Increased serum IL-17A and Th2 cytokine levels in patients with severe uncontrolled asthma
Increased serum IL-17A and Th2 cytokine levels in patients with severe uncontrolled asthma
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DOI：
10.1684/ecn.2017.0390
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发表时间：
2017-03-01
影响因子：
2.8
通讯作者：
Kurata, Hirokazu
中科院分区：
文献类型：
--
作者：
Hasegawa, Takehiro;Uga, Hitoshi;Kurata, Hirokazu
哮喘是一种慢性支气管炎和呼吸道重塑的综合征。最初，根据抗原特异性IgE水平，哮喘被分为特应性和非特应性类型。此外，最近哮喘根据其病理生理学被分成不同的内型，从而导致选择最理想和有效的治疗方法。虽然T辅助细胞2型(Th2)细胞因子被证实在特应性哮喘中起关键作用，但IL-17A已被报道与严重的难治性哮喘有关。患者和方法：本研究测定了34例健康人和77例哮喘患者血清中24种细胞因子/趋化因子的水平，并比较了不同疾病活动度和疾病特征的患者组之间的差异。结果：哮喘组患者血清中9种细胞因子水平显著高于对照组，IL-17A和SCF水平在控制不好组和控制良好组之间差异有统计学意义(P=0.003)。哮喘患者IL-17A水平与IL-4、IL-25、IL-10、干扰素-γ水平呈显著正相关，上述细胞因子水平最高的患者对大剂量吸入糖皮质激素治疗无效，1年内有急性加重史，需要全身激素治疗。讨论：这项研究考察了各种细胞因子和趋化因子的上调和下调与哮喘控制状态的关系。IL-17A在失控和难治性状态患者中显著上调。因此，IL-17A在哮喘急性发作中可能起重要作用，其高水平与Th2等细胞因子的上调共同提示哮喘的难治性内型。
Asthma is a syndrome of chronic bronchial inflammation and airway remodelling. Initially, asthma has been categorized into atopic and nonatopic types, based on antigen-specific IgE levels. Moreover, recently, asthma has been classified into different endotypes based on its pathophysiology, leading to the selection of the most optimal and effective therapies. Although T helper cell type 2 (Th2) cytokines were proven to play critical roles in atopic asthma, IL-17A has been reported to be involved in severe refractory asthma. Patients and methods: In this study, we measured the levels of 24 cytokines/chemokines in the sera of healthy controls (HCs) (n = 34) and patients with asthma (n = 77), that were compared among patient groups with different disease activities and characteristics. Results: The serum levels of nine cytokines were significantly higher in patients with asthma than in HCs, and the levels of IL-17A and SCF were significantly different between uncontrolled and well-controlled patient groups (p = 0.003). The IL-17A levels were significantly correlated with those of IL-4, IL-25, IL-10, and IFN-gamma in patients with uncontrolled asthma, and the patients with the highest levels of all the above cytokines were refractory to high-dose of inhaled corticosteroid therapy and have a history of acute exacerbation within 1 year, requiring systemic steroid therapy. Discussion: This study examines the profiles of upregulation and downregulation of various cytokines and chemokines in relation to asthmatic control status. IL-17A was significantly upregulated in patients with the uncontrolled and refractory status. Therefore, IL-17A may play important roles in asthmatic exacerbation, and its high level, in combination with upregulated Th2 and other cytokines, may indicate the refractory endotype of asthma.