The basophil surface marker CD203c identifies Aspergillus species sensitization in patients with cystic fibrosis Bojana Mirković, PhD, Gillian M. Lavelle,

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Presentation transcript:

The basophil surface marker CD203c identifies Aspergillus species sensitization in patients with cystic fibrosis Bojana Mirković, PhD, Gillian M. Lavelle, BSc, Ahmed Abdul Azim, MB, BCh, BAO, Kristine Helma, MD, Fatma S. Gargoum, MD, Kevin Molloy, MB, BCh, BAO, Yael Gernez, MD, PhD, Katie Dunne, PhD, Julie Renwick, PhD, Philip Murphy, MD, Richard B. Moss, MD, Catherine M. Greene, PhD, Cedric Gunaratnam, MB, Sanjay H. Chotirmall, MD, PhD, Noel G. McElvaney, MD Journal of Allergy and Clinical Immunology Volume 137, Issue 2, Pages 436-443.e9 (February 2016) DOI: 10.1016/j.jaci.2015.07.045 Copyright © 2015 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 1 Frequency of A fumigatus (Af)–positive sputum cultures in nonsensitized patients with CF (CF Af sensitized−; n = 25) and A fumigatus–sensitized patients (CF Af sensitized+; n = 23) in the 2-year period preceding the BAT. Patients with CF were screened for A fumigatus in sputum as part of routine care. Data are presented as means ± SEMs. **P < .01. Journal of Allergy and Clinical Immunology 2016 137, 436-443.e9DOI: (10.1016/j.jaci.2015.07.045) Copyright © 2015 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 2 A fumigatus (Af)–stimulated CD203c levels in nonsensitized patients, A fumigatus–sensitized patients, and patients with CF and ABPA. A, Patients with CF were classified as nonsensitized (n = 25) or A fumigatus sensitized (n = 23). B, The A fumigatus–sensitized cohort was further divided into those with (CF Af sensitized+ ABPA+; n = 7) or without (CF Af sensitized+ ABPA−; n = 16) ABPA. Data are presented as Tukey box plots, and the median is represented by the middle line. MFI, Mean fluorescence intensity. *P < .05 and ***P < .001. Journal of Allergy and Clinical Immunology 2016 137, 436-443.e9DOI: (10.1016/j.jaci.2015.07.045) Copyright © 2015 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 3 Correlation of A fumigatus (Af)–stimulated CD203c levels with FEV1 and BMI. A fumigatus–stimulated CD203c levels correlated with FEV1 (r2 = 0.6409, P = .0002; A) and BMI (r2 = 0.3009, P = .0278; B) in A fumigatus–sensitized (n = 16) but not nonsensitized patients with CF (FEV1: n = 25, r2 = 0.0198, P = .5027; BMI: r2 = 0.0905, P = .1439). MFI, Mean fluorescence intensity. Journal of Allergy and Clinical Immunology 2016 137, 436-443.e9DOI: (10.1016/j.jaci.2015.07.045) Copyright © 2015 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 4 Serologic immune parameters in patients with CF according to A fumigatus (Af) sensitization status. Total IgE (A), sIgE (B), and sIgG (C) serum levels were measured in nonsensitized patients (n = 25), A fumigatus–sensitized patients (n = 16), and patients with CF with ABPA (n = 7). Data are presented as Tukey box plots, and the median is represented by the middle line. *P < .05 and ***P < .001. Journal of Allergy and Clinical Immunology 2016 137, 436-443.e9DOI: (10.1016/j.jaci.2015.07.045) Copyright © 2015 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 5 Effect of itraconazole treatment on A fumigatus (Af)–stimulated CD203c levels in patients with CF. A fumigatus–stimulated CD203c levels in blood basophils from patients with CF before and after 6 weeks of treatment with oral itraconazole (n = 8, P = .4028) are presented as Tukey box plots, and the line in the middle of the box represents the median. MFI, Mean fluorescence intensity. Journal of Allergy and Clinical Immunology 2016 137, 436-443.e9DOI: (10.1016/j.jaci.2015.07.045) Copyright © 2015 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 6 Graphic representation of a simplified classification of Aspergillus species–associated disease by using a combination of A fumigatus (Af)–stimulated CD203c and total IgE and sIgE levels. The blue, red, and green dots denote nonsensitized patients (n = 25), A fumigatus–sensitized patients (n = 16), and patients with CF-ABPA (n = 7), respectively, as depicted with the 3-dimensional scatter plot. Journal of Allergy and Clinical Immunology 2016 137, 436-443.e9DOI: (10.1016/j.jaci.2015.07.045) Copyright © 2015 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 7 A schematic diagram illustrating the potential stages of A fumigatus (Af)–associated CF disease with detection methods and possible treatment interventions at each stage. Solid and hashed lines represent established and suggested treatment regimens, respectively. Journal of Allergy and Clinical Immunology 2016 137, 436-443.e9DOI: (10.1016/j.jaci.2015.07.045) Copyright © 2015 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig E1 Gating strategy for monitoring cell-surface expression of the basophil activation marker CD203c. A, Leukocytes were chosen based on forward scatter (FSC) and side scatter (SSC). B-D, Basophils were selected as the CD3−HLA-DR−CD41a−CD66b−Live/Dead− and CD123+ population (Fig E1, B) and monitored for CD203c expression levels after 10 minutes of stimulation with PBS, peanut, and A fumigatus (Af) extract (Fig E1, C and D). Shown are representative histograms from nonsensitized (Fig E1, C) and A fumigatus–sensitized patients with CF (Fig E1, D). All samples were adequate for flow gating strategy and analysis. Journal of Allergy and Clinical Immunology 2016 137, 436-443.e9DOI: (10.1016/j.jaci.2015.07.045) Copyright © 2015 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig E2 ROC curve analyses of the diagnostic performance of the BAT against sensitization status, as determined by sIgE levels. A fumigatus sIgE levels of greater than 0.35 kU/L have been considered indicative of sensitization, and this cutoff value was used to bisect our cohort into sensitized and nonsensitized patients based on their sIgE levels. The area under the ROC curve of 0.9134 (P < .0001) indicates the excellent discriminating ability of the BAT between nonsensitized (n = 33) and A fumigatus–sensitized (n = 15) patients with CF who were defined by using the A fumigatus sIgE levels (cutoff, 0.35 kU/L). Journal of Allergy and Clinical Immunology 2016 137, 436-443.e9DOI: (10.1016/j.jaci.2015.07.045) Copyright © 2015 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig E3 Frequency of Candida albicans–positive cultures in nonsensitized (CF Af sensitized−; n = 25) and A fumigatus (Af)–sensitized patients with CF (CF Af sensitized+; n = 23) in the 2-year period preceding the BAT. Patients with CF were screened for the presence of C albicans in their sputum samples as part of routine care. Culture data presented here were collected in the 2-year period preceding the BAT, and the differences between the 2 groups were nonsignificant (P = .0981). Data are presented as means ± SEMs. n.s., Not significant. Journal of Allergy and Clinical Immunology 2016 137, 436-443.e9DOI: (10.1016/j.jaci.2015.07.045) Copyright © 2015 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig E4 Effect of Pseudomonas aeruginosa colonization on A fumigatus–stimulated CD203c levels. Patients with CF (n = 48) were screened for the presence of nonmucoid and mucoid P aeruginosa in their sputum as a part of routine care. There was no significant difference in A fumigatus–stimulated CD203c levels between patients with nonmucoid (P = .3263) or mucoid (P = .2351) P aeruginosa compared with their noncolonized counterparts. Data are presented as means ± SEMs. n.s., Not significant. Journal of Allergy and Clinical Immunology 2016 137, 436-443.e9DOI: (10.1016/j.jaci.2015.07.045) Copyright © 2015 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig E5 Baseline CD203c levels in blood basophils before and after treatment with itraconazole or methylprednisolone. Baseline surface CD203c levels in blood basophils were evaluated by means of flow cytometry before and after 30 days of treatment with oral itraconazole (P = .3829, n = 8; A) and before and 7 (P = .3402, n = 4) and 30 days (and P = .1660, n = 4) after treatment with intravenous methylprednisolone (B). Data are presented as Tukey box plots, and the middle line represents the median. IV, Intravenous; MFI, mean fluorescence intensity. Journal of Allergy and Clinical Immunology 2016 137, 436-443.e9DOI: (10.1016/j.jaci.2015.07.045) Copyright © 2015 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig E6 A fumigatus–stimulated CD203c levels in blood basophils before and after treatment with methylprednisolone. A fumigatus–stimulated surface CD203c levels in blood basophils were evaluated by means of flow cytometry before and 7 days (P = .1604, n = 4) and 30 days (P = .2672, n = 4) after treatment with intravenous (IV) methylprednisolone. Data are presented as Tukey box plots, and the middle line represents the median. MFI, Mean fluorescence intensity. Journal of Allergy and Clinical Immunology 2016 137, 436-443.e9DOI: (10.1016/j.jaci.2015.07.045) Copyright © 2015 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig E7 Correlation of total IgE levels (A), sIgE levels (B), and specific/total IgE ratios (C) with CD203c levels in our CF cohort (n = 48). Total and sIgE levels are shown in logarithmic scale. Journal of Allergy and Clinical Immunology 2016 137, 436-443.e9DOI: (10.1016/j.jaci.2015.07.045) Copyright © 2015 American Academy of Allergy, Asthma & Immunology Terms and Conditions