喘息の治療におけるインタールイキン経路の標的化
1Experimental Studies, Airway Disease Section, National Heart and Lung Institute, Imperial College London, London, UK; National Institute for Health Research (NIHR), Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Trust and Imperial College London, London, UK.
Lancet (London, England)
|September 19, 2015
まとめ
T-ヘルパー-2 (Th2) サイトカインを阻害する標的治療は,重度のエオシノフィル性喘息に対して有望である. バイオマーカーは これらの先進的な治療法から 恩恵を受ける患者を特定するのに 極めて重要です
科学分野:
- 免疫学
- 肺科
- 薬理学について
背景:
- 喘息は複雑な呼吸器疾患で,標準的な治療法にもかかわらず重症な症状を経験する患者のサブセットです.
- 重度の喘息は制御不良,頻繁に悪化し,継続的な空気流の阻害によって特徴付けられます.
- Tヘルパー-2 (Th2) 細胞由来インタールイキン (IL-4,IL-5,IL-13) は,重度の喘息患者のほぼ半数のエオシノフィルおよびアレルギー性炎症に関与しています.
研究 の 目的:
- 重度の喘息におけるTh2誘発性炎症の役割を検討する.
- 重度の喘息に対する抗IgEおよび抗サイトカイン単体抗体の有効性を評価する.
- 重度の喘息の治療決定におけるバイオマーカーの可能性について議論する.
主な方法:
- 重度の喘息の病理生理学と治療に関する既存の文献のレビュー
- オマリズマブ,抗IL-5,抗IL-4Rα,および抗IL-13抗体などの標的治療を調査した研究の分析.
- 発症,喘息制御,肺機能 (FEV1) を含む臨床結果の検討
主要な成果:
- 抗IgE療法 (オマリズマブ) は重度のアレルギー性喘息に有効である.
- IL- 5, IL- 4Rα,またはIL- 13を標的とする単一クローン抗体は,重度のエオシノフィル性喘息の患者で改善された結果を示した.
- FDAは,重度のエオシノフィル性喘息に対して,抗-IL-5抗体を推奨しており,Th2抗剤の治療的役割を示唆している.
結論:
- 標的型抗Th2生物学的治療は,重度のエオシノフィル性喘息の管理における重要な進歩を表しています.
- これらの選択性抗体ベースの治療に適した患者を選択するには,バイオマーカーの識別が不可欠です.
- 現在の治療法では,低Th2発現による非エオシノフィルの炎症による喘息を治療できません.
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