Reply to comment on “Therapeutic Application of an Extract of Helicobacter pylori Ameliorates the Development of Allergic Airway Disease.”
Yolanda van Wijck*†, Pieter S. Hiemstra*†, Christian Taube*‡†
* Department of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands
‡ Present address: Department of Pulmonary Medicine, University Hospital Essen, Ruhrlandklinik, West German Lung Center, Essen, Germany
† Authors contributed equally
Conflict of interest: None declared
Corresponding author:
Yolanda van Wijck, Department of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands
phone: +31-71-5262950
fax: +31-71-5266877
e-mail: y.van_wijck@lumc.nl
To the Editor,
We would like to thank Kountouras and colleagues for their interest in our work and their comments to our publication. Kountouras et al. argue that a low infection rate with H. pylori and a high prevalence of asthma do not have to be associated, as there are certain areas with low asthma incidence despite low H. pylori infection rates. Indeed, asthma is a multifactorial disease that can be influenced by many factors such as genetics, diet, as well as exposure to environmental factors like pollution and microbial compounds. Therefore, it could be speculated that depending on the surrounding environment different factors might be predominant. Some epidemiological data has suggested that infection with H. pylori might play a role in determining asthma susceptibility(1, 2). In addition several experimental studies have investigated the underlying molecular mechanism(3, 4). However, these findings do not show that infection with H. pylori is the only factor influencing the development of asthma and it is completely plausible
that in different surroundings, other factors might be predominant in determining asthma susceptibility.
Kountouras et al. also argue that infection with H. pylori is associated with a higher risk on adult onset asthma, and that European children infected with a CagA-negative strain are more likely to develop asthma. Indeed, it has been shown that the protective effect of experimental infection for development of allergic airways inflammation is more effective in neonatal mice than in adult mice(3). In addition, CagA-deficient H. pylori strains could still inhibit allergic airways inflammation AAI in murine models (3). However, the focus of the present paper was on the use of bacterial lysates as a novel treatment option for allergic airway disease.
We completely agree that negative effects of an infection with H. pylori on health (ulcers, cancer and other) need to be considered and we clearly postulate that eradication therapy should be considered in patients infected with H. pylori. Our study does show that in addition to experimental infection, also administration of bacterial lysates can ameliorate allergic airway disease, which potential avoids all the drawbacks of live infection. Preliminary data shows that also on cultured human cells the extract can induce tolerance (unpublished observations, Y. van Wijck), and already some bacterial compounds have been identified which might be candidate
molecules which need to be further evaluated. This could lead to novel approaches for treatment of asthma.
1. Taube, C., and A. Muller. 2012. The role of Helicobacter pylori infection in the development of allergic asthma. Expert review of respiratory medicine 6: 441-449.
2. Smits, H. H., P. S. Hiemstra, C. Prazeres da Costa, M. Ege, M. Edwards, H. Garn, P. H.
Howarth, T. Jartti, E. C. de Jong, R. M. Maizels, B. J. Marsland, H. J. McSorley, A.
Muller, P. I. Pfefferle, H. Savelkoul, J. Schwarze, W. W. Unger, E. von Mutius, M.
Yazdanbakhsh, and C. Taube. 2016. Microbes and asthma: Opportunities for intervention.
The Journal of allergy and clinical immunology 137: 690-697.
3. Arnold, I. C., N. Dehzad, S. Reuter, H. Martin, B. Becher, C. Taube, and A. Muller. 2011.
Helicobacter pylori infection prevents allergic asthma in mouse models through the induction of regulatory T cells. The Journal of clinical investigation 121: 3088-3093.
4. Oertli, M., M. Sundquist, I. Hitzler, D. B. Engler, I. C. Arnold, S. Reuter, J. Maxeiner, M.
Hansson, C. Taube, M. Quiding-Jarbrink, and A. Muller. 2012. DC-derived IL-18 drives
Treg differentiation, murine Helicobacter pylori-specific immune tolerance, and asthma protection. The Journal of clinical investigation 122: 1082-1096.
