Mast cell activation test in the diagnosis of allergic disease and anaphylaxis Rajia Bahri, PhD, Adnan Custovic, MD, PhD, Peter Korosec, PhD, Marina Tsoumani,

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Presentation transcript:

Mast cell activation test in the diagnosis of allergic disease and anaphylaxis Rajia Bahri, PhD, Adnan Custovic, MD, PhD, Peter Korosec, PhD, Marina Tsoumani, MD, Martin Barron, PhD, Jiakai Wu, PhD, Rebekah Sayers, PhD, Alf Weimann, MEng, Monica Ruiz-Garcia, MD, Nandinee Patel, MD, Abigail Robb, BSc, Mohamed H. Shamji, PhD, Sara Fontanella, PhD, Mira Silar, BSc, E.N.Clare Mills, PhD, Angela Simpson, FRCP, PhD, Paul J. Turner, FRACP, PhD, Silvia Bulfone-Paus, MD, PhD Journal of Allergy and Clinical Immunology Volume 142, Issue 2, Pages 485-496.e16 (August 2018) DOI: 10.1016/j.jaci.2018.01.043 Copyright © 2018 The Authors Terms and Conditions

Journal of Allergy and Clinical Immunology 2018 142, 485-496 Journal of Allergy and Clinical Immunology 2018 142, 485-496.e16DOI: (10.1016/j.jaci.2018.01.043) Copyright © 2018 The Authors Terms and Conditions

Fig 1 Peanut- and grass pollen–induced degranulation of hMCs sensitized with sera of patients with peanut and grass pollen allergy (sensitized to both peanut and pollen, n = 5; sensitized to peanut only, n = 1; sensitized to grass pollen but not peanut, n = 1). hMCs were sensitized overnight with sera from patients with peanut allergy, patients with grass pollen allergy, or both; washed; and either left untreated or exposed for 1 hour to anti-IgE (10 μg/mL) as a positive control (left), different concentrations of peanut extract (middle), or grass pollen extract (right). A and B, hMC degranulation was measured based on CD63 (Fig 1, A) and CD107a (Fig 1, B) surface staining and analyzed by using flow cytometry. C, β-Hexosaminidase levels were measured in cell pellets, as well as in supernatants. Percentage β-hexosaminidase release is shown. D, PGD2 levels were measured in supernatants. The assay was performed in duplicates or triplicates with pooled hMCs from at least 3 different healthy donors. Symbols indicate individual patients, and values indicate means ± SDs. Journal of Allergy and Clinical Immunology 2018 142, 485-496.e16DOI: (10.1016/j.jaci.2018.01.043) Copyright © 2018 The Authors Terms and Conditions

Fig 2 hMC degranulation using hMCs from patients with peanut allergy. hMCs were sensitized overnight with sera of patients with peanut allergy or control sera (volume ratio, 1:10), washed, and either left untreated or exposed for 1 hour to anti-IgE (10 μg/mL; A), different concentrations of peanut extract (as indicated; B), or recombinant peanut allergens (rAra h 1, rAra h 2, rAra h 3, rAra h 6, and rAra h 8 [10 nmol/L]; C). hMC degranulation was measured by using CD63 surface staining and analyzed with flow cytometry. Fig 2, A and B, show one representative experiment of 2, and the assay was performed in duplicates or triplicates with pooled hMCs from at least 3 different healthy donors. Values indicate means ± SDs, and symbols show individual subjects. In Fig 2, C, the assay was performed in duplicates; lines indicate the mean of replicates, and symbols show each subject. Journal of Allergy and Clinical Immunology 2018 142, 485-496.e16DOI: (10.1016/j.jaci.2018.01.043) Copyright © 2018 The Authors Terms and Conditions

