UW Allergy, Pulmonary and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
University of Arizona Health Sciences Center, Tucson, AZ, USA.
Eur Respir J. 2021 Aug 5;58(2). doi: 10.1183/13993003.03393-2020. Print 2021 Aug.
Asthma is a complex respiratory disease that varies in severity and response to treatment. Several asthma phenotypes with unique clinical and inflammatory characteristics have been identified. Endotypes, based on distinct molecular profiles, help to further elucidate the heterogeneity within asthma. Type 2 inflammation, involving both the innate (type 2 innate lymphoid cell) and adaptive (T-helper type 2 cells) immune systems, underpins the complex pathophysiology of chronic inflammation in asthma, as well as the presence of comorbid disease ( chronic rhinosinusitis with nasal polyps, allergic rhinitis and atopic dermatitis). Type 2 inflammation is characterised by upregulation of the type 2 cytokines interleukin (IL)-4, IL-5 and IL-13, IgE-mediated release of immune mediators and dysfunction of epithelial or epidermal barriers. Targeting these key proximal type 2 cytokines has shown efficacy in recent studies adopting a personalised approach to treatment using targeted biologics. Elevated levels of biomarkers downstream of type 2 cytokines, including fractional exhaled nitric oxide, serum IgE and blood and sputum eosinophils, have been linked to mechanisms involved in type 2 inflammation. They have the potential to aid diagnosis, and to predict and monitor response to treatment. The objective of this review is to summarise the current understanding of the biology of type 2 inflammation in asthma, examine its influence on type 2 inflammatory comorbidities, and discuss how type 2 inflammatory biomarkers can be harnessed to further personalise treatments in the age of biologic medicines.
哮喘是一种复杂的呼吸系统疾病,其严重程度和对治疗的反应各不相同。已经确定了几种具有独特临床和炎症特征的哮喘表型。基于不同分子谱的内型有助于进一步阐明哮喘的异质性。涉及固有(2 型固有淋巴细胞)和适应性(辅助性 T 细胞 2 型)免疫系统的 2 型炎症是哮喘慢性炎症以及合并症(慢性鼻-鼻窦炎伴鼻息肉、过敏性鼻炎和特应性皮炎)的复杂病理生理学的基础。2 型炎症的特征是 2 型细胞因子白细胞介素(IL)-4、IL-5 和 IL-13 的上调、免疫介质的 IgE 介导释放以及上皮或表皮屏障的功能障碍。最近的研究采用针对生物制剂的个体化治疗方法,靶向这些关键的近端 2 型细胞因子显示出疗效。2 型细胞因子下游生物标志物,包括呼出气一氧化氮分数、血清 IgE 以及血液和痰液嗜酸性粒细胞水平的升高,与 2 型炎症涉及的机制有关。它们有可能有助于诊断,并预测和监测对治疗的反应。本综述的目的是总结目前对哮喘 2 型炎症生物学的理解,考察其对 2 型炎症合并症的影响,并讨论如何利用 2 型炎症生物标志物在生物药物时代进一步实现个体化治疗。
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