Lung DCs Legitimate Targets For Treating Asthma

December 30, 2006 by Mark

Allergic asthma is caused by an unwanted immune response known as a Th2 cell response. Most treatments for asthma currently target this Th2 cell response and its downstream effects. However, immune cells known as dendritic cells (DCs) are crucial activators of all T cell responses, including the Th2 cell response in asthma, so therapies that target DC function in the airways might represent a new way to treat individuals with allergic asthma.

Now, in a study appearing in the November issue of the Journal of Clinical Investigation, Bart Lambrecht and colleagues from Erasmus University, The Netherlands, have shown that inhalation of the immunosuppressive drug FTY720 suppresses the symptoms of allergic asthma in a mouse model of the disease. Inhalation of FTY720 suppressed the allergic Th2 cell response in the lungs by preventing lung DCs from leaving the lungs and going to the site at which they activate the allergic Th2 cell response. This demonstration that targeting lung DCs can suppress allergic asthma in mice might open new avenues of research for the development of drugs that target DC function to treat individuals with allergic asthma.

Asthma and the Obesity Connection

December 27, 2006 by Mark

A new asthma gene provides an unexpected link between asthma and obesity according to a research team at Sydney’s Garvan Institute, who are also part of the Cooperative Research Centre for Asthma and Airways.

Bennett Shum and colleagues have found that a fatty acid binding protein called aP2, which is already known for its role in diabetes and obesity, is also present in the lung where it is crucial in controlling inflammation in asthma.

About one in ten adults and one in six children in Australia now suffer from asthma. Its incidence in Western countries increased markedly over the last 20 years and has purportedly been linked to the rise in obesity.

“There’s up to three times the risk of being asthmatic if you are obese: the more obese, the greater the risk. We know that obese asthmatics who lose weight have large improvements in their asthma,” says asthma project leader Dr Michael Rolph.

Various triggers such as dust mites and pollen bring on asthma attacks, which are characterized by inflammation of the airways, a tightening of the surrounding muscles, and excess mucus production.

The scientists used a technique called gene profiling to discover novel genes that regulate airway inflammation and found very high levels of aP2 in human lung cells that had been tricked into thinking they were undergoing an asthma attack.

“We were really surprised to find aP2 in the lung”, said Shum. “So, we then looked at what would happen when we removed this gene in mouse models: mice without aP2 are protected from asthma attacks”.

“These findings suggest that blocking aP2 function is a novel approach for asthma treatment and other inflammatory lung diseases,” he added.

Enhanced Internet Resources For Patients

December 23, 2006 by Mark

The Asthma and Allergy Foundation of America (http://www.aafa.org) and The HealthCentral Network (http://www.TheHealthCentralNetwork.com), a Choice Media Division, announce that they will work together to create a new online resource for individuals with asthma and allergic disorders. The collaboration marries the deep health education expertise and resources of the Asthma and Allergy Foundation with The HealthCentral Network’s multimedia capabilities and vast online community of patients and experts.

“This partnership with The HealthCentral Network offers us a valuable modern vehicle to disseminate our extensive library of multimedia educational materials,” said Mike Tringale, M.S.M., the Foundation’s Director of Marketing and Communications. Asthma and Allergy Foundation of America is the leading nonprofit patient organization focused on improving the quality of life for people with asthma and allergies and provides practical information, community based services and support through a national network of chapters and support groups. “One of our first joint projects will be to create a Web site portal to create opportunities for patients, providers and caregivers in the asthma and allergy community to connect,” said Tringale. “Future projects will include the development of a blog allowing our supporters to interact on topics ranging from advocacy and policy issues, asthma and allergy program funding, patient rights, treatment guidelines and more.”

The HealthCentral Network’s new asthma Web site at http://www.MyAsthmaCentral.com and allergy Web site at http://www.MyAsthmaCentral.com are designed to leverage the wisdom and experience of asthma and allergy sufferers to help others coping with similar challenges. Building on a base of comprehensive medical information to inform and manage asthma, the new site seeks foremost to connect the asthma community through the voice of others who have been there. Through new tools such as customizable Web sites to keep extended families up-to-date during acute episodes, and regular blogs by those who can articulate the everyday realities of living with asthma, The HealthCentral Network seeks to provide in partnership with the Asthma and Allergy Foundation of America the ultimate community site to build awareness and understanding. More than 50 million individuals in the United States have allergies, and 20 million individuals have developed asthma, often triggered by or co-existing with other allergies.

