Detecting your child's asthma type with a nasal swab

Researchers at the University of Pittsburgh have developed a nasal swab test for children that diagnoses specific asthma subtypes, or endotypes. This non-invasive approach could help clinicians prescribe drugs more accurately and could lead to better treatments for a less-studied type of asthma that has previously been difficult to accurately diagnose. It could pave the way for research.

issued Today is Japan Automobile Manufacturers AssociationThe study results are based on three independent U.S.-based studies focused on Puerto Rican and African American youth, who have higher rates of asthma and are more likely to die from asthma than non-Hispanic whites. Based on data from a research study.

“Asthma is the most common chronic disease of childhood, particularly affecting Black and Puerto Rican children, so it is essential that we develop new treatments to better treat it.” young patient'' said lead author Juan Celedon, MD, professor of pediatrics at Pitt and chief of pulmonology at UPMC Children's Hospital of Pittsburgh.

“Asthma is a highly diverse disease with different endotypes, driven by different immune cells and with different responses to treatment, so the first step to better treatment is accurately diagnosing the endotype. ”

Traditionally, asthma has been divided into endotypes known as T2-high or T2-low based on the amount of T helper 2 inflammation present. More recently, T2-low has been split into two endotypes. T17-high has less T helper 2 inflammation and more T helper 17 inflammation, and low-low has lower levels of both types of inflammation.

Accurate diagnosis of endotype involves genetic analysis of lung tissue samples taken through a procedure called bronchoscopy, which is usually done under general anesthesia. For children, especially those with mild disease, it is not feasible or ethical to perform this invasive procedure, so clinicians have to assess immune markers in the blood, lung function, presence of allergies, etc. had to rely on imperfect tools.

“These tests allow us to estimate whether a child has a T2-high disease,” Celedon said. “However, they are not 100% accurate and cannot tell whether a child has T17 high or low disease. There are no clinical markers for these two subtypes. This gap is why we are unable to determine the accuracy of T17. Motivating us to develop better approaches to improve “endotype diagnosis of asthma.'' ”

Celedon and her team, which included first author Pitt graduate student Morin Yue, MD, MPH, and Pitt pediatrics instructor Christina Guyette, MD, MPH, studied 459 young people across three different studies. Nasal samples were collected from. Next, we analyzed the expression of eight T2 and T17 signature genes.

As expected, analysis of nasal swab samples revealed the patient's endotype. Across studies, 23% to 29% of participants had high T2, 35% to 47% had high T17, and 30% to 38% had low-low endotype.

Severe T2-high asthma can be treated with a powerful new class of drugs called biologics that target the immune cells that cause the disease. However, there are no asthma biologics available that directly target the T17-high and low-low endotypes.

“Better markers have driven research into this endotype, leading to better treatments for T2-high disease,” Celedon said. “But now that we have a simple nasal swab test to detect other endotypes, we can begin to develop biologics for high and low T17 diseases. .”

This rapid test for asthma endotypes may also help advance other areas of asthma research.

“One of the million-dollar questions about asthma is why some children get worse, others stay the same, and others get better as they enter adolescence. Before adolescence, asthma is more common in boys. However, the incidence of asthma increases in women during adolescence and adulthood,” Celedon said. “Is this related to endotype? Does endotype change over time or in response to treatment? We don't know. But we can easily measure endotype. Now we can start answering these questions.”

Gustavo Matutebello, MD, acting director of the Division of Pulmonary Diseases at the National Heart, Lung, and Blood Institute, part of the National Institutes of Health (NIH), said, We have the tools to test for childhood asthma, especially in children with a disproportionate burden of the disease, which could help us reach our goal of improving asthma. asthma result. This research has the potential to pave the way for more personalized treatments, especially in minority communities. Further research is needed. ”

Other authors of this study are Yueh Ying Han, PhD, Franziska J. Rosser, MD, MPH, Zhongli Xu, Christopher Qoyawayma, BSE, Erick Forno, MD, MPH, and Wei Chen, PhD. Pitt and UPMC. Dr. Edna Acosta Perez and Dr. Glorisa Canino (both University of Puerto Rico);