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Asthma is a readily controllable condition for most asthmatics, but not all of them. For people with severe asthma – about five per cent of the 300 million sufferers worldwide – controlling a suffocating attack is difficult and scary because the steroids delivered by their inhalers simply don’t work well enough. Steroid resistance can leave severe asthmatics in need of hospital treatment as their medication isn’t effective. Overlord raising hell crackers free. Picture: Shutterstock A viral infection like influenza or a cold can trigger inflammation in the lungs that in some severe asthmatics isn’t eased by steroids.
Even worse, some asthmatics develop chronic steroid resistance. It means frequent visits to the hospital for treatment and in some cases even mechanical ventilation is needed to aid oxygen delivery. This involves sending oxygen into the lungs through a tube passed into the airway from the throat. But now researchers have the molecular process that triggers steroid resistance in an unlikely place – our body clocks. Uaz racing 4x4 ural call pc to cell text. And they’ve found a way to stop it in an even unlikelier place, a compound that was being developed in an attempt to treat people with drug and alcohol addictions. New inhaled treatment “The happenstance we see in biology is continually amazing, but this vulnerable group of asthmatics really need some happenstance,” says lead researcher Professor Alastair Stewart at the University of Melbourne.
“These severe asthmatics, are four times more likely to end up in hospital when their symptoms worsen than other asthmatics.” A therapy is now under development that may turn out to be the first really new inhaled asthma treatment since inhaled steroids were. Once the researchers establish the safety of the therapy they can start extensive clinical trials in a process that can take between six-to-eight years.
It was more than ten years ago that Professor Stewart’s lab team first discovered that a key protein involved in regulating our immune systems – – was part of the mechanism by which steroid resistance emerges in the lungs. The protein triggers a tissue repair response that can become chronic and, over time, scar and stiffen the lung tissue in a process call fibrosis. “We actually made this discovery by accident,” says Professor Stewart. “We’d been investigating how steroids influence the ability of TGF-Beta to turn surface lining cells into tissue cells. But when our lab experiments unexpectedly revealed that TGF-Beta could blunt the anti-inflammatory effects of steroids we refocused on that area.” A coloured red scanning electron micrograph of inner surface of a lung, showing close-up of alveoli, the tiny air-sacs in our lungs. Picture: David Gregory & Debbie Marshall/Wellcome Collection “It was an exciting discovery because it meant that if we could understand the mechanisms involved at a molecular level, we stood a good chance of unpicking this molecular machinery to restore steroid responsiveness.” Following the pathways TGF-Beta uses about 20 known different “pathways” or sequenced actions when it is activated by different mechanical and chemical signals sensed outside the lung cell. These pathways dictate which of TGF-Beta’s many functions the cell will perform.
“We now had a laundry list of different mechanisms that we simply had to go through.” But seven years later they were up a blind alley. After meticulously testing all the pathways they still had no idea how TGF-Beta triggered steroid resistance. It was a huge anticlimax, but secretly Professor Stewart was relieved. He knew that if a pathway involving many of the important actions of TGF-Beta had been found as the cause, it would have been incredibly difficult to safely block, as TGF-Beta is critical to our immune system and wound healing.
Simply “turning off” the TGF-Beta protein could be extremely toxic, putting people at risk of cancer and a host of autoimmune gut diseases like colitis. “The students were all disappointed, but I was quietly pleased. I knew that we didn’t want to be interfering with TGF-Beta too broadly because it is just too valuable to our immune surveillance,” says Professor Stewart. It was then that PhD student Meina Li began to probe whether the key could be found further down one of the molecular signal pathways that connect TGF-Beta to different cell actions. She began searching previous research on TGF-Beta, reviewing about a hundred papers going back over 20 years.