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Review
. 2022 Dec 5;22(6):e45.
doi: 10.4110/in.2022.22.e45. eCollection 2022 Dec.

Immunologic Basis of Type 2 Biologics for Severe Asthma

Soyoon Sim  1   2 , Youngwoo Choi  1 , Hae-Sim Park  1   2
Affiliations
Review

Immunologic Basis of Type 2 Biologics for Severe Asthma

Soyoon Sim et al. Immune Netw. .

Abstract

Asthma is a chronic airway inflammatory disease characterized by reversible airway obstruction and airway hyperreactivity to various environmental stimuli, leading to recurrent cough, dyspnea, and wheezing episodes. Regarding inflammatory mechanisms, type 2/eosinophilic inflammation along with activated mast cells is the major one; however, diverse mechanisms, including structural cells-derived and non-type 2/neutrophilic inflammations are involved, presenting heterogenous phenotypes. Although most asthmatic patients could be properly controlled by the guided treatment, patients with severe asthma (SA; classified as a treatment-refractory group) suffer from uncontrolled symptoms with frequent asthma exacerbations even on regular anti-inflammatory medications, raising needs for additional controllers, including biologics that target specific molecules found in asthmatic airway, and achieving the precision medicine for asthma. This review summarizes the immunologic basis of airway inflammatory mechanisms and current biologics for SA in order to address unmet needs for future targets.

Keywords: Asthma; Biologics; Eosinophils; Inflammation; Phenotype; Precision medicine.

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Conflict of interest statement

Conflict of Interest: The authors declare no potential conflicts of interest.

Figures

Figure 1
Figure 1. Pathological mechanism of Innate and adaptive immune response in type 2 (A) and non-type 2 asthma (B).
DC, dendritic cell; Eos, eosinophil; Areg, amphiregulin; LT; leukotriene; PGD2, prostaglandin 2; LTC4, leukotriene C4; Neu, neutrophil; NE, neutrophil elastase; MPO, myeloperoxidase; MMP-9, matrix metalloprotease-9; S100A9, S100 calcium-binding protein A9; ECM, extracellular matrix.
Figure 2
Figure 2. Potential biological targets in type 2 asthma.
IL-4Rα, interleukin 4 receptor subunit alpha; IL-5Rα, interleukin 5 receptor subunit alpha.
See this image and copyright information in PMC

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