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BACKGROUND: TH2 cytokines are not responsible for the ongoing symptoms and pathology in children with severe therapy-resistant asthma (STRA). IL-33 induces airway hyperresponsiveness, but its role in airway remodeling and steroid resistance is unknown. OBJECTIVE: We sought to investigate the relationship between IL-33 and airway remodeling in pediatric patients with STRA. METHODS: IL-33 levels were quantified in neonatal mice given inhaled house dust mite (HDM), and the effect of blocking IL-13 on remodeling and IL-33 levels was assessed. HDM-induced allergic airways disease (AAD) in neonatal ST2(-/-) mice lacking the IL-33 receptor was assessed, together with collagen production after IL-33 administration. The effect of steroid therapy on IL-33 levels in patients with neonatal AAD was explored. IL-33 expression was quantified in endobronchial biopsy (EB) specimens from children with STRA and related to remodeling, and collagen production by airway fibroblasts from pediatric patients stimulated with IL-33 and budesonide was quantified. RESULTS: Blocking IL-13 after AAD was established in neonatal mice and did not reduce remodeling or IL-33 levels; airway hyperresponsiveness was only partially reduced. IL-33 promoted collagen synthesis both from asthmatic fibroblasts from pediatric patients and after intranasal administration in mice. Increased cellular expression of IL-33, but not IL-13, was associated with increased reticular basement membrane thickness in EB specimens from children with STRA, whereas remodeling was absent in HDM-exposed ST2(-/-) mice. IL-33 levels were maintained, whereas IL-13 levels were abrogated by steroid treatment in neonatal HDM-exposed mice and in EB specimens from children with STRA. CONCLUSION: IL-33 is a relatively steroid-resistant mediator that promotes airway remodeling in patients with STRA and is an important therapeutic target.

Original publication




Journal article


J Allergy Clin Immunol

Publication Date





676 - 685.e13


AAD, AHR, Airway hyperresponsiveness, Allergic airways disease, Asthma, BAL, Bronchoalveolar lavage, EB, Endobronchial biopsy, HDM, House dust mite, IL-33, RBM, Reticular basement membrane, STRA, Severe therapy-resistant asthma, airway remodeling, pediatric, steroid resistance, therapy, Adolescent, Airway Remodeling, Animals, Animals, Newborn, Anti-Inflammatory Agents, Asthma, Bronchial Hyperreactivity, Budesonide, Child, Collagen, Drug Resistance, Female, Glucocorticoids, Humans, Interleukin-13, Interleukin-33, Interleukins, Male, Mice, Mice, Inbred BALB C, Mice, Knockout, Pyroglyphidae