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Article ; Online: Reply.

Guntur, Vamsi P / Moore, Camille M / Manka, Laurie A

The Journal of allergy and clinical immunology

2023 Volume 151, Issue 5, Page(s) 1411

Language	English
Publishing date	2023-03-03
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	121011-7
ISSN	1097-6825 ; 1085-8725 ; 0091-6749
ISSN (online)	1097-6825 ; 1085-8725
ISSN	0091-6749
DOI	10.1016/j.jaci.2023.01.025
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Article: Long COVID: Where Are We in 2023?

Regunath, Hariharan / Goldstein, Nir M / Guntur, Vamsi P

Missouri medicine

2023 Volume 120, Issue 2, Page(s) 102–105

MeSH term(s)	Humans ; Post-Acute COVID-19 Syndrome ; COVID-19
Language	English
Publishing date	2023-04-20
Publishing country	United States
Document type	Journal Article
ZDB-ID	427362-x
ISSN	0026-6620
ISSN	0026-6620
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Article ; Online: Sex and gender in asthma.

Chowdhury, Nowrin U / Guntur, Vamsi P / Newcomb, Dawn C / Wechsler, Michael E

European respiratory review : an official journal of the European Respiratory Society

2021 Volume 30, Issue 162

Abstract: Asthma is a heterogenous disease, and its prevalence and severity are different in ... ...

Abstract	Asthma is a heterogenous disease, and its prevalence and severity are different in males
MeSH term(s)	Adult ; Asthma/diagnosis ; Asthma/drug therapy ; Asthma/epidemiology ; COVID-19 ; Child ; Female ; Gonadal Steroid Hormones ; Humans ; Male ; Pregnancy ; Prevalence ; SARS-CoV-2 ; Sex Factors
Chemical Substances	Gonadal Steroid Hormones
Language	English
Publishing date	2021-11-17
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	1077620-5
ISSN	1600-0617 ; 0905-9180
ISSN (online)	1600-0617
ISSN	0905-9180
DOI	10.1183/16000617.0067-2021
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Article: Safety and efficacy of electronic cigarettes: a review.

Peralta, A Rolando / Guntur, Vamsi P

Missouri medicine

2014 Volume 111, Issue 3, Page(s) 238–244

Abstract: Tobacco smoking remains the highest cause of preventable deaths worldwide. Electronic cigarettes have recently become popular as nicotine alternatives. With public use on the rise and recent tobacco industry interest, field experts and regulatory ... ...

Abstract	Tobacco smoking remains the highest cause of preventable deaths worldwide. Electronic cigarettes have recently become popular as nicotine alternatives. With public use on the rise and recent tobacco industry interest, field experts and regulatory agencies voiced concerns about their safety and unregulated production. Electronic cigarettes are safer than conventional cigarettes and at least as safe as other approved nicotine replacement therapies. Further evidence is needed as their popularity increases amidst controversy over safety and efficacy.
MeSH term(s)	Equipment and Supplies ; Humans ; Nicotine/administration & dosage ; Nicotine/adverse effects ; Nicotinic Agonists/administration & dosage ; Nicotinic Agonists/adverse effects ; Perception ; Smoking/adverse effects ; Smoking/epidemiology ; Smoking Cessation/methods
Chemical Substances	Nicotinic Agonists ; Nicotine (6M3C89ZY6R)
Language	English
Publishing date	2014-07-10
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	427362-x
ISSN	0026-6620
ISSN	0026-6620
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Article ; Online: Efficacy and safety of reslizumab in the treatment of eosinophilic granulomatosis with polyangiitis.

Manka, Laurie A / Guntur, Vamsi P / Denson, Joshua L / Dunn, Ryan M / Dollin, Yeshai T / Strand, Matthew J / Wechsler, Michael E

Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology

2021 Volume 126, Issue 6, Page(s) 696–701.e1

Abstract: ... corticosteroid (P < .05). Of the 10 subjects, 3 experienced an EGPA exacerbation during the treatment. One had ...

