By Debbie Bunch
May 5, 2025
First Bronchiectasis Medication May Be on the Way
An international study published in the New England Journal of Medicine suggests that brensocatib, an investigational, once-a-day oral medication, may be an effective treatment for bronchiectasis.
The multi-center randomized clinical trial, conducted on five continents and involving 1,721 patients, tested the effectiveness of two different doses of the new DPP-1 inhibitor. This inhibitor specifically targets neutrophil serine proteases, key mediators of neutrophilic inflammation common in bronchiectasis. Patients in the active treatment group received either a 10 mg or 25 mg dose and were compared to those who received a placebo.
The year-long study showed that both doses of the drug significantly lowered the annualized rate of exacerbations. Overall, 48.5% of the brensocatib patients were exacerbation-free at 52 weeks vs. 40.3% of those in the placebo group. Patients on the 25 mg dose also had a lower decline in FEV1.
Patients taking the drug reported better quality of life throughout the study, regardless of whether they experienced an acute exacerbation.
The authors note there is currently no FDA-approved medication for bronchiectasis and believe this drug may change that fact for the better. “This is a very promising new treatment and likely will be the first-ever FDA-approved treatment for bronchiectasis,” said Dr. Mark Metersky, a bronchiectasis specialist from the UConn School of Medicine who served on the Steering Committee for the clinical trial. Read Press Release Read Abstract
Researchers Turn to the Liver for New Immunotherapy for Asthma
Asthma medications can go a long way to helping people keep the condition under control. But they don’t do anything to treat the underlying cause of the disease, which is the immune system’s exaggerated response to respiratory allergens. While immunotherapies exist, they often take months or even years to have any meaningful effect.
Researchers from New York University and the UChicago Pritzker School of Molecular Engineering believe they have found a new type of immunotherapy that can more quickly and easily keep the immune system in check. Called liver-targeted immunotherapy (LIT), it exploits the liver’s natural ability to promote immune tolerance.
“The liver has long been known as a unique organ, capable of suppressing immune responses to harmless antigens from food and blood-borne particles,” explained senior study author Jeffrey Hubbell, from NYU. “We wondered – could we harness this natural tolerance mechanism to turn off allergic reactions?”
Hubbell and his colleagues chemically modified allergens by synthetically attaching sugar molecules called mannose to their surfaces. This process, known as synthetic mannosylation, allows the allergens to bypass the immune system’s usual alarms and instead be delivered directly to the liver, where specialized immune cells reprogram the response from inflammation to tolerance.
In a study conducted in mice, animals that received LIT developed a robust population of regulatory T cells that instructed the body to ignore allergens rather than attack them. Only two doses of the therapy protected against allergic asthma symptoms for one year.
The treatment also appeared to guard against anaphylaxis, which can sometimes develop with traditional immunotherapy when the immune system mounts an aggressive assault against the introduced allergen. When tested in sensitized mice, the mannosylated allergens were processed by the liver and did not provoke any allergic symptoms.
The study’s authors hope to begin human trials soon and believe that if the initial positive results of this new therapy hold up in those trials, it could revolutionize the treatment of allergic diseases. “Rather than fighting against the immune system’s natural tendencies, we’re working with them,” said Hubbell. “This could be the future of allergy treatment — a way to not just manage symptoms, but to cure the disease at its source.”
The study was published in Science Translational Medicine. Read Press Release Read Abstract
Young People Drive Down Smoking Rates
According to researchers from the University of California, San Diego, young people are responsible for the current decline in smoking rates across the country, suggesting there is a good chance the U.S. will eventually see an end to the epidemic of disease caused by smoking.
“The rapid decline in smoking among young adults is clear evidence that the smoking epidemic will come to an end in our lifetime,” said study author Matthew Stone, PhD. “Indeed, we project that the national smoking prevalence will be under 5% by 2035.”
The bad news is that smoking in people over the age of 50 has not declined as rapidly, which means smoking-related health issues are likely to continue for the foreseeable future. “The much slower decline in smokers over the age of 50, particularly in previously high smoking states, will mean that the high rates of lung cancer, heart disease, and chronic obstructive pulmonary disease that are caused by lifelong smoking will take longer to decrease,” said Dr. Stone.
Based on data from 1.77 million individuals drawn from the Tobacco Use Supplements to the U.S. Census Bureau’s Current Population Survey, the study found the most significant decline in smoking occurred in states with historically high smoking rates, with differences in prevalence across age, sex, race and ethnicity, and education persisting across the years.
These findings mirror those seen since researchers first linked smoking with lung cancer in the 1950s. In 1955, 59.9% of U.S. adults smoked. That dropped by more than half by 2000 and declined by another 50% by 2022. Smoking rates are expected to halve again by 2035. States that have made the most significant inroads in smoking cessation have also seen the largest decline in lung cancer mortality.
While celebrating these achievements, though, the investigators are quick to point out that the tobacco industry has successfully recruited a new generation of teenagers into e-cigarette use and nicotine addiction, and they stress additional research is needed to gauge the long-term impact of the shift.
JAMA Open Network published. Read Press Release Read Full Paper
