Pathophysiology of asthma: What has our current understanding taught us about new therapeutic approaches? - 28/08/11
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Abstract |
Current asthma therapy is based on the use of adrenergic bronchodilator and anti-inflammatory drugs the specificity, efficacy, duration of action, and safety of which have been derived through classical pharmacology and medicinal chemistry. That asthma is a TH2-type inflammatory disorder frequently associated with atopy and allergic comorbidities has led to a concentrated effort to find treatments that act selectively on this pathway. A systematic literature review was undertaken, as well as a review of the Web site Clinicaltrials.gov for ongoing trials. Targets have included T cells themselves and their associated cytokines, chemokines, and receptors mostly targeted with biological agents. With the exception of anti-human IgE, none of these have met the expectations predicted from animal models and human in vitro tests. For most of these new therapies, only a very small subpopulation appears to respond. A case is made for a different approach to drug discovery based on acquiring a greater understanding of asthma stratification, the relevant pathways involved, and the development of appropriate diagnostic tests enabling the targeting of selective treatments to those asthmatic phenotypes most likely to respond. The recognition that asthma is more than allergy mandates improved predictive animal models and an appreciation that many of the environmental insults that initiate, consolidate, and exacerbate asthma operate through an epithelium functioning in a disorderly fashion. An integrated model that places the epithelium at the forefront of asthma pathogenesis suggests that greater emphasis should be placed on therapeutics that increase the airways’ resistance against the inhaled environment rather than focusing only on suppression of inflammation.
Le texte complet de cet article est disponible en PDF.Key words : Asthma, biologic agents, TH2, epithelium, new treatments
Abbreviations used : ACQ, CTLA4, IL-4R, IL-13R, LABA, OX40L, RCT, Treg
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Disclosure of potential conflict of interest: S. T. Holgate is Nonexecutive Director of Synairgen, has consultant arrangements with Novartis and MSD, receives research support from the Medical Research Council UK, is Vice President of the British Lung Foundation, and is Vice President of Environmental Protection UK. |
Vol 128 - N° 3
P. 495-505 - septembre 2011 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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