Institute for Immunological Research, University of Cartagena, Cartagena, Colombia.
Curr Opin Allergy Clin Immunol. 2020 Jun;20(3):268-273. doi: 10.1097/ACI.0000000000000628.
Precision medicine could help to improve diagnosis and treatment of asthma; however, in the tropics there are special conditions to be considered for applying this strategy. In this review, we analyze recent advances of precision allergology in tropical regions, highlighting its limitations and needs in high-admixed populations living under environments with high exposure to house dust mites and helminth infections.
Advances have been made regarding the genetic characterization of the great diversity of populations living in the tropics. Genes involved in shared biological pathways between immune responses to nematodes and the allergic responses suggested new mechanisms of predisposition. Genome wide association studies of asthma are progressively focusing on some highly replicated genes such as those in chromosome 17q31-13, which have been also replicated in African ancestry populations. Some diagnostic difficulties, because of the endemicity of helminth infections, are now more evident in the context of phenotype definition.
The clinical impact of the advances in precision medicine for asthma in the tropics is still limited and mainly related to component resolved diagnosis. More basic and clinical research is needed to identify genetic, epigenetic, or other biologic markers that allow and accurate definition of phenotypes and endotypes of this heterogeneous disease. This will substantially improve the selection of personalized treatments.
精准医学有助于改善哮喘的诊断和治疗；然而，在热带地区，应用这一策略需要考虑特殊条件。在这篇综述中，我们分析了热带地区精准变态反应学的最新进展，强调了在高度混合人群中，生活在高屋尘螨和寄生虫感染暴露环境下，该策略的局限性和需求。
在遗传特征方面，生活在热带地区的人群的多样性已经取得了进展。涉及线虫免疫反应和过敏反应之间共享生物学途径的基因提示了新的易感性机制。哮喘的全基因组关联研究逐渐集中在一些高度复制的基因上，如染色体 17q31-13，这些基因在非洲裔人群中也得到了复制。由于寄生虫感染的流行，一些诊断上的困难，在表型定义方面现在更加明显。
热带地区哮喘精准医学进展的临床影响仍然有限，主要与成分解析诊断有关。需要更多的基础和临床研究来识别遗传、表观遗传或其他生物标志物，以准确定义这种异质性疾病的表型和内型。这将大大改善个体化治疗的选择。
