cytidylyl-3--5--guanosine and Asthma

Asthma is a major health problem, of which the prevalence and severity are increasing, particularly in industrialized nations. One hypothesis for this is that diminished exposure to childhood infections in modern society has led to decreased Th1-type inflammation. Reduced Th1 responses may lead to enhanced Th2-type inflammation, important in promoting asthma and allergic disease. The most common current treatment for asthma is corticosteroids; while these agents inhibit the function of inflammatory cells, they are ineffective in altering the initial Th2-type response to allergen in a sensitized individual. A novel therapeutic approach, recently reported in the preclinical setting, is the use of oligodeoxynucleotides (ODNs), which contain unmethylated motifs centered on CG dinucleotides. These CpG ODNs potently induce Th1 cytokines and suppress Th2 cytokines, and can prevent manifestations of asthma in animal models. These agents have the potential to reverse Th2-type responses to allergens and thus restore balance to the immune system. Clinical trials are ongoing.

Topics: Animals; Asthma; Bronchial Hyperreactivity; CpG Islands; Cytokines; Dinucleoside Phosphates; Disease Models, Animal; DNA, Bacterial; Humans; Hypersensitivity, Immediate; Immunoglobulin E; Inflammation; Mice; Molecular Mimicry; Oligodeoxyribonucleotides; Th1 Cells; Th2 Cells

Equine asthma represents a naturally occurring animal model for human allergic neutrophilic asthma. Inhalative nanoparticle-bound cytosine-phosphate-guanosine (CpG-GNP) immunotherapy, independent of specific allergens, has already shown promising clinical and immunological results in previous studies and offers the possibility to treat the underlying cause of the disease. This study analyses the relationship between dose and response, and evaluates a possible long-term effect.. In the prospective, randomised, double-blind clinical field study, 29 horses suffering from equine asthma received 10 inhalation treatments with either 187.5 µg CpG-GNP (CpG single dose [CpGsd]; n = 11), 375 µg CpG-GNP double dose (CpG double dose [CpGdd]; n = 9) (q48h for 20 days) or 1600 µg beclomethasone (n = 9) (q24h for 10 days). Each horse was examined three times: before the treatment (I), immediately after the 10 inhalations (II), and 8 weeks after the final inhalation (III). The three groups were compared according to clinical and laboratory parameters. The study examined the sustainability of the long-term effect of the treatment after 8 weeks, as well as the tolerability of the formula as a double dose.. The CpGsd resulted in a significant improvement in 82% of the parameters, the CpGdd in 72%. In the long-term evaluation, the CpGsd showed a significant improvement in 100% of the parameters in comparison to the initial values, the CpGdd in 67%. On the immunological level, the bronchoalveolar lavage revealed a significant reduction of IL-4, IL-8, and interferon-γ.. Both CpG groups displayed significant improvements in clinical and laboratory parameters, especially regarding the long-term effect of CpGsd. Doubling the CpG dose did not result in any improvement in comparison to the original single dose. On the immunological level, an anti-inflammatory, as well as an immunomodulatory effect, apart from a Th2-dominated immune response, could be observed. This immunomodulatory inhalation treatment could indicate a new possibility for human allergic asthma therapy.

Topics: Administration, Inhalation; Animals; Asthma; Bronchoalveolar Lavage Fluid; Cytokines; Dinucleoside Phosphates; Disease Models, Animal; Dose-Response Relationship, Drug; Double-Blind Method; Horse Diseases; Horses; Immunomodulation; Oligodeoxyribonucleotides; Prospective Studies; Treatment Outcome

Viral respiratory infections are increasingly implicated in allergic exacerbations. The mechanisms behind this are not known, but a virus-induced activation of eosinophils through TLRs could be involved. Herein, we investigated the expression and function of TLR7 and TLR9 in purified eosinophils from peripheral blood and assessed their role in allergic airway inflammation. Eosinophils expressed TLR7 and TLR9 proteins. Stimulation with the cognate ligands R-837 and CpG was found to prolong survival, up-regulate expression of CD11b and conversely down-regulate L-selectin expression, increase expression of the activation marker CD69, facilitate the chemotactic migration, and enhance IL-8 secretion by eosinophils. Also, CpG induced release of eosinophil-derived neurotoxin (EDN), and R-837 failed to do so. Analogously, eosinophils activated by CpG, but not R-837, promoted airway epithelial cell death and cytokine release. Priming with the allergic mediators histamine, IL-4, and most prominently IL-5, augmented the TLR-induced IL-8 and EDN secretion, revealing an ability to sensitize eosinophils for TLR7 and TLR9 activation. Moreover, the TLR responses of eosinophils were higher in allergic as compared with healthy subjects, manifested by an increase in IL-8 and EDN release. Correspondingly, allergic subjects displayed an elevated serum level of IL-5, suggesting increased IL-5-mediated priming. This study shows that activation via TLR7 and TLR9 affects several eosinophil functions and that the atopic status of the donor and the presence of a Th2-like cytokine milieu affect the outcome of the response. Thus, eosinophil activation via TLR7 and TLR9 might engender a link between viral infection and allergic exacerbations.

