维生素D辅助治疗过敏性哮喘的研究进展

过敏性哮喘是由多种炎症细胞和介质共同参与的以气道炎症为特征的疾病,病因和发病机制极其复杂,目前尚不完全清楚。维生素D最经典的作用是调节钙和磷的吸收,近年来随着对维生素D代谢和生物学效应的深入研究,发现维生素D对人体免疫系统存在更广泛的影响,在大多数疾病中均能发挥作用。维生素D参与哮喘辅助治疗的机制体现在多个方面,主要通过免疫学机制调节Th1/Th2平衡,降低气道重塑的风险。此外,维生素D能影响肠道菌群组成和比例,可能通过“肺—肠轴”缓解哮喘。在此基础上,维生素D与糖皮质激素等药物联用,可以增强药效,减少药物用量。本文就维生素D辅助治疗过敏性哮喘的研究进展进行总结分析。     

CCL8相关通路与过敏性疾病

CC趋化因子配体8(CC chemokine ligand 8, CCL8)与细胞表面受体结合后可调控与细胞增殖、分化、凋亡及炎症等相关的信号通路,在包括过敏性鼻炎、过敏性皮炎、过敏性哮喘等多种过敏性疾病的发病机制中发挥重要作用。本文介绍了与CCL8相关的JAK-STAT信号通路、p38 MAPK信号通路、NF-κB信号通路和STAT3信号通路通过影响辅助性T淋巴细胞分化、白细胞介素水平以及活性氧的产生等方面参与过敏性疾病发病的机制,期望针对CCL8及相关通路的研究为过敏性疾病的诊断与治疗提供参考。     

平喘固本合剂对昆系小鼠急性哮喘模型气道炎症作用影响

目的:探讨平喘固本合剂对昆系小鼠急性哮喘模型气道炎症作用影响及相关机制。方法:昆明系小鼠40只,随机分为对照组(A),哮喘模型组(B),喘固本合剂治疗组(C),布地奈德雾化治疗组(D)及平喘固本合剂联合布地奈德雾化治疗组(E)。用鸡卵蛋白(OVA)致敏建立昆系小鼠哮喘急性气道炎症模型,并给与药物治疗10天。对各组支气管肺泡灌洗液(BALF)中各种细胞进行分类并计数,观察肺组织的病理变化,同时应用ELISA法测定灌洗液中炎症相关因子的水平变化。结果:与B组比较,C组、D组、E组BALF中细胞总数、嗜酸性粒细胞数、巨噬细胞数及IL-4、IL-4/IFN-γ明显降低(P<0.05),IFN-γ明显升高(P<0.05)。对于IL-4、IL-4/IFN-γ水平的比较C组与D组无明显统计学差异,E组与两者具有明显统计学意义(P<0.05)。HE染色显示C组、D组、E组较单纯模型组炎症细胞浸润,平滑肌肥厚及黏膜肺组织水肿等炎症表现明显减轻。结论:平喘固本合剂对哮喘昆系小鼠气道炎症有明显的抑制作用,其作用机制可能与抑制IL-4的表达、炎性细胞聚积及促进IFN-γ的表达有关,并且可能与糖皮质激素有一定协同作用。     

支气管扩张合并支气管哮喘患者的病原菌检测及危险因素分析

目的分析支气管扩张合并支气管哮喘患者的病原菌及危险因素。方法选取湖州市中心医院115例支气管扩张合并支气管哮喘患者作为观察组,另选取同期110例健康体检者作为对照组。分析患者病原菌的组成、耐药性及发病危险因素。结果观察组患者送检痰样本经痰培养,阳性检出者68例,阳性率为59.13%(68/115)。全部样本共分离出104株病原菌,其中革兰阴性菌92株(以铜绿假单胞菌最多,占54.81%),革兰阳性菌8株,真菌4株。药敏试验结果表明革兰阴性菌对复方新诺明、头孢曲松、左旋左氧氟沙星和阿莫西林/克拉维酸等药物的耐药性均较高,对妥布霉素、亚胺培南、头孢哌酮/舒巴坦和哌拉西林的耐药性较低。Logistic回归分析显示,吸烟史、药物过敏史、食物过敏史、过敏性鼻炎、哮喘、过敏性肺炎、慢性支气管炎及慢性阻塞性肺疾病均是支气管扩张伴支气管哮喘发生的危险因素。结论支气管扩张合并支气管哮喘患者其病原菌以革兰阴性菌为主,吸烟史、药物过敏史、食物过敏史、过敏性鼻炎等是支气管扩张伴支气管哮喘发生的危险因素。     

