Quantification of inflammatory mediators to explore molecular mechanisms and sub-phenotypes of asthma

This thesis summarizes a series of studies using liquid chromatography coupled to mass spectrometry methodologies to quantify metabolites of fatty acids (i.e., oxylipins) and histamine in different samples from experimental models and clinical studies with the overall aim to define mechanisms and identify biomarkers for improved sub-phenotyping of asthma. Asthma is characterized by variable airflow obstruction, hyperresponsiveness and chronic inflammation in the airways. The substantial overlap among clinical descriptors has resulted in difficulties to establish diagnosis and predict response to treatment. Instead, a shift in focus towards identifying specific cellular and molecular mechanisms has emerged, aiming to define new treatable traits based on specific cellular and molecular pathways (defined as endotypes). Important pathobiological components involve the release of potent inflammatory mediators, such as histamine, prostaglandins (PGs) and leukotrienes (LTs), that cause bronchoconstriction and airway inflammation. A rapid hydrophilic interaction chromatography method failed to quantify the major histamine metabolite 1,4-methyl-5-imidazoleacetic acid (tele-MIAA) due to ion suppression from inorganic salts present in urine. Ion-pairing chromatography was therefore employed and the resulting increase in precision enabled the detection of higher baseline levels of tele-MIAA in females compared to males (3.0 vs. 2.1 μmol/mmol creatinine, respectively) (Paper I). In addition, levels of tele-MIAA reached up to 30 μmol/mmol creatinine in spot urine samples from mastocytosis patients. Three liquid chromatography coupled to tandem mass spectrometry (LC-MS/MS) methods quantified 130 oxylipins and were able to define kinetic release and enzymatic contribution of mast cell-derived mediators to smooth muscle contraction using isolated and intact airways from humans and guinea pigs in vitro. PGD2 levels were elevated 24-hour post anti-IgE stimulation of human bronchus, suggesting a prolonged mast cell activation (Paper II). Furthermore, exposure to house dust mite (HDM) induced strong release of lipoxygenase-derived LTB4, 5,15-DiHETE, 15-HETE and 15-HEDE along with eosinophilic infiltration in a C57BL/6 murine model of asthma. Interestingly, high levels of cysteinyl-leukotrienes (CysLTs) remained unchanged suggesting a different role of CysLTs in mice (Paper III). Urinary profiles of 11 eicosanoid metabolites in 100 healthy control subjects and 497 asthmatics defined normal baseline levels and revealed increased concentration of PGs, LTE4 and isoprostanes with asthma severity. Consensus clustering of 497 asthmatics identified a five-cluster model with distinct clinical characteristics, which included two new phenotypes, U1 and U5, with low levels of thromboxanes and PGs respectively (Paper IV). At the 12 to 18-month longitudinal time point for the 302 subjects with severe asthma, z-scored eicosanoid concentrations retained the five-cluster profile, despite technical and intra-subject variability. In conclusion, the developed bioanalytical methods were applied to define levels of histamine and eicosanoid metabolites in urine from healthy subjects. In addition, release of multiple oxylipins following mast cell-mediated bronchoconstriction and HDM-induced airway inflammation in model systems were explored to relate functions to levels of lipid mediators. For the first time, grouping of asthmatics according to profiles of eicosanoid metabolites in urine was performed and demonstrated sufficient resolution to identify five sub-phenotypes of asthma possessing distinct clinical characteristics. The presented approaches, for both in vitro and in vivo respiratory research, offer an opportunity to progress the development of new treatment options and suggests a panel of PGs, LTE4 and isoprostanes to be further validated as diagnostic markers in patients with asthma

Metabolomics analysis identifies sex-associated metabotypes of oxidative stress and the autotaxin-lysoPA axis in COPD.

Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease and a leading cause of mortality and morbidity worldwide. The aim of this study was to investigate the sex dependency of circulating metabolic profiles in COPD.Serum from healthy never-smokers (healthy), smokers with normal lung function (smokers), and smokers with COPD (COPD; Global Initiative for Chronic Obstructive Lung Disease stages I-II/A-B) from the Karolinska COSMIC cohort (n=116) was analysed using our nontargeted liquid chromatography-high resolution mass spectrometry metabolomics platform.Pathway analyses revealed that several altered metabolites are involved in oxidative stress. Supervised multivariate modelling showed significant classification of smokers from COPD (p=2.8×10-7). Sex stratification indicated that the separation was driven by females (p=2.4×10-7) relative to males (p=4.0×10-4). Significantly altered metabolites were confirmed quantitatively using targeted metabolomics. Multivariate modelling of targeted metabolomics data confirmed enhanced metabolic dysregulation in females with COPD (p=3.0×10-3) relative to males (p=0.10). The autotaxin products lysoPA (16:0) and lysoPA (18:2) correlated with lung function (forced expiratory volume in 1 s) in males with COPD (r=0.86; p<0.0001), but not females (r=0.44; p=0.15), potentially related to observed dysregulation of the miR-29 family in the lung.These findings highlight the role of oxidative stress in COPD, and suggest that sex-enhanced dysregulation in oxidative stress, and potentially the autotaxin-lysoPA axis, are associated with disease mechanisms and/or prevalence

Increased concentrations of polychlorinated biphenyls, hexachlorobenzene, and chlordanes in mothers of men with testicular cancer.

An increasing incidence of testicular cancer has been reported from several countries in the Western world during the last decades. According to current hypothesis, testicular cancer is initiated during the fetal period, and exposure to endocrine disruptors, i.e., xenoestrogens, has been of concern. In this investigation we studied the concentrations of the sum of 38 polychlorinated biphenyls (PCBs), p,p'-dichlorodiphenyl-dichloroethylene, hexachlorobenzene (HCB), and chlordanes, in 61 cases with testicular cancer and 58 age-matched controls. Furthermore, case and control mothers were also asked to participate, and 44 case mothers and 45 control mothers agreed. They were of similar age. In cases only the concentration on lipid basis of cis-nonachlordane was significantly increased, whereas case mothers showed significantly increased concentrations of the sum of PCBs, HCB, trans- and cis-nonachlordane, and the sum of chlordanes. Among case mothers the sum of PCBs yielded an odds ratio (OR) of 3.8; 95% confidence interval (CI), 1.4-10 was calculated using the median concentration for the control mothers as cutoff value. For HCB, OR = 4.4 (95% CI, 1.7-12); for trans-nonachlordane, OR = 4.1 (95% CI, 1.5-11); for cis-nonachlordane, OR = 3.1 (95% CI, 1.2-7.8); and for sum of chlordanes, OR = 1.9 (95% CI, 0.7-5.0). No consistent different risk pattern was found for seminoma or nonseminoma testicular cancer

Harmonisation, Mosaicing and Production of the Global Land Cover 2000 Database.

Abstract not availableJRC.H-Institute for environment and sustainability (Ispra

The FADS1 rs174550 Genotype Modifies the n-3 and n-6 PUFA and Lipid Mediator Responses to a High Alpha-Linolenic Acid and High Linoleic Acid Diets

Scope: The fatty acid composition of plasma lipids, which is associated with biomarkers and risk of non-communicable diseases, is regulated by dietary polyunsaturated fatty acids (PUFAs) and variants of fatty acid desaturase (FADS). We investigated the interactions between dietary PUFAs and FADS1 rs174550 variant.Methods and results: Participants (n = 118), homozygous for FADS1 rs174550 variant (TT and CC) followed a high alpha-linolenic acid (ALA, 5 percent of energy (E-%)) or a high linoleic acid (LA, 10 E-%) diet during an 8-week randomized controlled intervention. Fatty acid composition of plasma lipids and PUFA-derived lipid mediators were quantified by gas and liquid chromatography mass spectrometry, respectively. The high-LA diet increased the concentration of plasma LA, but not its lipid mediators. The concentration of plasma arachidonic acid decreased in carriers of CC and remained unchanged in the TT genotype. The high-ALA diet increased the concentration of plasma ALA and its cytochrome P450-derived epoxides and dihydroxys, and cyclooxygenase-derived monohydroxys. Concentrations of plasma eicosapentaenoic acid and its mono- and dihydroxys increased only in TT genotype carriers.Conclusions: These findings suggest the potential for genotype-based recommendations for PUFA consumption, resulting in modulation of bioactive lipid mediators which can exert beneficial effects in maintaining health.</p