“We are excited about promoting the Asthma and Allergy Foundation’s award- winning educational programs, cutting edge research, and outstanding internet resources to our millions of Web site visitors on The HealthCentral Network,” said Chris Schroeder, CEO and President of Choice Media. “Through this collaboration we hope to tap into the Foundation’s network of local chapters and support groups to create an inspirational online community that captures the patient experience and addresses real world needs.”

About The HealthCentral Network

The HealthCentral Network (http://www.aafa.org) is a division of Choice Media, Inc. and has over 30 general health and highly specific condition and wellness web properties, each committed to offering a voice in every day and personal language people can understand and connect with at critical points in their lives. Each site provides timely, interactive, in-depth, and trusted medical information, personalized tools and resources, and connections to vast communities of expertise for people seeking to engage in, manage and improve their health. The award-winning, multi-media experience combines medically-reviewed articles from doctors and researchers, as well as news, information, video and extensive engagement from every day people who have great experience and empathy in specific health areas. The Company also produces the Medical Breakthroughs television show, seen around the country.

Founded in the late 1990s, Choice Media, Inc. was recently acquired by a team of blue-chip investors including Sequoia Capital, Polaris Ventures, The Carlyle Group and Allen & Company. With a management team that combines decades of experience in interactive media and medical, science and news journalism, Choice Media, Inc. aims for the highest standards of quality, relevance and community for patients and their caregivers.

About the Asthma and Allergy Foundation of America

The Asthma and Allergy Foundation of America (AAFA), headquartered in Washington, DC, is the leading non-profit consumer and patient organization fighting asthma and allergic disease. The Foundation provides free information to the public, offers educational programs to consumers and health professionals, leads advocacy efforts to improve patient care and supports research to find cures. The Foundation’s services include a toll-free hotline, counseling and educational materials, and a free caregiver magazine. For more than 50 years, the Asthma and Allergy Foundation has been a leader in fiscal responsibility and charity management and has a coveted four-star rating from Charity Navigator and is a member of the National Health Council. To learn more about The Asthma and Allergy Foundation of America, visit http://www.aafa.org.

The HealthCentral Network
http://www.TheHealthCentralNetwork.com

Perceived Control Improves Asthma Health Status

December 19, 2006 by Mark

Patients with asthma who believe they have control of their condition are likely to report improved asthma-related health status and have a decreased risk of severe asthma attacks.

In a new study out of the University of California, San Francisco, researchers followed 865 patients (mean age 60 years) hospitalized for asthma for a median of 1.9 years after hospital discharge. Researchers collected demographic information, asthma history, perceived asthma control, and measured emergency department (ED) visits and hospitalizations for asthma.

Results indicated that greater perceived control was associated with better physical health status, better asthma-related quality of life, fewer days of restricted activity due to asthma, and lower asthma severity scores. A multivariate model also showed that greater perceived control was associated with significantly decreased prospective risk of ED visits and hospitalizations for asthma.

This study appears in the November issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians.

New Standard Certifies Pillows Asthma Friendly

December 14, 2006 by Mark

A new certification standard has been launched this holiday season to help people with asthma and allergies find pillows that are more suitable for them. The Asthma and Allergy Foundation of America (AAFA) reports that pillows and other bedding can be home to millions of dust mites and other allergens that cause asthma symptoms. Now, AAFA has launched the asthma friendly(R) Certification Program in the U.S. to help consumers identify the best tools for controlling and reducing allergen exposure in the home.

Medical experts advise that reducing exposure to dust mites should be a critical part of everyone’s allergy and asthma management plan. “Dust mites are among the most common indoor allergens,” says Clifford W. Bassett, MD, of the Long Island College Hospital of Brooklyn and Assistant Clinical Professor of Medicine. “We can’t emphasize enough how important it is to get tested to learn if you have allergic sensitivities and to take steps to reduce exposure to dust mites.”

The “asthma friendly” certification program is a joint effort between the nonprofit AAFA and the international research and testing organization, Allergy Standards Limited (ASL). Standards are written for different types of products then manufacturers submit products for laboratory testing to determine if they meet the standards and qualify for the “asthma friendly” certification mark. Abstracts of the standards and information about the program are online at http://www.asthmafriendly.com.

The first “asthma friendly” certified pillows will be available at Bed Bath and Beyond this holiday. Other certified products, such as stuffed toys, are already on the shelves at major retailers including Target, Kohl’s, Build-a-Bear Workshop, FAO Schwartz and Learning Express. See a list of certified products and retailers online at http://www.asthmafriendly.com. Next year, certified vacuum cleaners, paints, flooring and other types of items will also be available.