Fig 3 Correlation of serum Arachis hypogaea IgE measurements and hMC degranulation analysis in the panel of 14 patients with peanut allergy. Correlation of serum specific peanut IgE levels versus peanut extract–induced hMC degranulation (A), serum specific peanut IgE levels versus MC allergen CD-sens (B), and serum IgE levels specific for rAra h 1, rAra h 3, rAra h 2, and rAra h 6 versus hMC degranulation induced by the respective recombinant peanut allergen (C) are shown. IgE levels are expressed as natural logarithm (LN). Measurements noted as less than the limit of detection (<0.4) in Table E1 were given a value of half the limit of detection (0.2). CD-sens values were calculated as described previously by Johansson et al,25 with higher values implying greater sensitivity. Symbols indicate mean values for each investigated serum from patients with peanut allergy. Degranulation was measured based on surface expression of CD63 on hMCs by flow cytometry. Ara h IgE levels are expressed in natural logarithm (LN). Measurements noted as less than the limit of detection (<0.4) in Table E1 were given a value of half the limit of detection (0.2). Symbols indicate mean values for each investigated serum from patients with peanut allergy. Journal of Allergy and Clinical Immunology 2018 142, 485-496.e16DOI: (10.1016/j.jaci.2018.01.043) Copyright © 2018 The Authors Terms and Conditions

Fig 4 ROC curves comparing discrimination performance of the MAT with that of other diagnostic modalities in 42 peanut-sensitized subjects, of whom 30 reacted to less than 4.4 g of peanut protein with objective symptoms (A), and a subgroup of peanut-sensitized subjects with equivocal results for conventional allergy tests (B). In both scenarios the MAT had the most favorable diagnostic accuracy compared with other tests in identifying those with clinical reactivity to peanut. Journal of Allergy and Clinical Immunology 2018 142, 485-496.e16DOI: (10.1016/j.jaci.2018.01.043) Copyright © 2018 The Authors Terms and Conditions

Fig 5 FDA of the MAT. A, Raw data and smoothed curves for peanut-sensitized subjects (n = 42). B, Principal components analysis (PCA) of pattern response measured by using the MAT assay. Lines show the effect of adding (green line) or subtracting (red line) 2 SDs from the mean response curve (blue line). C, Distinct clusters of allergic responses to peanut obtained through k-means on FPC scores. Journal of Allergy and Clinical Immunology 2018 142, 485-496.e16DOI: (10.1016/j.jaci.2018.01.043) Copyright © 2018 The Authors Terms and Conditions

Fig 6 K-means cluster on sIgE data in patients with peanut allergy. A, IgE clusters on peanut-specific IgE versus the first FPC. B, MAT clusters on peanut-specific IgE versus the first FPC. Journal of Allergy and Clinical Immunology 2018 142, 485-496.e16DOI: (10.1016/j.jaci.2018.01.043) Copyright © 2018 The Authors Terms and Conditions

Fig E1 Characterization of hMCs. A, After 8 to 10 weeks of culture, hMC maturation was controlled by measuring the size granularity, (side scatter [SSC]–H/forward scatter [FSC]–H) and CD117 surface expression by using flow cytometry. Control shows fluorescence minus one values for CD117 control staining. B, Serum IgE binding. hMCs were sensitized overnight with human serum (1:10 dilution) or not for control hMCs and washed. IgE fixed on the surfaces of hMCs was detected by using flow cytometry. Numbers represent percentage cells in the gate. C and D, Immunofluorescence for tryptase (Fig E1, C) and chymase (Fig E1, D). A spectrum of tryptase and chymase expression is seen within the MC population. E and F, MC metachromatic granules were identified by using May-Grünwald Giemsa (Fig E1, E) or toluidine blue (Fig E1, F) staining. Journal of Allergy and Clinical Immunology 2018 142, 485-496.e16DOI: (10.1016/j.jaci.2018.01.043) Copyright © 2018 The Authors Terms and Conditions

Fig E2 Correlation of surface expression and mediators release measurement. hMCs were sensitized overnight with serum from patients with peanut allergy, patients with grass pollen allergy, or both (volume ratio, 1:10); washed; and either left untreated or exposed for 1 hour to different concentrations of peanut or grass pollen extract or anti-IgE (10 μg/mL) as a positive control. hMC degranulation was measured by CD63 and CD107a surface staining and analyzed by using flow cytometry. β-Hexosaminidase levels were measured in cell pellets, as well as in supernatants, and expressed as percentage β-hexosaminidase release. PGD2 levels were measured in supernatants. The assay was performed in duplicates or triplicates with pooled hMCs from at least 3 different healthy donors. Correlations were calculated by using Spearman R (R2) values (A) with both absolute values and percentages of readout induced by anti-IgE summarized in B. Journal of Allergy and Clinical Immunology 2018 142, 485-496.e16DOI: (10.1016/j.jaci.2018.01.043) Copyright © 2018 The Authors Terms and Conditions

