Severe Asthma: Updated Therapy Approach Based on Phenotype and Biomarker

Asthma is responsible for considerable global morbidity and health-care costs affecting over 300 million people worldwide. This illness is a heterogeneous condition characterized by chronic airway inflammation and pulmonary tissue remodeling resulting in a variety of clinical manifestations and treatment responses. Recent studies have shown an increasing appreciation of heterogeneity in asthma based on molecular phenotyping, biomarkers, and differential responses to therapies. In terms of asthma classification, perhaps the most important distinction to make is whether the patient has evidence of an eosinophilic inflammatory process characterized by type 2 immune response (Th2) or not. Therefore, personalized therapies to asthmatic patients just will be a reality by identifying and characterizing biomarkers. This review approaches the advances in diagnoses and management of asthma and severe asthma and highlights those with difficult-to-treat asthma based on each phenotype and biomarkers, to assist in the optimization of conventional therapy and to guide the use of targeted therapies

Cellular and molecular analysis of intranasally effect of extract of leaves cissampelos sympodialis eichl. (menispermaceae) and its alkaloids in experimental allergic process

Cissampelos sympodialis Eichl (Menispermaceae) is a plant commonly found in semi-arid regions of Brazil. Its roots and leaves are used in folk medicine to treat arthritis, rheumatism and respiratory disorders. Studies have shown its anti-inflammatory, immunomodulatory and anti-asthmatic effects. The aim of this study was: 1) to evaluate the effect of administration, intranasally (i.n.) of the leave extract (AFL) and its alkaloids warifteine (WAR), methylwarifteine (MWA) and milonine (MIL) in the lungs of BALB/c mice sensitized and challenged with ovalbumin (OVA) and 2) to analyze the effects of alkaloids on inflammatory cells and their molecules related to inflammation. The parameters evaluated in vivo were: the cell migration into bronchoalveolar lavage (BAL), histopathological changes in the lung tissue and analysis of IgE levels on the serum. In vitro assays, were evaluated the phosphorylation of JNK kinase enzyme and expression of COX-2 on cultured macrophage and mast cells. The results showed that the AFL and the alkaloids were able to inhibit the migration of inflammatory cells, mainly eosinophils to the lung. However the AFL and milonine induced neutrophil migration to the lung. Treatment with the extract and the alkaloids inhibited the production of mucus by goblet cells present in the bronchial epithelium and the migration of TCD4+ and TCD8+ into the lung tissue, except warfteine that increased the TCD8+ subpopulation,. Only the AFL treatment was able to decrease serum IgE concentration and, among the alkaloids, MWA was able to inhibit the production of interleukin-13 (IL-13) by cells from the BAL. In vitro tests showed that the alkaloids presented no toxicity for macrophage and mast cells at all concentrations tested 0.1, 1.0 and 10 μM. However, only milonine was able to inhibit degranulation of mast cells via inhibition of histamine release. The inhibition of JNK phosphorylation was observed with MWA and MIL independent of COX-2 activation. These results indicate that the extract, when administered intranasally, has antiasthmatic effect by decreasing the eosinophil migration into the lung and the mucus production and, MWA is one of the important compounds present into the extract due to decreasing the JNK phosphorylation. In addition, these data provide additional information to produce an herbal plant for the treatment of intranasal airway inflammatory disorders and the MWA may be the molecular marker for the quality and effect of the herbal medicine.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPESCissampelos sympodialis Eichl. (Menispermaceae) é uma planta comumente encontrada em regiões semiáridas do Brasil. Suas raízes e folhas são usadas na medicina popular no tratamento de artrite, reumatismo e doenças respiratórias. Estudos têm demonstrado seu efeito anti-inflamatório, antiasmático e imunomodulador. Os objetivos do presente trabalho foram: 1) avaliar o efeito da administração, por instilação nasal (i.n.), do extrato das folhas de Cissampelos sympodialis (AFL) e de seus alcaloides warifteina (WAR), metilwarifteina (MWA) e milonina (MIL) em pulmões de camundongos BALB/c sensibilizados e desafiados com ovalbumina (OVA) e 2) analisar o efeito destes alcaloides sobre células inflamatórias e suas moléculas relacionadas com a inflamação. Os parâmetros avaliados in vivo foram: padrão de migração de células no lavado bronco alveolar (BAL), alterações histopatológicas no tecido pulmonar e análise dos níveis de IgE no soro. Nas análises in vitro, em cultura de macrófagos e mastócitos, foram avaliados a fosforilação das enzimas JNK quinase e a expressão da COX-2. Os resultados demonstraram que o AFL e os alcaloides foram capazes de inibir a migração das células da inflamação, em especial, os eosinófilos no pulmão. Entretanto, o AFL e a milonina induziram aumento no número de neutrófilos no pulmão. Os tratamentos com o extrato e os alcaloides inibiram a produção de muco pelas células caliciformes presentes no epitélio brônquico e a migração de linfócitos T CD4+ e TCD8+ da cavidade pulmonar, com exceção da warifteina que aumentou a subpopulação T CD8+. Apenas o tratamento com AFL foi capaz de diminuir a concentração de IgE sérica e, entre os alcaloides, somente a MWA foi capaz de inibir a produção da interleucina-13 (IL-13) pelas células do BAL. Nos ensaios in vitro, observou-se que os alcaloides não apresentaram toxicidade para mastócitos e macrófagos em todas as concentrações testadas 0.1, 1.0 e 10 μM. Entretanto, apenas a milonina foi capaz de inibir degranulação de mastócitos via inibição da liberação da histamina. A inibição da fosforilação da JNK foi observada com a MWA e a MIL independentes da expressão da enzima COX-2. Estes resultados indicam que o extrato, quando administrado por instilação nasal, apresenta efeito antiasmático principalmente pela diminuição da migração de eosinófilos para o pulmão e pela produção de muco e que a MWA é um dos compostos presentes no extrato importante para o efeito antiasmático da planta devido á diminuição da fosforilação da JNK. Em adição, estes dados fornecem informações para a produção de um fitoterápico da planta para o tratamento intranasal de doenças inflamatórias das vias aéreas e a MWA pode ser o marcador molecular de qualidade e efeito do fitoterápico

