Department of Pharmacology, School of Medicine, University of Nevada , Reno, Nevada.
Am J Physiol Lung Cell Mol Physiol. 2019 May 1;316(5):L843-L868. doi: 10.1152/ajplung.00416.2018. Epub 2019 Feb 27.
Severe asthma develops as a result of heightened, persistent symptoms that generally coincide with pronounced neutrophilic airway inflammation. In individuals with severe asthma, symptoms are poorly controlled by high-dose inhaled glucocorticoids and often lead to elevated morbidity and mortality rates that underscore the necessity for novel drug target identification that overcomes limitations in disease management. Many incidences of severe asthma are mechanistically associated with T helper 17 (T17) cell-derived cytokines and immune factors that mediate neutrophilic influx to the airways. T17-secreted interleukin-17A (IL-17A) is an independent risk factor for severe asthma that impacts airway smooth muscle (ASM) remodeling. T17-derived cytokines and diverse immune mediators further interact with structural cells of the airway to induce pathophysiological processes that impact ASM functionality. Transforming growth factor-β1 (TGF-β1) is a pivotal mediator involved in airway remodeling that correlates with enhanced T17 activity in individuals with severe asthma and is essential to T17 differentiation and IL-17A production. IL-17A can also reciprocally enhance activation of TGF-β1 signaling pathways, whereas combined T1/T17 or T2/T17 immune responses may additively impact asthma severity. This review seeks to provide a comprehensive summary of cytokine-driven T cell fate determination and T17-mediated airway inflammation. It will further review the evidence demonstrating the extent to which IL-17A interacts with various immune factors, specifically TGF-β1, to contribute to ASM remodeling and altered function in T17-driven endotypes of severe asthma.
严重哮喘是由于持续性、高度的症状发展而来,这些症状通常与明显的中性粒细胞气道炎症一致。在严重哮喘患者中,高剂量吸入糖皮质激素治疗效果不佳,症状控制不佳,常导致发病率和死亡率升高,这突显了识别新的药物靶点的必要性,以克服疾病管理中的局限性。许多严重哮喘的发生机制与 T 辅助 17(T17)细胞衍生的细胞因子和免疫因子有关,这些因子介导中性粒细胞向气道的浸润。T17 分泌的白细胞介素-17A(IL-17A)是严重哮喘的独立危险因素,影响气道平滑肌(ASM)重塑。T17 衍生的细胞因子和多种免疫介质进一步与气道的结构细胞相互作用,诱导影响 ASM 功能的病理生理过程。转化生长因子-β1(TGF-β1)是参与气道重塑的关键介质,与严重哮喘患者 T17 活性增强相关,是 T17 分化和 IL-17A 产生所必需的。IL-17A 还可以反过来增强 TGF-β1 信号通路的激活,而 T1/T17 或 T2/T17 免疫反应可能会相加影响哮喘的严重程度。本综述旨在全面总结细胞因子驱动的 T 细胞命运决定和 T17 介导的气道炎症。它还将进一步回顾证明 IL-17A 与各种免疫因子(特别是 TGF-β1)相互作用的程度,以促进 ASM 重塑和严重哮喘的 T17 驱动表型中功能的改变。
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