Unit of Airway Inflammation, Department of Experimental Medical Research, Lund University.
Department of Allergology and Respiratory Medicine, Skane University Hospital, Lund Sweden.
Curr Opin Pulm Med. 2019 Jan;25(1):79-86. doi: 10.1097/MCP.0000000000000536.
The clinical and inflammatory heterogeneity in asthma constitutes a major challenge for improved treatment. This review describes the nature of the inflammatory complexity and how it can be decoded to yield improved disease understanding and personalized treatment. The focus is on the difficult task of revealing the immunological complexity as it occurs inside diseased patient tissues.
The inflammatory heterogeneity in asthma stretches beyond the classical division into allergic Th2 eosinophilic versus Th1 and/or Th17 neutrophilic (or paucigranulocytic) phenotypes. Rather than having one distinct type of inflammation, many patients display a patchwork of overlapping immune signatures. The patient diversity is further increased by differences in regard of distal lung involvement. Faced with this staggering complexity, calls have been made for a pragmatic biomarker-guided identification of treatable traits. In parallel, novel high-dimensional analyses and multiplex imaging aid the long-term goal of decoding the underlying molecular endotypes.
Asthma is vastly heterogeneous with multiple and superimposed inflammatory and anatomical phenotypes. Despite the intensive research and introduction of highly immune-selective dugs, basic questions remain; especially as still too many of today's uncontrolled patients remain poorly understood. Here, pragmatic biomarker strategies, combined with novel methodological approaches that ultimately reveal the complete immunological complexity, will pave the way for improved differential diagnosis and personalized medication.
哮喘的临床和炎症异质性是改善治疗的主要挑战。本文描述了炎症复杂性的本质，以及如何对其进行解码以提高对疾病的理解和实现个体化治疗。重点是揭示发生在患病组织内的免疫复杂性这一艰巨任务。
哮喘的炎症异质性超出了经典的 Th2 型嗜酸性粒细胞与 Th1 和/或 Th17 型中性粒细胞（或少细胞性）表型的划分。许多患者并非表现为单一类型的炎症，而是呈现出重叠的免疫特征。远端肺部受累的差异进一步增加了患者的多样性。面对这种惊人的复杂性，人们呼吁采用实用的生物标志物指导来识别可治疗的特征。与此同时，新型的多维分析和多重成像方法有助于实现解码潜在分子表型的长期目标。
哮喘具有高度异质性，存在多种重叠的炎症和解剖学表型。尽管进行了大量的研究并引入了高度免疫选择性药物，但仍存在许多基本问题尚未解决；尤其是目前仍有太多未得到有效控制的患者情况仍不清楚。在这里，实用的生物标志物策略结合最终揭示完整免疫复杂性的新方法学途径，将为改善鉴别诊断和个体化用药铺平道路。
