, IL-9 and IL-13, which are necessary for immunoglobulin (Ig)E production, airway eosinophilia and goblet cell hyperplasia [1]. IL-18 is another pro-inflammatory cytokine, initially described as interferon (IFN)-γ-inducing factor [2]. IL-18 can act as a cofactor for Th2 cell development and IgE production [3]. Recently, an IL-18 gene polymorphism was reported to be associated with asthma severity and higher serum IL-18 levels: the rs5744247 variant, which has higher transcriptional activity than the wildtype allele [4]. In addition, the IL-18 receptor (IL-18R) gene (on 2q21) has been identified as a candidate gene associated with increased susceptibility to asthma in children [5], and polymorphisms of the gene have been associated with allergic asthma and airway hyperresponsiveness (AHR) [6]. We have evaluated serum levels of IL-18 and the expression of IL-18Rα, as well as other Th2-associated cytokines, in stable allergic asthmatic subjects, compared with allergic nonasthmatic subjects and healthy controls. We studied 36 subjects, which included 15 allergic asthmatic subjects, 11 nonasthmatic allergic subjects and 10 healthy controls (table 1). All subjects underwent a methacholine inhalation challenge [7] and had skin-prick tests to a panel of 16 environmental allergens. Total IgE, and serum IL-18, IL-4, IL-10, IL-12, IL-13 and IFN-γ were measured using commercially available ELISA kits (Medical and Biological Laboratories Co., Nagoya, Japan; RD DRG International Inc., Mountainside, NJ, USA). The allergic subjects were studied outside …

Allergen inhalation challenge in smoking compared with non-smoking asthmatic subjects.

Background Smoking asthmatics experience more severe symptoms, require more rescue medication and have more asthma‐related hospitalizations than non‐smoking asthmatics. However, studies in mice suggest that mainstream cigarette smoke may reduce airway inflammation and may attenuate airway hyperresponsiveness. A comparison of allergen‐induced airway inflammatory responses of smoking and non‐smoking atopic asthmatics has not been examined previously.