Abstract	Background: Eosinophilic granulomatosis with polyangiitis (EGPA), a rare vasculitis with substantial morbidity, is characterized by asthma, eosinophilia, sinusitis, pulmonary infiltrates, neuropathy, positivity for antineutrophil cytoplasmic antibody, and multiorgan vasculitis. Although treatment options previously included corticosteroids and immunosuppressants, anti-interleukin 5 therapies have gained interest in EGPA treatment. Mepolizumab was approved for and recently benralizumab was found to have safety and efficacy in EGPA. Objective: To determine the safety and efficacy of reslizumab in EGPA. Methods: In this open-label, pilot study, we evaluated the safety and efficacy of intravenous reslizumab (3 mg/kg) in EGPA in 10 subjects. Oral corticosteroid dose, adverse events, exacerbations, symptom control, disease activity, blood markers, and lung function were evaluated before, during, and after 7 monthly reslizumab treatments. Results: Reslizumab was tolerated and resulted in a significant reduction in daily oral corticosteroid (P < .05). Of the 10 subjects, 3 experienced an EGPA exacerbation during the treatment. One had a severe adverse event, requiring removal from the study. Conclusion: Yielding similar results to other anti-interleukin 5 biologic medications, reslizumab is generally a safe and effective treatment for EGPA that warrants further study. Trial registration: ClinicalTrials.gov Identifier: NCT02947945.
MeSH term(s)	Adrenal Cortex Hormones/therapeutic use ; Adult ; Anti-Asthmatic Agents/adverse effects ; Anti-Asthmatic Agents/therapeutic use ; Antibodies, Monoclonal, Humanized/adverse effects ; Antibodies, Monoclonal, Humanized/therapeutic use ; Eosinophilia/drug therapy ; Female ; Granulomatosis with Polyangiitis/drug therapy ; Humans ; Interleukin-5/antagonists & inhibitors ; Male ; Middle Aged ; Prednisone/therapeutic use ; Treatment Outcome
Chemical Substances	Adrenal Cortex Hormones ; Anti-Asthmatic Agents ; Antibodies, Monoclonal, Humanized ; IL5 protein, human ; Interleukin-5 ; reslizumab (35A26E427H) ; Prednisone (VB0R961HZT)
Language	English
Publishing date	2021-02-04
Publishing country	United States
Document type	Clinical Trial ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1228189-x
ISSN	1534-4436 ; 0003-4738 ; 1081-1206
ISSN (online)	1534-4436
ISSN	0003-4738 ; 1081-1206
DOI	10.1016/j.anai.2021.01.035
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Article: Signatures of Mitochondrial Dysfunction and Impaired Fatty Acid Metabolism in Plasma of Patients with Post-Acute Sequelae of COVID-19 (PASC).

Guntur, Vamsi P / Nemkov, Travis / de Boer, Esther / Mohning, Michael P / Baraghoshi, David / Cendali, Francesca I / San-Millán, Inigo / Petrache, Irina / D'Alessandro, Angelo

Metabolites

2022 Volume 12, Issue 11

Abstract: Exercise intolerance is a major manifestation of post-acute sequelae of severe acute respiratory syndrome coronavirus infection (PASC, or "long-COVID"). Exercise intolerance in PASC is associated with higher arterial blood lactate accumulation and lower ... ...

