Endotypes in bronchiectasis: moving towards precision medicine. A narrative review
M Martins1, H R Keir2, J D Chalmers2
1Pulmonology Department, Centro Hospitalar Universitário de São João, Porto, Portugal.
Pulmonology
|April 8, 2023
Summary
Endotyping bronchiectasis, identifying disease subtypes based on distinct biological mechanisms, aids in personalized treatment. Biomarkers and microbiome analysis are key to guiding therapy and improving patient outcomes.
Area of Science:
- Pulmonary Medicine and Respiratory Research
- Immunology and Inflammation Studies
- Microbiome and Genetics Research
Background:
- Bronchiectasis presents significant diagnostic and management challenges due to patient heterogeneity in causes, symptoms, and outcomes.
- The concept of 'endotypes'—disease subtypes with unique biological mechanisms—offers a framework for improved bronchiectasis management.
- Understanding disease heterogeneity is crucial for developing targeted therapies.
Approach:
- A comprehensive literature search was conducted on PubMed and Google Scholar for studies on bronchiectasis endotyping.
- Included were randomized controlled trials, observational studies, systematic reviews, and meta-analyses published up to October 2022.
- Search terms included 'bronchiectasis', 'endotypes', 'biomarkers', 'microbiome', and 'inflammation', with specific exclusion criteria applied.
Key Points:
- Bronchiectasis patients can be classified into distinct endotypes based on comorbidities, underlying causes, or inflammatory profiles.
- Specific biomarkers correlating with endotypes can predict treatment response and prognosis.
- Examples include immunodeficiency and allergic bronchopulmonary aspergillosis as treatable endotypes, and inflammatory markers like neutrophil extracellular traps and eosinophilia.
Conclusions:
- Endotyping reveals bronchiectasis subtypes beyond etiology, including those defined by inflammatory mechanisms.
- Future research focusing on host response biomarkers, infection, and the microbiome will guide personalized treatments.
- Advances in understanding inflammatory pathways, microbiome, and genetics are essential for personalized medicine in bronchiectasis.
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