0
0
University of Pittsburgh Researchers Develop Non-Invasive Method for Precision Asthma Treatment
Researchers at the University of Pittsburgh have introduced a groundbreaking nasal swab test that can identify specific asthma subtypes, or endotypes, in children. This non-invasive approach promises to help doctors prescribe medications more accurately and could pave the way for improved treatments for asthma, particularly for lesser-known subtypes that have been challenging to diagnose until now.
Published in the Journal of the American Medical Association (JAMA) today, the study is based on data from three separate U.S.-based research projects focusing on Puerto Rican and African American children. These groups suffer from higher rates of asthma and experience more severe outcomes compared to their non-Hispanic white counterparts.
Senior author Dr. Juan Celedón, a professor of pediatrics at the University of Pittsburgh and chief of pulmonary medicine at UPMC Children’s Hospital of Pittsburgh, emphasized the importance of improving treatments for these underserved populations. “Asthma is the most common chronic disease of childhood, and it disproportionately affects Black and Puerto Rican children, so it’s essential that we develop new therapies to better treat these young patients,” Celedón said.
Asthma is a complex disease, with different immune cells responsible for its various endotypes, each responding differently to treatments. The first step to better therapies, the researchers argue, is accurate endotype diagnosis. Traditionally, asthma has been classified into two main categories—T2-high and T2-low—based on the presence of certain inflammatory markers. More recently, the T2-low category was divided further into two subtypes: T17-high and low-low, based on the types of inflammation present.
However, accurately diagnosing these endotypes has traditionally required invasive procedures like bronchoscopy, which are not ideal for children. Instead, doctors have relied on blood tests, lung function tests, and allergy history—methods that, though useful, cannot provide the definitive endotype diagnosis needed, particularly for the T17-high and low-low subtypes. This gap in diagnostic accuracy inspired Celedón and his team to seek a better solution.
The research team, including Pitt graduate student Molin Yue and Dr. Kristina Gaietto, an instructor of pediatrics at Pitt, analyzed nasal swabs from 459 youths across three studies. They focused on the expression of eight genes associated with the T2 and T17 inflammation pathways. The results were promising, with the nasal swabs revealing the asthma endotype in nearly all cases. Specifically, 23% to 29% of participants had T2-high asthma, 35% to 47% had T17-high asthma, and 30% to 38% had the low-low endotype.
This novel nasal swab method could not only help clinicians better understand the specific asthma subtypes in their young patients but could also drive the development of new biologic therapies for the T17-high and low-low endotypes. Current asthma biologics mainly target T2-high asthma, leaving other subtypes underserved in terms of effective treatments.
Dr. Celedón highlighted the potential for further advancements in asthma research, noting that the nasal swab test could lead to breakthroughs in understanding why asthma behaves differently in children as they grow older. “One of the million-dollar questions in asthma is why some kids get worse as they enter puberty, while others stay the same or improve,” Celedón said. “We now have a tool to answer these questions, which could improve treatments and outcomes.”
Dr. Gustavo Matute-Bello, acting director of the Division of Lung Diseases at the National Heart, Lung, and Blood Institute (NHLBI), praised the research for its potential to improve asthma care, particularly in minority communities. “Having tools to test which biological pathways have a major role in asthma in children, especially those who have a disproportionate burden of disease, may help achieve our goal of improving asthma outcomes,” he said.
This study’s findings mark a significant step forward in personalized medicine for asthma, offering a promising path to more accurate diagnoses and more effective treatments, particularly for minority children who face the greatest risks from this chronic condition.
The full study, titled “Transcriptomic profiles in nasal epithelium and asthma endotypes in youth,” is available in the Journal of the American Medical Association (DOI: 10.1001/jama.2024.22684).
