Asthma endotypes in flux: integrating type 1 and type 2 inflammation for biological therapy advancement.

IF 1.3 4区 医学 Q3 ALLERGY
Picheswara Rao Polu, Vamsi Krishna Bikki
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引用次数: 0

Abstract

Objective: To synthesize current understanding of type 1 (T1) and type 2 (T2) asthma endotypes and evaluate how their integration can advance precision biological therapy selection for improved patient outcomes.

Data sources: Comprehensive literature review of peer-reviewed articles from PubMed, Embase, and Cochrane databases focusing on asthma immunopathology, endotype characterization, biomarker development, and biological therapies. Additional sources included clinical trial registries, regulatory agency documents, and recent conference proceedings.

Study selection: Studies were selected based on relevance to T1/T2 inflammatory pathways, biomarker validation, biological therapy efficacy, and endotype-guided treatment strategies. Priority was given to randomized controlled trials, systematic reviews, and large observational studies with clear endotype characterization.

Results: T2 inflammation, characterized by interleukin-4 (IL-4), IL-5, and IL-13 pathways with eosinophilic involvement, has well-established biomarkers (blood eosinophils, fractional exhaled nitric oxide (FeNO), periostin) and successful targeted biologics (anti-IL-5, anti-IL-4 receptor alpha (anti-IL-4Rα), anti-immunoglobulin E (anti-IgE)). T1 inflammation, involving interferon-gamma (IFN-γ), tumor necrosis factor-alpha (TNF-α), and IL-17 with neutrophilic predominance, lacks validated biomarkers and effective therapeutics. Emerging evidence demonstrates significant T1/T2 overlap in severe asthma, challenging traditional dichotomous classification. Multi-pathway targeting strategies and upstream cytokine inhibition show promise for mixed endotypes.

Conclusion: Integration of T1 and T2 endotype characterization through validated biomarkers and multi-omics approaches is essential for advancing precision medicine in asthma. Future therapeutic strategies must address endotype plasticity and mixed inflammatory patterns to optimize biological therapy selection and improve treatment outcomes in heterogeneous asthma populations.

哮喘内源性变化:整合1型和2型炎症促进生物治疗进展。
目的:综合目前对1型(T1)和2型(T2)哮喘内型的认识,并评估它们的整合如何推进精确的生物治疗选择,以改善患者的预后。数据来源:对PubMed、Embase和Cochrane数据库中同行评议文章的综合文献综述,重点是哮喘免疫病理、内型表征、生物标志物发展和生物治疗。其他来源包括临床试验注册、监管机构文件和最近的会议记录。研究选择:根据T1/T2炎症途径的相关性、生物标志物验证、生物治疗疗效和内源性引导治疗策略来选择研究。优先考虑随机对照试验、系统评价和具有明确内源性特征的大型观察性研究。结果:T2炎症以白细胞介素-4 (IL-4)、IL-5和IL-13通路为特征,与嗜酸性粒细胞有关,具有成熟的生物标志物(血液嗜酸性粒细胞、分数呼出一氧化氮(FeNO)、骨膜蛋白)和成功的靶向生物制剂(抗IL-5、抗IL-4受体α(抗il - 4r α)、抗免疫球蛋白E(抗ige))。T1炎症涉及干扰素-γ (IFN-γ)、肿瘤坏死因子-α (TNF-α)和白细胞介素-17,具有中性粒细胞优势,缺乏经过验证的生物标志物和有效的治疗方法。新出现的证据表明,严重哮喘患者T1/T2有显著重叠,挑战了传统的二分法。多途径靶向策略和上游细胞因子抑制显示了混合内源性的希望。结论:通过验证的生物标志物和多组学方法整合T1和T2内型表征对于推进哮喘精准医学至关重要。未来的治疗策略必须解决内型可塑性和混合炎症模式,以优化生物治疗选择,改善异质性哮喘人群的治疗结果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of Asthma
Journal of Asthma 医学-过敏
CiteScore
4.00
自引率
5.30%
发文量
158
审稿时长
3-8 weeks
期刊介绍: Providing an authoritative open forum on asthma and related conditions, Journal of Asthma publishes clinical research around such topics as asthma management, critical and long-term care, preventative measures, environmental counselling, and patient education.
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