Emerging molecular phenotypes of asthma

Abstract

Although asthma has long been considered a heterogeneous disease, attempts to define subgroups of asthma have been limited. In recent years, both clinical and statistical approaches have been utilized to better merge clinical characteristics, biology, and genetics. These combined characteristics have been used to define phenotypes of asthma, the observable characteristics of a patient determined by the interaction of genes and environment. Identification of consistent clinical phenotypes has now been reported across studies. Now the addition of various 'omics and identification of specific molecular pathways have moved the concept of clinical phenotypes toward the concept of molecular phenotypes. The importance of these molecular phenotypes is being confirmed through the integration of molecularly targeted biological therapies. Thus the global term asthma is poised to become obsolete, being replaced by terms that more specifically identify the pathology associated with the disease.

Severe asthma in humans and mouse model suggests a CXCL10 signature underlies corticosteroid-resistant Th1 bias

“…It is increasingly recognized that asthma is a disease with multiple phenotypes, each with its own unique molecular mechanisms, natural history, and response to therapy (2,3). Corticosteroids (CS) have remained the mainstay of therapy, but for many patients, these therapies are ineffective (4), and research of underlying mechanisms may give insight into the etiologies of CS resistance and identify future therapeutic targets.…”

Personalised medicine in sleep respiratory disorders: focus on obstructive sleep apnoea diagnosis and treatment

“…The identification of phenotypes of asthma [1,2] or chronic obstructive pulmonary disease (COPD) [3][4][5] has boosted a major change in the way we diagnose and treat these diseases and has widened our perspective for new treatments. In patients with lung cancer, innovative treatments have been developed towards specific molecular targets, with increased efficacy and improved outcomes compared to traditional chemotherapy [6,7].…”

Novel concepts in airway inflammation and remodelling in asthma

“…Although unbiased analyses to identify clinical phenotypes have been extensively undertaken, and many of these approaches have included inflammatory parameters, especially eosinophilic inflammation [9,10], assessments of airway remodelling have yet to be incorporated. It is acknowledged that currently available molecular therapies, including novel monoclonal antibodies, target inflammatory mediators and are successful in patients with a T-helper cell type 2 (Th2)-predominant profile [11], but therapies for non-Th2-high or noninflammatory phenotypes are needed [12].…”