AAFA recommends the following simple tips for controlling dust mites at home:

– Reduce humidity throughout the house, keeping humidity below 50 percent.

– Wash bed sheets weekly in 130-degree hot water to kill dust mites and their eggs.

– Keep pets off of beds and out of bedrooms to minimize pet dander — a food source for dust mites.

– Look for asthma friendly(R) certified pillows and other bedding.

Common Asthma Inhaler Causing Deaths

December 12, 2006 by Mark

Three common asthma inhalers containing the drugs salmeterol or formoterol may be causing four out of five U.S. asthma-related deaths per year and should be taken off the market, researchers from Cornell and Stanford universities have concluded after a search of medical literature.

They base these conclusions on a statistical analysis of 19 published trials involving 33,826 patients. This so-called meta-analysis found that patients who inhaled the long-acting beta-agonists salmeterol (trade names Serevent and Advair, both made by GlaxoSmithKline) or formoterol (trade name Foradil, made by Novartis Pharmaceuticals) were 3.5 times more likely to die from asthma and 2.5 times more likely to be hospitalized (whether or not death resulted), compared with those taking a placebo.

The reason, say the researchers, is because although these medications relieve asthma symptoms, they also promote bronchial inflammation and sensitivity without warning.

Nevertheless, asthma death is relatively rare — 15 patients in the meta-analysis who were taking the beta-agonists died, compared with three in the placebo group, over a six-month period.

“In total, there are about 5,000 deaths a year due to asthma, whether or not a person is taking a long-acting beta-agonist,” said Edwin Salpeter, the J.G. White Distinguished Professor of Physical Sciences Emeritus at Cornell, who led the statistical analysis in the study. An eminent astrophysicist, Salpeter has more recently focused his attention on medical statistics. “We can show that overall it is statistically significant that, compared to patients taking a placebo, these long-acting beta-agonists kill a lot of people,” he said.

“These asthma deaths are generally in healthy young adults,” said his daughter, Shelley Salpeter, the lead author of the paper appearing online and in the June 20 issue of Annals of Internal Medicine. She is a clinical professor of medicine at Stanford’s School of Medicine and a physician at Santa Clara Valley Medical Center in San Jose, Calif.

“We estimate that approximately 4,000 out of the 5,000 asthma deaths that occur in the U.S. each year are actually caused by these long-acting beta-agonists, and we urge that these agents be taken off the market,” she added.

Adding an anti-inflammatory drug to a long-acting beta-agonist adds little benefit, report the Salpeters. Advair, for example, (the fourth bestselling drug in the world with $5.6 billion in annual sales), combines salmeterol with an anti-inflammatory drug to provide some protection against bronchial inflammation associated with beta-agonists. But hospitalizations still doubled for patients inhaling a long-acting beta-agonist combined with an anti-inflammatory drug compared with asthma patients taking a placebo and an anti-inflammatory drug by itself.

Of the 19 studies surveyed in the meta-analysis, the largest — the Salmeterol Multicenter Asthma Research Trial with 26,000 participants — reported a fourfold increased risk for asthma-related deaths and a twofold increase in life-threatening asthma events in patients using salmeterol. If older people who also suffered from chronic obstructive pulmonary disease were removed from the analysis, the Salpeters report, salmeterol would be associated with a six times greater risk for asthma-related deaths.

The meta-analysis found that 53 of 3,083 patients inhaling beta-agonists were hospitalized for an asthma attack compared with 12 of 2,008 patients who received a placebo, meaning that there was one hospitalization for every 71 patients treated with a long-acting beta-agonist per year.

The Salpeters say that these two long-acting beta-agonists can result in death because tolerance to them develops over time.

“These agents can improve symptoms through bronchodilation at the same time as increasing underlying inflammation and bronchial hyper-responsiveness, thus worsening asthma control without any warning of increased symptoms,” said Shelley Salpeter.

“It is particularly frightening that long-acting beta-agonists are detrimental, whether salmeterol or formoterol, whether taken alone or with anti-inflammatory drugs, both for children and for adults,” said Ed Salpeter.

New Target For Asthma Treatment

December 10, 2006 by Mark

Cincinnati scientists have found further evidence that certain defensive white cells in the body cause or play a major role in the symptoms experienced by asthma patients.

Their findings, scientists say, could lead to the identification of a new treatment “target” to help the estimated 17 million asthma sufferers in the United States.

The scientists, at the University of Cincinnati (UC) Academic Health Center and Cincinnati Children’s Hospital Medical Center, report their results in the Proceedings of the National Academy of Sciences.

