Asthma Biomarkers: Do They Bring Precision Medicine Closer to the Clinic?

Abstract

Measurement of biomarkers has been incorporated within clinical research of asthma to characterize the population and to associate the disease with environmental and therapeutic effects. Regrettably, at present, there are no specific biomarkers, none is validated or qualified, and endotype-driven choices overlap. Biomarkers have not yet reached clinical practice and are not included in current asthma guidelines. Last but not least, the choice of the outcome upholding the value of the biomarkers is extremely difficult, since it has to reflect the mechanistic intervention while being relevant to both the disease and the particular person. On the verge of a new age of asthma healthcare standard, we must embrace and adapt to the key drivers of change. Disease endotypes, biomarkers, and precision medicine represent an emerging model of patient care building on large-scale biologic databases, omics and diverse cellular assays, health information technology, and computational tools for analyzing sizable sets of data. A profound transformation of clinical and research pattern from population to individual risk and from investigator-imposed subjective disease clustering (hypothesis driven) to unbiased, data-driven models is facilitated by the endotype/biomarker-driven approach.

Keywords: Asthma; biomarkers; precision medicine.

Fig. 1. The audacious goal of precision medicine. Understanding the complex networks of molecular, genetic and environmental in combination with strong health economics data and in alignment with patients participation will open the door for prevention strategies and curative therapies for asthma.

Fig. 2. What we need to achieve the audacious goal of precision medicine. Harmonization between stakeholders and tools with agreement on a broad research program encouraging creative approaches and testing them rigorously both for robustness and for applicability for real life personalized care is needed to bring precision medicine to the clinic.

Fig. 3. Advancing the asthma biomarkers field. Profiling type 2 and non-type 2 asthma should follow the concept of complex endotypes/subendotypes in parallel with addition of new targets such as ASM, epithelial components of asthma and epigenetic modifications together with integration of systems medicine and advances in HIT. Validation and qualification of asthma biomarkers is an essential step for facilitating regulatory approval and acceptance into the health system. Improved understanding and common usage of disease phenotypes, endotypes, biomarkers, and precision therapies at the point of care is key for bringing the precision medicine into asthma clinic. Both full patient monitoring using novel digital technology and the concept of endotypes/novel biomarkers/patient centered care need to be reinforced as part of the healthcare system transformation. Development and implementation of a new asthma taxonomy including disease endotypes is highly needed. ASM, airway smooth muscle; HIT, health information technology.