Fig E3 hMCs are more susceptible to IgE-mediated degranulation than LAD2 cells. hMCs were sensitized overnight with 1 μg/mL human IgE washed and either left untreated (0 μg/mL) or exposed for 1 hour to anti-IgE (10 μg/mL). A and B, hMC degranulation was measured based on CD63 (Fig E3, A) and CD107a (Fig E3, B) surface staining and analyzed by using flow cytometry. C, β-Hexosaminidase levels were measured in cell pellets, as well as in supernatants. Percentage of β-hexosaminidase release is shown. D, PGD2 levels were measured in supernatants. The assay was performed with pooled hMCs from at least 3 different healthy donors. Journal of Allergy and Clinical Immunology 2018 142, 485-496.e16DOI: (10.1016/j.jaci.2018.01.043) Copyright © 2018 The Authors Terms and Conditions

Fig E4 hMC degranulation in patients with a clinical history of systemic reaction to wasp (n = 21) or honeybee (n = 6) venom. hMCs were sensitized overnight with patients' sera, washed, and then incubated with varying concentrations of wasp venom extract (as indicated) for 1 hour. hMC degranulation was measured based on CD63 surface expression by using flow cytometry. Journal of Allergy and Clinical Immunology 2018 142, 485-496.e16DOI: (10.1016/j.jaci.2018.01.043) Copyright © 2018 The Authors Terms and Conditions

Fig E5 hMC degranulation in peanut-sensitized patients from the validation cohort (n = 42). A, hMCs were sensitized overnight with patients' sera, washed, and then incubated with varying concentrations of peanut extract (as indicated) or anti-IgE (10 μg/mL) for 1 hour. hMC degranulation was measured based on CD63 surface expression by using flow cytometry. B, Corresponding ROC curve. AUC, Area under curve; PN, peanut. Journal of Allergy and Clinical Immunology 2018 142, 485-496.e16DOI: (10.1016/j.jaci.2018.01.043) Copyright © 2018 The Authors Terms and Conditions

Fig E6 First and second derivatives of response curves for peanut-sensitized patients. Journal of Allergy and Clinical Immunology 2018 142, 485-496.e16DOI: (10.1016/j.jaci.2018.01.043) Copyright © 2018 The Authors Terms and Conditions

Fig E7 Scores of patients on the first 2 principal components of the allergic response. Journal of Allergy and Clinical Immunology 2018 142, 485-496.e16DOI: (10.1016/j.jaci.2018.01.043) Copyright © 2018 The Authors Terms and Conditions

Fig E8 Evaluation measures distribution for the choice of the optimal number of cluster obtained with the package NbClust. Journal of Allergy and Clinical Immunology 2018 142, 485-496.e16DOI: (10.1016/j.jaci.2018.01.043) Copyright © 2018 The Authors Terms and Conditions

Fig E9 Functional t test for differences between responses in the 5 clusters. Journal of Allergy and Clinical Immunology 2018 142, 485-496.e16DOI: (10.1016/j.jaci.2018.01.043) Copyright © 2018 The Authors Terms and Conditions

Fig E10 Velocity and acceleration in the distinct response patterns in the clusters. Journal of Allergy and Clinical Immunology 2018 142, 485-496.e16DOI: (10.1016/j.jaci.2018.01.043) Copyright © 2018 The Authors Terms and Conditions

Fig E11 K-means clustering on sIgE data in patients with peanut allergy. A, MAT responses on the first 2 principle components, assigned to the 2 IgE clusters detected. B, IgE clusters on MAT response curves to peanut. Journal of Allergy and Clinical Immunology 2018 142, 485-496.e16DOI: (10.1016/j.jaci.2018.01.043) Copyright © 2018 The Authors Terms and Conditions