吸入糖皮质激素对哮喘患者外周血CD34^＋细胞、IL-5和嗜酸粒细胞的影响

目的：探讨糖皮质激素对支气管哮喘患者外周血CD34＋细胞、白细胞介素-5（IL-5）和嗜酸粒细胞（EOS）的影响.方法：选择哮喘急性发作期患者30例,常规取血测定CD34＋细胞、IL-5和EOS;用吸入治疗2周后,再次取血测定外周血EOS计数、IL-5水平及CD34＋细胞数目.结果：哮喘患者外周血EOS、IL-5及CD34＋细胞数明显高于正常组（P＜0.01）EOS凋亡指数呈显著下降（P＜0.01）.经吸入布地奈德治疗2周后,IL-5、EOS及CD34＋水平均显著降低.EOS凋亡指数呈显著增加,哮喘患者血清IL-5水平与EOS数呈显著正相关（r=0.92,P＜0.01）,与CD34＋细胞数亦呈显著正相关（r=0.90,P＜0.01）.结论：糖皮质激素可能影响CD34＋造血细胞的释放和向外周组织的迁移.     

细胞因子在重症哮喘发病机制中的研究进展

重症哮喘是指在过去一年中超过50%的时间需要给予高剂量糖皮质激素联合长效β2-受体激动剂和白三烯调节剂或全身激素治疗,才能维持哮喘控制或即使在上述治疗下仍不能有效控制症状的疾病。重症哮喘发病机制复杂,危险因素多,治疗困难,是临床热点和难点问题。免疫介导的炎症反应在重症哮喘疾病发生中处于重要地位,多种炎症细胞和前炎性因子介导的免疫应激均参与了重症哮喘的发生和发展。本综述对细胞因子的表达与重症哮喘炎症病理改变做了分析,有助于深入研究重症哮喘发病机制,以期为临床诊断和寻找更为有效的靶向治疗药物提供新的理论依据和策略。     

ILCs在哮喘疾病中作用的研究进展

哮喘是一种容易反复发作的气道炎症性疾病,病人会出现气道高反应性(airway hyperresponsiveness,AHR)、黏液分泌增多、气道重塑以及气流受限等临床症状.引发哮喘的因素较多,如遗传因素、环境因素等.按照临床表型,哮喘可分为过敏性哮喘和非过敏性哮喘. T细胞2(T helper 2, Th2)长期以来被认为在过敏性哮喘疾病中发挥关键的调节作用,故过敏性哮喘又称Th2型哮喘.随着非Th2型哮喘以及固有淋巴细胞(innate lymphocytes, ILCs)的发现, ILCs在哮喘疾病中的功能逐渐成为研究的焦点.最近的研究发现, ILCs是Ⅱ型细胞因子IL-5和IL-13的有效来源,并可调节适应性免疫应答,在哮喘疾病中发挥重要作用.本文主要综述ILCs在哮喘疾病中作用的最新研究进展.     

糖皮质激素下调JAK/STAT抑制嗜酸粒细胞哮喘

摘要 目的：探究糖皮质激素对嗜酸粒细胞哮喘(Eosinophilic asthma, EA) 2 型固有免疫细胞(Type 2 innate lymphoid cells, ILC2s)的影响及相关机制。方法：研究对象来自我院 2021年6月至 2022年6月的EA患者和健康对照（Healthy control, HC）,收集相应临床基线资料并评估病情、进行血常规、肺功能等检查;应用流式细胞术检测外周血单个核细胞（Peripheral blood mononuclear cell, PBMC） ILC2s(CD45+Lin-CD127+CD294+);ELISA检测外周血IL-5、IL-13浓度。糖皮质激素治疗EA 患者3月后,观察PBMC中ILC2s及IL-5、IL-13浓度。C57BL/6J小鼠给予鸡卵清蛋白(Ovalbumin,OVA) 20 μg 腹腔注射致敏后用1%OVA雾化吸入激发哮喘EA模型,阴性对照（Negative control, NC）组小鼠用同等体积PBS作为对照。EA造模成功的小鼠通过流式细胞术检测血液及肺泡灌洗液中ILC2s,HE染色检测小鼠肺泡灌洗液中嗜酸性粒细胞(Eosinophil, EOS)及肺部炎症。EA小鼠经糖皮质激素处理后,检测肺部炎症情况;流式细胞术检测PBMC、肺泡灌洗液（Bronchoalveolar lavage fluid, BALF）中 ILC2s;分离肺组织ILC2s,western blot检测相关蛋白表达情况。结果：EA组的ILC2s比例升高, EOS升高,2型细胞因子IL-5、IL-13增加,糖皮质激素治疗1月及3月后ILC2s比例下降,2型细胞因子IL-5、IL-13下降。与NC组小鼠比较,EA组小鼠PBMC及BALF中ILC2s升高,BALF中EOS升高,血清中2型细胞因子IL-5、IL-13升高,肺部炎症加重。糖皮质激素治疗后,肺部炎症减轻,EOS下降,ILC2s减少,2型细胞因子IL-5、IL-13下降,下调JAK/STAT蛋白。结论：在EA中,糖皮质激素通过下调JAK/STAT蛋白抑制ILC2s的功能减轻肺部炎症,为激素治疗嗜酸性粒细胞哮喘的机制提供了新方向。     