Abstract	Exercise intolerance is a major manifestation of post-acute sequelae of severe acute respiratory syndrome coronavirus infection (PASC, or "long-COVID"). Exercise intolerance in PASC is associated with higher arterial blood lactate accumulation and lower fatty acid oxidation rates during graded exercise tests to volitional exertion, suggesting altered metabolism and mitochondrial dysfunction. It remains unclear whether the profound disturbances in metabolism that have been identified in plasma from patients suffering from acute coronavirus disease 2019 (COVID-19) are also present in PASC. To bridge this gap, individuals with a history of previous acute COVID-19 infection that did not require hospitalization were enrolled at National Jewish Health (Denver, CO, USA) and were grouped into those that developed PASC (n = 29) and those that fully recovered (n = 16). Plasma samples from the two groups were analyzed via mass spectrometry-based untargeted metabolomics and compared against plasma metabolic profiles of healthy control individuals (n = 30). Observational demographic and clinical data were retrospectively abstracted from the medical record. Compared to plasma of healthy controls or individuals who recovered from COVID-19, PASC plasma exhibited significantly higher free- and carnitine-conjugated mono-, poly-, and highly unsaturated fatty acids, accompanied by markedly lower levels of mono-, di- and tricarboxylates (pyruvate, lactate, citrate, succinate, and malate), polyamines (spermine) and taurine. Plasma from individuals who fully recovered from COVID-19 exhibited an intermediary metabolic phenotype, with milder disturbances in fatty acid metabolism and higher levels of spermine and taurine. Of note, depletion of tryptophan-a hallmark of disease severity in COVID-19-is not normalized in PASC patients, despite normalization of kynurenine levels-a tryptophan metabolite that predicts mortality in hospitalized COVID-19 patients. In conclusion, PASC plasma metabolites are indicative of altered fatty acid metabolism and dysfunctional mitochondria-dependent lipid catabolism. These metabolic profiles obtained at rest are consistent with previously reported mitochondrial dysfunction during exercise, and may pave the way for therapeutic intervention focused on restoring mitochondrial fat-burning capacity.
Language	English
Publishing date	2022-10-26
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662251-8
ISSN	2218-1989
ISSN	2218-1989
DOI	10.3390/metabo12111026
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Article ; Online: Characteristics and outcomes of ambulatory patients with suspected COVID-19 at a respiratory referral center.

Guntur, Vamsi P / Modena, Brian D / Manka, Laurie A / Eddy, Jared J / Liao, Shu-Yi / Goldstein, Nir M / Zelarney, Pearlanne / Horn, Carrie A / Keith, Rebecca C / Make, Barry J / Petrache, Irina / Wechsler, Michael E

Respiratory medicine

2022 Volume 197, Page(s) 106832

Abstract: Rationale: SARS-CoV-2 continues to cause a global pandemic and management of COVID-19 in outpatient settings remains challenging.: Objective: We sought to describe characteristics of patients with chronic respiratory disease (CRD) experiencing ... ...

Abstract	Rationale: SARS-CoV-2 continues to cause a global pandemic and management of COVID-19 in outpatient settings remains challenging. Objective: We sought to describe characteristics of patients with chronic respiratory disease (CRD) experiencing symptoms consistent with COVID-19, who were seen in a novel Acute Respiratory Clinic, prior to widely available testing, emergence of variants, COVID-19 vaccination, and post-vaccination (breakthrough) SARS-CoV-2 infections. Methods: Retrospective electronic medical record data were analyzed from 907 adults with presumed COVID-19 seen between March 16, 2020 and January 7, 2021. Data included demographics, comorbidities, medications, vital signs, laboratory tests, pulmonary function tests, patient disposition, and co-infections. The overdispersed data (aod) R package was used to create a logit model using COVID-19 diagnosis by PCR as the dichotomous outcome variable. Univariate, conventional multivariate and elastic net machine learning were used to analyze data. Results: Male gender, elevated baseline temperature, and respiratory rate predicted COVID-19 diagnosis. Eosinopenia, neutrophilia, and lymphocytosis were also associated with COVID-19 diagnosis. However, asthma and COPD diagnoses were not associated with SARS-CoV-2 PCR positive test. Male gender, low oxygen saturation, and lower forced expiratory volume in 1 s (FEV Conclusions: CRD patients with acute respiratory symptoms in the ambulatory setting were more likely to have COVID-19 if male, febrile and tachypneic. Patients with lower pre-morbid FEV
MeSH term(s)	Adult ; COVID-19/diagnosis ; COVID-19/epidemiology ; COVID-19 Testing ; COVID-19 Vaccines ; Fever/diagnosis ; Humans ; Male ; Referral and Consultation ; Retrospective Studies ; SARS-CoV-2
Chemical Substances	COVID-19 Vaccines
Language	English
Publishing date	2022-04-07
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1003348-8
ISSN	1532-3064 ; 0954-6111
ISSN (online)	1532-3064
ISSN	0954-6111
DOI	10.1016/j.rmed.2022.106832
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Article ; Online: Refractory neutrophilic asthma and ciliary genes.

