The future of allergy and clinical immunology. Prof. GW Canonica

2. Prof.
Giorgio
Walter
Canonica
Allergy
and
Respiratory
Diseases
Clinic
DIMI-­‐University
of
Genoa
IRCCS
AOU
San
Mar:no-­‐Genova
Italy
President
President
SLAAI, March 15, 2015
The Future of Allergy
and
Clinical Immunology

3. The Starting
Point

4. “If
it
were
not
for
the
great
variability
among
individuals,
medicine
might
have
well
been
a
science
and
not
an
art.”
Sir
William
Osler
(1849–1919)

5. Bieber
T.
2013

6. Bieber
T.
2013

7. Fuchs
NEJM
2014

8. Fuchs
NEJM
2014

9. Fuchs
NEJM
2014

10. Collins
&
Varmus
NEJM
2015

11. Yanez
et
al.
WAO
J.2014

12. Yanez
et
al.
WAO
J.2014

13. Gustaffson
et
al
Gen.Med.
2015

14. Gustaffson
et
al
Gen.Med.
2015

15. Gustaffson
et
al
Gen.Med.
2015

16. The
Past/Present

17. one
disease
=
one
drug
The
Blockbuster
Model
ONE SIZE
FITS ALL

20. The
past
treatment
approach
ReacGve
Medicine
or
Medicine
by
AKempts

21. RENNARD
et
al.,
ANNALSATS
2015

22. Arostegui
et
al.,
PLOSone
2014

23. Arostegui
et
al.,
PLOSone
2014

24. Arostegui
et
al.,
PLOSone
2014

25. BIOMARKER
KATZ
et
al.
AnnalsATS
2014

26. Taylor
RD
et
al.,
JACI
2011

27. PubMed
8
Marzo
2015

28. BIOMARKERS
of
asthma
phenotyping

29. Leung
et
al.
Ther.Adv.Resp.Med.2014

30. Leung
et
al.
Ther.Adv.Resp.Med.2014

31. Chung
et
al
ERJ
2014
Phenotyping……….

32. Braido,
Holgate
&
Canonica
2012

33. Braido,
Holgate
&
Canonica
2012

34. 5
DRAZEN
J.M.
NEJM
September
29,
2011

35. 6
DRAZEN
J.M.
NEJM
September
29,
2011

36. Braido, Holgate, Canonica. Pulm.Pharm.Ther. 2012
Future scenario in Allergy & Asthma treatment
GENERALISTs

37. Braido, Holgate, Canonica. Pulm.Pharm.Ther. 2012
Future scenario in Allergy & Asthma treatment
66%
pa@ents
accordingly
to
Drazen
NEJM
2011

38. Braido, Holgate, Canonica. Pulm.Pharm.Ther. 2012
Future scenario in Allergy & Asthma treatment
SPECIALISTS

39. The promise of personalized medicine
• More effective medicines
• Safer medicines
• Cheaper medicines
• Better healthcare
• Cheaper healthcare
• Less (rather than more)
healthcare disparity

40. 11
Hamburg & Collins 2010

41. 12
Hamburg & Collins 2010

42. G551D
is
the
third
most
common
muta:on,
affec@ng
~4%
of
pa@ents.
For
pa:ents
homozygous
for
Δ508,
Vertex
has
another
drug,
VX-­‐809,
which
acts
by
increasing
the
transport
of
CFTR
protein
to
the
cell
surface.
A
phase
2
clinical
trial
of
combined
VX-­‐809
and
VX-­‐770
treatment
in
Δ508
pa:ents
is
in
progress.
Vx-­‐770
poten:ates
CFTR
func:on
by
promo:ng
decoupling
between
the
ga:ng
cycle
and
ATP
hydrolysis
cycle.
Jih
KY.
et
al.
PNAS.
2013;
110:
4404-­‐9
Vx-­‐770;
Ivaca[or
A CFTR potentiator in patients with cystic fibrosis and
the G551D mutation (most
prevalent
ga:ng
muta:on)
Ramsey BW, et al. N Engl J Med. 2011; 3658: 1663-72
Complex disease will be stratified into a series of
pathway specific disorders creating opportunities for
both companion diagnostics and targeted
prevention and treatments.
But also a new Taxonomy of disease based upon causative
pathways rather than signs and symptoms.

