Am J Respir Crit Care Med. 2017 Jan 15;195(2):e4-e19. doi: 10.1164/rccm.201611-2248ST.
Airway remodeling (AR) is a prominent feature of asthma and other obstructive lung diseases that is minimally affected by current treatments. The goals of this Official American Thoracic Society (ATS) Research Statement are to discuss the scientific, technological, economic, and regulatory issues that deter progress of AR research and development of therapeutics targeting AR and to propose approaches and solutions to these specific problems. This Statement is not intended to provide clinical practice recommendations on any disease in which AR is observed and/or plays a role.
An international multidisciplinary group from within academia, industry, and the National Institutes of Health, with expertise in multimodal approaches to the study of airway structure and function, pulmonary research and clinical practice in obstructive lung disease, and drug discovery platforms was invited to participate in one internet-based and one face-to-face meeting to address the above-stated goals. Although the majority of the analysis related to AR was in asthma, AR in other diseases was also discussed and considered in the recommendations. A literature search of PubMed was performed to support conclusions. The search was not a systematic review of the evidence.
Multiple conceptual, logistical, economic, and regulatory deterrents were identified that limit the performance of AR research and impede accelerated, intensive development of AR-focused therapeutics. Complementary solutions that leverage expertise of academia and industry were proposed to address them.
To date, numerous factors related to the intrinsic difficulty in performing AR research, and economic forces that are disincentives for the pursuit of AR treatments, have thwarted the ability to understand AR pathology and mechanisms and to address it clinically. This ATS Research Statement identifies potential solutions for each of these factors and emphasizes the importance of educating the global research community as to the extent of the problem as a critical first step in developing effective strategies for: (1) increasing the extent and impact of AR research and (2) developing, testing, and ultimately improving drugs targeting AR.
气道重塑（AR）是哮喘和其他阻塞性肺疾病的一个显著特征，目前的治疗方法对其影响很小。本美国胸科学会（ATS）官方研究声明的目的是讨论阻碍 AR 研究和针对 AR 的治疗药物开发进展的科学、技术、经济和监管问题，并提出解决这些具体问题的方法和解决方案。本声明并非旨在就观察到和/或在其中发挥作用的任何疾病提供 AR 的临床实践建议。
邀请了来自学术界、工业界和美国国立卫生研究院的一个国际多学科小组，他们在气道结构和功能的多模态研究、阻塞性肺疾病的肺研究和临床实践以及药物发现平台方面具有专业知识，参与了一次基于互联网和一次面对面的会议，以解决上述目标。尽管大多数与 AR 相关的分析都在哮喘中进行，但在其他疾病中的 AR 也进行了讨论和考虑，并在建议中考虑了这些疾病。在支持结论的基础上，对 PubMed 进行了文献检索。该搜索并非对证据的系统评价。
确定了多个概念性、逻辑、经济和监管障碍，这些障碍限制了 AR 研究的开展，并阻碍了针对 AR 的治疗药物的加速、密集开发。提出了互补的解决方案，以利用学术界和工业界的专业知识来解决这些问题。
迄今为止，与开展 AR 研究的固有难度相关的众多因素以及对追求 AR 治疗的经济激励不足，阻碍了人们对 AR 病理和机制的理解，并在临床上对其进行干预。本 ATS 研究声明确定了针对这些因素的潜在解决方案，并强调了教育全球研究界了解问题的严重程度的重要性，这是制定有效策略的关键第一步：（1）增加 AR 研究的范围和影响，以及（2）开发、测试和最终改进针对 AR 的药物。