Guntur, Vamsi P / Manka, Laurie A / Moore, Camille M / Wynn, Elizabeth / Vladar, Eszter K / Alam, Rafeul / Pham, Tuyet-Hang / Fingerlin, Tasha E / Martin, Richard J

The Journal of allergy and clinical immunology

2022 Volume 149, Issue 6, Page(s) 1970–1980

Abstract: Background: Refractory asthma (RA) remains poorly controlled, resulting in high health care utilization despite guideline-based therapies. Patients with RA manifest higher neutrophilia as a result of increased airway inflammation and subclinical ... ...

Abstract	Background: Refractory asthma (RA) remains poorly controlled, resulting in high health care utilization despite guideline-based therapies. Patients with RA manifest higher neutrophilia as a result of increased airway inflammation and subclinical infection, the underlying mechanisms of which remain unclear. Objective: We sought to characterize and clinically correlate gene expression differences between refractory and nonrefractory (NR) asthma to uncover molecular mechanisms driving group distinctions. Methods: Microarray gene expression of paired airway epithelial brush and endobronchial biopsy samples was compared between 60 RA and 30 NR subjects. Subjects were hierarchically clustered to identify subgroups of RA, and biochemical and clinical traits (airway inflammatory molecules, respiratory pathogens, chest imaging) were compared between groups. Weighted gene correlation network analysis was used to identify coexpressed gene modules. Module expression scores were compared between groups using linear regression, controlling for age, sex, and body mass index. Results: Differential gene expression analysis showed upregulation of proneutrophilic and downregulation of ciliary function genes/pathways in RA compared to NR. A subgroup of RA with downregulated ciliary gene expression had increased levels of subclinical infections, airway neutrophilia, and eosinophilia as well as higher chest imaging mucus burden compared to other RA, the dominant differences between RA and NR. Weighted gene correlation network analysis identified gene modules related to ciliary function, which were downregulated in RA and were associated with lower pulmonary function and higher airway wall thickness/inflammation, markers of poorer asthma control. Conclusions: Identification of a novel ciliary-deficient subgroup of RA suggests that diminished mucociliary clearance may underlie repeated asthma exacerbations despite adequate treatment, necessitating further exploration of function, mechanism, and therapeutics.
MeSH term(s)	Asthma/metabolism ; Biomarkers ; Bronchoscopy ; Humans ; Inflammation/metabolism ; Lung/pathology ; Mucociliary Clearance
Chemical Substances	Biomarkers
Language	English
Publishing date	2022-01-13
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	121011-7
ISSN	1097-6825 ; 1085-8725 ; 0091-6749
ISSN (online)	1097-6825 ; 1085-8725
ISSN	0091-6749
DOI	10.1016/j.jaci.2021.12.761
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Article ; Online: The potential use of tyrosine kinase inhibitors in severe asthma.

Guntur, Vamsi P / Reinero, Carol R

Current opinion in allergy and clinical immunology

2012 Volume 12, Issue 1, Page(s) 68–75

Abstract: Purpose of review: Severe asthma comprises heterogeneous phenotypes that share in common a poor response to traditional therapies. Recent and ongoing work with tyrosine kinase inhibitors suggests a potential beneficial role in treatment of severe asthma. ...