43. Crea:on
of
a
New
Taxonomy
first
requires
an
“Informa:on
Commons”
in
which
data
on
large
popula:ons
of
pa:ents
become
broadly
available
for
research
use
and
a
“Knowledge
Network”
that
adds
value
to
these
data
by
highligh:ng
their
inter-­‐
connectedness
and
integra:ng
them
with
evolving
knowledge
of
fundamental
biological
processes
Toward
Precision
Medicine.
US
Nat
Acad
Sci
2011
Reclassification of human disease by
identifiable causal pathways

44. AGUSTI
A.,
Thorax
2014

45. AGUSTI
A.,
Thorax
2014

46. AGUSTI
A.,
Thorax
2014
biomarkers
SYSTEMIC INFLAMMOME

47. AGUSTI
A.,
Thorax
2014

48. AGUSTI
A.,
Thorax
2014

49. SUSTAINABILITY
The
Present/Future

50. ASTHMA HORIZON PLANNING
in the next 5 years
tralokinumab
(an@
IL
13,
MedImmune)
ligelizumab
(an@
IgE,
Novar@s)
dupilumab
(an@
IL
4
rec,Sanofi
Regeron)

51. Pelaia
et
al.Nature
Medicine
2012

53. Kupckyk
et
al.
Allergy
2014

54. Kupckyk
et
al.
Allergy
2014

55. JACI
2013
ISSN 0091-6749
V O L U M E 1 2 9 N O. 4
A P R I L 2 0 1 2
www.jacionline.org
THE JOURNAL OF
AllergyAND Clinical
Immunology
CURRENT PERSPECTIVES
ICON: Food allergy
The role of dendritic cells in food allergy
ROSTRUM
Multiple-allergen and single-allergen
immunotherapy strategies in polysensitized
patients: Looking at the published evidence
Health literacy and asthma
WORKSHOP SUMMARY
Understanding the complexity of IgE-related
phenotypes from childhood to young
adulthood: A Mechanisms of the Development
of Allergy (MeDALL) Seminar
CLINICAL REVIEWS
An update on the role of human dendritic cells
in patients with atopic dermatitis
MECHANISMS OF ALLERGIC DISEASES
The role of dendritic cells in asthma
EDITORIALS
We call for iCAALL: International Collaboration
in Asthma, Allergy and Immunology
The airway epithelium in childhood asthma
TH
9 cells: In front and beyond TH
2
Nonimmediate drug allergy: Diagnostic benefit
of skin testing and practical approach
OFFICIAL JOURNAL OF

56. Kim
et
al.
COAI,
2014

57. Parulekar,
AEk
&
Hanania
COAI
2014

58. Corren
et
al
NEJM,
August
3,
2011

59. Corren
et
al
NEJM
August
3,
2011
HIGH
Perios.n
Total
LOW
perios.n

60. Hanania
et
al.
AJRCCM
2013

61. Hanania
et
al.
AJRCCM
2013

62. 2014

63. et
al.
AJRCCM
2014

64. COSTY TREATMENT REQUIREMENTS
Predic.ve
Biomarkers
of
Response
Defini.on
of
Eligibility
to
Treatment
Pay
by
Results
Reimbursement
SUSTAINABILITY

65. Holgate,
Brit.J.Clin
Pharm.2013

66. Wenzel
S.,
Nature
Med.2012

67. Auffray
et
al.
Genome
Med
2009;1:2
PaEent
reported
Clinical
FuncEonal
Cellular
Molecular
Future
of
phenotyping:
‘Systems
Medicine’

68. Prof.
Giorgio
Walter
Canonica
Allergy
and
Respiratory
Diseases
Clinic
DIMI-­‐University
of
Genoa
IRCCS
AOU
San
Mar:no-­‐Genova
Italy
President
President
SLAAI, March 15, 2015
The Future of Allergy
and
Clinical Immunology
(Part IV - final)

