哮喘儿童感染严重急性呼吸综合征冠状病毒2:不同内型会有相同后果吗?
SARS-CoV-2 in Asthmatic Children: Same Consequences in Different Endotypes?
作者信息
Bosco Alice, Fanos Vassilios, Bosone Serena, Incandela Valeria, La Ciacera Federica, Dessì Angelica
机构信息
Neonatal Intensive Care Unit, AOU Cagliari, Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy.
出版信息
Metabolites. 2025 Jun 16;15(6):406. doi: 10.3390/metabo15060406.
During the early stages of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, concerns arose regarding the susceptibility of asthmatic children, one of the most common chronic conditions in childhood and a major cause of hospitalization in pediatric settings. Unexpectedly, evidences showed milder clinical courses and fewer asthma exacerbations in these patients, even if cases of critical and fatal infection, often related to specific clinical features of the patient, are not negligible. In this regard, obesity is considered not only an important comorbidity in patients with difficult-to-treat asthma but also a risk factor for more severe forms of COVID-19. These observations are of even greater concern in the context of an increase in childhood obesity that began even before the SARS-CoV-2 pandemic and has continued also as a consequence of it. Given asthma's heterogeneity, especially in children, an endotype-based approach is crucial. This is possible through a detailed analysis of the complex metabolic pathways that correlate asthma, COVID-19 infection and obesity thanks to new high-through-put technologies, especially metabolomics, which with minimally invasive sampling, including on exhaled breath condensate (EBC), can provide precise and unbiased evidence in support of existing endotypes, making it possible to identify not only the most vulnerable individuals and thus risk stratification through specific biomarkers, but also new molecular and therapeutic targets. This review explores asthma endotypes by highlighting their shared immunometabolic pathways with COVID-19. Findings suggest that metabolomics could enable more accurate risk stratification and guide personalized interventions during viral pandemics, especially in the presence of relevant comorbidities such as obesity.
在严重急性呼吸综合征冠状病毒2(SARS-CoV-2)大流行的早期阶段,人们对哮喘儿童的易感性产生了担忧,哮喘是儿童期最常见的慢性病之一,也是儿科住院的主要原因。出乎意料的是,证据显示这些患者的临床病程较轻,哮喘发作较少,即使与患者特定临床特征相关的重症和致命感染病例也不容忽视。在这方面,肥胖不仅被认为是难治性哮喘患者的重要合并症,也是更严重形式的COVID-19的危险因素。在SARS-CoV-2大流行之前就已开始且因大流行而持续的儿童肥胖症增加的背景下,这些观察结果更令人担忧。鉴于哮喘的异质性,尤其是在儿童中,基于内型的方法至关重要。通过利用新的高通量技术,特别是代谢组学,详细分析与哮喘、COVID-19感染和肥胖相关的复杂代谢途径,这是可行的。代谢组学通过微创采样,包括对呼出气体冷凝物(EBC)采样,可以提供精确且无偏差的证据来支持现有的内型,不仅能够通过特定生物标志物识别最易感染个体并进行风险分层,还能确定新的分子和治疗靶点。本综述通过强调哮喘内型与COVID-19共有的免疫代谢途径来探讨哮喘内型。研究结果表明,代谢组学能够实现更准确的风险分层,并在病毒大流行期间指导个性化干预,尤其是在存在肥胖等相关合并症的情况下。