“Recognition and description of specific metagenomic profiles in conjunction with disease characteristics will contribute to the ‘precision medicine’ in patients with respiratory allergy – associated diseases”
Interviewee: Dr. Paraskevi Xepapadaki, Pediatrician and Associate Professor in Pediatrics- Allergology, Allergy Department, 2nd Pediatric Clinic, University of Athens
Can you please introduce yourself and describe what your background is?
I am Pediatrician and Associate Professor in Pediatrics- Allergology in the Allergy Department, 2nd Pediatric Clinic, University of Athens, also partner in CURE. My main research focus involves the effects of viral infection on asthma and lung function testing in children, while in clinical daily practice, I am supervising and actively participating in the evaluation of children with allergy related diseases (food, skin, respiratory and drug allergy, immunotherapy and biologicals). In addition, I am responsible for the Respiratory Allergy outpatient clinic within the Allergy Department and since June 2014 I am also responsible for the Pulmonology outpatient clinic. Last, I served as a past member of the Pediatric Board of the European Academy of Allergy and Clinical Immunology (EAACI), and from 2018 I am a member of the Pediatric Asthma Section of the World Allergy Organization (WAO).
2. The National and Kapodistrian University of Athens (NKUA) and the Medical University of Lodz (MUL) are together responsible for the clinical cohort of the CURE project. What does the clinal cohort do, what is your role, and how is it linked to the rest of the project?
The clinical cohort is a group of asthma patients and healthy individuals observed over time and plays a central role in the development of the CURE project. The main objective of the cohort is to prospectively monitor variations in respiratory symptoms. In parallel, it serves to collect biological samples from the participants, supporting the progress of our work and of other partners in the project for phage isolation, host response and metagenomic longitudinal pattern analyses. Prospective data of disease activity and exposures are now merged into a common database with trajectories from the same subjects obtained from the metagenome metadata and host responses.
As part of my role in the project, I designed the study protocol, I coordinate the research teams involved in the clinical study and I am responsible for recruiting children with asthma and controls in my centre but also for following up with the recruitment in other clinical centres. Moreover, I monitor the progress and adherence to the protocol, ensuring the overall success and scientific value of the study.
What can you tell us about your research so far?
We were able to complete the intense one-month, and one-year follow-up of the clinical cohort with a minimal number of drop-outs, while symptom activity was monitored using high-end e-medicine technology. Questionnaires and physiological measurements including lung function, inflammation, responsiveness and immune status data were obtained as planned.
Since the monitoring period officially ended in March 2020 and databases with clinical data are finalized, we are diligently working on the analysis of cohort characteristics and disease activity. This data will be combined with the metagenomic and host immune data obtained by other partners while unsupervised analyses will be used to identify asthma clusters characterized by distinct patterns of microbiome/immunological configurations.
3. NKUA and MUL are in regular contact with asthma patients for sample collection. What are patients’ expectations of the CURE Project? What are their feelings towards phage therapy as a potential solution for asthma treatment?
During the intense one-month and one-year follow-up, we established a very close relationship with the CURE participants. A key point of participants' recruitment and adherence was that they were aware from the beginning of the purpose and obligations of their participation during the study. Frequent communication with members of the study team provided asthmatic patients the safety of a close follow-up from a group of experts. Moreover, we continued providing telemedicine guidance and in person clinical evaluation, where needed, during the COVID-19 pandemic.
At the end of the study when we asked CURE participants to evaluate their participation in the project, the vast majority stated that they were extremely satisfied from the monitoring and from their potential contribution to a “novel” therapeutic approach. The vast majority were not aware that phage therapy has existed for more than a hundred years, for example to treat bacterial infections, and were excited about participating in a project that aimed at transforming the way we treat respiratory diseases.
4. From a clinical perspective, what are your thoughts and personal expectations of CURE?
I am confident that CURE will transform phage therapeutic technology in the Western world and will kick off new projects for implementing phage therapy for patients with asthma. Recognition and description of specific metagenomic profiles in conjunction with disease characteristics will identify “the” specific and suitable strains for each individual, contributing to “precision medicine” for patients with respiratory allergy – associated diseases.