Differential modulation of allergic rhinitis nasal transcriptome by dupilumab and allergy immunotherapy

Abstract

BackgroundNasal epithelial cells are important regulators of barrier function and immune signaling; however, in allergic rhinitis (AR) these functions can be disrupted by inflammatory mediators. We aimed to better discern AR disease mechanisms using transcriptome data from nasal brushing samples from individuals with and without AR.MethodsData were drawn from a feasibility study of individuals with and without AR to Timothy grass and from a clinical trial evaluating 16 weeks of treatment with the following: dupilumab, a monoclonal antibody that binds interleukin (IL)‐4Rα and inhibits type 2 inflammation by blocking signaling of both IL‐4/IL‐13; subcutaneous immunotherapy with Timothy grass (SCIT), which inhibits allergic responses through pleiotropic effects; SCIT + dupilumab; or placebo. Using nasal brushing samples from these studies, we defined distinct gene signatures in nasal tissue of AR disease and after nasal allergen challenge (NAC) and assessed how these signatures were modulated by study drug(s).ResultsTreatment with dupilumab (normalized enrichment score [NES] = −1.73, p = .002) or SCIT + dupilumab (NES = −2.55, p < .001), but not SCIT alone (NES = +1.16, p = .107), significantly repressed the AR disease signature. Dupilumab (NES = −2.55, p < .001), SCIT (NES = −2.99, p < .001), and SCIT + dupilumab (NES = −3.15, p < .001) all repressed the NAC gene signature.ConclusionThese results demonstrate type 2 inflammation is an important contributor to the pathophysiology of AR disease and that inhibition of the type 2 pathway with dupilumab may normalize nasal tissue gene expression.

Dupilumab dampens mucosal type 2 response during acetylsalicylic acid challenge in N-ERD patients

“…This is in agreement with previous studies which found ALOX15 to be downregulated after dupilumab treatment. 38 At the same time, CYP1B1 encoding cytochrome P450, which is responsible for metabolizing arachidonic acid to 20-hydroxyeicosatetraenoic acid and has been shown to lead to relaxation of airways 20,39 , was strongly downregulated during provocation one but not provocation two. This could indicate that long-term treatment with the anti-IL-4Rα inhibitor dupilumab may ameliorate the imbalance in the arachidonic acid pathway.…”