title: Distinct endotypes of steroid-resistant asthma characterized by IL-17A(high) and IFN-γ(high) immunophenotypes: Potential benefits of calcitriol.
abstract: BACKGROUND
  A small population of patients with severe asthma does not respond to glucocorticoids (steroid resistant [SR]). They have high morbidity, highlighting an urgent need for strategies to enhance glucocorticoid responsiveness.
  
  
  OBJECTIVE
  We investigated the immunologic differences between steroid-sensitive (SS) and SR asthmatic patients and the effect on immunophenotype of oral calcitriol treatment because it has been previously shown to beneficially modulate the clinical response to glucocorticoids in patients with SR asthma.
  
  
  METHODS
  CD8-depleted PBMCs were isolated from 12 patients with SS and 23 patients with SR asthma and cultured for 7 days with anti-CD3 and IL-2 with or without dexamethasone. Cytokine production was assessed in supernatants by using the Cytometric Bead Array. Patients with SR asthma were subsequently randomized to oral calcitriol or placebo therapy, and identical studies were repeated.
  
  
  RESULTS
  Patients with SR asthma produced significantly increased IL-17A and IFN-γ levels compared with those in patients with SS asthma, although it was evident that cells from individual patients might overproduce one or the other of these cytokines. Production of IL-17A was inversely and production of IL-13 was positively associated with the clinical response to prednisolone. Oral calcitriol, compared with placebo, therapy of the patients with SR asthma significantly improved dexamethasone-induced IL-10 production in vitro while suppressing dexamethasone-induced IL-17A production. This effect mirrored the previously demonstrated improvement in clinical response to oral glucocorticoids in calcitriol-treated patients with SR asthma.
  
  
  CONCLUSIONS
  IL-17A(high) and IFN-γ(high) immunophenotypes exist in patients with SR asthma. These data identify immunologic pathways that likely underpin the beneficial clinical effects of calcitriol in patients with SR asthma by directing the SR cytokine profile toward a more SS immune phenotype, suggesting strategies for identifying vitamin D responder immunophenotypes.
authors.affiliation: MRC and Asthma UK Centre for Allergic Mechanisms in Asthma, King's College London, London, United Kingdom.
authors.forename: Emma S
authors.initials: ES
authors.lastname: Chambers
authors.affiliation: MRC and Asthma UK Centre for Allergic Mechanisms in Asthma, King's College London, London, United Kingdom; Asthma UK Centre for Applied Research, Centre for Primary Care and Public Health, Blizard Institute, Queen Mary, University of London, London, United Kingdom.
authors.forename: Alexandra M
authors.initials: AM
authors.lastname: Nanzer
authors.affiliation: MRC and Asthma UK Centre for Allergic Mechanisms in Asthma, King's College London, London, United Kingdom.
authors.forename: Paul E
authors.initials: PE
authors.lastname: Pfeffer
authors.affiliation: MRC and Asthma UK Centre for Allergic Mechanisms in Asthma, King's College London, London, United Kingdom.
authors.forename: David F
authors.initials: DF
authors.lastname: Richards
authors.affiliation: Homerton University NHS Foundation Trust, London, United Kingdom.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Timms
authors.affiliation: Asthma UK Centre for Applied Research, Centre for Primary Care and Public Health, Blizard Institute, Queen Mary, University of London, London, United Kingdom.
authors.forename: Adrian R
authors.initials: AR
authors.lastname: Martineau
authors.affiliation: MRC and Asthma UK Centre for Allergic Mechanisms in Asthma, King's College London, London, United Kingdom; Asthma UK Centre for Applied Research, Centre for Primary Care and Public Health, Blizard Institute, Queen Mary, University of London, London, United Kingdom.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Griffiths
authors.affiliation: MRC and Asthma UK Centre for Allergic Mechanisms in Asthma, King's College London, London, United Kingdom.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Corrigan
authors.affiliation: MRC and Asthma UK Centre for Allergic Mechanisms in Asthma, King's College London, London, United Kingdom. Electronic address: catherine.hawrylowicz@kcl.ac.uk.
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Hawrylowicz
mesh_terms: D000305:Adrenal Cortex Hormones / Q000494:pharmacology; D000328:Adult; D001249:Asthma / Q000188:drug therapy* / Q000276:immunology / Q000473:pathology; D017252:CD3 Complex / Q000494:pharmacology; D002117:Calcitriol / Q000627:therapeutic use*; D003907:Dexamethasone / Q000494:pharmacology; D004351:Drug Resistance; D005260:Female; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D016130:Immunophenotyping; D007371:Interferon-gamma / Q000096:biosynthesis* / Q000276:immunology; D016753:Interleukin-10 / Q000096:biosynthesis / Q000276:immunology; D020381:Interleukin-17 / Q000096:biosynthesis* / Q000276:immunology; D007376:Interleukin-2 / Q000494:pharmacology; D007963:Leukocytes, Mononuclear / Q000187:drug effects* / Q000276:immunology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011239:Prednisolone / Q000627:therapeutic use*; D061251:Primary Cell Culture; D012720:Severity of Illness Index
chemical_list: D000305:Adrenal Cortex Hormones; D017252:CD3 Complex; C508609:IL10 protein, human; C508717:IL17A protein, human; D007155:Immunologic Factors; D020381:Interleukin-17; D007376:Interleukin-2; D016753:Interleukin-10; D003907:Dexamethasone; D007371:Interferon-gamma; D011239:Prednisolone; D002117:Calcitriol
keywords: Asthma; IL-17A; glucocorticoids; steroid resistant; steroid sensitive; vitamin D