The infectious march: the complex interaction between microbes and the immune system in asthma.
The infectious march: the complex interaction between microbes and the immune system in asthma.
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DOI：
10.1016/j.iac.2010.09.008
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发表时间：
2010-11
影响因子：
2.6
通讯作者：
Mohapatra, Shyam
中科院分区：
文献类型：
--
作者：
Wong, Terianne;Hellermann, Gary;Mohapatra, Shyam
我们对感染性疾病和免疫系统与哮喘之间关系的认识已经取得了重大进展，但仍存在许多未解之谜。呼吸道感染，如在生命的前2年由呼吸道合胞病毒和鼻病毒引起的感染，仍然明显与以后的喘息和哮喘有关，但其机制尚未完全阐明。是否存在由婴儿期感染引发的“传染性行军”，并进展为疾病病理学，或者感染呼吸道感染的婴儿是否易患哮喘？这篇综述集中在微生物和免疫系统之间相互作用的共同主题上，并对迄今为止的证据进行了批判性的评估。微生物改变免疫反应的各种机制以及这可能如何影响哮喘与新的和有前途的预防和治疗的临床实践一起讨论沿着。使用敏感的聚合酶链反应检测方法的最新进展允许对病毒感染导致哮喘的因果关系假设进行更严格的测试，但证据仍然不明确。根据新的受试者纳入/排除指南，讨论了临床试验中的各种例外和不一致，希望提供一些标准化。尽管过去的疫苗接种失败和一些临床试验的结果令人失望，但包括RNA干扰和杀微生物剂靶向递送在内的新的预防策略为遭受哮喘发病率增加以及医疗保健费用和生活质量损失的巨大负担的世界提供了大量希望。
There has been significant progress in our knowledge about the relationship between infectious disease and the immune system in relation to asthma, but many unanswered questions still remain. Respiratory tract infections such as those caused by respiratory syncytial virus and rhinovirus during the first 2 years of life are still clearly associated with later wheezing and asthma, but the mechanism has not been completely worked out. Is there an “infectious march” triggered by infection in infancy that progresses to disease pathology or are infants who contract respiratory infections predisposed to developing asthma? This review focuses on the common themes in the interaction between microbes and the immune system, and presents a critical appraisal of the evidence to date. The various mechanisms whereby microbes alter the immune response and how this might influence asthma are discussed along with new and promising clinical practices for prevention and therapy. Recent advances in using sensitive polymerase chain reaction detection methods have allowed more rigorous testing of the causality hypothesis of virus infection leading to asthma, but the evidence is still equivocal. Various exceptions and inconsistencies in the clinical trials are discussed in light of new guidelines for subject inclusion/exclusion in hopes of providing some standardization. Despite past failures in vaccination and disappointing results of some clinical trials, the new strategies for prophylaxis including RNA interference and targeted delivery of microbicides offer a large dose of hope to a world suffering from an increasing incidence of asthma as well as a huge burden of health care cost and loss of quality of life.
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