Working with genetically altered mice, the Cincinnati researchers studied a group of cells called eosinophils. Originally evolved to defend the body against parasite infection, a problem no longer common in the Western world, eosinophils are known to accumulate during allergic responses–and especially in mucous in the lungs of asthma patients.

“Researchers have been looking at the role of eosinophils in asthma for decades,” says research associate and first author Patricia Fulkerson, PhD. “Since people in the Western world don’t have parasites in their guts to the extent they used to, the question is what eosinophils do now?”

“Previous studies linking eosinophils to asthma were done in single models,” Fulkerson explains. “We increased the power of our study by looking at multiple models, and by doing that we show a strong role for eosinophils in mucous production in asthma.”

The researchers, led by Professor Marc Rothenberg, MD, PhD, of UC College of Medicine and Cincinnati Children’s Hospital Medical Center, also showed that eosinophils contribute to the recruitment of the immunity-regulating proteins known as cytokines, a process that allows mucous to accumulate in the lung.

“Previously most scientists looked at one model at a time–eliminating as many eosinophils as possible, inducing each model with asthma, and then watching what happens in an allergic response,” Fulkerson explains. “Using just one model, however, it’s difficult to determine the role of eosinophils versus that model’s own genetic strategy.”

So instead of a single model, Rothenberg, Fulkerson and their colleagues used three different ones. They studied one mouse model in which eosinophils don’t develop from bone marrow, as they should, and two models in which eosinophils remain in the blood stream instead of rallying into the lung tissue to protect against asthma.

They then looked at the characteristics that all three models had in common so they could attribute any alteration in their appearance (or phenotype) to eosinophils, and not to that particular model’s genetics.

In the absence of eosinophils, the researchers report, they found that allergen-induced mucous production dropped in all models, suggesting that “eosinophils play a big role in mucous production in response to an allergen challenge.”

The researchers also report that eosinophils alter the lungs’ “micro environment” by stimulating production of the signaling cytokines. Involved in triggering the body’s immune defense mechanism to take action against infection, cytokines are responsible for almost all the characteristics of asthma.

“If cytokines are produced in the lungs, you’ll end up with asthma,” says Fulkerson. “But we found in eosinophil-free models that the cytokines that together produce almost all the visible symptoms of asthma–known as IL (interleukin) 4 and IL 13–were markedly reduced.

Having shown that eosinophils play an important part in mucous production and airway obstruction in asthma, the researchers’ next goal was to determine how they actually do that.

Examination of mouse lung tissue revealed increased genetic activity associated with the characteristics of asthma: mucous, airway obstruction and hyperactivity.

“We took two of these models and looked at changes in gene expression in the lung caused by eosinophils,” says Fulkerson. “We only picked up the genes that were in common in both models, so we can say the changes were eosinophil dependent versus model dependent.

“So now we have this list of genes that are eosinophil dependent in an experimental animal model and we’re identifying new pathways that have never been attributed to eosinophils before,” Fulkerson adds. “Now we and other researchers will pursue this to learn exactly what eosinophils are doing to those pathways and to see how we can block their contributions to asthma.

Some of these genetic pathways were known to be important in asthma, says Fulkerson, but no one had previously attributed them to eosinophils.

“That’s the exciting part,” she says. “If we can prevent eosinophils from being activated, then perhaps we can develop new targets for treatment. The goal is to find new approaches to asthma, because although we can treat asthma symptoms fairly well, we’re not so good at dealing with the long-term consequences.

“And this doesn’t only involve asthma. There are a lot of other diseases, especially digestive diseases, in which we see high levels of eosinophils that don’t belong there,” Fulkerson says.

Diet May Help Prevent Allergies And Asthma

December 9, 2006 by Mark

A recent publication from the Global Allergy and Asthma European Network (GA2LEN) (1) provides new insights into the role that diet may play in the development of allergies, especially in children. The work suggests that the significant changes in European diets over the past 20-40 years may have contributed to the increased incidence of allergic diseases in both children and adults seen over this period. Members of the nutrition work package responsible for the report consider that its findings are just the beginning of GA2LEN’s potential role in greater understanding of this complex area.