Topics: Asthma; Case-Control Studies; Dinucleoside Phosphates; Eosinophil-Derived Neurotoxin; Eosinophils; Humans; Interleukins; Th2 Cells; Toll-Like Receptor 7; Toll-Like Receptor 9

Murine models of acute atopic asthma may be inadequate to study the effects of recurrent exposure to inhaled allergens, such as the epithelial changes seen in asthmatic patients. We developed a murine model in which chronic airway inflammation is maintained by repeated allergen [ovalbumin (OVA)] inhalation; using this model, we examined the response to mucosal administration of CpG DNA (oligonucleotides) and specific antigen immunotherapy. Mice repeatedly exposed to OVA developed significantly greater airway hyperresponsiveness and goblet cell hyperplasia, but not airway eosinophilia, compared with those exposed only twice. CpG-based immunotherapy significantly reversed both acute and chronic markers of inflammation as well as airway hyperresponsiveness. We further examined the effect of mucosal immunotherapy on the response to a second, unrelated antigen. Mice sensitized to both OVA and schistosome eggs, challenged with inhaled OVA, and then treated with OVA-directed immunotherapy demonstrated significant reduction of airway hyperresponsiveness and a moderate reduction in eosinophilia, after inhalation challenge with schistosome egg antigens. In this model, immunotherapy treatment reduced bronchoalveolar lavage (BAL) levels of Th2 cytokines (IL-4, IL-5, IL-13, and IL-10) without changing BAL IFN-gamma. Antigen recall responses of splenocytes from these mice demonstrated an antigen-specific (OVA) enhanced release of IL-10 from splenocytes of treated mice. These results suggest that CpG DNA may provide the basis for a novel form of immunotherapy of allergic asthma. Both antigen-specific and, to a lesser extent, antigen-nonspecific responses to mucosal administration of CpG DNA are seen.

Topics: Administration, Inhalation; Allergens; Animals; Asthma; Base Sequence; Bronchial Hyperreactivity; Bronchoalveolar Lavage Fluid; Cytokines; Dinucleoside Phosphates; Disease Models, Animal; Female; Immunity, Mucosal; Immunotherapy; Mice; Mice, Inbred C57BL; Oligodeoxyribonucleotides; Ovalbumin

Asthma is an inflammatory disease of the airways that is induced by Th2 cytokines and inhibited by Th1 cytokines. Despite a steady increase in the incidence, morbidity, and mortality from asthma, no current treatment can reduce or prevent asthma for a prolonged period. We examined the ability of unmethylated CpG oligodeoxynucleotides (ODN), which are potent inducers of Th1 cytokines, to prevent the inflammatory and physiological manifestations of asthma in mice sensitized to ragweed allergen. Administration of CpG ODN 48 h before allergen challenge increased the ratio of IFN-gamma to IL-4 secreting cells, diminished allergen-induced eosinophil recruitment, and decreased the number of ragweed allergen-specific IgE-producing cells. These effects of CpG ODN were sustained for at least 6 wk after its administration. Furthermore, there was a vigorous Th1 memory response to the recall Ag, inhibition of peribronchial and perivascular lung inflammation, and inhibition of bronchial hyperresponsiveness 6 wk after administration of CpG ODN. Administration of CpG ODN in IFN-gamma -/- mice failed to inhibit eosinophil recruitment, indicating a critical role of IFN-gamma in mediating these effects. This is the first report of a treatment that inhibits allergic lung inflammation in presensitized animals for a prolonged period and thus has relevance to the development of an effective long term treatment for asthma.

Topics: Allergens; Animals; Anti-Allergic Agents; Asthma; Chemotaxis, Leukocyte; Cytidine; Dinucleoside Phosphates; Disease Models, Animal; Female; Guanosine; Immunoglobulin E; Interferon-gamma; Interleukin-4; Mice; Mice, Inbred BALB C; Mice, Mutant Strains; Nebulizers and Vaporizers; Oligodeoxyribonucleotides; Plant Proteins; Pollen; Pulmonary Eosinophilia; Th1 Cells; Th2 Cells; Time Factors; Trachea

Asthma has been increasing in industrialized countries. Evidence suggests that asthma is caused by a Th2 immune response to inhaled environmental Ags and that childhood infections protect against this. We have shown that bacterial DNA contains motifs, centered on unmethylated CpG dinucleotides, which induce Th1-type responses. We hypothesized that the Th1 effect of these CpG motifs may oppose the Th2 type allergic response and suggest that this may account for the protective effect of childhood infection against asthma. We examined the effects of CpG-motif oligodeoxynucleotides (CpG ODN) in a murine model of asthma. Airway eosinophilia, Th2 cytokine induction, IgE production, and bronchial hyperreactivity were prevented by coadministration of CpG ODN with the Ag. Significantly, in a previously sensitized mouse, CpG ODN can prevent allergen-induced airway inflammation. These studies suggest that exposure to CpG DNA may protect against asthma.

Topics: Animals; Asthma; Bronchial Hyperreactivity; Cytokines; Dinucleoside Phosphates; Immunoglobulin E; Mice; Mice, Inbred C57BL; Oligodeoxyribonucleotides; Th1 Cells; Th2 Cells