Division of Allergy, Asthma, and Immunology, Scripps Clinic, San Diego, California, USA.
Curr Opin Allergy Clin Immunol. 2021 Feb 1;21(1):79-85. doi: 10.1097/ACI.0000000000000708.
The aim of this study was to highlight the phenotypes and endotypes of asthma as a tool for selection of the Food and Drug Administration approved biologic therapies.
An evolving concept of asthma has led to the identification of distinct phenotypes and endotypes in this disease. Asthma endotypes are defined as the biological mechanism and are often categorized as T2-high and T2-low based on the influence of T helper type 2 (T2) cells and type 2 cytokines, including interleukin (IL)-4, IL-5, IL-9 and IL-13. Biomarkers such as peripheral blood absolute eosinophil count, total IgE, specific IgE and fractional exhaled nitric oxide may be used as indicators of asthma endotypes and help predict response to biologic therapies. There are currently five biologic therapies approved as a treatment option for T2-high asthma: omalizumab, benralizumab, mepolizumab, reslizumab and dupilumab.
Here, we explore the current understandings of asthma endotypes and review their associated phenotypes. We provide practical and evidence-based guidance for clinicians considering a biologic for asthma add-on maintenance therapy.
本研究旨在强调哮喘的表型和内型，作为选择食品和药物管理局批准的生物疗法的工具。
哮喘的概念不断发展，导致该疾病中出现了不同的表型和内型。哮喘内型定义为生物学机制，通常根据辅助性 T 细胞 2（T2）细胞和 2 型细胞因子（包括白细胞介素-4（IL-4）、白细胞介素-5（IL-5）、白细胞介素-9 和白细胞介素-13）的影响分为 T2 高和 T2 低。外周血绝对嗜酸性粒细胞计数、总 IgE、特异性 IgE 和呼出气一氧化氮分数等生物标志物可用作哮喘内型的指标，并有助于预测对生物疗法的反应。目前有五种生物疗法被批准作为 T2 高型哮喘的治疗选择：奥马珠单抗、贝那利珠单抗、美泊利珠单抗、瑞利珠单抗和度普利尤单抗。
本文探讨了哮喘内型的现有认识，并回顾了它们相关的表型。为考虑使用生物疗法进行哮喘附加维持治疗的临床医生提供了实用和基于证据的指导。
