Is IgE or eosinophils the key player in allergic asthma pathogenesis? Are we asking the right question?
Is IgE or eosinophils the key player in allergic asthma pathogenesis? Are we asking the right question?
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DOI：
10.1186/s12931-018-0813-0
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发表时间：
2018-06-08
影响因子：
5.8
通讯作者：
Kasujee I
中科院分区：
文献类型：
--
作者：
Matucci A;Vultaggio A;Maggi E;Kasujee I
支气管哮喘（BA）是一种慢性炎症性疾病，在病理生理和病因上具有明显的异质性。BA的异质性可能与诱发机制（过敏性与非过敏性）、组织病理学背景（嗜酸性粒细胞与非嗜酸性粒细胞）和临床表现有关，特别是在恶化的严重程度和频率方面。根据Th2炎症程度，哮喘可分为至少两种不同的内型（T2“高”和T2“低”）。对于严重不受控制的哮喘患者，针对免疫球蛋白E （IgE）或白细胞介素(IL)-5的单克隆抗体（mab）现在可作为附加治疗。个体患者的治疗决策应考虑炎症“驱动机制”方面的生物学背景，因为这应该预测患者对治疗的可能反应。问题不在于抗ige或抗嗜酸性粒细胞策略哪个更有效，而在于气道起源的机制是什么。虽然IgE参与炎症级联反应的早期，可被认为是过敏性哮喘的一个原因，嗜酸性粒细胞增多可被认为是整个过程的结果。本文讨论了IgE和IL-5/嗜酸性粒细胞通路在过敏性哮喘气道炎症发病机制中的不同作用，以及选择抗IgE单抗或抗IL-5治疗的可能原因。
Bronchial asthma (BA) is a chronic inflammatory disease with a marked heterogeneity in pathophysiology and etiology. The heterogeneity of BA may be related to the inducing mechanism(s) (allergic vs non-allergic), the histopathological background (eosinophilic vs non-eosinophilic), and the clinical manifestations, particularly in terms of severity and frequency of exacerbations. Asthma can be divided into at least two different endotypes based on the degree of Th2 inflammation (T2 ‘high’ and T2 ‘low’). For patients with severe uncontrolled asthma, monoclonal antibodies (mAbs) against immunoglobulin E (IgE) or interleukin (IL)-5 are now available as add-on treatments. Treatment decisions for individual patients should consider the biological background in terms of the “driving mechanisms” of inflammation as this should predict the patients’ likely responses to treatment. The question is not whether an anti-IgE or an anti-eosinophilic strategy is more effective, but rather what the mechanism is at the origin of the airway. While IgE is involved early in the inflammatory cascade and can be considered as a cause of allergic asthma, eosinophilia can be considered a consequence of the whole process. This article discusses the different roles of the IgE and IL-5/eosinophil pathways in the pathogenic mechanisms of airway inflammation occurring in allergic asthma, and the possible reasons to choose an anti-IgE mAb or anti-IL-5 treatment.
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