Science and Research

Clinical relevance of Aspergillus fumigatus sensitization in cystic fibrosis

RATIONALE: The clinical relevance of sensitization to Aspergillus (A) fumigatus in cystic fibrosis (CF) is unclear. Some researchers propose that specific A fumigatus IgE is an innocent bystander, whereas others describe it as the major cause of TH-2-driven asthma-like disease. OBJECTIVES: Lung function parameters in mild CF patients may be different in patients with and without A fumigatus sensitization. We aimed to ascertain whether allergen exposure to A fumigatus by bronchial allergen provocation (BAP) induces TH-2 inflammation comparable to an asthma-like disease. METHODS: A total of 35 patients, aged 14.8 +/- 8.5 years, and 20 healthy controls were investigated prospectively. The patients were divided into two groups: group 1 (n = 18): specific (s)IgE negative, and group 2 (n = 17): sIgE positive (>/=0.7 KU/L) for A fumigatus. Lung function, exhaled NO, and induced sputum were analysed. All sensitized patients with an FEV1 > 75% (n = 13) underwent BAP with A fumigatus, and cell counts, and the expression of IL-5, IL-13, INF-gamma, and IL-8 as well as transcription factors T-bet, GATA-3, and FoxP3, were measured. RESULTS: Lung function parameters decreased significantly compared to controls, but not within the CF patient group. After BAP, 8 of 13 patients (61%) had a significant asthmatic response and increased eNO 24 hours later. In addition, marked TH-2-mediated inflammation involving eosinophils, IL-5, IL-13, and FoxP3 became apparent in induced sputum cells. CONCLUSION: Our study demonstrated the clinical relevance of A fumigatus for the majority of sensitized CF patients. A distinct IgE/TH-2-dominated inflammation was found in induced sputum after A fumigatus exposure.

  • Eickmeier, O.
  • Zissler, U. M.
  • Wittschorek, J.
  • Unger, F.
  • Schmitt-Grohe, S.
  • Schubert, R.
  • Herrmann, E.
  • Zielen, S.

Keywords

  • Aspergillus fumigatus
  • IgE
  • basic mechanisms
  • bronchial allergen provocation
  • clinical immunology
  • cystic fibrosis
Publication details
DOI: 10.1111/cea.13557
Journal: Clin Exp Allergy
Pages: 325-333 
Number: 3
Work Type: Original
Location: CPC-M
Disease Area: AA, CFBE
Partner / Member: HMGU
Access-Number: 31886564
See publication on PubMed

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