Aspirin-Exacerbated Respiratory Disease Involves a Cysteinyl Leukotriene-Driven IL-33-Mediated Mast Cell Activation Pathway.
Aspirin-exacerbated respiratory disease (AERD), a severe eosinophilic inflammatory disorder of the airways, involves overproduction of cysteinyl leukotrienes (cysLTs), activation of airway mast cells (MCs), and bronchoconstriction in response to nonselective cyclooxygenase inhibitors that deplete homeostatic PGE2. The mechanistic basis for MC activation in this disorder is unknown. We now demonstrate that patients with AERD have markedly increased epithelial expression of the alarmin-like cytokine IL-33 in nasal polyps, as compared with polyps from aspirin-tolerant control subjects. The murine model of AERD, generated by dust mite priming of mice lacking microsomal PGE2 synthase (ptges(-/-) mice), shows a similar upregulation of IL-33 protein in the airway epithelium, along with marked eosinophilic bronchovascular inflammation. Deletion of leukotriene C4 synthase, the terminal enzyme needed to generate cysLTs, eliminates the increased IL-33 content of the ptges(-/-) lungs and sharply reduces pulmonary eosinophilia and basal secretion of MC products. Challenges of dust mite-primed ptges(-/-) mice with lysine aspirin induce IL-33-dependent MC activation and bronchoconstriction. Thus, IL-33 is a component of a cysLT-driven innate type 2 immune response that drives pathogenic MC activation and contributes substantially to AERD pathogenesis.
Department of Medicine, Harvard Medical School, Boston, MA 02115; Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA 02115; Jeff and Penny Vinik Center for Allergic Disease Research, Boston, MA 02115;
Tao
T
Liu
Department of Medicine, Harvard Medical School, Boston, MA 02115; Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA 02115; Jeff and Penny Vinik Center for Allergic Disease Research, Boston, MA 02115;
Yoshihide
Y
Kanaoka
Department of Medicine, Harvard Medical School, Boston, MA 02115; Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA 02115; Jeff and Penny Vinik Center for Allergic Disease Research, Boston, MA 02115;
Nora A
NA
Barrett
Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA 02115; Jeff and Penny Vinik Center for Allergic Disease Research, Boston, MA 02115;
Chunli
C
Feng
Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA 02115; Jeff and Penny Vinik Center for Allergic Disease Research, Boston, MA 02115;
Denise
D
Garofalo
Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA 02115; Jeff and Penny Vinik Center for Allergic Disease Research, Boston, MA 02115;
Juying
J
Lai
Department of Medicine, Harvard Medical School, Boston, MA 02115; Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA 02115; Jeff and Penny Vinik Center for Allergic Disease Research, Boston, MA 02115;
Kathleen
K
Buchheit
Department of Surgery, Harvard Medical School, Boston, MA 02115; and.
Neil
N
Bhattacharya
Department of Medicine, Harvard Medical School, Boston, MA 02115; Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA 02115; Jeff and Penny Vinik Center for Allergic Disease Research, Boston, MA 02115;
Tanya M
TM
Laidlaw
Department of Medicine, Harvard Medical School, Boston, MA 02115; Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA 02115; Jeff and Penny Vinik Center for Allergic Disease Research, Boston, MA 02115;
Howard R
HR
Katz
Department of Medicine, Harvard Medical School, Boston, MA 02115; Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA 02115; Jeff and Penny Vinik Center for Allergic Disease Research, Boston, MA 02115; Department of Pediatrics, Harvard Medical School, Boston, MA 02115 jboyce@rics.bwh.harvard.edu.
Joshua A
JA
Boyce
D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D055963:Asthma, Aspirin-Induced / Q000235:genetics / Q000276:immunology* / Q000473:pathology; D015232:Dinoprostone / Q000235:genetics / Q000276:immunology; D005260:Female; D006801:Humans; D007113:Immunity, Innate; D000067596:Interleukin-33 / Q000235:genetics / Q000276:immunology*; D019746:Intramolecular Oxidoreductases / Q000235:genetics / Q000276:immunology; D015289:Leukotrienes / Q000235:genetics / Q000276:immunology*; D008297:Male; D008407:Mast Cells / Q000276:immunology* / Q000473:pathology; D051379:Mice; D018345:Mice, Knockout; D008875:Middle Aged; D000071876:Prostaglandin-E Synthases; D011657:Pulmonary Eosinophilia / Q000235:genetics / Q000276:immunology / Q000473:pathology
C506536:IL33 protein, human; C506535:Il33 protein, mouse; D000067596:Interleukin-33; D015289:Leukotrienes; D019746:Intramolecular Oxidoreductases; C000605862:PTGES protein, human; D000071876:Prostaglandin-E Synthases; C000605865:Ptges protein, mouse; D015232:Dinoprostone