慢性阻塞性肺疾病和重度哮喘中的 NETosis 炎症。
NETopathic Inflammation in Chronic Obstructive Pulmonary Disease and Severe Asthma.
机构信息
Respiratory Global Medicines Development, AstraZeneca, Gothenburg, Sweden.
Respiratory, Inflammation and Autoimmunity, IMED Biotech Unit, AstraZeneca, Gothenburg, Sweden.
出版信息
Front Immunol. 2019 Feb 5;10:47. doi: 10.3389/fimmu.2019.00047. eCollection 2019.
Neutrophils play a central role in innate immunity, inflammation, and resolution. Unresolving neutrophilia features as a disrupted inflammatory process in the airways of patients with chronic obstructive pulmonary disease (COPD) and severe asthma. The extent to which this may be linked to disease pathobiology remains obscure and could be further confounded by indication of glucocorticoids or concomitant respiratory infections. The formation of neutrophil extracellular traps (NETs) represents a specialized host defense mechanism that entrap and eliminate invading microbes. NETs are web-like scaffolds of extracellular DNA in complex with histones and neutrophil granular proteins, such as myeloperoxidase and neutrophil elastase. Distinct from apoptosis, NET formation is an active form of cell death that could be triggered by various microbial, inflammatory, and endogenous or exogenous stimuli. NETs are reportedly enriched in neutrophil-dominant refractory lung diseases, such as COPD and severe asthma. Evidence for a pathogenic role for respiratory viruses (e.g., ), bacteria (e.g., ) and fungi (e.g., ) in NET induction is emerging. Dysregulation of this process may exert localized NET burden and contribute to NETopathic lung inflammation. Disentangling the role of NETs in human health and disease offer unique opportunities for therapeutic modulation. The chemokine CXCR2 receptor regulates neutrophil activation and migration, and small molecule CXCR2 antagonists (e.g., AZD5069, danirixin) have been developed to selectively block neutrophilic inflammatory pathways. NET-stabilizing agents using CXCR2 antagonists are being investigated in proof-of-concept studies in patients with COPD to provide mechanistic insights. Clinical validation of this type could lead to novel therapeutics for multiple CXCR2-related NETopathologies. In this Review, we discuss the emerging role of NETs in the clinicopathobiology of COPD and severe asthma and provide an outlook on how novel NET-stabilizing therapies via CXCR2 blockade could be leveraged to disrupt NETopathic inflammation in disease-specific phenotypes.
中性粒细胞在先天免疫、炎症和消退中发挥核心作用。未解决的中性粒细胞增多症是慢性阻塞性肺疾病(COPD)和严重哮喘患者气道炎症过程中断的特征。这种情况与疾病病理生物学的关联程度仍不清楚,并且可能由于糖皮质激素的指示或同时存在的呼吸道感染而进一步复杂化。中性粒细胞胞外诱捕网(NETs)的形成代表一种专门的宿主防御机制,可捕获和消除入侵的微生物。NETs 是细胞外 DNA 与组蛋白和中性粒细胞颗粒蛋白(如髓过氧化物酶和中性粒细胞弹性蛋白酶)复杂形成的网状支架。与细胞凋亡不同,NET 形成是一种主动的细胞死亡形式,可由各种微生物、炎症和内源性或外源性刺激触发。据报道,NETs 在以中性粒细胞为主的难治性肺部疾病中丰富,如 COPD 和严重哮喘。呼吸道病毒(例如)、细菌(例如)和真菌(例如)在诱导 NET 形成中的致病作用的证据正在出现。该过程的失调可能会导致局部 NET 负担增加,并导致 NET 性肺部炎症。阐明 NET 在人类健康和疾病中的作用为治疗性调节提供了独特的机会。趋化因子 CXCR2 受体调节中性粒细胞的激活和迁移,并且已经开发出小分子 CXCR2 拮抗剂(例如,AZD5069、danirixin)来选择性阻断中性粒细胞炎症途径。正在对 COPD 患者进行使用 CXCR2 拮抗剂的 NET 稳定剂的概念验证研究,以提供机制见解。这种类型的临床验证可能会导致针对多种与 CXCR2 相关的 NET 病理的新型治疗方法。在这篇综述中,我们讨论了 NET 在 COPD 和严重哮喘的临床病理生物学中的新兴作用,并展望了如何通过 CXCR2 阻断利用新型 NET 稳定疗法来破坏疾病特异性表型中的 NET 性炎症。