Xingbin Ai, PhD: How the Nervous System Influences Pediatric Asthma

At the American Academy of Allergy, Asthma & Immunology Annual Meeting (AAAAI) 2022 , clinicians from across the country have gathered to discuss new approaches to asthma and allergy management.

In one session titled “Childhood Asthma: All in the Nerves”, Xingbin Ai, PhD, Boston University School of Medicine, approaches pediatric care from a unique perspective: by blocking certain neurogenic changes that occur in the lungs at childhood, patients may avoid asthma and allergic responses in adulthood.

In an interview with HCPLive, Ai spoke of how the nerves play a central role in how children respond to asthma in addition to the challenges of studying pediatric asthma.

“For asthma studies, if you look at the entire field pretty much everybody's work is focused on adult asthma or asthmatics as adult patients,” Ai said. “Part of it is because it's hard to get children samples with asthma, and the other part of it is asthma in children is a little bit harder to study,” Ai said. “It's hard to diagnose until they are 5 years old, and there's a lot of plasticity, because children's lungs continue to develop probably until 18 years of age.”

Ai added that in almost every single organ, the nerve property functions as the “first responder”. As such, Ai and a team of investigators considered the mechanisms that control lung development through the lens of nervous system development, and discovered several neurogenic factors associated with allergen exposure.

“If you have a respiratory virus infection, or have allergy exposure, the immune cells actually are a major source of this neurogenic factors,” Ai said. “So you would imagine if you have the ongoing inflammation, you actually end up having additional factors that can contribute to the airway innovation. How the money is wired up is completely different from a healthy, or non-inflamed, lung.”

Though Ai and investigators focused on several divisions of the nervous system, including sensory and sympathetic nerves, the data on cholinergic nerves proved the most interesting.

“For somebody who is not working in the lung field, cholinergic is almost like a feedback loop from your central nervous system, so once you get the trigger, the cholinergic nerve gets fired up, they receive acetylcholine, and then that can trigger a whole host of response in lung cells, the most important one is the airway smooth muscle contraction,” Ai said. “So these are the signals that really makes the muscle very, very hyper contractile.”

With the current study, Ai hopes to change the general perspective on how nerves influence asthma and allergy responses in pediatric patients. She added that with the new development of neutralizing antibodies, pediatric patients can be administered treatment that is safer than general anti-inflammatory drugs. Further research is needed to test these targeted drugs, but the versatility of the lung

“The beauty of the lung in my view is that it’s open; it's not like brain, for example, you cannot really treat a patient with a lot of neurological diseases because there's a blood brain barrier,” Ai said. “Many chemicals cannot pass into the brain, but the lung, the beauty of it is it’s highly druggable. Inhalers (are) one of the breakthroughs for children with allergic attack, they can just inhale the steroid that relaxes the muscle so they can breath better. So I think the other goal was not finding more targeted nerves to prevent this acute response, and ultimately to achieve long-term stability of the delivery drug.”

To hear more from Dr. Ai, watch the full interview above.