Abstract
Metabolomic indicators of asthma treatment responses have yet to be identified. In this study, we aimed to uncover plasma metabolomic profiles associated with asthma exacerbations while on inhaled corticosteroid (ICS) treatment. We determined whether these profiles change with age from adolescence to adulthood. We utilized data from 170 individuals with asthma on ICS from the Mass General Brigham Biobank to identify plasma metabolites associated with asthma exacerbations while on ICS and examined potential effect modification of metabolite-exacerbation associations by age. We used liquid chromatography–high-resolution mass spectrometry-based metabolomic profiling. Sex-stratified analyses were also performed for the significant associations. The age range of the participating individuals was 13–43 years with a mean age of 33.5 years. Of the 783 endogenous metabolites tested, eight demonstrated significant associations with exacerbation after correction for multiple comparisons and adjusting for potential confounders (Bonferroni p value < 6.2 × 10−4). Potential effect modification by sex was detected for fatty acid metabolites, with males showing a greater reduction in their metabolite levels with ICS exacerbation. Thirty-eight metabolites showed suggestive interactions with age on exacerbation (nominal p-value < 0.05). Our findings demonstrate that plasma metabolomic profiles differ for individuals who experience asthma exacerbations while on ICS. The differentiating metabolites may serve as biomarkers of ICS response and may highlight metabolic pathways underlying ICS response variability.
Highlights
Asthma imparts a tremendous global health and economic burden, affecting over 350 million people worldwide [1,2,3,4]
Study, [24] we examined plasma metabolomics to identify metabolites associated with asthma exacerbations while on inhaled corticosteroid (ICS)
There was no significant difference between ICS-asthmatics with and without exacerbation based on age, body mass index (BMI), and smoking status; exacerbation status differed by sex (p = 0.03) and race (p = 0.03)
Summary
Asthma imparts a tremendous global health and economic burden, affecting over 350 million people worldwide [1,2,3,4]. Inhaled corticosteroids (ICS) are the most commonly used controller medications for the treatment of individuals with moderate to severe asthma [10]. Approximately 25 to 35% of asthma patients either do not respond or respond poorly to ICS [11,12]. Metabolomics, the systematic analysis of small molecules in a biological sample, provides an integrated profile of genetics, environmental exposures, and phenotype, reflecting the “net results” of genetic, transcriptomic, proteomic, and environmental interactions, making it ideally suited to the study of asthma etiology and phenotypes [21,22]. Pharmacometabolomics is an emerging discipline that has the potential to improve our understanding of the mechanistic effects of drugs and inform precision medicine initiatives for individuals with asthma on ICS [23]
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