The prevalence of allergic diseases has increased dramatically over the past few decades, especially in children. One child in three is allergic today and one in two people in Europe are likely to be suffering from at least one allergy by 2015. It is generally agreed that a combination of heredity and environmental factors is responsible for the development of the allergy and asthma. However, the evolution of these diseases has been far too rapid for genetics to be the sole explanation. Among the wide range of environmental factors under discussion, changes in the European diet in the last 20-40 years are considered to be a possible explanation. Indeed, the way in which children are fed early in life may have a direct effect on the subsequent development of asthma and allergies, according to a recent publication from the Global Allergy and Asthma European Network (GA2LEN). (1)

In a paper entitled “Nutrition and allergic disease”, published this year in Clinical and Experimental Allergy Reviews, 12 European experts working together in the GA2LEN nutrition work package present the evidence and define fertile topics for future research. (2) The work package team is led by Professor Philip C Calder, Institute of Human Nutrition, University of Southampton. (3)

Key findings: breastfeeding, early diet and probiotics

The three main areas producing key findings are breastfeeding, intake of certain nutrients, and probiotics. (4)

Exclusive breastfeeding, that is providing the infant with no other liquid or food other than breast milk, is believed to be effective in reducing subsequent development of allergies. It appears that exclusive breastfeeding for four months helps protect the child from cow’s milk protein allergy until 18 months, reduces the likelihood of dermatitis (skin allergy) until three years, and reduces the risk of recurrent wheeze (or asthma) until six years’ of age. However, the longer term effects of breast feeding on allergic outcomes are not known and require investigation.

The protective effect of four months of exclusive breastfeeding is important for all children but it is especially valuable for those at high risk of developing allergies. Children are at high risk of developing allergies if one or both parents are affected by allergic disease. If it is not possible for the high-risk child to be breastfed, hypoallergenic formula combined with avoidance of solid foods for 4-6 months offers an alternative source of protection. The studies show that hypoallergenic formula helps prevent cows’ milk protein allergy developing before the age of five years and offers protection against atopic dermatitis (eczema or other skin allergy) until the age of four years.

A second major area of importance appears to be the components of the diet. For example, antioxidants in the diet, such as vitamin C, vitamin E and selenium coming mainly from fruit and vegetables, may have a protective effect. Furthermore, different fats found in milk, butter, vegetable oils and fish may have different effects on development of allergies and asthma. Although it is difficult to find clear-cut evidence, it appears that reducing sodium intake, increasing magnesium intake, eating apples and other fruit and vegetables, and avoiding margarine might help some asthmatics. However much of the research conducted to date has not been systematic in its approach and this makes the drawing of hard conclusions very difficult.

The role of probiotics and prebiotics in the diet is promising. Living organisms such as probiotics appear to protect against the development of allergies by producing changes in the bacteria in the gut that stimulate the immune system. A double blind, placebo-controlled study has recently shown that probiotics can help reduce the risk of atopic disease. This is an important area for future research.

Meeting the challenge

The review highlighted several areas in nutrition and diet that appear to be fruitful for future research in allergic disease, and therefore for future disease control. In particular, it has highlighted gaps in relation to specific effects of maternal and infant nutrition on allergy and asthma in later life. Patients, health professionals and policy makers alike would benefit from such research and from more large-scale studies on diet and allergy. Key focuses should be identification of dietary patterns or factors likely to be involved in altering risk of development of allergies and asthma, and developing the evidence base about whether supplementation with specific fats or probiotics could contribute both to the protection and treatment of allergic diseases. The studies required will need to be large and to be well planned, designed and executed. They are likely to require cross-country collaboration.

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Notes:

1. GA2LEN – the Global Allergy and Asthma European Network is a “Network of Excellence” funded by the European Union 6th Research Framework Programme. It consists of 26 research centres spread throughout Europe, as well as the European Academy of Allergology and Clinical Immunology (EAACI) and the European Federation of Allergy and Airways Diseases Patients Associations (EFA).

2. The 72-page peer-reviewed paper entitled “Nutrition and allergic disease” is published in Clinical and Experimental Allergy Reviews 6: 117-188, 2006 Blackwell Publishing Ltd.

3. The article represents the work of Workpackage 2.1 of GA2LEN. Correspondence should be addressed to the workpackage leader, P. C. Calder, BSc, PhD, DPhil, Professor of Nutritional Immunology, Institute of Nutrition, University of Southampton, UK.

4. The full list of indicators comprises: Sodium and potassium, magnesium, lipids including fatty acids in milk, butter, vegetable oils and fish, antioxidants, including fruit and vegetable intake, flavonoids and flavonoid-rich foods, Vitamin C, Vitamin E, b-Carotene, Vitamin A, selenium, zinc and copper, and probiotics and prebiotics.

Hello world!

December 9, 2006 by Mark

Welcome to my Asthma Blog.