Immunological corollary of the pulmonary mycobiome in bronchiectasis: The Cameb study

Micheál Mac Aogáin, Ravishankar Chandrasekaran, Albert Lim Yick Hou, Low Teck Boon, Gan Liang Tan, Tidi Hassan, Ong Thun How, Amanda Hui Qi Ng, Denis Bertrand, Jia Yu Koh, Sze Lei Pang, Zi Yang Lee, Xiao Wei Gwee, Christopher Martinus, Yang Yie Sio, Sri Anusha Matta, Fook Tim Chew, Holly R. Keir, John E Connolly, John Arputhan AbisheganadenMariko Siyue Koh, Niranjan Nagarajan, James D. Chalmers, Sanjay H. Chotirmall

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Abstract

Introduction: Understanding the composition and clinical importance of the fungal mycobiome was recently identified as a key topic in a "research priorities" consensus statement for bronchiectasis. Methods: Patients were recruited as part of the CAMEB study: an international multicentre cross-sectional Cohort of Asian and Matched European Bronchiectasis patients. The mycobiome was determined in 238 patients by targeted amplicon shotgun sequencing of the 18S-28S rRNA internally transcribed spacer regions ITS1 and ITS2. Specific qPCR for detection of and conidial quantification for a range of airway Aspergillus species was performed. Sputum galactomannan, Aspergillus-specific IgE, IgG and Thymus and Activation Regulated Chemokine levels were measured systemically and associated to clinical outcomes. Results: The bronchiectasis mycobiome is distinct, and characterised by specific fungal genera including Aspergillus, Cryptococcus, and ClavisporaA. fumigatus (in Singapore/Kuala Lumpur) and A. terreus (in Dundee) dominated profiles, the latter associating with exacerbations. High frequencies of Aspergillus-associated disease including sensitization and allergic bronchopulmonary aspergillosis were detected. Each revealed distinct mycobiome profiles and associated with more severe disease, poorer pulmonary function and increased exacerbations. Conclusion: The pulmonary mycobiome is of clinical relevance in bronchiectasis. Screening for Aspergillus-associated disease should be considered even in apparently stable patients.

Original languageEnglish
Article number1800766
Pages (from-to)1-14
Number of pages14
JournalEuropean Respiratory Journal
Volume52
Issue number1
Early online date7 Jun 2018
DOIs
Publication statusPublished - Jul 2018

Keywords

  • Fungi
  • Aspergillus
  • microbiome
  • mycobiome
  • bronchiectasis

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