Asthma outcomes: Biomarkers

• Published in: Journal of allergy and clinical immunology 2012-03, Vol.129 (3), p.S9-S23
• Main Authors: Szefler, Stanley J., MD, Wenzel, Sally, MD, Brown, Robert, MD, MPH, Erzurum, Serpil C., MD, Fahy, John V., MD, MSc, Hamilton, Robert G., PhD, Hunt, John F., MD, Kita, Hirohito, MD, Liu, Andrew H., MD, Panettieri, Reynold A., MD, Schleimer, Robert P., PhD, Minnicozzi, Michael, PhD
• Format: Article
• Language: English
• Subjects: Allergens - immunology; Allergies; Allergy and Immunology; Asthma - metabolism; Asthma - physiopathology; Asthma - therapy; Automation; Biomarkers; Biomarkers - metabolism; Biomedical Research - standards; Breath Tests - methods; Clinical trials; Disease; Eosinophils; Exhalation; fractional exhaled nitric oxide; Humans; Hypersensitivity, Immediate - diagnosis; IgE; Immunoglobulin E - blood; Leukotriene E4 - urine; Multiallergen screen; Nitric Oxide - metabolism; Population; Reporting requirements; Sputum - cytology; sputum eosinophils; Studies; total eosinophils; urinary leukotriene E4
• ISSN: 0091-6749; 1097-6825
• DOI: 10.1016/j.jaci.2011.12.979

Background Measurement of biomarkers has been incorporated within clinical research studies of asthma to characterize the population and associate the disease with environmental and therapeutic effects. Objective National Institutes of Health institutes and federal agencies convened an expert group to propose which biomarkers should be assessed as standardized asthma outcomes in future clinical research studies. Methods We conducted a comprehensive search of the literature to identify studies that developed and/or tested asthma biomarkers. We identified biomarkers relevant to the underlying disease process progression and response to treatment. We classified the biomarkers as either core (required in future studies), supplemental (used according to study aims and standardized), or emerging (requiring validation and standardization). This work was discussed at an National Institutes of Health–organized workshop convened in March 2010 and finalized in September 2011. Results Ten measures were identified; only 1, multiallergen screening to define atopy, is recommended as a core asthma outcome. Complete blood counts to measure total eosinophils, fractional exhaled nitric oxide (F eno ), sputum eosinophils, urinary leukotrienes, and total and allergen-specific IgE are recommended as supplemental measures. Measurement of sputum polymorphonuclear leukocytes and other analytes, cortisol measures, airway imaging, breath markers, and system-wide studies (eg, genomics, proteomics) are considered as emerging outcome measures. Conclusion The working group participants propose the use of multiallergen screening in all asthma clinical trials to characterize study populations with respect to atopic status. Blood, sputum, and urine specimens should be stored in biobanks, and standard procedures should be developed to harmonize sample collection for clinical trial biorepositories.