Immunologic and Molecular Phenotypes in AATD and Sarcoidosis

描述(由申请人提供)： 这项建议是对申请申请RFA-12-013，“AAT缺乏和结节病的基因组研究(GRADS)”的回应。作为一个在临床和研究角度上在结节病和α-1抗胰酶缺乏症(AATD)方面拥有重要专业知识的中心，我们有能力为这项RFA招募患者和对照，并在中心范围的研究中获得准确的表型鉴定和收集相关标本。我们的研究人员在RFA的科学重点领域拥有专业知识，包括基因组学、免疫学/免疫表型鉴定和临床研究，这些研究将成为U01拨款的来源。这项研究的目的是确定结节病和AATD的分子和免疫学表型或特征，这两种疾病是遗传和环境相互作用的结果。基于这些信息，我们提出了三个目标来解决我们的假设，即关键的免疫基因和免疫途径导致结节病和AATD的不同免疫反应和免疫调节，并最终改变疾病的表型和严重程度。第一个目标是作为一项研究范围的建议，将在所有地点进行，以确定结节病和AATD支气管肺泡灌洗细胞和外周血细胞中宿主的固有和免疫分子特征，并与正常健康对照和吸烟诱导的COPD对照进行比较。全基因组转录图谱将被用来定义病例中的分子图谱--与对照组相比，但也在病例对照研究中，以确定与疾病和更严重的疾病形式相关的基因。对BAL微生物群的评价是为了进一步确定疾病的分子图谱和疾病表型，因为可能是疾病的微生物病原学决定了结节病的疾病表型，而微生物组改变了AATD的疾病表型。AIMS 2和AIMS 3将作为我们的临床现场特定方案，但将与研究广泛的研究提供协同和集成。在目标2中，我们将确定结节病和AATD的肺中是否存在免疫调节缺陷或功能障碍，重点是T调节细胞和Th1/Th17表型，在疾病与对照组和更严重的疾病中。这些信息将提供重要的机制数据，但也可被研究范围内的方案评估为免疫表型信息。最后，在目标3中，我们将整合来自目标1和目标2以及到目前为止的先前基因研究的信息，以确定决定疾病免疫基因组反应和改变疾病严重程度的遗传决定因素和表达数量位点。这些信息不仅将为U01研究范围的信息提供资源，而且还将提供可能对疾病诊断和预后有影响的信息，并为未来研究的治疗提供靶点。 相关：结节病和AATD是导致显著发病率和死亡率的罕见疾病。为什么有些人会患上这些疾病，而另一些人不会，自然历史也没有得到很好的理解。这项提案将定义可能作为疾病的生物标志物或预测因素，甚至最终需要治疗的因素。得出的数据将定义疾病和严重疾病的致病机制。最后，将在公共领域提供的GREDS U01的数据和信息，供其他研究人员用于未来疾病机制和易感性的研究。

DESCRIPTION (provided by applicant): This proposal is in response to the request for application, RFA-12-013, "Genomic Research in AAT-Deficiency and Sarcoidosis study (GRADS)". As a center with significant expertise in sarcoidosis and alpha- 1 anti-trypsin deficiency (AATD) from a clinical and research standpoint, we have the ability to recruit patients and controls for this RFA as well as obtain accurate phenotyping and to collect relevant specimens for us in a center-wide study. Our investigators have expertise in the scientific focus of the RFA, including genomics, immunology/immunophenotyping, and clinically based research, which would serve as a resource for this U01 grant. The goal of this study is to define the molecular and immunologic phenotype or signature of sarcoidosis and AATD, two diseases that result from genetic and environmental interaction. Based on this information we propose three aims to address our hypothesis that key immune genes and pathways result in differential immune response and immune modulation in both sarcoidosis and AATD and ultimately modify disease phenotype and severity. The first aim is proposed as a study-wide proposal, to be conducted at all sites, to define the host innate and immune molecular profile in sarcoidosis and AATD bronchoalveolar lavage cells and peripheral blood cells compared to normal healthy controls and smoking-induced COPD controls. Genome-wide transcription profiles would be used to define the molecular profiles, in cases-compared to controls, but also in a case-comparison study to define the genes associated with disease and more severe forms of disease. Evaluation of BAL microbiome is proposed to further define the molecular profiles of disease and disease phenotype, as it is likely that microbiologic etiology of disease determines disease phenotype in sarcoidosis, while the microbiome modifies disease phenotype in AATD. Aims 2 and 3 will serve as our clinical site-specific protocol, but will provide synergy and integration with the study-wid research. In Aim 2, we will determine if there is a deficient or dysfunctional immune regulation occurring in the lung of sarcoidosis and AATD, focusing on T-regulatory cells and Th1/Th17 phenotype, in disease compared to controls and in more severe disease. This information will provide important mechanistic data, but also be evaluable for use by the study-wide protocols as immunophentoyping information. Finally, in Aim 3, we will integrate information from Aims 1 and 2 and from prior genetic studies to date to define genetic determinants and expression quantitative loci that determine the immunogenomic response in disease and modify disease severity. This information will not only provide a resource to the U01 study-wide information, but information that may have implications in disease diagnosis and prognois and provide targets for therapies for future study. RELEVANCE: Sarcoidosis and AATD are rare diseases that result in significant morbidity and mortality. The reason why some develop these diseases and others do not and the natural history is not well understood. This proposal will define factors that may serve as biomarkers or predictors of disease and ultimately even need for therapy. The data derived will define pathogenetic mechanisms of disease and severe disease. Finally, the data and information for the GRADS U01 that will be available in the public domain to be used by other investigators for future study of disease mechanisms and susceptibility.