Immunopathogenesis of allergic bronchopulmonary aspergillosis and airway remodeling.

  title={Immunopathogenesis of allergic bronchopulmonary aspergillosis and airway remodeling.},
  author={Henk F. Kauffman},
  journal={Frontiers in bioscience : a journal and virtual library},
  • H. Kauffman
  • Published 2003
  • Biology, Medicine
  • Frontiers in bioscience : a journal and virtual library
Allergic bronchopulmonary aspergillosis (ABPA) is a hypersensitivity lung disease clinically characterized by manifestation of wheezing, pulmonary infiltrates and bronchiectasis and fibrosis which afflicts asthmatic and cystic fibrosis (CF) patients. The pathophysiologic mechanisms are mediated by a first and direct interaction of Aspergillus fumigatus (Af) antigens with airway epithelial cells, followed by an immunologic/allergic inflammatory response to Af antigens. In the first phase, Af… 

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Pathophysiology and immunology of allergic bronchopulmonary aspergillosis.

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ABPA is characterized by marked local and systemic eosinophilia, an adaptive immune response with elevated levels of A. fumigatus-specific IgG, IgA and IgE antibodies, and a profound nonspecific IL-4-dependent elevation in total IgE.

Allergic bronchopulmonary aspergillosis in patients with cystic fibrosis

Diagnosis of ABPA in CF patients should be sought in those with evidence of clinical and radiologic deterioration that is not attributable to another etiology, a markedly elevated total serum IgE level (while off steroid therapy) and evidence of A. fumigatus sensitization.

Immune regulation during allergic bronchopulmonary mycosis

Observations from both models underline the importance of initial innate immune responses and their translation into appropriate adaptive responses and data derived from knockout studies give emphasis to targeting cytokines and chemokines as a therapeutic strategy in the treatment of ABPM.

Allergic bronchopulmonary aspergillosis: review of literature and proposal of new diagnostic and classification criteria

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The importance of recognizing ABPA relates to the improvement of patient symptoms, and delay in development or prevention of bronchiectasis, one manifestation of permanent lung damage in ABPA.

Chemokines indicate allergic bronchopulmonary aspergillosis in patients with cystic fibrosis.

Longitudinally, levels of TARC indicate ABPA exacerbations, suggesting TARC as a marker for identification and monitoring of ABPA in patients with CF.

Review of current and future therapeutics in ABPA

New treatments including novel antifungal agents, monoclonal antibodies against aspects of the adaptive immune response as well as targeted immunotherapies may be better tolerated and achieve improved outcomes but have not yet been studied in large-scale randomised control trials.

Asthma and Fungus: Role in Allergic Bronchopulmonary Aspergillosis (ABPA) and Other Conditions

It is also imperative to establish validated clinical definitions of fungal allergic manifestations in pediatric patients with asthma to fully understand this complex interaction.

Allergic bronchopulmonary aspergillosis

Early diagnosis and appropriate treatment can delay (or even prevent) the onset of bronchiectasis, which suggests that all patients of bronchial asthma should be screened for ABPA, especially in chest clinics.

Aspergillus Species in Bronchiectasis: Challenges in the Cystic Fibrosis and Non-cystic Fibrosis Airways

Questions remain including if fungal epidemiology in bronchiectasis is uniform across countries, and to what extent immunopathological mechanisms—related to fungal airway infections—occurs in different disease states.

Allergic Bronchopulmonary Aspergillosis: A Diagnostic Challenge

D diagnosis of ABPA can be missed due to general unfamiliarity with this entity and its clinical presentation similar to the lung tumor, but accurate diagnosis can be derived from the bronchial washing if the features of “allergic mucin” are recognized and confirmed with microbiological examination.




Enhanced Pulmonary Allergic Responses to Aspergillus in CCR2−/− Mice1

Findings demonstrate that CCR2 plays an important role in the immune response against A. fumigatus, thereby limiting the allergic airway inflammatory and remodeling responses to this fungus.

Immunologic studies in bronchoalveolar fluid in a patient with allergic bronchopulmonary aspergillosis.

A pathologic study of allergic bronchopulmonary aspergillosis.

Allergens as proteases: an Aspergillus fumigatus proteinase directly induces human epithelial cell detachment.

Asp f I CD4+ TH2-like T-cell lines in allergic bronchopulmonary aspergillosis.

Asp f I-specific T-cell lines established from patients with ABPA were characterized as being CD4+ TH2-like in their cytokine synthesis pattern, and secreted IL-4 behaved in an autocrine fashion, stimulating proliferation.

Activated T cells and cytokines in bronchoalveolar lavages from patients with various lung diseases associated with eosinophilia.

In conclusion, whereas increased IL-4 levels were found only in diseases characterized by increased IgE production, IL-5 was elevated in all patients with increased numbers of eosinophils and may represent the ongoing inflammatory responses.

Serum IgA antibodies to Aspergillus fumigatus in various stages of allergic bronchopulmonary aspergillosis.

Proteases from Aspergillus fumigatus induce release of proinflammatory cytokines and cell detachment in airway epithelial cell lines.

It was shown that fungal serine protease activity induced the production of interleukin (IL)-8 and IL-6 and monocyte chemotactic protein-1 and caused cell detachment in a dose-dependent fashion and by eliciting a cytokine response, the epithelium may signal the mucosal inflammatory response against A. fumigatus.