Asthma is a chronic, inflammatory disease of the lung that currently afflicts more than 300 million people worldwide. While asthma is mediated by an excessive Th2 immune response to allergens, recent evidence suggests that production of the Th17 cytokine, IL-17A, is associated with the development of more severe disease. While severe asthmatics are at greatest risk for morbidity or death following acute exacerbations, and can be refractory to therapies that are highly effective in individuals with mild disease, the molecular mechanisms whereby IL-17A contributes to the development of severe allergic asthma are ill-defined. A greater understanding of the molecular mechanisms through which IL-17A facilitates severe asthma would provide additional therapeutic targets for populations underserved by current therapies. Using a mouse model we provide evidence that severe asthma is associated with increased IL-17A production, and is compounded by enhanced Il17ra expression and elevated responsiveness to IL-17A. These alterations in IL-17A production and responsiveness exacerbate IL-13-driven STAT6 activation, gene expression, and airway responses. Our preliminary data suggests that IL-17A-mediated enhancement of IL-13-driven responses occur through two, non-mutually independent mechanisms in mouse cells;1) by causing the dissociation of a complex including IL-13R?1 and TRAF3, which normally limits IL-13-driven STAT6 phosphorylation, and 2) by activating transcription factors (NF-?B, C/EBP? and C/EBP?) which can enhance IL-13/STAT6 driven gene expression. While preliminary studies presented here also suggest that similar mechanisms may operate in human cell lines, the extent to which the observations made in our mouse model apply to humans with severe asthma is unclear.
Three specific aims are proposed to identify the molecular mechanisms through which IL-17A enhances asthma severity in mice, and humans.
Specific Aim 1 will determine if the increased IL-13-driven STAT6 phosphorylation and AHR observed in the presence of IL-17A is the result of the dissociation of the IL- 13R?1:TRAF3 complex following initiation of IL-17A signaling.
Specific Aim 2 will dissect the importance of IL- 17A-driven activation of NF-?B (canonical versus non-canonical), C/EBP? and C/EBP? in IL-13/IL-17A synergy in vitro and in vivo.
Specific Aim 3 will directly test whether similar synergistic interactions between IL-13 and IL-17A are observed in asthma relevant, primary human cells. Additionally, we will determine whether severe asthma in children is associated, as it is in the mouse, with increased IL-17A production, IL17RA expression, and IL-17A responsiveness. Collectively, the studies proposed in this application will move us beyond the "Th2 paradigm" of allergic asthma, begin to characterize the mechanisms whereby Th17-products trigger the development of severe allergic asthma, and determine whether similar mechanisms may be at play in mice and humans. A better understanding of these mechanisms will enable us to identify novel targets for therapeutic interventions in individuals with severe asthma, a population underserved by current therapies.

Public Health Relevance

Elevated IL-17A levels have been linked to the development of severe asthma in humans, a debilitating, treatment-resistant form of allergic asthma that accounts for the majority of asthma-related mortality and morbidity. However, the mechanisms through which IL-17A exacerbates disease severity remain unclear, representing an important knowledge gap that is preventing the development of novel treatments that directly address the unique disease processes driving pathogenesis in severe asthma. The long term goal of the current project is the design of novel therapeutics that specifically disease in severe asthmatics, a population underserved by current treatments.

National Institute of Health (NIH)
Research Project (R01)
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Special Emphasis Panel (ZRG1)
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Noel, Patricia
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