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	   Exposure  to second hand smoke (SHS) is associated with elevated life risk of asthma  development and more severe asthma symptoms, suggesting that SHS exposure  promotes a more severe form of asthma. Recent scientific findings suggest that  there are numerous subtypes of asthma, and that specific therapies for each  type of asthma may more successfully control asthma symptoms. Understanding the  type of asthma associated with SHS exposure is important to develop specific  treatments for individuals with SHS-related asthma.  
Tobacco  smoke exposure alters the function of immune cells and is associated with  increased levels of neutrophils in the blood and airway. Neutrophils are very  reactive immune cells that produce inflammatory mediators that can damage the  lung and worsen asthma symptoms. Previous studies have shown that increased  numbers of neutrophils in asthmatic airways is partially mediated by the  activity of a specific type of immune cell termed Type 17 T helper (Th17)  cells, which produce immune signaling molecules that recruit neutrophils to the  airway. This research proposal will test the hypothesis that SHS exposure  increases the severity of asthma symptoms by promoting the development of Th17  cells and neutrophil-driven inflammation. 
To test  this hypothesis, I will use blood samples from identical twin pairs in which at  least one twin has asthma and/or SHS exposure to perform the following  experiments: 1) I will characterize the types of T helper cells in the blood,  including Th17 cells, from twin pairs with or without SHS exposure or asthma  and correlate the types of T helper cells with the number of neutrophils in the  blood; 2) I will assess how SHS modifies expression of important immune genes  by T cells leading to altered development of T helper cells and more severe  asthma symptoms.  
These  studies will determine how SHS exposure affects the immune cells that promote  more severe asthma symptoms and identify diagnostic markers of SHS-related  asthma that may help determine the most appropriate asthma treatment in the  clinic. The use of samples from twins enables us to more easily distinguish the  effects of SHS exposure on asthma while controlling for genetics and other  exposures during childhood. Additionally, increased understanding of how SHS  impacts asthma will lead to the development of more informed regulatory and  promotional material to control tobacco smoke exposure. 
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