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Immune response to Streptococcus pneumoniae in asthma patients: comparison between stable situation and exacerbation.

Clin Exp Immunol. 2013 Jul;173(1):92-101

Authors: Otero C, Paz RD, Galassi N, Bezrodnik L, Finiasz MR, Fink S

Abstract
In Argentina, more than 3 million people suffer from asthma, with numbers rising. When asthma patients acquire viral infections which, in turn, trigger the asthmatic response, they may develop subsequent bacterial infections, mainly by Streptococcus (S.) pneumoniae. This encapsulated Gram(+) bacterium has been considered historically a T cell-independent antigen. Nevertheless, several papers describe the role of T cells in the immune response to S. pneumoniae. We evaluated the response to S. pneumoniae and compared it to the response to Mycobacterium (M.) tuberculosis, a different type of bacterium that requires a T helper type 1 (Th1) response, in cells from atopic asthmatic children, to compare parameters for the same individual under exacerbation and in a stable situation whenever possible. We studied asthma patients and a control group of age-matched children, evaluating cell populations, activation markers and cytokine production by flow cytometry, and cytokine concentration in serum and cell culture supernatants by enzyme-linked immunosorbent assay (ELISA). No differences were observed in γδ T cells for the same patient in either situation, and a tendency to lower percentages of CD4(+) CD25(hi) T cells was observed under stability. A significantly lower production of tumour necrosis factor (TNF)-α and a significantly higher production of interleukin (IL)-5 was observed in asthma patients compared to healthy individuals, but no differences could be observed for IL-4, IL-13 or IL-10. A greater early activation response against M. tuberculosis, compared to S. pneumoniae, was observed in the asthmatic patients' cells. This may contribute to explaining why these patients frequently acquire infections caused by the latter bacterium and not the former.

PMID: 23607482 [PubMed - indexed for MEDLINE]

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Long-term respiratory consequences of premature birth at less than 32 weeks of gestation.

Early Hum Dev. 2013 Jul 30;

Authors: Greenough A

Abstract
Chronic respiratory morbidity is a common adverse outcome of very premature birth, particularly in infants who had developed bronchopulmonary dysplasia (BPD). Prematurely born infants who had BPD may require supplementary oxygen at home for many months and affected infants have increased healthcare utilisation until school age. Chest radiograph abnormalities are common; computed tomography of the chest gives predictive information in children with ongoing respiratory problems. Readmission to hospital is common, particularly for those who have BPD and suffer respiratory syncytial virus lower respiratory infections (RSV LRTIs). Recurrent respiratory symptoms requiring treatment are common and are associated with evidence of airways obstruction and gas trapping. Pulmonary function improves with increasing age, but children with BPD may have ongoing airflow limitation. Lung function abnormalities may be more severe in those who had RSV LRTIs, although this may partly be explained by worse premorbid lung function. Worryingly, lung function may deteriorate during the first year. Longitudinal studies are required to determine if there is catch up growth.

PMID: 23910576 [PubMed - as supplied by publisher]

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Pharmacogenetics and the Development of Personalized Approaches for Combination Therapy in Asthma.

Curr Allergy Asthma Rep. 2013 Aug 3;

Authors: Miller SM, Ortega VE

Abstract
Asthma is a common, chronic disease of the airways that is treated with a combination of different therapies. The combination of LABA and ICS therapy results in a synergistic interaction that is efficacious in improving asthma symptom control; however, genetic variation has the potential to alter therapeutic efficacy. Both agents mediate complex molecular pathways consisting of gene variation that has been investigated with the analysis of candidate genes in the β2-adrenergic receptor and glucocorticoid pathway. These pharmacogenetic studies have been limited to retrospective analyses of clinical trial cohorts and a small number of prospective, genotype-stratified trials. More recently, genome-wide association studies in combination with replication in additional cohorts and in vitro cell-based models have been used to identify novel pathway-related pharmacogenetic variations. This review of the pharmacogenetics of the β2-adrenergic receptor and glucocorticoid pathways highlights the genotypic effects of variation in multiple genes from interacting pathways which may contribute to differential responses to inhaled beta agonists and glucocorticoids. As our understanding of these genetic mechanisms improves, panels of biomarkers may be developed to determine which combination therapies are the most effective with the least risk to an individual asthma patient. Before we can usher in an era of personalized medicine for asthma, it is first important to improve our ability to analyze large volumes of genetic data in large clinical trial cohorts using a combination of study designs, analytical methods, and in vitro functional studies.

PMID: 23912588 [PubMed - as supplied by publisher]

Reduced medication use and improved pulmonary function with supplements containing vegetable and fruit concentrate, fish oil and probiotics in asthmatic school children: a randomised controlled trial.

Br J Nutr. 2013 Jul 14;110(1):145-55

Authors: Lee SC, Yang YH, Chuang SY, Huang SY, Pan WH

Abstract
Dietary pattern changes may be one of the key factors associated with increasing asthma prevalence. Observational studies have found negative associations between fruit, vegetable and fish consumption and risk of asthma. Experimental studies have also shown that probiotics can modulate the immune system. However, each dietary component exhibits a modest effect. The objective of the present study was to investigate the joint effect of multiple beneficial dietary components on asthma. We designed a 16-week school-based double-blind placebo-controlled randomised trial. The supplement group received fruit plus vegetable concentrate, fish oil and probiotics (FVFP supplement), while the control group received placebos. A total of 192 asthmatic children aged 10-12 years were recruited from elementary schools in metropolitan Taipei. Pulmonary function, medication usage, Paediatric Asthma Quality of Life Questionnaire (PAQLQ) score and the Childhood Asthma Control Test score were evaluated at baseline, and at weeks 8 and 16. Compared with the placebo group, the supplement group showed significant improvement in pulmonary function parameters (91 v. 178 ml for forced vital capacity (FVC), 40 v. 107 ml for forced expiratory volume in 1 s (FEV1) and 1·6 v. 4·8 % for FEV1:FVC ratio; all P values < 0·01) and had a significantly reduced proportion of those using short-acting inhaled bronchodilators and inhaled corticosteroids. However, the PAQLQ score and the Childhood Asthma Control Test score were not significantly different between the two groups, possibly because the majority of the children were treated routinely. FVFP supplements reduced medication use and improved pulmonary function in asthmatic children. The present study supports an adjuvant intervention with a combination of fruit, vegetable, fish and probiotic foods.

PMID: 23211647 [PubMed - indexed for MEDLINE]