严重哮喘的免疫反应和恶化。
Immune responses and exacerbations in severe asthma.
机构信息
Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Department of Immunology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
出版信息
Curr Opin Immunol. 2021 Oct;72:34-42. doi: 10.1016/j.coi.2021.03.004. Epub 2021 Mar 24.
Asthma as a clinical entity manifests with a broad spectrum of disease severity. Unlike milder asthma, severe disease is poorly controlled by inhaled corticosteroids, the current standard of care. Transcriptomic data, along with patient characteristics and response to biologics show that though Type 2 (T2) immune response remains an integral feature of asthma, additional molecular and immunologic factors may play important roles in pathogenesis. Mechanisms of T2 development, cellular sources of T2 cytokines and their relationship to additional immune pathways concurrently activated may distinguish several different subphenotypes, and perhaps endotypes of asthma, with differential response to non-specific and targeted anti-inflammatory therapies. Recent data have also associated non-T2 cytokines derived from T cells, particularly IFN-γ, and epithelial mediators with severe asthma. These topics and their relationships to acute asthma exacerbations are discussed in this review.
哮喘作为一种临床实体，表现出疾病严重程度的广泛谱。与较轻的哮喘不同，严重疾病对吸入性皮质类固醇的控制不佳，而吸入性皮质类固醇是目前的标准治疗方法。转录组数据以及患者特征和对生物制剂的反应表明，尽管 2 型（T2）免疫反应仍然是哮喘的一个重要特征，但其他分子和免疫因素可能在发病机制中发挥重要作用。T2 发展的机制、T2 细胞因子的细胞来源及其与同时激活的其他免疫途径的关系，可能区分几种不同的亚表型，也许是哮喘的内表型，对非特异性和靶向抗炎治疗有不同的反应。最近的数据还将来源于 T 细胞的非 T2 细胞因子，特别是 IFN-γ，以及上皮介质与严重哮喘联系起来。本文综述了这些主题及其与急性哮喘加重的关系。
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