Researchers at the University of Pittsburgh have unveiled an innovative nasal swab test aimed specifically at pediatric patients to distinguish among various asthma subtypes, also known as endotypes.
This non-invasive test could enable healthcare professionals to prescribe more precise medications, marking a significant advance in the treatment of asthma variations that have traditionally presented diagnostic difficulties.
Research Findings
The findings from this research, featured in JAMA, derive from three distinct studies conducted across the United States, focusing on young individuals from Puerto Rican and African American communities.
These populations report higher asthma rates and elevated mortality linked to the condition compared to their non-Hispanic white counterparts.
Dr. Juan Celedón, the lead investigator and a professor of pediatrics and pulmonary medicine at UPMC Children’s Hospital of Pittsburgh, emphasized the pressing need for novel asthma therapies, particularly for Black and Puerto Rican children who experience a disproportionate impact from this chronic disease.
He pointed out that asthma’s complexity, which includes various endotypes influenced by different immune cell activities, highlights the necessity for accurate endotype identification to facilitate effective treatments.
Asthma Endotype Classification
Asthma is often classified into two main endotype categories: T2-high and T2-low, primarily distinguished by the level of T helper 2 inflammation.
Recently, the T2-low group has been further divided into two additional subcategories: T17-high, with its heightened T helper 17 inflammation and diminished T helper 2 inflammation, and low-low, characterized by minimal activity in both inflammation types.
In the past, identifying an individual’s asthma endotype required invasive genetic analysis through bronchoscopy—an approach involving lung tissue extraction under general anesthesia that is impractical for many children, especially those with less severe symptoms.
Consequently, doctors have resorted to relying on less consistent indicators, such as immune biomarkers in blood tests, various lung function evaluations, and allergy histories.
Dr. Celedón pointed out that while current diagnostic methods can indicate the presence of T2-high asthma, they fall short of distinguishing between T17-high and low-low subtypes due to the absence of definitive clinical markers.
This gap in reliable diagnostic tools motivated the development of a more effective testing approach.
Implications for Future Research
Working alongside first authors Molin Yue and Kristina Gaietto, Dr. Celedón’s team gathered nasal swab samples from 459 young participants in the three studies and examined the expression of eight genes related to T2 and T17 endotypes.
Their analysis revealed that roughly 23% to 29% of the participants had T2-high asthma, while anywhere between 35% and 47% fell into the T17-high category, and 30% to 38% were identified as having the low-low endotype.
Patients suffering from severe T2-high asthma have treatment options available in the form of biologic drugs targeting the immune cells behind their condition.
However, there are currently no biologics that can specifically address the needs of those with T17-high and low-low endotypes. Dr. Celedón praised the advancements made in managing T2-high asthma, attributing this progress to effective markers that have spurred further research.
The introduction of an easy nasal swab test that can identify other endotypes opens new avenues for investigating biologics tailored to T17-high and low-low diseases.
In addition to facilitating the development of biologics, this rapid diagnostic tool has the potential to enhance asthma research on a larger scale. Dr. Celedón raised important questions regarding the evolution of asthma in children as they enter puberty, noting the condition’s prevalence in boys prior to this transition and its subsequent increase in females during adulthood.
The precise relationship between endotype and these shifts remains uncertain.
However, with the newfound capability to easily assess asthma endotypes, researchers are better positioned to investigate these intriguing questions.
Dr. Gustavo Matute-Bello, acting director of the Division of Lung Diseases at the National Heart, Lung, and Blood Institute, recognized the importance of developing tools that examine biological pathways implicated in childhood asthma, particularly within populations that suffer from a disproportionate burden of the disease.
He stressed that this research holds promise for shaping personalized treatment strategies for minority communities, although further studies will be crucial to substantiate these findings.
Source: ScienceDaily