O tratamento da asma hoje e amanhã
Asthma treatment, today and tomorrow
Hisbello S. Campos
Resumo
A incorporação progressiva de novos conhecimentos na etiopatogenia da asma vem sendo útil para compreender os fundamentos da grande diversidade observada nas apresentações clínicas e desfechos terapêuticos. A compreensão crescente dos diferentes mecanismos envolvidos na alteração do comportamento celular no trato respiratório deixa claro que a abordagem atual, com padronização diagnóstica e terapêutica, é inadequada. Os complexos e imbricados mecanismos genéticos e ambientais envolvidos fazem de cada asmático um paciente único. Gradativamente, o modelo clássico de atenção médica vem sendo substituído pela Medicina de Precisão, na qual dados genéticos, ambientais e de estilo de vida são empregados no diagnóstico e definição terapêutica. No campo da asma, possivelmente, essa transição significará a incorporação de novos elementos diagnósticos capazes de diferenciar o endotipo vigente e o(s) alvo(s) terapêutico(s) necessário(s) em cada momento, assim como permitirá colocar o agente terapêutico diretamente sobre seu alvo. As Ciências Ômicas serão fundamentais na identificação dos biomarcadores efetivos. Possivelmente, usaremos biomarcadores que identifiquem a variação genética, o mecanismo determinante e o alvo terapêutico. No tratamento, usaremos biológicos, antagonizando ações moleculares prejudiciais, microRNAs para reverter a disfunção celular presente, e suplementos alimentares que corrijam a disbiose corresponsável pela disfunção presente. Com a ajuda da teranóstica, desenvolveremos microvesículas capazes de inserir o agente terapêutico diretamente no seu alvo. Aí, então, poderemos ser capazes de curar a asma.
Palavras-chave
Abstract
The progressive incorporation of new knowledge in the pathogenesis of asthma has proved useful in understanding why there is such heterogeneity in the clinical presentations and therapeutic outcomes of the condition. The growing understanding of the diverse mechanisms involved in altering cellular behavior in the respiratory tract shows that the current approach, with standardized diagnosis and therapy, is inadequate. Complex and overlapping genetic and environmental mechanisms mean that each asthmatic patient is unique. Gradually, the classic medical care model is being replaced by Precision Medicine, in which genetic, environmental, and lifestyle data are used in diagnosis and therapeutic prescription. In the field of asthma, such transition will possibly mean the incorporation of new diagnostic elements capable of differentiating the current endotype and the therapeutic target(s) which are important at each moment, as well as placing the therapeutic agent directly over its target. The Omics Sciences will be fundamental in the identification of effective biomarkers. Possibly in the near future, we will use biomarkers to identify genetic variation, pathogenic mechanism, and therapeutic target. With regard to treatment, we will use biological agents which antagonize harmful molecular actions; microRNAs to reverse cellular dysfunction; and dietary supplements which correct dysbiosis co-responsible for the dysfunction. With the help of theranostics, we will develop microvesicles capable of inserting a therapeutic agent directly into its target. Maybe then, we will be able to cure asthma.
Keywords
References
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Submitted date:
03/09/2018
Accepted date:
07/09/2018
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