小鼠过敏性哮喘模型的研究进展及评价

支气管哮喘（简称哮喘）是常见的慢性病,随着过敏患者的增加,小鼠过敏性哮喘模型的研究越来越重要。本文通过对近年来国内外小鼠过敏性哮喘的实验研究文献进行总结,从实验小鼠的选择、制备模型的方法及模型的评价指标等方面进行综合分析,为进一步开展哮喘研究提供帮助。     

过敏性哮喘动物模型在致敏、哮喘发作和气道高反应性等方面的应用研究

过敏性哮喘的发病率呈上升趋势。使用了几十年的主要治疗药物肾上腺糖皮质激素副作用较大,因此发现好的预防和治疗方法成为迫切要解决的问题。动物模型是研究人类疾病的重要手段,但不少疑难病的发病机理不明确,因而制备的动物模型和人类疾病的相似度有差异。但I型变态反应作为过敏性哮喘的发病机理是比较明确的,据此制备的动物模型和人类的哮喘就有很高的相近度,结果的可信度就较高。本文回顾了哮喘动物模型制备的基本方法和某些重要的细节。着重讨论了当今最常用的气道高反应性模型的优劣。如果综合运用不同特点的模型尤其是能观察记录哮喘发作全过程包括速发和迟发反应的模型,将可以更直接地探索哮喘发病过程和治疗药物。对气道重塑及基因敲除和转基因技术在动物模型中的研究和使用也做了一般性论述。动物模型将是一个有力的工具为最后有效地预防和治疗过敏性哮喘找到突破口。     

Allergic asthma: influence of genetic and environmental factors

Allergic asthma is a chronic airway inflammatory disease in which exposure to allergens causes intermittent attacks of breathlessness, airway hyper-reactivity, wheezing, and coughing. Allergic asthma has been called a "syndrome" resulting from a complex interplay between genetic and environmental factors. Worldwide, >300 million individuals are affected by this disease, and in the United States alone, it is estimated that >35 million people, mostly children, suffer from asthma. Although animal models, linkage analyses, and genome-wide association studies have identified numerous candidate genes, a solid definition of allergic asthma has not yet emerged; however, such studies have contributed to our understanding of the multiple pathways to this syndrome. In contrast with animal models, in which T-helper 2 (T(H)2) cell response is the dominant feature, in human asthma, an initial exposure to allergen results in T(H)2 cell-dependent stimulation of the immune response that mediates the production of IgE and cytokines. Re-exposure to allergen then activates mast cells, which release mediators such as histamines and leukotrienes that recruit other cells, including T(H)2 cells, which mediate the inflammatory response in the lungs. In this minireview, we discuss the current understanding of how associated genetic and environmental factors increase the complexity of allergic asthma and the challenges allergic asthma poses for the development of novel approaches to effective treatment and prevention.     

IL-23/Th17轴在变应性哮喘中的研究进展

变应性哮喘是一种由辅助性T细胞（T helper cell,Th cell）调节的慢性炎症性疾病。Th1/Th2的失衡一直被认为是变应性哮喘的发病机制,Th2细胞及其分泌的细胞因子白介素4（interleukin 4,IL-4）、IL-5以及IL-13在变应性哮喘特异性症状的发病中发挥重要作用。最近研究发现Th17细胞及其分泌的IL-17参与变应性哮喘的发展过程,IL-23在Th17细胞维持生存和功能成熟中发挥重要作用,并参与抗原诱导的气道炎症反应。该文对目前IL-23/Th17轴在变应性气道炎症反应中的研究进展作一综述。     

Current prospective of aldose reductase inhibition in the therapy of allergic airway inflammation in asthma

