Analysis of the fungal microbiome in exhaled breath condensate of patients with asthma

Carpagnano, Giovanna Elisiana; Malerba, Mario; Lacedonia, Donato; Susca, Antonia; Logrieco, Antonio F.; Carone, Mauro; Cotugno, Grazia; Palmiotti, Giuseppe Antonio

doi:10.2500/aap.2016.37.3943

Cited by 24 publications

(22 citation statements)

References 29 publications

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“…Moreover, although this review focuses on the bacterial microbiome in asthma, there are many other microbial organisms (fungi and other eukarya, and viruses) that also play key roles in host physiology and immune development [6, 76–79]. Also, with the characterization of other microbiomes within the human body (i.e.…”

Section: Discussionmentioning

confidence: 99%

Asthma and the microbiome: defining the critical window in early life

Stiemsma

Turvey

2017

Allergy Asthma Clin Immunol

144

131

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Asthma is a chronic inflammatory immune disorder of the airways affecting one in ten children in westernized countries. The geographical disparity combined with a generational rise in prevalence, emphasizes that changing environmental exposures play a significant role in the etiology of this disease. The microflora hypothesis suggests that early life exposures are disrupting the composition of the microbiota and consequently, promoting immune dysregulation in the form of hypersensitivity disorders. Animal model research supports a role of the microbiota in asthma and atopic disease development. Further, these model systems have identified an early life critical window, during which gut microbial dysbiosis is most influential in promoting hypersensitivity disorders. Until recently this critical window had not been characterized in humans, but now studies suggest that the ideal time to use microbes as preventative treatments or diagnostics for asthma in humans is within the first 100 days of life. This review outlines the major mouse-model and human studies leading to characterization of the early life critical window, emphasizing studies analyzing the intestinal and airway microbiotas in asthma and atopic disease. This research has promising future implications regarding childhood immune health, as ultimately it may be possible to therapeutically administer specific microbes in early life to prevent the development of asthma in children.

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Section: Discussionmentioning

confidence: 99%

Asthma and the microbiome: defining the critical window in early life

Stiemsma

Turvey

2017

Allergy Asthma Clin Immunol

144

131

View full text Add to dashboard Cite

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“…A study comparing EBC and sputum samples from asthma patients showed a 100% overlap in the culturable fungi identified between the two sample types (5), and a study examining the bacterial pathogens cultured from BAL and EBC samples in patients with ventilator-associated pneumonia showed a high concordance between the two sampling methods (16). In comparison, when PCR assays for 10 common respiratory pathogens were performed on EBC and sputum samples from chronic obstructive pulmonary disease patients, the results were found not to correlate well (17).…”

Section: Discussionmentioning

confidence: 99%

Microbiota in Exhaled Breath Condensate and the Lung

Glendinning

Wright

Tennant

et al. 2017

Appl Environ Microbiol

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The lung microbiota is commonly sampled using relatively invasive bronchoscopic procedures. Exhaled breath condensate (EBC) collection potentially offers a less invasive alternative for lung microbiota sampling. We compared lung microbiota samples retrieved by protected specimen brushings (PSB) and exhaled breath condensate collection. We also sought to assess whether aerosolized antibiotic treatment would influence the lung microbiota and whether this change could be detected in EBC. EBC was collected from 6 conscious sheep and then from the same anesthetized sheep during mechanical ventilation. Following the latter EBC collection, PSB samples were collected from separate sites within each sheep lung. On the subsequent day, each sheep was then treated with nebulized colistimethate sodium. Two days after nebulization, EBC and PSB samples were again collected. Bacterial DNA was quantified using 16S rRNA gene quantitative PCR. The V2-V3 region of the 16S rRNA gene was amplified by PCR and sequenced using Illumina MiSeq. Quality control and operational taxonomic unit (OTU) clustering were performed with mothur. The EBC samples contained significantly less bacterial DNA than the PSB samples. The EBC samples from anesthetized animals clustered separately by their bacterial community compositions in comparison to the PSB samples, and 37 bacterial OTUs were identified as differentially abundant between the two sample types. Despite only low concentrations of colistin being detected in bronchoalveolar lavage fluid, PSB samples were found to differ by their bacterial compositions before and after colistimethate sodium treatment. Our findings indicate that microbiota in EBC samples and PSB samples are not equivalent.IMPORTANCE Sampling of the lung microbiota usually necessitates performing bronchoscopic procedures that involve a hospital visit for human participants and the use of trained staff. The inconvenience and perceived discomfort of participating in this kind of research may deter healthy volunteers and may not be a safe option for patients with advanced lung disease. This study set out to evaluate a less invasive method for collecting lung microbiota samples by comparing samples taken via protected specimen brushings (PSB) to those taken via exhaled breath condensate (EBC) collection. We found that there was less bacterial DNA in EBC samples compared with that in PSB samples and that there were differences between the bacterial communities in the two sample types. We conclude that while EBC and PSB samples do not produce equivalent microbiota samples, the study of the EBC microbiota may still be of interest.

