Asthma is a common chronic respiratory disease where patients suffer from restricted airways and airway inflammation (mainly eosinophilic type 2 (T2) inflammation). Inhaled (ICS)/oral corticosteroids (OCS) and, more recently T2-targeting biologics, are prescribed as mainstay therapies for asthma. Despite these therapies, a subset of asthma patients continues to have symptoms and airway inflammation, suggesting an underlying additional asthma pathology. We have observed multiple airway autoantibodies in 55% of moderate-to-severe asthma patients associated with inadequate response to corticosteroids and anti-T2 biologics. Increased airway degranulation (eosinophilic and/or infective) together with lymphopenia (low lymphocyte counts) underlie these self-reactive/autoimmune-like events. In healthy individuals, regulatory lymphocytes limit the development and activity of self-reactive cells, including those capable of producing autoantibodies. Lymphopenia can lead to skewed non-regulatory to regulatory lymphocyte subsets that support a microenvironment with reduced ability to limit self-reactivity. In this study, wanted to measure B cell subsets by flow cytometry and non-regulatory to regulatory B cell ratios in asthma patients and healthy controls. To understand B cell compartmentalization, we analyzed peripheral and sputum B cells. We identified decreased regulatory B cells (Bregs), in particular CD5+ Bregs, and skewed non-regulatory to regulatory B cell ratios in both circulation and airways of asthma patients. Compared to healthy controls, only patients requiring daily OCS had significantly lower CD5+ Bregs, suggesting a reduced regulatory component in more severe patients. Further, CD5+ Bregs, capable of producing immunomodulatory interleukin-10, were significantly lower in patients with a history of multiple lymphopenic events (70% requiring daily OCS). Together, this supports the need to investigate lymphopenia-induced dysregulation of Bregs, increase in autoreactive B cells and airway autoreactivities, and subsequent progression into a more-severe therapy refractory autoimmune pathology. This opens a new avenue for asthma treatment, particularly for the severe population with airway autoimmune responses often not targeted/controlled by current anti-inflammatory therapies. / Thesis / Master of Science (MSc) / Asthma is a common respiratory disease where patients have difficulty breathing and airway inflammation. Corticosteroids and/or targeting biologic therapies are prescribed to reduce inflammation. Despite these treatments, some patients still have inflammation. In patients that don’t respond well to treatment, we have found evidence of self-attacking antibodies that can further lead to disease severity. These antibodies are produced by self-attacking B cells normally suppressed by regulatory B cells (Bregs). We wanted to measure if asthma patients have reduced ability to limit self-attacking B cells because of reduced Bregs. We found that asthma patients have lower Bregs and an imbalance of non-regulatory to regulatory B cells in the blood and airways. Together, we show B cell subsets that suggest a self-attacking asthma component, not targeted by current asthma treatments. Understanding the involvement of Bregs in asthma opens a new therapeutic option in those that don’t respond well to current treatment.
| Identifer | oai:union.ndltd.org:mcmaster.ca/oai:macsphere.mcmaster.ca:11375/29107 |
| Date | January 2023 |
| Creators | Miyasaki, Kate |
| Contributors | Mukherjee, Manali, Biochemistry and Biomedical Sciences |
| Source Sets | McMaster University |
| Language | English |
| Detected Language | English |
| Type | Thesis |
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