Reply to Moitra et al. : Individual Chronotype May Confound Asthma Symptoms and Therapy
Reply to Moitra et al. : Individual Chronotype May Confound Asthma Symptoms and Therapy
复制标题
回复莫伊特拉等人。
DOI：
10.1164/rccm.201809-1712le
复制
发表时间：
2019
影响因子：
24.7
通讯作者：
Durrington H
中科院分区：
文献类型：
--
作者：
Durrington H
我们非常感兴趣地阅读了Durrington及其同事(1)关于哮喘中的时间和嗜酸性粒细胞生物标志物的文章。虽然时间生物学和时间治疗方法现在正在广泛的疾病中被考虑，包括心血管疾病、神经系统疾病和癌症，但在气道疾病，特别是哮喘中很少观察到同样的方法。在这一点上，本文解释了哮喘病理生物学中临床上重要的时间生物学方面，从而为使用时间治疗方法进行哮喘管理打开了一扇机会之窗。然而，我们想评论一下时间型的确定，这是涉及人类参与者的时间生物学研究的重要组成部分。时间类型是一个人活动和休息的首选时间，分为三组：早晨（早醒早睡，在一天的早些时候达到他们的身心活动高峰），晚上（晚醒晚睡，在一天结束的时候达到他们的身心活动高峰），以及两者都没有(2)。重要的是要注意，任何昼夜节律功能的模式在不同的时间类型之间都有很大差异。几项研究表明，昼夜节律功能的相位滞后（相位提前或延迟）在两种极端的时间类型（早晨型和晚上型）之间可以相差多达12个小时，这意味着早晨型的人的某种昼夜节律所达到的顶相（节奏发生高峰的时间）可能与晚上型的人完全不同。这也可能与这些个体基因组成的暂时或永久变化有关（2,3）。我们注意到，作者在他们的研究中没有确定患者的时型。虽然作者测量了痰嗜酸性粒细胞和eotaxin水平的昼夜模式，在凌晨4点达到顶峰，下午4点达到最低点，但这两个阶段之间的差异并不显著。我们认为这种差异可能受到时间类型效应的影响；即不同时型患者的痰嗜酸性粒细胞的端相不同，这些细胞的节律性受到不同授时细胞（而非疾病）的影响，导致相移。我们还想建议作者，如果可能的话，使用任何可用的时间型评估问卷来评估患者的时间型，并对其进行调整，以评估一天中不同时间的嗜酸性粒细胞模式。虽然研究不同呼吸条件下的时间生物学模式，包括哮喘和阻塞性睡眠呼吸暂停，现在被优先考虑（4,5），使用时间生物学作为一种确定诊断和治疗策略的方法仍然需要
We read the article regarding time of day and eosinophil biomarkers in asthma by Durrington and colleagues (1) with great interest. Although chronobiology and chronotherapeutic approaches are now being considered in a wide range of diseases, including cardiovascular diseases, neurological diseases, and cancer, the same is rarely observed in airway diseases, especially asthma. At this point, this paper explains clinically important chronobiological aspects of asthma pathobiology, and thus opens up a window of opportunity for using a chronotherapeutic approach for asthma management. However, we want to comment on chronotype determination, which is an essential part of chronobiological studies involving human participants.Chronotype is the preferred timing of activity and rest of an individual and is categorized into three groups: morning (early wake-up and early bed time, achieve their peak physical and mental activity during the early part of the day), evening (late wake-up and late bedtime, achieve their peak physical and mental activity during the end part of the day), and neither (2). It is important to note that the pattern of any circadian rhythm function can vary largely between different chronotypes. Several studies have shown that the phase lag (phase advance or delay) of circadian rhythm functions can vary up to 12 hours between the two extreme chronotypes (morning and evening types), which means the acrophase (the time at which the peak of a rhythm occurs) attained by a certain circadian rhythm in a morningtype person could be absolutely different than that of the eveningtype person, and that may also be associated with temporary or permanent changes in the genetic makeup of those individuals (2, 3). We noticed that the authors did not determine the chronotype of the patients in their study. Although the authors had measured the circadian pattern of sputum eosinophils and eotaxin levels with a zenith at 4 AM and a nadir at 4 PM, the differences between these two phases were not found to be significant. We believe that the difference could have been influenced by the chronotype effect; that is, the acrophase of sputum eosinophils was different among patients of different chronotypes, and the rhythmicity of those cells was under the influence of different zeitgebers (other than the disease), resulting in a phase shift. We would also like to propose that the authors, if possible, assess the chronotypes of the patients using any available chronotype assessment questionnaire and adjust it for assessing eosinophil patterns across the times of the day. Although studying the chronobiological patterns in different respiratory conditions, including asthma and obstructive sleep apnea, is now being given priority (4, 5), using chronobiology as a way to determine diagnosis and therapeutic strategy still needs