Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine and Cystic Fibrosis Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
German Center for Lung Research (DZL), associated partner site, Berlin, Germany.
Eur Respir Rev. 2024 Sep 18;33(173). doi: 10.1183/16000617.0001-2024. Print 2024 Jul.
Chronic airway inflammation is a central feature in the pathogenesis of bronchiectasis (BE), which can be caused by cystic fibrosis (CFBE; hereafter referred to as CF lung disease) and non-CF-related conditions (NCFBE). Inflammation in both CF lung disease and NCFBE is predominantly driven by neutrophils, which release proinflammatory cytokines and granule proteins, including neutrophil serine proteases (NSPs). NSPs include neutrophil elastase, proteinase 3 and cathepsin G. An imbalance between NSPs and their antiproteases has been observed in people with CF lung disease and people with NCFBE. While the role of the protease/antiprotease imbalance is well established in both CF lung disease and NCFBE, effective therapies targeting NSPs are lacking. In recent years, the introduction of CF transmembrane conductance regulator (CFTR) modulator therapy has immensely improved outcomes in many people with CF (pwCF). Despite this, evidence suggests that airway inflammation persists, even in pwCF treated with CFTR modulator therapy. In this review, we summarise current data on neutrophilic inflammation in CF lung disease to assess whether neutrophilic inflammation and high, uncontrolled NSP levels play similar roles in CF lung disease and in NCFBE. We discuss similarities between the neutrophilic inflammatory profiles of people with CF lung disease and NCFBE, potentially supporting a similar therapeutic approach. Additionally, we present evidence suggesting that neutrophilic inflammation persists in pwCF treated with CFTR modulator therapy, at levels similar to those in people with NCFBE. Collectively, these findings highlight the ongoing need for new treatment strategies targeting neutrophilic inflammation in CF lung disease.
慢性气道炎症是支气管扩张症(BE)发病机制的核心特征,可由囊性纤维化(CFBE;以下简称 CF 肺病)和非 CF 相关疾病(NCFBE)引起。CF 肺病和 NCFBE 中的炎症主要由中性粒细胞驱动,中性粒细胞释放促炎细胞因子和颗粒蛋白,包括中性粒细胞丝氨酸蛋白酶(NSPs)。NSP 包括中性粒细胞弹性蛋白酶、蛋白酶 3 和组织蛋白酶 G。在 CF 肺病患者和 NCFBE 患者中观察到 NSP 与其抗蛋白酶之间的失衡。虽然蛋白酶/抗蛋白酶失衡在 CF 肺病和 NCFBE 中都有明确的作用,但缺乏针对 NSP 的有效治疗方法。近年来,CF 跨膜电导调节剂(CFTR)调节剂治疗的引入极大地改善了许多 CF 患者(pwCF)的预后。尽管如此,有证据表明,即使在接受 CFTR 调节剂治疗的 pwCF 中,气道炎症仍然存在。在这篇综述中,我们总结了 CF 肺病中性粒细胞炎症的现有数据,以评估中性粒细胞炎症和高、不受控制的 NSP 水平在 CF 肺病和 NCFBE 中是否发挥相似的作用。我们讨论了 CF 肺病患者和 NCFBE 患者中性粒细胞炎症特征之间的相似性,这可能支持类似的治疗方法。此外,有证据表明,在接受 CFTR 调节剂治疗的 pwCF 中,中性粒细胞炎症仍然存在,其水平与 NCFBE 患者相似。综上所述,这些发现强调了在 CF 肺病中针对中性粒细胞炎症的新治疗策略的持续需求。
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