Biomarcadores e imunobiológicos na asma
Biomarkers and immunobiological agents in asthma
Ataualpa Pereira dos Reis; Jose Augusto Nogueira Machado
Resumo
A maioria dos asmáticos é bem controlada com o uso de corticosteroides inalados e beta-agonistas de ação prolongada; contudo, uma proporção de pacientes não responde a esta terapia, e mantém controle limitado da doença. Este grupo experimenta exacerbações frequentes, e requer admissão hospitalar. O desenvolvimento de novos agentes biológicos e biomarcadores da doença abre novas avenidas para o tratamento. Nós revisamos as últimas informações pertinentes aos biomarcadores e agentes biológicos, e demonstramos como os pacientes podem ser identificados e se beneficiar destes tratamentos. As fontes de dados incluíram artigos originais, revisões e publicações indexados nos bancos de dados PubMed, MEDLINE, LILACS, SciELO e publicações on-line, nos últimos 15 anos. As informações mais recentes da medicina personalizada com análise genética e biomarcadores da inflamação Th2 permitiram identificar fenótipos de asma que incluem um fenótipo T2 alto. Estudos recentes dirigidos para IgE, IL-5, IL-13, IL-17 e para os receptores de cadeias alfa de IL-4 mostraram alguma eficácia em alguns pacientes fenotipados. Para aqueles sem evidência de inflamação Th2, nenhuma terapia específica foi identificada. A disponibilidade de biomarcadores e agentes bioterapêuticos que são dirigidos para IgE, interleucinas IL-5, IL-4, IL-13 e IL-17, são uma excitante modalidade de medicina molecular. Contudo, estes agentes bioterapêuticos somente são efetivos quando dirigidos para pacientes com fenótipos de asma específicos.
Palavras-chave
Abstract
Most asthmatic individuals are well managed with inhaled corticosteroids and prolonged-action beta-agonists; however, some patients are unresponsive to therapy and attain limited disease control. The latter group experiences frequent exacerbations requiring hospital admission. The development of new biological agents and disease biomarkers has provided novel avenues for treatment. We review the latest information regarding biomarkers and biological agents and demonstrate how potential patients may be identified for treatment. Data sources included original articles, reviews, and published works indexed in PubMed, MEDLINE, LILACS, SciELO, and other online databases over the past 15 years. The latest findings from personalized medicine with genetic analysis and clinical biomarkers of Th2 inflammation have allowed the identification of asthma phenotypes including a T2-high phenotype. Recent studies targeting IgE, IL-5, IL13, IL-17, and the IL4 receptor alpha chain have shown some efficacy in phenotyped patients. For those without evidence of Th2 inflammation, no specific therapies have been identified. The availability of biomarkers and biotherapeutic agents targeting IgE, IL-5, IL-4, IL-13, and IL-17 is an exciting advance in molecular medicine. However, those biotherapeutic agents are effective only when used in patients with specific asthma phenotypes.
Keywords
References
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Submitted date:
04/17/2018
Accepted date:
12/18/2018
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