Inflammatory phenotypes in patients with severe asthma are associated with distinct airway microbiology

Taylor, Steven L., Leong, Lex E. X., Choo, Jocelyn M., Wesselingh, Steve, Yang, Ian A., Upham, John W., Reynolds, Paul N., Hodge, Sandra, James, Alan L., Jenkins, Christine, Peters, Matthew J., Baraket, Melissa, Marks, Guy B., Gibson, Peter G., Simpson, Jodie L. and Rogers, Geraint B. (2017) Inflammatory phenotypes in patients with severe asthma are associated with distinct airway microbiology. Journal of Allergy and Clinical Immunology, 141 1: 94-103.e15. doi:10.1016/j.jaci.2017.03.044

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Author Taylor, Steven L.
Leong, Lex E. X.
Choo, Jocelyn M.
Wesselingh, Steve
Yang, Ian A.
Upham, John W.
Reynolds, Paul N.
Hodge, Sandra
James, Alan L.
Jenkins, Christine
Peters, Matthew J.
Baraket, Melissa
Marks, Guy B.
Gibson, Peter G.
Simpson, Jodie L.
Rogers, Geraint B.
Title Inflammatory phenotypes in patients with severe asthma are associated with distinct airway microbiology
Journal name Journal of Allergy and Clinical Immunology   Check publisher's open access policy
ISSN 1097-6825
0091-6749
Publication date 2017-05-04
Sub-type Article (original research)
DOI 10.1016/j.jaci.2017.03.044
Open Access Status File (Author Post-print)
Volume 141
Issue 1
Start page 94
End page 103.e15
Total pages 25
Place of publication Philadelphia, PA, United States
Publisher Mosby
Language eng
Subject 2723 Immunology and Allergy
2403 Immunology
Abstract Background: Asthma pathophysiology and treatment responsiveness are predicted by inflammatory phenotype. However, the relationship between airway microbiology and asthma phenotype is poorly understood. Objective: We aimed to characterize the airway microbiota in patients with symptomatic stable asthma and relate composition to airway inflammatory phenotype and other phenotypic characteristics. Methods: The microbial composition of induced sputum specimens collected from adult patients screened for a multicenter randomized controlled trial was determined by using 16S rRNA gene sequencing. Inflammatory phenotypes were defined by sputum neutrophil and eosinophil cell proportions. Microbiota were defined by using α- and β-diversity measures, and interphenotype differences were identified by using similarity of percentages, network analysis, and taxon fold change. Phenotypic predictors of airway microbiology were identified by using multivariate linear regression. Results: Microbiota composition was determined in 167 participants and classified as eosinophilic (n = 84), neutrophilic (n = 14), paucigranulocytic (n = 60), or mixed neutrophilic-eosinophilic (n = 9) asthma phenotypes. Airway microbiology was significantly less diverse (P = .022) and more dissimilar (P = .005) in neutrophilic compared with eosinophilic participants. Sputum neutrophil proportions, but not eosinophil proportions, correlated significantly with these diversity measures (α-diversity: Spearman r = -0.374, P < .001; β-diversity: r = 0.238, P = .002). Interphenotype differences were characterized by a greater frequency of pathogenic taxa at high relative abundance and reduced Streptococcus, Gemella, and Porphyromonas taxa relative abundance in patients with neutrophilic asthma. Multivariate regression confirmed that sputum neutrophil proportion was the strongest predictor of microbiota composition. Conclusions: Neutrophilic asthma is associated with airway microbiology that is significantly different from that seen in patients with other inflammatory phenotypes, particularly eosinophilic asthma. Differences in microbiota composition might influence the response to antimicrobial and steroid therapies and the risk of lung infection.
Formatted abstract
Background: Asthma pathophysiology and treatment responsiveness are predicted by inflammatory phenotype. However, the relationship between airway microbiology and asthma phenotype is poorly understood.

Objective: We aimed to characterize the airway microbiota in patients with symptomatic stable asthma and relate composition to airway inflammatory phenotype and other phenotypic characteristics.

Methods: The microbial composition of induced sputum specimens collected from adult patients screened for a multicenter randomized controlled trial was determined by using 16S rRNA gene sequencing. Inflammatory phenotypes were defined by sputum neutrophil and eosinophil cell proportions. Microbiota were defined by using α- and β-diversity measures, and interphenotype differences were identified by using similarity of percentages, network analysis, and taxon fold change. Phenotypic predictors of airway microbiology were identified by using multivariate linear regression.

Results: Microbiota composition was determined in 167 participants and classified as eosinophilic (n = 84), neutrophilic (n = 14), paucigranulocytic (n = 60), or mixed neutrophilic-eosinophilic (n = 9) asthma phenotypes. Airway microbiology was significantly less diverse (P = .022) and more dissimilar (P = .005) in neutrophilic compared with eosinophilic participants. Sputum neutrophil proportions, but not eosinophil proportions, correlated significantly with these diversity measures (α-diversity: Spearman r = -0.374, P < .001; β-diversity: r = 0.238, P = .002). Interphenotype differences were characterized by a greater frequency of pathogenic taxa at high relative abundance and reduced Streptococcus, Gemella, and Porphyromonas taxa relative abundance in patients with neutrophilic asthma. Multivariate regression confirmed that sputum neutrophil proportion was the strongest predictor of microbiota composition.

Conclusions: Neutrophilic asthma is associated with airway microbiology that is significantly different from that seen in patients with other inflammatory phenotypes, particularly eosinophilic asthma. Differences in microbiota composition might influence the response to antimicrobial and steroid therapies and the risk of lung infection.
Keyword Asthma
Eosinophil
Microbiome
Neutrophil
Q-Index Code C1
Q-Index Status Provisional Code
Grant ID 569246
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: HERDC Pre-Audit
Faculty of Medicine
School of Clinical Medicine Publications
Admin Only - School of Clinical Medicine
 
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