Eosinophilic airway inflammation in asthmatic patients is associated with an altered airway microbiome Asger Sverrild, MD, PhD, Pia Kiilerich, MSc, PhD,

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Presentation transcript:

Eosinophilic airway inflammation in asthmatic patients is associated with an altered airway microbiome Asger Sverrild, MD, PhD, Pia Kiilerich, MSc, PhD, Asker Brejnrod, MSc, Rebecca Pedersen, MSc, PhD, Celeste Porsbjerg, MD, PhD, Anders Bergqvist, MSc, Jonas S. Erjefält, MSc, PhD, Karsten Kristiansen, MSc, Vibeke Backer, MD, DMSc Journal of Allergy and Clinical Immunology Volume 140, Issue 2, Pages 407-417.e11 (August 2017) DOI: 10.1016/j.jaci.2016.10.046 Copyright © 2016 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 1 α-Diversity (A) and β-diversity (B) in the BAL microbiome as stratified by healthy subjects (green) or patients with either eosinophil-high or neutrophil-high asthma (blue) or patients with eosinophil-low or neutrophil-low asthma (red) in the submucosa. α-Diversity was calculated as the Shannon index (a measure of species richness and evenness), and β-diversity was calculated by using the Whittaker index (a measure of dissimilarity between communities). Significant differences between the groups were tested by using a Kruskal-Wallis test with Dunn corrections for multiple comparisons and indicated by a horizontal bar between the 2 columns, with stars denoting the P values. Corrected P values without significance are given for comparisons in which the P value was close to .05. ★P < .05, ★★P < .01, and ★★★P < .001, respectively. Journal of Allergy and Clinical Immunology 2017 140, 407-417.e11DOI: (10.1016/j.jaci.2016.10.046) Copyright © 2016 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 2 PCoA plots using weighted UniFrac distances in the BAL microbiome. A, PCoA plot with healthy control subjects, patients with eosinophil-high asthma, and patients with eosinophil-low asthma. Analysis of similarity (ANOSIM) conducted on each pairwise comparison and Holm corrected for the number of pairwise comparisons showed a significant difference in microbiome composition between healthy subjects versus patients with eosinophil-low asthma (P < .05) and patients with eosinophil-high asthma versus patients with eosinophil-low asthma (P < .01) but not between healthy control subjects and patients with eosinophil-high asthma (P = .10). Ellipses represent the 0.95 confidence level. Environmental variables and individual bacterial abundances were fitted onto the ordination and displayed as vectors. The degree of submucosal eosinophilia (P < .01, R2 = 0.26) and mannitol reactivity (P = .01, R2 = 0.20) were major drivers explaining the separation. Submucosal neutrophilia (P = .12, R2 = 0.12) was not significant but is shown in the plot. For the bacterial vectors, only the 5% most extreme correlations are shown. The length and direction of a vector represents the correlation between the vector and the microbiome data. B, PCoA plot with asthmatic patients only colored according to submucosal eosinophilia. ANOSIM analysis confirmed the significant difference in microbiome composition between patients with eosinophil-high asthma and those with eosinophil-low asthma (P < .01). Ellipses represent the 0.95 confidence level. Environmental variables and individual bacterial abundances were fitted onto the ordination and displayed as vectors. For analysis of the asthmatic patients, the degree of submucosal eosinophilia (P < .05, R2 = 0.28) and mannitol reactivity (P < .01, R2 = 0.38) were major drivers of separation. The length of the vector represents the correlation between the vector and the microbiome data. Submucosal neutrophilia (P = .51, R2 = 0.07) was not significant but is shown in the plot. For the bacterial vectors, only the 5% most extreme vectors are shown. The length and direction of a vector represents the correlation between the vector and the microbiome data. Journal of Allergy and Clinical Immunology 2017 140, 407-417.e11DOI: (10.1016/j.jaci.2016.10.046) Copyright © 2016 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 3 Taxa summary plots of the 20 most abundant bacterial genera in healthy control subjects (n = 10) and patients with asthma (n = 23) stratified according to the EG2 (A) or MPO (B) levels in submucosa. Journal of Allergy and Clinical Immunology 2017 140, 407-417.e11DOI: (10.1016/j.jaci.2016.10.046) Copyright © 2016 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 4 Abundance of bacterial genera in BAL fluid from patients with eosinophil-high asthma or patients with eosinophil-low asthma. The expectation-maximization algorithm was run on normalized count data for all OTUs in each sample to identify genera that differed significantly in abundance in BAL fluid from asthmatic patients with either high or low submucosal eosinophilia. Only genera with 100% prevalence in both groups are shown. Normalized counts of all OTUs belonging to a specific bacterial genus were summed within each sample, and the averages and SEMs for all samples in each group (high or low) were divided into bacterial genera that were either significantly more abundant (A) or significantly less abundant (B) in patients with eosinophil-low asthma compared with those with eosinophil-high asthma. Horizontal bars between the different columns represent significant findings, with stars denoting P values. ★P < .05, ★★P < .01, and ★★★P < .001, respectively. Journal of Allergy and Clinical Immunology 2017 140, 407-417.e11DOI: (10.1016/j.jaci.2016.10.046) Copyright © 2016 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig E1 A, PCoA plot with healthy control subjects, patients with neutrophil-high asthma, and patients with neutrophil-low asthma. ANOSIM for the neutrophilic plot shows no significant difference between any of the groups: healthy control subjects versus patients with neutrophil-low asthma (P = .27), patients with neutrophil-high asthma versus patients with neutrophil-low asthma (P = .27), and healthy control subjects versus patients with neutrophil-high asthma (P = .19). Ellipses represent the 0.95 confidence level. B, PCoA plot with asthmatic patients only colored based on neutrophil-high or neutrophil-low asthma. ANOSIM analysis showed no separation of the samples because of submucosal neutrophilia (P = .12). Ellipses represent the 0.95 confidence level. Journal of Allergy and Clinical Immunology 2017 140, 407-417.e11DOI: (10.1016/j.jaci.2016.10.046) Copyright © 2016 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig E2 KEGG orthologues that differed in abundance between patients with eosinophil-high asthma and those with eosinophil-low asthma. Journal of Allergy and Clinical Immunology 2017 140, 407-417.e11DOI: (10.1016/j.jaci.2016.10.046) Copyright © 2016 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig E3 Correlation between measured Feno values and normalized abundance of the NO synthase KEGG orthologue. Journal of Allergy and Clinical Immunology 2017 140, 407-417.e11DOI: (10.1016/j.jaci.2016.10.046) Copyright © 2016 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig E4 Assessment of robustness of the chosen cutoff points on the conclusions. The y-axis show the nominal Kruskal-Wallis P value of the variable tested against the cutoff on the x-axis. Analysis from Fig 1, A (α-diversity), and Fig 1, B (β-diversity), was performed on an equally spaced grid of 20 cutoffs from 0 to 1. As in Fig 1, A and B, hypothesis testing was performed against eosinophil counts measured in submucosal tissue by means of EG2 staining and neutrophil counts from submucosal tissue stained with MPO. Journal of Allergy and Clinical Immunology 2017 140, 407-417.e11DOI: (10.1016/j.jaci.2016.10.046) Copyright © 2016 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig E5 α-Diversity and β-diversity in BAL microbiomes according to sputum eosinophilic and neutrophilic inflammation. α-Diversity and β-diversity in the BAL microbiome as stratified by healthy subjects (green), patients with eosinophil-high asthma (blue), or patients with eosinophil-low asthma (red) in sputum are shown. α-Diversity was calculated as the Shannon index (a measure of species richness and evenness), and β-diversity was calculated by using the Whittaker index (a measure of the dissimilarity between communities). Significant differences between the groups were tested by using a Kruskal-Wallis test with Dunn corrections for multiple comparisons and indicated by a horizontal bar between the 2 columns, with stars denoting P values. Corrected P values without significance are presented for comparisons in which the P value was close to .05. ★P < .05, ★★P < .01, and ★★★P < .001, respectively. Journal of Allergy and Clinical Immunology 2017 140, 407-417.e11DOI: (10.1016/j.jaci.2016.10.046) Copyright © 2016 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig E6 PCoA plot with asthmatic patients only colored according to submucosal periostin staining intensity. ANOSIM analysis showed no separation of the samples because of submucosal periostin (P = .26). Ellipses represent the 0.95 confidence level. Journal of Allergy and Clinical Immunology 2017 140, 407-417.e11DOI: (10.1016/j.jaci.2016.10.046) Copyright © 2016 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig E7 α-Diversity and β-diversity in the BAL microbiomes according to the level of periostin staining activity in submucosa. α-Diversity and β-diversity in the BAL microbiome as stratified by healthy subjects (green), patients with periostin-high asthma (blue), or patients with periostin-low asthma (red) in sputum are shown. α-Diversity was calculated as the Shannon index (a measure of species richness and evenness), and β-diversity was calculated by using the Whittaker index (a measure of the dissimilarity between communities). Significant differences between the groups were tested by using a Kruskal-Wallis test with Dunn corrections for multiple comparisons and indicated by a horizontal bar between the 2 columns, with stars denoting P values. Corrected P values without significance are given for comparisons in which the P value was close to .05. ★★P < .01. Journal of Allergy and Clinical Immunology 2017 140, 407-417.e11DOI: (10.1016/j.jaci.2016.10.046) Copyright © 2016 American Academy of Allergy, Asthma & Immunology Terms and Conditions