Abstract	Purpose of review: Severe asthma comprises heterogeneous phenotypes that share in common a poor response to traditional therapies. Recent and ongoing work with tyrosine kinase inhibitors suggests a potential beneficial role in treatment of severe asthma. Recent findings: Various receptor and nonreceptor tyrosine kinase pathways contribute to aspects of airway inflammation, airway hyperresponsiveness, and remodeling of asthma. Selective and nonselective tyrosine kinase inhibitors may be useful to block pathways that are pathologically overactive or overexpressed in severe asthma. Recent in-vivo studies have demonstrated the utility of inhibitors against specific tyrosine kinases (epidermal growth factor receptor, c-kit/platelet derived growth factor receptor, vascular endothelial growth factor receptor, spleen tyrosine kinase, and janus kinase) in altering key aspects of severe asthma. Summary: Asthma and even severe asthma does not consist of a single phenotype. Targeting key inflammatory and remodeling pathways engaged across subphenotypes with tyrosine kinase inhibitors appears to hold promise.
MeSH term(s)	Airway Remodeling/drug effects ; Airway Remodeling/immunology ; Asthma/drug therapy ; Asthma/enzymology ; Asthma/immunology ; Humans ; Protein Kinase Inhibitors/pharmacology ; Protein Kinase Inhibitors/therapeutic use ; Protein-Tyrosine Kinases/antagonists & inhibitors ; Protein-Tyrosine Kinases/immunology ; Signal Transduction/drug effects
Chemical Substances	Protein Kinase Inhibitors ; Protein-Tyrosine Kinases (EC 2.7.10.1)
Language	English
Publishing date	2012-02
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Review
ZDB-ID	2088710-3
ISSN	1473-6322 ; 1528-4050
ISSN (online)	1473-6322
ISSN	1528-4050
DOI	10.1097/ACI.0b013e32834ecb4f
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Article ; Online: Benralizumab as a Steroid-Sparing Treatment Option in Eosinophilic Granulomatosis with Polyangiitis.

Guntur, Vamsi P / Manka, Laurie A / Denson, Joshua L / Dunn, Ryan M / Dollin, Yeshai T / Gill, Mary / Kolakowski, Christena / Strand, Matthew J / Wechsler, Michael E

The journal of allergy and clinical immunology. In practice

2020 Volume 9, Issue 3, Page(s) 1186–1193.e1

Abstract: ... with the pre- and posttreatment phases (4.6, P = .008 for treatment vs pre- and postphases combined ...

Abstract	Background: Eosinophilic granulomatosis with polyangiitis (EGPA) is a vasculitis associated with significant morbidity and mortality that has historically been treated with systemic corticosteroids and immunosuppressants. The IL-5 antagonist mepolizumab was Food and Drug Administration approved in 2017 after demonstrating safety and efficacy in EGPA. We hypothesized that benralizumab, an IL-5 receptor antagonist approved for eosinophilic asthma, would demonstrate safety and efficacy in EGPA. Objectives: To determine the safety and efficacy of benralizumab in EGPA as measured by reduction in oral corticosteroid dose and EGPA exacerbations. Methods: We conducted a prospective 40-week open-label pilot study of benralizumab 30 mg administered subcutaneously in 10 patients with EGPA. Adverse events, oral corticosteroid dosing, exacerbations, and lung function were evaluated before, during, and after benralizumab treatment. Paired tests and tests derived from longitudinal models were used to compare outcome variables between phases or visits. Results: Benralizumab was well tolerated and resulted in reduction of median corticosteroid dose from 15 mg at the start to 2 mg at the end of treatment. Geometric mean corticosteroid dose was reduced from 11.6 mg during pretreatment to 6.3 mg during treatment phase. Five patients were able to achieve a dose of 0 mg. Mean annualized exacerbation rate was lowest during the treatment (1.5) compared with the pre- and posttreatment phases (4.6, P = .008 for treatment vs pre- and postphases combined). Conclusions: Benralizumab was well tolerated, facilitated oral corticosteroid reduction, and reduced exacerbations in EGPA. Larger controlled trials are warranted to further evaluate the role of benralizumab in EGPA.
MeSH term(s)	Antibodies, Monoclonal, Humanized ; Churg-Strauss Syndrome/diagnosis ; Churg-Strauss Syndrome/drug therapy ; Granulomatosis with Polyangiitis ; Humans ; Pilot Projects ; Prospective Studies ; Steroids
Chemical Substances	Antibodies, Monoclonal, Humanized ; Steroids ; benralizumab (71492GE1FX)
Language	English
Publishing date	2020-10-14
Publishing country	United States
Document type	Clinical Trial ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2843237-X
ISSN	2213-2201 ; 2213-2198
ISSN (online)	2213-2201
ISSN	2213-2198
DOI	10.1016/j.jaip.2020.09.054
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