Advancing asthma treatment


Date: 02.03.2018

SciTech Europa Quarterly explores the groundbreaking research and development underway in order to address the chronic condition, asthma.

Asthma is a disease which affects the breathing tubes — when an asthma attack begins, the airways narrow and begin to fill with inflammatory products. During this attack, there are severe obstructions to the airways as a result of smooth muscles contracting as well as the plugging of airway inflammatory cells and mucus. Unlike the majority of chronic diseases, there is no singular test which can diagnose asthma, and no singular asthma treatment. Common symptoms are ordinarily non-specific and can include: shortness of breath, wheezing, and coughing.

In the European Commission’s report ‘State of Health in the EU: Companion Report 2017’ it outlined that although the management of the increasing number of patients with chronic diseases receiving primary care has improved in some European countries, avoidable admissions for conditions such as asthma remain evident, where the rate of these admissions in Belgium is higher than the EU average. Meanwhile, it adds that France’s work to strengthen primary care and develop care co-ordination models for patients with chronic disease has shown promise. SciTech Europa Quarterly explores the research and development underway within current studies of asthma and advancing asthma treatment.

How common is asthma?

Asthma affects around 300 million people worldwide, including 10-20% of children. Its cause stems from a genetic predisposition as well as from exposure to environmental and lifestyle factors. In December 2017, research conducted by scientists from the Institute national de la santé et de la recherche médicale (INSERM) and Paris Diderot University, France, the National Heart and Lung Institute, UK, the University of Chicago and the University of Colorado Anschute Medical Campus (TAGC), US, was published in Nature Genetics. The research detailed their discovery of five new regions of a genome which increases the risk of asthma. Results of the study reported that the genetic loci associated with asthma are enhanced in epigenetic marks which characterise gene enhancers.

The study merged the data of millions of DNA polymorphisms within the genome in more than 142,000 asthmatic, and non-asthmatic, subjects of Europe, Africa, Latin, and Japanese, ancestry. As a result, meta-analyses of the ethnically diverse population identified around 878 genetic variations that belong to 18 loci which are tied to an asthma risk. The conclusions which were drawn from the study revealed that genetic variants associated with asthma are located near the epigenetic markers within immune cells, of which suggests that these variants have a role in the regulation of immunological mechanisms. Moreover, the involvement of various identified candidate genes in the immune response to viruses has also been listed as another key factor in a predisposition to asthma, therefore viral infection could increase the risk of asthma.

The multi-test approach

The UK National Institute of Clinical Effectiveness (NICE) published ‘Asthma: diagnosis, monitoring and chronic asthma management’ in November 2017; the review emphasised the importance of using objective tests to confirm a diagnosis of asthma. In this, it recommended two tests in particular which would help to achieve more accurate diagnosis, and therefore more effective asthma treatment.

Two tests are currently being used to diagnose asthma:

Spirometry tests assess how well a patient’s lungs work by measuring how much air they inhale and exhale, and how quickly; and

Fractional inhaled nitric oxide (FeNO) tests measure the level of nitric oxide in patients’ breath, where increased levels signify lung inflammation.

Director of the centre for guidelines at NICE, Professor Mark Baker, told The Irish Times: “We are recommending objective testing with spirometry and Feno for most people with suspected asthma; a significant enhancement to current practice which will take some time to implement, with additional infrastructure and training needed in primary care.”

What is the future of asthma treatment?

Scientists from Rutgers University, US, and Shanghai University, China, examined in excess of 6,000 compounds, identifying a drug called TSG12 which relaxes the muscles and opens the airways of asthma patients. The non-toxic treatment could lead to more effective methods of drug therapies for millions of patients suffering from asthma, as well as other respiratory disorders. TSG12 was found to prevent pulmonary resistance in both egg-and dust mite-induced asthma, as well as in chronic obstruction pulmonary disease (COPD).

As reported in The Daily Pioneer, lead author of the study published in Science Translational Medicine, immunologist Luis Ulloa, Rutgers New Jersey Medical School, said: “We found that the TSG12 is both non-toxic and more effective in reducing pulmonary resistance and could be a promising therapeutic approach for treating asthma without losing their effectiveness over time.”

The study found that metallothionein-2 (MT-2) protein in asthmatic lung tissue both relaxes airway smooth muscle cells, and opens the airways, allowing asthma patients to breathe. Development of TSG12 from the MT-2 protein:

Relaxed airway smooth muscle cells;

Expanded pulmonary airways; and

Reduced pulmonary resistance.

In conclusion, the researchers found that TSG12 is more effective than any current FDA-approved asthma treatment, including bronchodilator inhalers used by the vast majority of asthma patients.

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