The prevalence of asthma and costs of its care have been continuously increasing, but novel therapeutic options to treat this inflammatory disease have not been brought to the US market. Current therapies such as inhaled steroids, long-acting beta-agonist bronchodilators, antihistamines and immunomodulators may control the symptoms of allergic asthma but fail to modify the underlying disease. Excessive use of steroids and other immunosuppresents alter the patient's quality of life, produce undesirable toxicities, and increase the risk of other pathologies such as diabetes. Hence novel therapeutic options to manage asthma are desirable. In the present review, we have discussed the role of the polyol pathway enzyme aldose reductase (AR) in the amplification of allergic airway inflammation. Recent studies have indicated that AR inhibition prevents the NF-κB-dependent generation of pro-inflammatory cytokines and chemokines in mouse models of allergic airway inflammation indicating the potential use of AR inhibition as a novel tool to control allergic responses. Since orally available AR inhibitors have already undergone phase III clinical trials for diabetic neuropathy and appear to have a manageable side effects profile, they could be readily developed as potential new drugs for the treatment of asthma and related complications.     

Murine model of allergen induced asthma

Asthma is a major cause of morbidity and mortality, affecting some 300 million people throughout the world (1). More than 8% of the US population has asthma, with the prevalence increasing (2). As with other diseases, animal models of allergic airway disease greatly facilitate understanding of the underlying pathophysiology, help identify potential therapeutic targets, and allow preclinical testing of possible new therapies. Models of allergic airway disease have been developed in several animal species, but murine models are particularly attractive due to the low cost, ready availability, and well-characterized immune systems of these animals (3). Availability of a variety of transgenic strains further increases the attractiveness of these models (4). Here we describe two murine models of allergic airway disease, both employing ovalbumin as the antigen. Following initial sensitization by intraperitoneal injection, one model delivers the antigen challenge by nebulization, the other by intratracheal delivery. These two models offer complementary advantages, with each mimicking the major features of human asthma (5). The major features of acute asthma include an exaggerated airway response to stimuli such as methacholine (airway hyperresponsiveness; AHR) and eosinophil-rich airway inflammation. These are also prominent effects of allergen challenge in our murine models (5,6), and we describe techniques for measuring them and thus evaluating the effects of experimental manipulation. Specifically, we describe both invasive (7) and non-invasive (8) techniques for measuring airway hyperresponsiveness as well as methods for assessing infiltration of inflammatory cells into the airways and the lung. Airway inflammatory cells are collected by bronchoalveolar lavage while lung histopathology is used to assess markers of inflammation throughout the organ. These techniques provide powerful tools for studying asthma in ways that would not be possible in humans.     

The role of interferon-gamma on immune and allergic responses

Allergic diseases have been closely related to Th2 immune responses, which are characterized by high levels of interleukin (IL) IL-4, IL-5, IL-9 and IL-13. These cytokines orchestrate the recruitment and activation of different effector cells, such as eosinophils and mast cells. These cells along with Th2 cytokines are key players on the development of chronic allergic inflammatory disorders, usually characterized by airway hyperresponsiveness, reversible airway obstruction, and airway inflammation. Accumulating evidences have shown that altering cytokine-producing profile of Th2 cells by inducing Th1 responses may be protective against Th2-related diseases such as asthma and allergy. Interferon-gamma (IFN-gamma), the principal Th1 effector cytokine, has shown to be crucial for the resolution of allergic-related immunopathologies. In fact, reduced production of this cytokine has been correlated with severe asthma. In this review, we will discuss the role of IFN-gamma during the generation of immune responses and its influence on allergic inflammation models, emphasizing its biologic properties during the different aspects of allergic responses.     

Periostin regulates goblet cell metaplasia in a model of allergic airway inflammation

Periostin is a 90-kDa member of the fasciclin-containing family and functions as part of the extracellular matrix. Periostin is expressed in a variety of tissues and expression is increased in airway epithelial cells from asthmatic patients. Recent studies have implicated a role for periostin in allergic eosinophilic esophagitis. To further define a role for periostin in Th2-mediated inflammatory diseases such as asthma, we studied the development of allergic pulmonary inflammation in periostin-deficient mice. Sensitization and challenge of periostin-deficient mice with OVA resulted in increased peripheral Th2 responses compared with control mice. In the lungs, periostin deficiency resulted in increased airway resistance and significantly enhanced mucus production by goblet cells concomitant with increased expression of Gob5 and Muc5ac compared with wild type littermates. Periostin also inhibited the expression of Gob5, a putative calcium-activated chloride channel involved in the regulation of mucus production, in primary murine airway epithelial cells. Our studies suggest that periostin may be part of a negative-feedback loop regulating allergic inflammation that could be therapeutic in the treatment of atopic disease.     

