Diane Lefaudeux1, Bertrand De Meulder1, Matthew J Loza2, Nancy Peffer2, Anthony Rowe3, Frédéric Baribaud2, Aruna T Bansal4, Rene Lutter5, Ana R Sousa6, Julie Corfield7, Ioannis Pandis8, Per S Bakke9, Massimo Caruso10, Pascal Chanez11, Sven-Erik Dahlén12, Louise J Fleming13, Stephen J Fowler14, Ildiko Horvath15, Norbert Krug16, Paolo Montuschi17, Marek Sanak18, Thomas Sandstrom19, Dominic E Shaw20, Florian Singer21, Peter J Sterk22, Graham Roberts23, Ian M Adcock13, Ratko Djukanovic23, Charles Auffray1, Kian Fan Chung24. 1. European Institute for Systems Biology and Medicine, CIRI UMR5308, CNRS-ENS-UCBL-INSERM, Lyon, France. 2. Janssen Research and Development LLC, Spring House, Pa. 3. Janssen Research and Development Ltd, High Wycombe, United Kingdom. 4. Acclarogen, St John's Innovation Centre, Cambridge, United Kingdom. 5. Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands. 6. Respiratory Therapeutic Unit, GlaxoSmithKline, Stockley Park, United Kingdom. 7. AstraZeneca R&D Molndal, and Areteva R&D, Nottingham, United Kingdom. 8. Data Science Institute, Imperial College London, London, United Kingdom. 9. Department of Clinical Science, University of Bergen, Bergen, Norway. 10. Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy. 11. Département des Maladies Respiratoires, Aix Marseille Université Marseille, Marseille, France. 12. Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden. 13. National Heart and Lung Institute, Imperial College & Biomedical Research Unit, Royal Brompton & Harefield NHS Trust, London, United Kingdom. 14. Centre for Respiratory Medicine and Allergy, University of Manchester, Manchester, United Kingdom. 15. Department of Pulmonology, Semmelweis University, Budapest, Hungary. 16. Fraunhofer Institute for Toxicology and Experimental Medicine, Hannover, Germany. 17. Faculty of Medicine, Catholic University of the Sacred Heart, Rome, Italy. 18. Department of Medicine, Jagiellonian University Medical School, Krakow, Poland. 19. Department of Public Health and Clinical Medicine, Medicine, Umeå university, Umeå, Sweden. 20. Respiratory Research Unit, University of Nottingham, Nottingham, United Kingdom. 21. University Children's Hospital Bern, Bern, Switzerland. 22. NIHR Respiratory Biomedical Research Unit, Clinical and Experimental Sciences, Southampton, United Kingdom. 23. Faculty of Medicine, University of Southampton, Southampton, United Kingdom. 24. National Heart and Lung Institute, Imperial College & Biomedical Research Unit, Royal Brompton & Harefield NHS Trust, London, United Kingdom. Electronic address: f.chung@imperial.ac.uk.
Abstract
BACKGROUND: Asthma is a heterogeneous disease in which there is a differential response to asthma treatments. This heterogeneity needs to be evaluated so that a personalized management approach can be provided. OBJECTIVES: We stratified patients with moderate-to-severe asthma based on clinicophysiologic parameters and performed an omics analysis of sputum. METHODS: Partition-around-medoids clustering was applied to a training set of 266 asthmatic participants from the European Unbiased Biomarkers for the Prediction of Respiratory Diseases Outcomes (U-BIOPRED) adult cohort using 8 prespecified clinic-physiologic variables. This was repeated in a separate validation set of 152 asthmatic patients. The clusters were compared based on sputum proteomics and transcriptomics data. RESULTS: Four reproducible and stable clusters of asthmatic patients were identified. The training set cluster T1 consists of patients with well-controlled moderate-to-severe asthma, whereas cluster T2 is a group of patients with late-onset severe asthma with a history of smoking and chronic airflow obstruction. Cluster T3 is similar to cluster T2 in terms of chronic airflow obstruction but is composed of nonsmokers. Cluster T4 is predominantly composed of obese female patients with uncontrolled severe asthma with increased exacerbations but with normal lung function. The validation set exhibited similar clusters, demonstrating reproducibility of the classification. There were significant differences in sputum proteomics and transcriptomics between the clusters. The severe asthma clusters (T2, T3, and T4) had higher sputum eosinophilia than cluster T1, with no differences in sputum neutrophil counts and exhaled nitric oxide and serum IgE levels. CONCLUSION: Clustering based on clinicophysiologic parameters yielded 4 stable and reproducible clusters that associate with different pathobiological pathways.
BACKGROUND: Asthma is a heterogeneous disease in which there is a differential response to asthma treatments. This heterogeneity needs to be evaluated so that a personalized management approach can be provided. OBJECTIVES: We stratified patients with moderate-to-severe asthma based on clinicophysiologic parameters and performed an omics analysis of sputum. METHODS: Partition-around-medoids clustering was applied to a training set of 266 asthmatic participants from the European Unbiased Biomarkers for the Prediction of Respiratory Diseases Outcomes (U-BIOPRED) adult cohort using 8 prespecified clinic-physiologic variables. This was repeated in a separate validation set of 152 asthmatic patients. The clusters were compared based on sputum proteomics and transcriptomics data. RESULTS: Four reproducible and stable clusters of asthmatic patients were identified. The training set cluster T1 consists of patients with well-controlled moderate-to-severe asthma, whereas cluster T2 is a group of patients with late-onset severe asthma with a history of smoking and chronic airflow obstruction. Cluster T3 is similar to cluster T2 in terms of chronic airflow obstruction but is composed of nonsmokers. Cluster T4 is predominantly composed of obese female patients with uncontrolled severe asthma with increased exacerbations but with normal lung function. The validation set exhibited similar clusters, demonstrating reproducibility of the classification. There were significant differences in sputum proteomics and transcriptomics between the clusters. The severe asthma clusters (T2, T3, and T4) had higher sputum eosinophilia than cluster T1, with no differences in sputum neutrophil counts and exhaled nitric oxide and serum IgE levels. CONCLUSION: Clustering based on clinicophysiologic parameters yielded 4 stable and reproducible clusters that associate with different pathobiological pathways.
Authors: Whitney W Stevens; Anju T Peters; Bruce K Tan; Aiko I Klingler; Julie A Poposki; Kathryn E Hulse; Leslie C Grammer; Kevin C Welch; Stephanie S Smith; David B Conley; Robert C Kern; Robert P Schleimer; Atsushi Kato Journal: J Allergy Clin Immunol Pract Date: 2019-05-22
Authors: A T Hastie; C Steele; C W Dunaway; W C Moore; B M Rector; E Ampleford; H Li; L C Denlinger; N Jarjour; D A Meyers; E R Bleecker Journal: Clin Exp Allergy Date: 2018-04-15 Impact factor: 5.018
Authors: Nathaniel Weathington; Michael E O'Brien; Josiah Radder; Thomas C Whisenant; Eugene R Bleecker; William W Busse; Serpil C Erzurum; Benjamin Gaston; Annette T Hastie; Nizar N Jarjour; Deborah A Meyers; Jadranka Milosevic; Wendy C Moore; John R Tedrow; John B Trudeau; Hesper P Wong; Wei Wu; Naftali Kaminski; Sally E Wenzel; Brian D Modena Journal: Am J Respir Crit Care Med Date: 2019-10-01 Impact factor: 21.405