p-Cymene and Rosmarinic Acid Ameliorate TNBS-Induced Intestinal Inflammation Upkeeping ZO-1 and MUC-2: Role of Antioxidant System and Immunomodulation

p-Cymene (p-C) and rosmarinic acid (RA) are secondary metabolites that are present in medicinal herbs and Mediterranean spices that have promising anti-inflammatory properties. This study aimed to evaluate their intestinal anti-inflammatory activity in the trinitrobenzene sulphonic acid (TNBS)-induced colitis model in rats. p-C and RA (25–200 mg/kg) oral administration reduced the macroscopic lesion score, ulcerative area, intestinal weight/length ratio, and diarrheal index in TNBS-treated animals. Both compounds (200 mg/kg) decreased malondialdehyde (MDA) and myeloperoxidase (MPO), restored glutathione (GSH) levels, and enhanced fluorescence intensity of superoxide dismutase (SOD). They also decreased interleukin (IL)-1β and tumor necrosis factor (TNF)-α, and maintained IL-10 basal levels. Furthermore, they modulated T cell populations (cluster of differentiation (CD)4+, CD8+, or CD3+CD4+CD25+) analyzed from the spleen, mesenteric lymph nodes, and colon samples, and also decreased cyclooxigenase 2 (COX-2), interferon (IFN)-γ, inducible nitric oxide synthase (iNOS), and nuclear transcription factor kappa B subunit p65 (NFκB-p65) mRNA transcription, but only p-C interfered in the suppressor of cytokine signaling 3 (SOCS3) expression in inflamed colons. An increase in gene expression and positive cells immunostained for mucin type 2 (MUC-2) and zonula occludens 1 (ZO-1) was observed. Altogether, these results indicate intestinal anti-inflammatory activity of p-C and RA involving the cytoprotection of the intestinal barrier, maintaining the mucus layer, and preserving communicating junctions, as well as through modulation of the antioxidant and immunomodulatory systems