KIT inhibition by imatinib in patients with severe refractory asthma

Katherine N. Cahill, Howard R. Katz, Jing Cui, Juying Lai, Shamsah Kazani, Allison Crosby-Thompson, Denise Garofalo, Mario Castro, Nizar Jarjour, Emily DiMango, Serpil Erzurum, Jennifer L. Trevor, Kartik Shenoy, Vernon M. Chinchilli, Michael E. Wechsler, Tanya M. Laidlaw, Joshua A. Boyce, Elliot Israel

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66 Scopus citations

Abstract

BACKGROUND: Mast cells are present in the airways of patients who have severe asthma despite glucocorticoid treatment; these cells are associated with disease characteristics including poor quality of life and inadequate asthma control. Stem cell factor and its receptor, KIT, are central to mast-cell homeostasis. We conducted a proof-of-principle trial to evaluate the effect of imatinib, a KIT inhibitor, on airway hyperresponsiveness, a physiological marker of severe asthma, as well as on airway mast-cell numbers and activation in patients with severe asthma. METHODS: We conducted a randomized, double-blind, placebo-controlled, 24-week trial of imatinib in patients with poorly controlled severe asthma who had airway hyperresponsiveness despite receiving maximal medical therapy. The primary end point was the change in airway hyperresponsiveness, measured as the concentration of methacholine required to decrease the forced expiratory volume in 1 second by 20% (PC20). Patients also underwent bronchoscopy. RESULTS: Among the 62 patients who underwent randomization, imatinib treatment reduced airway hyperresponsiveness to a greater extent than did placebo. At 6 months, the methacholine PC20 increased by a mean (±SD) of 1.73±0.60 doubling doses in the imatinib group, as compared with 1.07±0.60 doubling doses in the placebo group (P=0.048). Imatinib also reduced levels of serum tryptase, a marker of mast-cell activation, to a greater extent than did placebo (decrease of 2.02±2.32 vs. 0.56±1.39 ng per milliliter, P=0.02). Airway mast-cell counts declined in both groups. Muscle cramps and hypophosphatemia were more common in the imatinib group than in the placebo group. CONCLUSIONS: In patients with severe asthma, imatinib decreased airway hyperresponsiveness, mast-cell counts, and tryptase release. These results suggest that KIT-dependent processes and mast cells contribute to the pathobiologic basis of severe asthma.

Original languageEnglish
Pages (from-to)1911-1920
Number of pages10
JournalNew England Journal of Medicine
Volume376
Issue number20
DOIs
StatePublished - May 18 2017

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    Cahill, K. N., Katz, H. R., Cui, J., Lai, J., Kazani, S., Crosby-Thompson, A., Garofalo, D., Castro, M., Jarjour, N., DiMango, E., Erzurum, S., Trevor, J. L., Shenoy, K., Chinchilli, V. M., Wechsler, M. E., Laidlaw, T. M., Boyce, J. A., & Israel, E. (2017). KIT inhibition by imatinib in patients with severe refractory asthma. New England Journal of Medicine, 376(20), 1911-1920. https://doi.org/10.1056/NEJMoa1613125