Airway molecular endotypes of asthma: dissecting the heterogeneity
- PMID: 25961390
- PMCID: PMC4857192
- DOI: 10.1097/ACI.0000000000000148
Airway molecular endotypes of asthma: dissecting the heterogeneity
Abstract
Purpose of review: This review will cover advances over the past year in defining airway endotypes in asthma by gene expression and the relationship between these endotypes and clinical traits.
Recent findings: Expression profiling studies of asthmatic airway samples continue to reveal significant heterogeneity in airway inflammation and dysfunction. Recent studies have indicated multiple distinct, but related Th2 inflammatory asthma endotypes. Moreover, novel biomarkers of Th2 inflammation are being identified in more accessible nasal brushing and induced sputum cell samples. New data suggest the presence of multiple non-Th2-driven asthma molecular endotypes, including ones related to neutrophilic inflammation, airway remodeling, and chemosensory dysfunction. Many of these endotypes are associated with clinical disease features and treatment response.
Summary: Molecular endotyping of asthmatic patients using gene expression profiling of airway samples is helping to uncover disease mechanisms and potential novel treatment targets. The advancement of endotyping methods holds the promise of future personalized treatment for asthma.
Conflict of interest statement
References
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    - Baines KJ, Simpson JL, Wood LG, et al. Transcriptional phenotypes of asthma defined by gene expression profiling of induced sputum samples. J Allergy Clin Immunol. 2011;127:153–160. - PubMed
 
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    - Bhakta NR, Solberg OD, Nguyen CP, et al. A qPCR-based metric of Th2 airway inflammation in asthma. Clin Transl Allergy. 2013;3:24. This study details the development and characterization of a simple qPCR-based metric for determination of the Th2-high asthma endotype using bronchial airway epithelial brushings. - PMC - PubMed
 
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    - Modena BD, Tedrow JR, Milosevic J, et al. Gene expression in relation to exhaled NO identifies novel asthma phenotypes with unique biomolecular pathways. Am J Respir Crit Care Med. 2014;190:1363–1372. The manuscript represents one of the largest whole-genome expression profiling studies of bronchial airway brushings conducted to date. This study uses a novel approach to identify asthma endotypes first identifying genes associated with FeNO. Their work suggests multiple variants of the Th2-high endotype exist and suggest other endotypes and possible pathways driving these endotypes. - PMC - PubMed
 
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