哮喘联盟

   摘要
   目前已经认识到哮喘是一类可合并有不同临床表现的广泛综合征。哮喘治疗的未来进展是需要明确这些哮喘表型的特征以及导致这些临床表现的潜在细胞机制。本文将描述哮喘生物学的研究现状。包括在哮喘和过敏方面先驱研究者的工作回顾，这些工作是如何引导我们认识TH1 和TH2细胞因子的，以及“卫生学假说”的发展。本文将讨论TH1-TH2哮喘模型在动物和人类研究中的应用和局限性，以及这些认知如何解决周围的卫生学假说和其他竞争模型的争议。本文将讨论在对哮喘病理生物学机制了解的基础上发展的治疗新方法，包括这些治疗方法的成功以及不足之处。本文将回顾引导哮喘表型认知的早期工作。这包括各种哮喘炎症亚型的早期发现以及这些炎症亚型与治疗反应的关联性如何。最后，本文将描述哮喘生物学的最新发现，包括气道上皮在哮喘发病机制中的作用，在哮喘中可能作为新治疗靶点的重要新细胞因子，以及最新描述天然免疫细胞的识别和他们在哮喘中的作用。提高对各种哮喘表型复杂生物学基础的认知是哮喘以及危重哮喘综合征患者优化治疗的关键。
 

（林江涛 审校）
Clin Rev Allergy Immunol. 2014 Jan 8. [Epub ahead of print]


 

Immunobiology of the Critical Asthma Syndrome.
 

Harper RW, Zeki AA.
 

Abstract
It is now recognized that asthma incorporates a broad spectrum of syndromes with varying clinical manifestations. Future improvements in asthma treatment will require a clear characterization of these asthma phenotypes and the cellular mechanisms underlying these clinical manifestations. Herein, we will describe the current knowledge of asthma biology. This will include a review of the early pioneers in asthma and allergy, how this work led to our understanding of TH1 and TH2 cytokines, and the development of the "hygiene hypothesis." We will discuss the utility and limitations of the TH1-TH2 model of asthma in animal and human studies, and how this knowledge addresses controversies surrounding the hygiene hypothesis and other competing models. We will discuss novel therapies that have been developed based on mechanistic understanding of asthma pathobiology, including successes and shortcomings of these therapies. We will review the early work that led to the recognition of "asthma phenotypes." This will include the early discovery of various inflammatory subtypes in asthma and how these inflammatory subtypes correlate with response to therapy. Finally, we will describe recent discoveries in asthma biology that will include the role of the airway epithelium in asthma pathogenesis, novel cytokines important in asthma that may serve as novel therapeutic targets, and the identification of newly described innate immune cells and their role in asthma. Improved understanding of the complex biology underpinning the various asthma phenotypes is critical for our ability to optimize treatment for all patients that suffer from asthma and critical asthma syndromes.
 

Clin Rev Allergy Immunol. 2014 Jan 8. [Epub ahead of print]