Animal models of allergic bronchopulmonary aspergillosis

Among the allergic fungi, Aspergillus fumigatus, a saprophytic mold, distributed widely in the environment is a frequently recognized etiologic agent in a number of allergic conditions. Among the different allergic diseases caused by this fungus, allergic bronchopulmonary aspergillosis (ABPA) is by far the most significant one. The immunopathogenesis of this disease is not fully understood. Although several immunomodulatory treatments are available for allergic disease, none of them are applicable or relevant or useful in fungal induced allergy. It is essential to understand the pathogenesis of the disease including the antigen induced immunoregulation and the resulting factors, such as cytokine, chemokines, pathways activating factors, inflammatory and airway remodeling factors need to be understood for intervening with appropriate treatment. Animal models are essential in understanding these features of the disease. Several models of allergic aspergillosis have been developed in recent years in various animals. However, murine models have been studied more carefully and extensively. The exposure to antigen in mice leads to allergy very similar to ABPA with high IgE, elevated peripheral blood and lung eosinophils, pulmonary inflammation, and airway hyperreactivity. The role of various cytokines and chemokines and their receptors were also studied. In addition, immunotherapy and vaccination have been attempted in recent years using the murine model of ABPA. This review covers the murine model of Aspergillus induced allergy and asthma and presented critically our current understanding of the subject and the potential application of such a model in future for developing treatment modalities. This revised version was published online in June 2006 with corrections to the Cover Date.     

Schistosoma japonicum peptide SJMHE1 suppresses airway inflammation of allergic asthma in mice

Helminths and their products can shape immune responses by modulating immune cells, which are dysfunctional in inflammatory diseases such as asthma. We previously identified SJMHE1, a small molecule peptide from the HSP60 protein of Schistosoma japonicum. SJMHE1 can inhibit delayed‐type hypersensitivity and collagen‐induced arthritis in mice. In the present study, we evaluated this peptide's potential intervention effect and mechanism on ovalbumin‐induced asthma in mice. SJMHE1 treatment suppressed airway inflammation in allergic mice, decreased the infiltrating inflammatory cells in the lungs and bronchoalveolar lavage fluid, modulated the production of pro‐inflammatory and anti‐inflammatory cytokines in the splenocytes and lungs of allergic mice, reduced the percentage of Th2 cells and increased the proportion of Th1 and regulatory T cells (Tregs). At the same time, Foxp3 and T‐bet expression increased, and GATA3 and RORγt decreased in the lungs of allergic mice. We proved that SJMHE1 can interrupt the development of asthma by diminishing airway inflammation in mice. The down‐regulation of Th2 response and the up‐regulation of Th1 and Tregs response may contribute to the protection induced by SJMHE1 in allergic mice. SJMHE1 can serve as a novel therapy for asthma and other allergic or inflammatory diseases.     

Dermatology for the practicing allergist: Tinea pedis and its complications

Tinea pedis is a chronic fungal infection of the feet, very often observed in patients who are immuno-suppressed or have diabetes mellitus. The practicing allergist may be called upon to treat this disease for various reasons. Sometimes tinea infection may be mistaken for atopic dermatitis or allergic eczema. In other patients, tinea pedis may complicate allergy and asthma and may contribute to refractory atopic disease. Patients with recurrent cellulitis may be referred to the allergist/immunologist for an immune evaluation and discovered to have tinea pedis as a predisposing factor. From a molecular standpoint, superficial fungal infections may induce a type2 T helper cell response (Th2) that can aggravate atopy. Th2 cytokines may induce eosinophil recruitment and immunoglobulin E (IgE) class switching by B cells, thereby leading to exacerbation of atopic conditions. Three groups of fungal pathogens, referred to as dermatophytes, have been shown to cause tinea pedis: Trychophyton sp, Epidermophyton sp, and Microsporum sp. The disease manifests as a pruritic, erythematous, scaly eruption on the foot and depending on its location, three variants have been described: interdigital type, moccasin type, and vesiculobullous type. Tinea pedis may be associated with recurrent cellulitis, as the fungal pathogens provide a portal for bacterial invasion of subcutaneous tissues. In some cases of refractory asthma, treatment of the associated tinea pedis infection may induce remission in airway disease. Very often, protracted topical and/or oral antifungal agents are required to treat this often frustrating and morbid disease. An evaluation for underlying immuno-suppression or diabetes may be indicated in patients with refractory disease.