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“…Ergosterol has also demonstrated a low affinity for the development of asthma [52]. However, exposure to fungal spores has been shown by multiple studies in adults to be associated with asthma exacerbations; yet, there are very few studies involving children [53][54][55]. In a study analyzing the fungal microbiome in exhaled breath condensate (EBC) of patients with asthma in Italy, Carpagnano et al [53] found that in 47 adults with asthma, 94% of the people were colonized in the EBC by Cladodosporium species, 21% by Alternaria, and 24% by Penicillium species [53].…”

Section: Endotoxinmentioning

confidence: 99%

“…However, exposure to fungal spores has been shown by multiple studies in adults to be associated with asthma exacerbations; yet, there are very few studies involving children [53][54][55]. In a study analyzing the fungal microbiome in exhaled breath condensate (EBC) of patients with asthma in Italy, Carpagnano et al [53] found that in 47 adults with asthma, 94% of the people were colonized in the EBC by Cladodosporium species, 21% by Alternaria, and 24% by Penicillium species [53]. Fungal colonization tended to be higher in asthmatics with severe and uncontrolled asthma with sensitization to fungal species such as Alternaria [53][54][55].…”

Section: Endotoxinmentioning

confidence: 99%

The Impact of Ambient Environmental Exposures to Microbial Products on Asthma Outcomes from Birth to Childhood

Howard

Orhurhu

Huang

et al. 2019

Curr Allergy Asthma Rep

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Purpose of Review Asthma is a chronic respiratory condition with increasing domestic and worldwide prevalence that burdens individuals and the healthcare system with high costs associated with long-term treatments and acute emergency room (ER) visits. It can be triggered by ambient microbes, including bacteria, viruses, and fungi. In this review, we examine the outcomes of asthma patients in relation to environmental exposures to ambient microbe products, focusing on whether exposure leads to asthma development from birth to childhood and if particular microbes are associated with worsened asthma exacerbations. Recent Findings Bacterial endotoxin is more prominent in homes with pets and may cause cytokine cascades that lead to asthma exacerbation. However, some studies have demonstrated a protective effect with early exposure. Patients with positive Aspergillus skin testing are more prone to moderate-severe or severe-uncontrolled asthma. Fungal sensitization is also associated with earlier onset of asthma and demonstrates a dose-dependent relationship of symptom severity and duration. Among viruses, rhinovirus has the greatest association with decreased lung function, severe asthma, and asthma-related hospital admissions. Distribution of microbial products and associated asthma symptoms depends on the geographical climate. Genetic variations among individuals also mitigate the effects of microbial products on asthma development and symptom severity. Summary Microbial products of bacteria, fungi, and viruses are associated with the development of asthma, more severe asthma symptoms, and worse outcomes. However, some early exposure studies have also demonstrated a protective effect. Bacterial and fungal products are related to decreased lung function and earlier onset of asthma. Viral products are related to asthma-associated hospital admissions; and the climate and patient genetics can also temper or intensify the relationships between microbial products, asthma development, and asthma symptom severity. Further research should focus on the effects of early microbe exposure and its interaction with human immune systems and asthma-related outcomes.

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Analysis of the fungal microbiome in exhaled breath condensate of patients with asthma

Abstract: When considering the high morbidity and mortality of patients with severe asthma in whom we found an important fungal airways colonization, we support the use of the analysis of exhaled fungal microbiome in these subjects.

Cited by 24 publications

References 29 publications

Asthma and the microbiome: defining the critical window in early life

Asthma and the microbiome: defining the critical window in early life

Microbiota in Exhaled Breath Condensate and the Lung

The Impact of Ambient Environmental Exposures to Microbial Products on Asthma Outcomes from Birth to Childhood

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