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Review
. 2020;99(7):566-576.
doi: 10.1159/000506651. Epub 2020 Jun 8.

Immune Modulation in Asthma: Current Concepts and Future Strategies

Marek Lommatzsch  1
Affiliations
Review

Immune Modulation in Asthma: Current Concepts and Future Strategies

Marek Lommatzsch. Respiration. 2020.

Abstract

Asthma treatment concepts have profoundly changed over the last 20 years, from standard therapeutic regimens for all patients with asthma towards individually tailored interventions targeting treatable traits ("precision medicine"). A precise and highly effective immune modulation with minimal adverse effects plays a central role in this new concept. Recently, there have been major advances in the treatment of asthma with immune-modulatory compounds. One example is the approval of several highly potent biologics for the treatment of severe asthma. New immune-modulatory strategies are expected to enter clinical practice in the future; these innovations will be especially important for patients with treatment-resistant asthma.

Keywords: Allergen immunotherapy; Asthma; Immune modulation; Oral corticosteroids.

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Conflict of interest statement

The author received research grants from Deutsche Forschungs­gemeinschaft (DFG), GSK, Astra Zeneca, and honoraria for lectures and advisory boards from ALK, Allergopharma, Astra Zeneca, Bencard, Berlin-Chemie, Boehringer-Ingelheim, Bosch, Chiesi, Circassia, GSK, HAL Allergy, Janssen-Cilag, MSD, Mundipharma, Novartis, Nycomed/Takeda, Sanofi, TEVA, UCB.

Figures

Fig. 1
Fig. 1
History of asthma pharmacology. Drug classes that are currently used in asthma therapy are shown, and the decade or year of their first approval.
Fig. 2
Fig. 2
Immunopathology and immune modulation of “type 2 high” asthma. There are 2 main pathways in the pathogenesis of airway inflammation in “type 2 high” asthma: via allergen-presenting dendritic cells (DC) which expand allergen-specific T-helper cells (Th2) and/or via an activation of ILC2. Both cell types are regulated by the transcription factor GATA-3. Both pathways can be triggered by epithelial cytokines (such as TSLP, IL-25, IL-33) and result in a release of type 2 cytokines such as IL-4, IL-5, or IL-13, and an enhanced IgE production by B cells. Immune-modulatory interventions that have been studied in clinical trials are shown (currently approved interventions for the treatment of asthma are marked with green color).
Fig. 3
Fig. 3
Changes of asthma biomarkers during a treatment with biologics: blood eosinophil counts, FeNO values, and total IgE serum concentrations during treatment with anti-IgE (omalizumab), anti-IL-5-(R) (mepolizumab, reslizumab, benralizumab), anti-IL-4/13 (dupilumab), or anti-TSLP (tezepelumab) in published clinical trials with patients with severe asthma.
See this image and copyright information in PMC

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