University of Pittsburgh Researchers Develop Non-Invasive Nasal Swab Test for Asthma Subtypes

A groundbreaking advancement in pediatric asthma diagnostics has emerged from the University of Pittsburgh. Researchers have developed a nasal swab test that can diagnose specific asthma subtypes, or endotypes, in children. This non-invasive method has the potential to revolutionize the way healthcare providers prescribe medications and could spawn new avenues of research into less common asthma types.

Pioneering Asthma Subtype Detection

The findings were recently published in the esteemed medical journal JAMA. They are based on comprehensive data from three distinct U.S. studies focusing on Puerto Rican and African American youth. These groups bear a disproportionately higher burden of asthma and more frequent fatalities as a result of the disease compared to non-Hispanic white children.

Asthma is the leading chronic disease among children and impacts minority populations such as Black and Puerto Rican kids more severely. Developing new treatments is crucial, and accurate diagnosis of asthma endotypes is the first step toward this goal. Because asthma varies widely and responds differently to treatments based on its endotype, understanding these differences is paramount.

Juan Celedón, M.D., Dr.P.H., senior author, professor of pediatrics at Pitt and chief of pulmonary medicine at UPMC Children’s Hospital of Pittsburgh

The Complexity of Asthma Endotypes

Asthma has historically been categorized into two primary endotypes: T2-high and T2-low. The T2-high subtype is characterized by significant T helper 2 inflammation, while T2-low has less such inflammation. Recent research has further refined T2-low into two distinct subtypes: T17-high, which features more T helper 17 inflammation, and low-low, marked by minimal inflammation of both T helper 2 and 17 types.

The Challenges of Accurate Diagnosis

Traditionally, establishing an asthma endotype requires genetic analysis of a lung tissue sample obtained through a bronchoscopy, a procedure involving general anesthesia. This invasive method is impractical and medically unethical for many children, particularly those with milder asthma cases. Consequently, healthcare professionals have relied on imperfect tools like blood immune markers, lung function assessments, and allergy presence to make presumptive diagnoses.

“These traditional methods help us infer if a child suffers from T2-high asthma, but they fall short of 100% accuracy,” explained Dr. Celedón. “They offer no insight into the T17-high and low-low endotypes, for which no clinical markers exist. This knowledge gap inspired our quest to refine asthma endotype diagnosis techniques.”

The Nasal Swab Breakthrough

Dr. Celedón and his team, spearheaded by first authors Molin Yue, a Pitt graduate student, and Kristina Gaietto, an instructor of pediatrics at Pitt, collected nasal epithelial samples from 459 participants across multiple studies. Their analysis concentrated on the expression of eight specific genes that are key indicators of T2 and T17 inflammation.

The results were promising and consistent across studies: 23% to 29% of participants exhibited a T2-high endotype, 35% to 47% were identified as T17-high, and 30% to 38% fell into the low-low category. The nasal swab test thus demonstrated its capability to diagnose these endotypes accurately.

Implications for Treatment and Research

The emergence of this rapid, non-invasive test for asthma endotypes is a significant leap forward. For severe T2-high asthma, the medical community already benefits from biologics, advanced drugs targeting immune cells responsible for the condition. However, there are currently no biologics designed to address T17-high or low-low endotypes.

“Now that we have an efficient nasal swab test to detect these other endotypes, the door is open for new research aimed at creating targeted biologics,” added Dr. Celedón. “This development will help in advancing personalized treatments, particularly for underserved communities.”

Supporting Research and Medical Advancements

Gustavo Matute-Bello, M.D., acting director of the Division of Lung Diseases at the National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health (NIH), highlighted the importance of this research, stating, “Having tools to identify which biological pathways dominate asthma in children, especially those disproportionately affected by the disease, may advance our goal of improving asthma management. This research could lead to more personalized treatments, particularly benefiting minority groups. Further studies will be necessary to build on these findings.”

Study Authors and Funding

Other contributors to the study included Yueh Ying Han, Franziska J. Rosser, Zhongli Xu, Christopher Qoyawayma, Erick Forno, and Wei Chen, all from Pitt and UPMC; and Edna Acosta-Perez and Glorisa Canino from the University of Puerto Rico.

The research received funding from various NIH grants, including HL079966, HL117191, HL150431, HL119952, UL1TR001857, HL129949, K08 HL159333, and HL149693. It is important to note that this content is the sole responsibility of the researchers and does not necessarily reflect the views of the NIH.

Conclusion

The University of Pittsburgh’s new nasal swab test represents a major milestone in asthma diagnostics for children. By enabling precise identification of T2-high, T17-high, and low-low asthma endotypes, this tool paves the way for more effective treatments and targeted research. As medical advancements continue in the field, personalized care for children with asthma will likely improve, addressing the specific needs of minority populations with heightened susceptibility to the disease.

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