Co-Expression Analysis of Airway Epithelial Transcriptome in Asthma Patients with Eosinophilic vs. Non-Eosinophilic Airway Infiltration.

Asthma heterogeneity complicates the search for targeted treatment against airway inflammation and remodeling. We sought to investigate relations between eosinophilic inflammation, a phenotypic feature frequent in severe asthma, bronchial epithelial transcriptome, and functional and structural measures of airway remodeling. We compared epithelial gene expression, spirometry, airway cross-sectional geometry (computed tomography), reticular basement membrane thickness (histology), and blood and bronchoalveolar lavage (BAL) cytokines of = 40 moderate to severe eosinophilic (EA) and non-eosinophilic asthma (NEA) patients distinguished by BAL eosinophilia. EA patients showed a similar extent of airway remodeling as NEA but had an increased expression of genes involved in the immune response and inflammation (e.g., ), reactive oxygen species generation (, ), cell activation and proliferation (), cargo transporting (, ), and tissue remodeling (, , ), and a lower expression of genes involved in epithelial integrity (e.g., ) and histone acetylation (). Genes co-expressed in EA were involved in antiviral responses (e.g., ), cell migration (, ), cell adhesion (), epithelial-mesenchymal transition (), and airway hyperreactivity and remodeling (, ), and several were linked to asthma in genome- (e.g., , ) or epigenome-wide association studies (, , , ). Signaling pathways inferred from the co-expression pattern were associated with airway remodeling (e.g., TGF-β/Smad2/3, E2F/Rb, and Wnt/β-catenin).