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Endotipos basados en la disfunción inflamatoria y mucociliar en todo el espectro de enfermedades crónicas de las vías
Erin Cant1, Mathieu Bottier1, Morven Shuttleworth1
1Division of Respiratory Medicine and Gastroenterology, University of Dundee, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK.
Chest
|August 28, 2025
Resumen
Las enfermedades respiratorias crónicas como la EPOC y el asma comparten inflamación y disfunción mucociliar. Los pacientes pueden clasificarse por endotipos inflamatorios biológicos, no solo por etiquetas de enfermedad, para mejores estrategias de tratamiento.
Área de la Ciencia:
- Medicina de los pulmones
- Inmunología
- Microbiología
Sus antecedentes:
- Las enfermedades respiratorias crónicas como la EPOC, el asma, la bronquiectasia y la fibrosis quística presentan características clínicas superpuestas.
- Las características clave incluyen inflamación de las vías respiratorias y deterioro del aclaramiento mucociliar.
Objetivo del estudio:
- Investigar la relación entre la inflamación y el aclaramiento mucociliar en enfermedades respiratorias crónicas.
- Para determinar si los factores biológicos, en lugar de las etiquetas tradicionales de la enfermedad, pueden estratificar a los pacientes en subtipos terapéuticamente relevantes.
Principales métodos:
- Se clasificaron a los pacientes con asma, EPOC, ER y FQ, y se analizó el esputo espontáneo.
- Las mediciones incluyeron marcadores inflamatorios (elastasa neutrófila, citoquinas), propiedades del esputo (ADN, mucinas, reología, peso seco) y composición del microbioma.
- Se utilizó la agrupación de medios K para identificar subtipos de pacientes basados en características biológicas.
Principales resultados:
- Se observaron diferencias significativas en los marcadores inflamatorios, las propiedades del esputo y la diversidad del microbioma entre los grupos de enfermedad y los controles.
- La agrupación por medios K identificó dos endotipos inflamatorios distintos: neutrófico y Th2-dominante.
- El endotipo neutrófilo se asoció con características más graves de la enfermedad, aumento de las proteobacterias en el microbioma del esputo y fue más frecuente en pacientes con FQ y EB.
- El endotipo Th2 mostró perfiles de propiedades de esputo y características de microbioma distintos.
Conclusiones:
- Enfermedades de las vías respiratorias con propiedades mucosas y perfiles inflamatorios heterogéneos.
- La estratificación de los pacientes basada en los endotipos inflamatorios, más que únicamente en las etiquetas de la enfermedad, es factible y clínicamente relevante.
- La integración del endotipado con los biomarcadores de aclaramiento inflamatorio y mucociliar puede mejorar la evaluación del paciente y orientar las decisiones terapéuticas.
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