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The airway fungal microbiome in asthma.

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journal contribution
posted on 23.07.2021, 10:38 by Eva-Maria Rick, Kerry F Woolnough, Paul J Seear, Abbie Fairs, Jack Satchwell, Matthew Richardson, William R Monteiro, Michelle Craner, Michelle Bourne, Andrew J Wardlaw, Catherine H Pashley
BACKGROUND:Fungal involvement in asthma is associated with severe disease. The full spectrum of fungal species in asthma is not well described and is derived largely from insensitive culture techniques. OBJECTIVES:To use high-throughput sequencing to describe the airway mycobiota in asthmatics with and without fungal-sensitisation and healthy controls; to compare samples representing different airway compartments; to determine if the mycobiota was influenced by the fungal composition of outdoor air, and to compare findings with clinically relevant outcomes. METHODS:We amplified the internal transcribed spacer region 2 of the nuclear ribosomal operon to identify the fungal species present. Ninety-seven subjects were recruited and provided sputum (83 asthmatics; 14 healthy subjects), with 29 also undergoing a bronchoscopy. A subset of airway samples were compared with matched outdoor air and mouthwash samples. RESULTS:Two hundred and six taxa at the species level were identified in sputum, most at low relative abundance. Aspergillus fumigatus, Candida albicans and Mycosphaerella tassiana had the highest relative abundances and were the most prevalent species across all subjects. The airway mycobiota consisted of a complex community with high diversity between individuals. Notable shifts in the balance of fungi detected in the lung were associated with asthma status, asthma duration and biomarkers of inflammation. Aspergillus tubingensis, a member of the Aspergillus niger species complex, was most prevalent from bronchoscopic protected brush samples and significantly associated with a low sputum neutrophilia. Cryptococcus pseudolongus, from the Cryptococcus humicola species complex, was more abundant from bronchoscopy samples than sputum, and differentially more abundant in asthma than health. CONCLUSIONS AND CLINICAL RELEVANCE:The airway mycobiota was dominated by a relatively small number of species, but was distinct from the oropharyngeal mycobiota and air samples. Members of the Aspergillus niger and Cryptococus humicola species complexes may play unexpected roles in the pathogenesis of asthma.

Funding

The research was supported by the NIHR Leicester Biomedical Research Centre, the Midlands Asthma and Allergy Research Association (MAARA), Asthma UK (AUK-PHD-2013-250) and the Henry Smith Charity, the Academy of Medical Sciences [SBF003\1125], the Wellcome Trust, the Government Department of Business, Energy and Industrial Strategy and the British Heart Foundation

History

Citation

Rick, E-M, Woolnough, KF, Seear, PJ, et al. The airway fungal microbiome in asthma. Clin Exp Allergy. 2020; 50: 1325– 1341. https://doi.org/10.1111/cea.13722

Author affiliation

Department of Respiratory Sciences

Version

VoR (Version of Record)

Published in

Clinical and Experimental Allergy

Volume

50

Pagination

1325– 1341

Publisher

Wiley

issn

0954-7894

eissn

1365-2222

Acceptance date

08/08/2020

Copyright date

2020

Available date

23/07/2021

Spatial coverage

England

Language

eng