Metabolomic fingerprinting and systemic inflammatory profiling of asthma COPD overlap (ACO)

• Published in: Respiratory research Vol. 21; no. 1; pp. 126 - 16
• Main Authors: Ghosh, Nilanjana, Choudhury, Priyanka, Kaushik, Sandeep Rai, Arya, Rakesh, Nanda, Ranjan, Bhattacharyya, Parthasarathi, Roychowdhury, Sushmita, Banerjee, Rintu, Chaudhury, Koel
• Format: Journal Article
• Language: English
• Published: London BioMed Central 24.05.2020; BioMed Central Ltd; Nature Publishing Group; BMC
• Subjects: Adult; Asthma; Asthma - genetics; Asthma - metabolism; Asthma COPD overlap (ACO); Cerebrospinal fluid; Chitinase; Cholesterol; Chronic obstructive lung disease; Chronic obstructive pulmonary disease; Cohort Studies; Colony-stimulating factor; Diagnostic systems; Disease; DNA Fingerprinting - methods; Energy metabolism; Eotaxin; Ethanolamine; Fatty acids; Female; Fingerprinting; Gas chromatography; Gene Expression Profiling - methods; Granulocyte-macrophage colony-stimulating factor; Growth factors; Humans; Immunology; Inflammation; Inflammation Mediators - metabolism; Inflammatory mediators; Interferon; Interleukin 10; Interleukin 12; Interleukin 13; Interleukin 18; Interleukin 2; Interleukin 4; Interleukin 5; Interleukin 6; Interleukin 8; Interleukins; Lactic acid; Male; Mannose; Markers; Mass spectrometry; Medicine; Medicine & Public Health; Metabolism; Metabolites; Metabolomics; Metabolomics - methods; Methods; Middle Aged; Monocyte chemoattractant protein 1; NMR; Nuclear magnetic resonance; Patients; Physiological aspects; Pilot Projects; Pneumology/Respiratory System; Pulmonary Disease, Chronic Obstructive - genetics; Pulmonary Disease, Chronic Obstructive - metabolism; Random Allocation; Respiratory function; Scientific imaging; Stearic acid; Succinic acid; Thymus; Taiwan; Metabolomics; Inflammatory mediators; Asthma COPD overlap (ACO); Mass spectrometry
• ISSN: 1465-993X; 1465-9921; 1465-993X
• DOI: 10.1186/s12931-020-01390-4

Background Asthma-COPD overlap (ACO) refers to a group of poorly studied and characterised patients reporting with disease presentations of both asthma and COPD, thereby making both diagnosis and treatment challenging for the clinicians. They exhibit a higher burden in terms of both mortality and morbidity in comparison to patients with only asthma or COPD. The pathophysiology of the disease and its existence as a unique disease entity remains unclear. The present study aims to determine whether ACO has a distinct metabolic and immunological mediator profile in comparison to asthma and COPD. Methods Global metabolomic profiling using two different groups of patients [discovery (D) and validation (V)] were conducted. Serum samples obtained from moderate and severe asthma [ n  = 34(D); n  = 32(V)], moderate and severe COPD [ n  = 30(D); 32(V)], ACO patients [ n  = 35(D); 40(V)] and healthy controls [ n  = 33(D)] were characterized using gas chromatography mass spectrometry (GC-MS). Multiplexed analysis of 25 immunological markers (IFN-γ (interferon gamma), TNF-α (tumor necrosis factor alpha), IL-12p70 (interleukin 12p70), IL-2, IL-4, IL-5, IL-13, IL-10, IL-1α, IL-1β, TGF-β (transforming growth factor), IL-6, IL-17E, IL-21, IL-23, eotaxin, GM-CSF (granulocyte macrophage-colony stimulating factor), IFN-α (interferon alpha), IL-18, NGAL (neutrophil gelatinase-associated lipocalin), periostin, TSLP (thymic stromal lymphopoietin), MCP-1 (monocyte chemoattractant protein- 1), YKL-40 (chitinase 3 like 1) and IL-8) was also performed in the discovery cohort. Results Eleven metabolites [serine, threonine, ethanolamine, glucose, cholesterol, 2-palmitoylglycerol, stearic acid, lactic acid, linoleic acid, D-mannose and succinic acid] were found to be significantly altered in ACO as compared with asthma and COPD. The levels and expression trends were successfully validated in a fresh cohort of subjects. Thirteen immunological mediators including TNFα, IL-1β, IL-17E, GM-CSF, IL-18, NGAL, IL-5, IL-10, MCP-1, YKL-40, IFN-γ, IL-6 and TGF-β showed distinct expression patterns in ACO. These markers and metabolites exhibited significant correlation with each other and also with lung function parameters. Conclusions The energy metabolites, cholesterol and fatty acids correlated significantly with the immunological mediators, suggesting existence of a possible link between the inflammatory status of these patients and impaired metabolism. The present findings could be possibly extended to better define the ACO diagnostic criteria, management and tailoring therapies exclusively for the disease.