Precision Medicine in Targeted Therapies for Severe Asthma: Is There Any Place for "Omics" Technology?

Abstract

According to the current guidelines, severe asthma still represents a controversial topic in terms of definition and management. The introduction of novel biological therapies as a treatment option for severe asthmatic patients paved the way to a personalized approach, which aims at matching the appropriate therapy with the different asthma phenotypes. Traditional asthma phenotypes have been decomposing by an increasing number of asthma subclasses based on functional and physiopathological mechanisms. This is possible thanks to the development and application of different omics technologies. The new asthma classification patterns, particularly concerning severe asthma, include an increasing number of endotypes that have been identified using new omics technologies. The identification of endotypes provides new opportunities for the management of asthma symptoms, but this implies that biological therapies which target inflammatory mediators in the frame of specific patterns of inflammation should be developed. However, the pathway leading to a precision approach in asthma treatment is still at its beginning. The aim of this review is providing a synthetic overview of the current asthma management, with a particular focus on severe asthma, in the light of phenotype and endotype approach, and summarizing the current knowledge about "omics" science and their therapeutic relevance in the field of bronchial asthma.

Figure 1

T2-high and T2-low asthma pathway. The T2-high subtype is characterized by the presences of high level of eosinophils in airways, and the T2-low subtype is characterized by Neutrophilic or Paucigranulocytic airway inflammation. APC antigen presenting cell, ILC2 type 2 innate lymphoid cells, TSLP thymic stromal lymphopoietin, and TNF (tumor necrosis factor).

Figure 2

From omics technology to personalized medicine. From DNA microarray to Next Generation Sequencing (NGS), system biology provides for management and data analysis. This path is moving forward to the development of “precision medicine” approaches.