Professor Ratko Djukanovic

• Professor Djukanovic has a lifelong interest in asthma, especially its severe forms. where his focus is on: 1) underlying pathobiological mechanisms of asthma, 2) stratification of asthma into clinical phenotypes and mechanism-based endotypes, 3) unmet needs of severe asthma management. He also has an interest in the mechanisms and treatments of severe viral infections of the lung.
• Underlying mechanisms of asthma: Professor Djukanovic has conducted pioneer studies into the pathology of asthma, applying research bronchoscopy  (with endobronchial biopsy and bronchoalveolar lavage) and sputum induction. He led the initial task forces which defined the use of these two techniques, thereby paving the way for standardised research approches that enabled in-depth descriptions of the roles of various inflammatory cells and their mediators. He developed an explant model, consisting of bronchial biopsies placed into tissue culture, that could be stimulated ex vivo with relevant triggers, applying as needed, novel agents not yet approved for in vivo use in humans volunteers. 
• Stratification of asthma into clinical phenotypes and mechanism-based endotypes: Professor Djukanovic led the discovery of biomarkers using omics technology (transcriptomics, proteomics, lipidomics, breathomics). After the first ever study of transcriptomics biomarkers in the epithelium of patients with Chronic Obstructive Pulmonary Disease (COPD), together with a colleague from Amsterdam and two colleagues from Imperial College, London, he created a large (€27 milllion) programme for severe asthma (U-BIOPRED), funded by the EU Innovative Medicines Initiative. This has resulted in more than 100 publications, providing insight into novel phenotypes and endotypes of asthma.
• Unmet needs of severe asthma management: Professor Djukanovic has collaborated very widely throughout his career. Recognising the power of collaborative work, in 2018 he established a European Clinical Research Collaboration, SHARP (Severe Heterogenous Asthma Research Network-Patient Centred). This network consists of 29 European Countries and their registries of around 16,000 people with severe asthma, treated at 340 severe asthma centres/clinics. With the aim to transform the way research is conducted, he invited the European Lung Foundation to appoint a patient as his co-chair so that the current leadersship now comprises two clinicians and one patient co-chair, with a flat leadership structure to enable all voices to be heard and all research ideas considered.
• Mechanisms and treatments of severe viral infections of the lung: Together with Professor Sir Stephen Holgate and Proferssor Donna Davies, Professor Djukanovic founded in 2003 a spin-out company called Synairgen (link to Synairgen/s website) with the aim to bring their clinical and basic science skills to more effective development of novel medicines for respiratory diseases. The company's focus has since been based on the discovery that Interferon-ß (IFN-ß) is centrally involved in the lung defences against virus and that its production by the bronchial epithelium is deficient in people with asthma and those with COPD. They conducted a series of studies showing the safety of nebulised IFN-ß in people with chronic airways disease (asthma and COPD) and providing proof of concept for its effectiveness to prevent progression of virus infection and development of exacerbations. The advent of COVID-19 presented an opportunity to test the efficacy of nebulised IFN-ß in a potentially deadly viral disease; the first Phase 2 trial showed very promising efficacy (link to Lancet Respiratory Medicine article) and a subsequent Phase 3 trial also showed potential for efficacy in the more severe patients in whom standard treatment was not effective enough.

Professor Djukanovic's research in translational research is currently focused on identifying biomarkers that predict responses to biologics, i.e. monoclonal antibodies directed against key mediators of severe asthma. As a Board Member of the U-BIOPRED Alliance (link to U-BIOPRED website), Professor is also working on identifying the unmet needs in people who either do not respond fully or fail to respond to biologics.

Professor Djukanovic is co-founder of the International Collaborative Asthma Network (link to ICAN website), an initiative that aims to promote innovation and to strengthen international collaborations on asthma in general and severe asthma in particular.  There is a heightened need in the space beyond the T2 asthma phenotype. The first meeting took place in May 2022 in San Francisco, creating a junior investigators research forum focusing on international collaboration in the following 5 areas:  1) Establishing an International entity to foster future meetings, data sharing, and innovative asthma research 2) Validating innovative disease mechanisms hypotheses, 3) Developing new technologies and therapies, 4) Organizing pilot studies of personalized severe asthma treatments, and 5) Engaging young investigators.

Professor Djukanovic continues to lead with the European SHARP collaboration on severe asthma, with a series of projects addressing the unmet needs in management of severe asthma, especially from the patient perspective.

Professor Djukanovic is also engaged in research into the psychoneuroimmunology networks that are involved in asthma, seeking to understand how the mind and immunity interact and develop methods to help patients cope better with their chronic disease.