Urinary leukotriene E4 and prostaglandin D2 metabolites increase in adult and childhood severe asthma characterized by type 2 Inflammation : a clinical observational study

Rationale: New approaches are needed to guide personalized treatment of asthma.Objective: To test if urinary eicosanoid metabolites can direct asthma phenotyping.Methods: Urinary metabolites of prostaglandins (PG), cysteinyl-leukotrienes (LT) and isoprostanes were quantified in the Unbiased Biomarkers for the Prediction of Respiratory Diseases Outcomes (U-BIOPRED) study including 86 adults with mild-to-moderate asthma (MMA), 411 with severe asthma (SA), and 100 healthy controls (HC). Validation was performed in 302 SA subjects followed-up after 12-18 months, and externally in 95 adolescents with asthma.Measurement and Main Results: Metabolite levels in HC were unrelated to age, BMI and sex, except for the PGE2-pathway. Eicosanoid levels were generally greater in MMA relative to HC, with further elevations in SA, except for PGE2-metabolites in males, which were the same or lower in non-smoking asthmatics as in HC. Metabolite levels were unchanged in asthmatics adherent to oral corticosteroid treatment as documented by urinary prednisolone detection, whereas SA treated with omalizumab had lower levels of LTE4 and the PGD2 metabolite 2,3-dinor-11?-PGF2?. High levels of LTE4 and PGD2-metabolites were associated with lower lung-function, and increased levels of exhaled nitric oxide and eosinophil markers in blood, sputum and urine in U-BIOPRED and in adolescents with asthma. These type-2 (T2) asthma associations were reproduced in the follow-up visit of the U-BIOPRED study, and found to be as sensitive to detect T2 inflammation as the established biomarkers. Conclusions: Monitoring of urinary eicosanoids can identify T2 asthma and introduces a new non-invasive approach for molecular phenotyping of adult and adolescent asthma

Mapping atopic dermatitis and anti–IL-22 response signatures to type 2–low severe neutrophilic asthma

Background: Transcriptomic changes in patients who respond clinically to biological therapies may identify responses in other tissues or diseases. Objective: We sought to determine whether a disease signature identified in atopic dermatitis (AD) is seen in adults with severe asthma and whether a transcriptomic signature for patients with AD who respond clinically to anti–IL-22 (fezakinumab [FZ]) is enriched in severe asthma. Methods: An AD disease signature was obtained from analysis of differentially expressed genes between AD lesional and nonlesional skin biopsies. Differentially expressed genes from lesional skin from therapeutic superresponders before and after 12 weeks of FZ treatment defined the FZ-response signature. Gene set variation analysis was used to produce enrichment scores of AD and FZ-response signatures in the Unbiased Biomarkers for the Prediction of Respiratory Disease Outcomes asthma cohort. Results: The AD disease signature (112 upregulated genes) encompassing inflammatory, T-cell, TH2, and TH17/TH22 pathways was enriched in the blood and sputum of patients with asthma with increasing severity. Patients with asthma with sputum neutrophilia and mixed granulocyte phenotypes were the most enriched (P < .05). The FZ-response signature (296 downregulated genes) was enriched in asthmatic blood (P < .05) and particularly in neutrophilic and mixed granulocytic sputum (P < .05). These data were confirmed in sputum of the Airway Disease Endotyping for Personalized Therapeutics cohort. IL-22 mRNA across tissues did not correlate with FZ-response enrichment scores, but this response signature correlated with TH22/IL-22 pathways. Conclusions: The FZ-response signature in AD identifies severe neutrophilic asthmatic patients as potential responders to FZ therapy. This approach will help identify patients for future asthma clinical trials of drugs used successfully in other chronic diseases