Airway gene expression identifies subtypes of type 2 inflammation in severe asthma

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningfagfællebedømt

Background: Type 2 inflammation is characterized by enhanced activity of interleukin (IL)-4, -5 and -13, and treatments targeting these pathways are available for treatment of severe asthma. At present, the pattern of pathway activity and the implications overlapping of pathway activity are unknown. Objective: We hypothesized that clustering of airway mRNA expression would identify distinct molecular subtypes of severe asthma and thereby uncover the prevalence and overlap of pathway activity. Methods: Sputum mRNA expression of genes related to expression of IL-5(CLC, CPA3 and DNASE1L3), IL-13(IL13Ra1, TNFSF14 and SERPINB2), T1/Th17 activity(IL1B, ALPL and CXCR2) and in vitro response to corticosteroids (FKBP512) and mepolizumab (ARAP3) was analysed in patients (n = 109) with severe asthma and healthy controls (n = 22). A cluster analysis of gene expression was performed. The response to a short course of OCS was assessed in a subset of patients (n = 29). Results: Five molecular clusters were identified. Three had abundant T2 gene expression of which two (n = 39 and n = 9) were characterized by abundant expression of both IL-13- and IL-5-related genes. The last (n = 6) had only abundant IL-5-related gene expression. These T2-high molecular clusters could not be distinguished using T2 biomarkers. T2- and Th1/Th17-related mRNA expression were co-expressed across all clusters. OCS significantly reduced T2 gene expression (CLC, IL13Ra1, SERPINB2 and ARAP3) and significantly increase expression of Th1/Th17-related genes (ALPL and CXCR2). Conclusions and clinical relevance: Clustering of airway mRNA expression identified five molecular clusters of severe asthma of which three were considered T2 high. Co-expression of IL-5- and IL-13-related genes at moderate levels was present in almost half of patients, while marked elevated expression of both was rare. In contrast to IL-5, clusters with isolated IL-13- and Th1/Th17-related gene expression were not identified.

OriginalsprogEngelsk
TidsskriftClinical and Experimental Allergy
Vol/bind52
Udgave nummer1
Sider (fra-til)59-69
Antal sider11
ISSN0954-7894
DOI
StatusUdgivet - 2022

Bibliografisk note

Funding Information:
This work was supported by private grants from The Toyota Foundation, The A.P.Møller Foundation, The Timber Merchant Vilhelm Bang Foundation, The Christian X of Denmark Foundation and The Shipowner Per Henriksen, R. and Wife Foundation.

Funding Information:
This work was supported by private grants from The Toyota Foundation, The A.P.M?ller Foundation, The Timber Merchant Vilhelm Bang Foundation, The Christian X of Denmark Foundation and The Shipowner Per Henriksen, R. and Wife Foundation. The authors would like to thank statistician Anne Helms Andreasen (Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Denmark) for statistical assistance on cluster analysis.

Publisher Copyright:
© 2021 John Wiley & Sons Ltd.

ID: 314154457