Alveolar T-helper type-2 immunity in atopic asthma is associated with poor clinical control

Anders Bergqvist, Cecilia Andersson, Michiko Mori, Andrew F. Walls, Leif Bjermer, Jonas Erjefält

Research output: Contribution to journalArticlepeer-review

247 Downloads (Pure)

Abstract

Real-world evaluation studies have shown that many patients with asthma remain symptomatic despite treatment with inhaled corticosteroids (ICSs). As conventional ICSs have poor access to the peripheral airways, the aim of the present paper was to study the relationship between peripheral airway inflammation and clinical control in allergic asthma. Consequently, bronchial and transbronchial biopsies were obtained from patients with poorly controlled asthma [n=12, asthma control test (ACT) score < 20], patients with well-controlled asthma (n= 12, ACT score >= 20) and healthy controls (n= 8). Tissue sections were immunostained to assess multiple leucocyte populations. To determine the degree of T-helper type-2 (Th2) immunity, the logarithmic value of the ratio between Th2 cells/mm(2) and Th1 cells/mm(2) was used as a surrogate score for Th2-skewed immunity. In the bronchi, the leucocyte infiltration pattern and the Th2-score were similar between patients with well-controlled asthma and those with poorly controlled asthma. In contrast, in the alveolar parenchyma, the expression of T-helper cells was significantly higher in patients with poorly controlled asthma than in patients with well-controlled asthma (P < 0.01). Furthermore, the alveolar Th2-score was significantly higher in patients with poorly controlled asthma (median 0.4) than in the controlled patients (median -0.10, P < 0.05). In addition, in contrast with bronchial Th2-score, the alveolar Th2-score correlated significantly with ACT score (r(s)=-0.62, P < 0.01) in the pooled asthma group. Collectively, our data reveal an alveolar Th2-skewed inflammation, specifically in asthmatic patients who are poorly controlled with ICSs, and suggest that pharmacological targeting of the peripheral airways may be beneficial in this large patient category.
Original languageEnglish
Pages (from-to)47-56
JournalClinical Science
Volume128
Issue number1
DOIs
Publication statusPublished - 2015

Subject classification (UKÄ)

  • Immunology in the medical area
  • Respiratory Medicine and Allergy

Free keywords

  • alveolar parenchyma
  • asthma control asthma
  • peripheral inflammation
  • T-helper type-2 (Th2)

Fingerprint

Dive into the research topics of 'Alveolar T-helper type-2 immunity in atopic asthma is associated with poor clinical control'. Together they form a unique fingerprint.

Cite this