69. Mirnezami
et
al.NEJM
2012

70. PROJECTIONS
FOR
MEDICINE

71. PROJECTIONS
FOR
TECHNOLOGY

72. PROJECTIONS
FOR
INTEGRATION

73. Chung
et
al
ERJ
2014
Phenotyping……….

74. Rossi
et
al
Proteomics
Clin
Appl.
2014

75. ASTHMA
Rossi
et
al
Proteomics
Clin
Appl.
2014

76. Rossi
et
al
Proteomics
Clin
Appl.
2014
ASTHMA 2

77. Redhu
et
al
AACI
2013

78. Pascual
R.M.
&
Peters
S.P.
J.A.C.I.
2005

79. Airway Remodeling in Severe Asthma:
ASM
Pepe C et al. JACI 2005;116:554-9.
Moderate
Asthma
Severe
Asthma
Severe AsthmaFEV1
SMOOTH MUSCLE AREA

80. Int.J.Immunopathol.
&
Pharmacol.
2012

81. 0.00
1.00
2.00
3.00
4.00
5.00
6.00
7.00
8.00
t=p/4
x
arithme2c
mean
of
orthogonal
intercepts
PRE
POST
RESULTS
Riccio,
Dal
Negro
et
al.,Int.J.Immunopathol.
&
Pharmacol.2012

82. 3.00
5.50
8.00
10.50
13.00
BEFORE
AFTER
TREATMENT
t=p/4
x
arithme2c
mean
of
ortogonal
intercept
12 month Xolair treatment
RESULTS
Riccio,
Dal
Negro
et
al.,Int.J.Immunopathol.
&
Pharmacol.2012
RESPONDER
NON
RESPONDER
6.25 µ
Severe
Asthma
Cut
off

83. Mauri
et
al.
Immunol.LeCers
2014

84. Gal
3-­‐GALACTIN
3
Responder
Non Responder

85. Galactin 3
in biopsies
of
Xolair treated patients
Responder Non Responder

86. Gao
et
al.
Resp
Res.
2015

87. IgE/Eosinophilic
Neutrophilic
GalecKn
3
ASTHMA
InflammaKon

88. 3 years since Xolair suspension
Nopp et al. Allergy 2010;65:56-60
FEV1
RESPONDER
NON RESPONDER
Gal 3

89. Galactin 3
as Biomarker of
SUPERESPONDER
to
Omalizumab
POSSIBLE
CLINICAL
MEANING

90. System
Biology
Nature
Biotechnology
September
,8
2014,

91. Nature
Biotechnology
September
8,
2014
System
Biology

93. Lu
et
al
NEJM
2014

94. Lu
et
al
NEJM
2014

95. FINAL
MESSAGE
Bioinforma2cs,
E-­‐health
records,
Bio-­‐banks
and
data
protec2on
Although
‘omics’
datasets
have
provided
remarkable
insights,
it
is
by
analysing,
linking
and
comparing
different
large
datasets
(genomic,
clinical
outcomes,
imaging
etc.)
that
the
greatest
insights
have
been
gained
–
so-­‐
called
‘big
data’.

96. XVIII Congreso Latinoamericano de Alergia, Asma e Inmunología 2015
Presidente: Alfonso Mario Cepeda Sarabia
Comité Organizador Local: Edgardo Jares, Anahí Yañez, Estrella Asayag
Presidentes Sociedad Latinoamericana de Alergia, Asma e Inmunología, Slaai:
2013-2015: Alfonso Mario Cepeda Sarabia - 2015-2017: Juan Carlos Sisul Alvariza
Buenos Aires, marzo 14-16, 2015
http://www.slaai2015.com/comites-del-congreso/
Información Slaai: www.slaai.org
Programa Congreso Para Todos
Conferencias XVIII Congreso Latinoamericano de Alergia, Asma e Inmunología
Sociedad Latinoamericana de Alergia, Asma e Inmunología, SLaai