Quantification of inflammatory mediators to explore molecular mechanisms and sub-phenotypes of asthma

Sammanfattning: This thesis summarizes a series of studies using liquid chromatography coupled to mass spectrometry methodologies to quantify metabolites of fatty acids (i.e., oxylipins) and histamine in different samples from experimental models and clinical studies with the overall aim to define mechanisms and identify biomarkers for improved sub-phenotyping of asthma. Asthma is characterized by variable airflow obstruction, hyperresponsiveness and chronic inflammation in the airways. The substantial overlap among clinical descriptors has resulted in difficulties to establish diagnosis and predict response to treatment. Instead, a shift in focus towards identifying specific cellular and molecular mechanisms has emerged, aiming to define new treatable traits based on specific cellular and molecular pathways (defined as endotypes). Important pathobiological components involve the release of potent inflammatory mediators, such as histamine, prostaglandins (PGs) and leukotrienes (LTs), that cause bronchoconstriction and airway inflammation. A rapid hydrophilic interaction chromatography method failed to quantify the major histamine metabolite 1,4-methyl-5-imidazoleacetic acid (tele-MIAA) due to ion suppression from inorganic salts present in urine. Ion-pairing chromatography was therefore employed and the resulting increase in precision enabled the detection of higher baseline levels of tele-MIAA in females compared to males (3.0 vs. 2.1 μmol/mmol creatinine, respectively) (Paper I). In addition, levels of tele-MIAA reached up to 30 μmol/mmol creatinine in spot urine samples from mastocytosis patients. Three liquid chromatography coupled to tandem mass spectrometry (LC-MS/MS) methods quantified 130 oxylipins and were able to define kinetic release and enzymatic contribution of mast cell-derived mediators to smooth muscle contraction using isolated and intact airways from humans and guinea pigs in vitro. PGD2 levels were elevated 24-hour post anti-IgE stimulation of human bronchus, suggesting a prolonged mast cell activation (Paper II). Furthermore, exposure to house dust mite (HDM) induced strong release of lipoxygenase-derived LTB4, 5,15-DiHETE, 15-HETE and 15-HEDE along with eosinophilic infiltration in a C57BL/6 murine model of asthma. Interestingly, high levels of cysteinyl-leukotrienes (CysLTs) remained unchanged suggesting a different role of CysLTs in mice (Paper III). Urinary profiles of 11 eicosanoid metabolites in 100 healthy control subjects and 497 asthmatics defined normal baseline levels and revealed increased concentration of PGs, LTE4 and isoprostanes with asthma severity. Consensus clustering of 497 asthmatics identified a five-cluster model with distinct clinical characteristics, which included two new phenotypes, U1 and U5, with low levels of thromboxanes and PGs respectively (Paper IV). At the 12 to 18-month longitudinal time point for the 302 subjects with severe asthma, z-scored eicosanoid concentrations retained the five-cluster profile, despite technical and intra-subject variability. In conclusion, the developed bioanalytical methods were applied to define levels of histamine and eicosanoid metabolites in urine from healthy subjects. In addition, release of multiple oxylipins following mast cell-mediated bronchoconstriction and HDM-induced airway inflammation in model systems were explored to relate functions to levels of lipid mediators. For the first time, grouping of asthmatics according to profiles of eicosanoid metabolites in urine was performed and demonstrated sufficient resolution to identify five sub-phenotypes of asthma possessing distinct clinical characteristics. The presented approaches, for both in vitro and in vivo respiratory research, offer an opportunity to progress the development of new treatment options and suggests a panel of PGs, LTE4 and isoprostanes to be further validated as diagnostic markers in patients with asthma.