Ma Zifeng, Li Cui, Xue Lingna, Zhang Shaoyan, Yang Yongqing, Zhang Huiyong, Lu Zhenhui
Institute of Respiratory Disease, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China.
Laboratory of Molecular Biology, Yueyang Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China.
Ann Transl Med. 2021 Apr;9(8):682. doi: 10.21037/atm-21-1189.
Obese asthma represents a disease phenotype, which is associated with worse disease control and unresponsiveness to standard anti-inflammatory regimens, including inhaled corticosteroids. Obesity-related innate airway hyperresponsiveness (AHR) plays a role in this asthma phenotype via activation of the IL-1β/innate lymphoid cell 3 (ILC3)/IL-17A pathway. Linggan Wuwei Jiangxin (LGWWJX) formula may be a promising therapeutic option for obese asthma according to traditional Chinese medicine theory, clinical experience and related research.
The murine model of allergic asthma with obesity was induced by ovalbumin (OVA) sensitization and challenge in combination with a high fat diet (HFD). LGWWJX formula intervention was oral administrated. AHR and bronchoalveolar lavage fluid (BALF) cellularity were measured. Lung and liver histopathology assessment was performed by haematoxylin and eosin (H&E) staining. IL-1β and IL-17A in BALF and serum were evaluated by ELISA. Additionally, the influence of different concentrations of LGWWJX formula on IL-1β stimulated IL-17A mRNA expression in ILC3 cells was evaluated in vitro.
LGWWJX treatment significantly reduced AHR and allergic airway inflammatory responses in asthmatic mice, as measured by pulmonary histopathology and BALF cellularity, and these effects were more pronounced in obese asthmatic mice. While eosinophil infiltration in BALF was suppressed with LGWWJX treatment in non-obese asthmatic mice, neutrophils and basophils were significantly decreased in obese asthmatic mice. Notably, LGWWJX also demonstrated remarkable efficacy for weight loss and improvements in hepatic steatosis in mice fed with a HFD. Furthermore, the protein levels of IL-1β in both serum and BALF, as well as those of BALF IL-17A, declined with LGWWJX intervention in both obese and non-obese asthmatic mice, and results from ex-vivo experiments found that LGWWJX significantly attenuated the expression of IL-17A in ILC3 cells with or without stimulation by IL-1β.
LGWWJX may exert a protective effect on asthmatic individuals, especially those with concurrent obesity, most likely through mechanisms including the inhibition of the IL-1β/ILC3/IL-17A/AHR axis, anti-inflammatory effects, weight loss, and the regulation of lipid metabolism. This suggests a promising role of LGWWJX, alone or in combination with anti-inflammatory agents, for the treatment of obese asthma.
肥胖型哮喘是一种疾病表型,与疾病控制不佳以及对包括吸入性糖皮质激素在内的标准抗炎方案无反应有关。肥胖相关的先天性气道高反应性(AHR)通过激活白细胞介素-1β/先天性淋巴细胞3(ILC3)/白细胞介素-17A途径在这种哮喘表型中起作用。根据中医理论、临床经验和相关研究,苓甘五味姜辛汤(LGWWJX)可能是肥胖型哮喘的一种有前景的治疗选择。
通过卵清蛋白(OVA)致敏和激发联合高脂饮食(HFD)诱导肥胖型过敏性哮喘小鼠模型。对LGWWJX进行口服干预。测量气道高反应性和支气管肺泡灌洗液(BALF)细胞数。通过苏木精和伊红(H&E)染色进行肺和肝组织病理学评估。通过酶联免疫吸附测定(ELISA)评估BALF和血清中的白细胞介素-1β和白细胞介素-17A。此外,在体外评估不同浓度的LGWWJX对白细胞介素-1β刺激的ILC3细胞中白细胞介素-17A mRNA表达的影响。
通过肺组织病理学和BALF细胞数测量,LGWWJX治疗显著降低了哮喘小鼠的气道高反应性和过敏性气道炎症反应,并且这些作用在肥胖型哮喘小鼠中更明显。在非肥胖型哮喘小鼠中,LGWWJX治疗抑制了BALF中的嗜酸性粒细胞浸润,而在肥胖型哮喘小鼠中,中性粒细胞和嗜碱性粒细胞显著减少。值得注意的是,LGWWJX对喂食HFD的小鼠还显示出显著的减肥效果和肝脂肪变性改善作用。此外,在肥胖和非肥胖型哮喘小鼠中,LGWWJX干预后血清和BALF中的白细胞介素-1β蛋白水平以及BALF白细胞介素-17A蛋白水平均下降,体外实验结果发现,无论有无白细胞介素-1β刺激,LGWWJX均显著减弱ILC3细胞中白细胞介素-17A的表达。
LGWWJX可能对哮喘患者,尤其是合并肥胖的患者发挥保护作用,最可能的机制包括抑制白细胞介素-1β/ILC3/白细胞介素-17A/AHR轴、抗炎作用、减肥以及调节脂质代谢。这表明LGWWJX单独或与抗炎药物联合用于治疗肥胖型哮喘具有广阔前景。