Page 17 - Škrgat, Sabina, ed. 2022. Severe Asthma - Basic and Clinical Views. Koper: University of Primorska Press. Severe Asthma Forum, 1
P. 17
otypes and Immune Cells in Severe Asthma 1.1
Matija Rijavec1,2 and Peter Korošec1,3
Abstract 1 University Clinic
Severe asthma accounts for a small proportion of asthma prevalence, however due to high re- of Respiratory and Allergic
quirements for treatment the majority of medical resources are directed toward those patients. Diseases Golnik, Slovenia
Asthma is a highly heterogeneous disease, an umbrella diagnosis for several diseases with var-
iable clinical presentations (phenotypes) and distinct mechanistic pathways (endotypes), and 2 Biotechnical Faculty,
its pathophysiology is not yet completely understood. Thus despite similar clinical symptoms, University of Ljubljana,
asthma patients may respond very differently to the same therapeutic interventions. Asthma Ljubljana, Slovenia
endotypes are currently regarded as type 2 high (T2-high) or non-T2. Th2 cells, innate lym-
phoid cells, eosinophils and mast cells are the most important cell types associated with T2- 3 Faculty of Pharmacy,
high asthma, on the other hand neutrophils, Th1 and Th17 cells are involved in non-T2 asth- University of Ljubljana,
ma. As more and more innate and adaptive immune cell types and mediators are identified as Ljubljana, Slovenia
important drivers of asthma, asthma endotype definitions are still fluid and continue to evolve.
The identification and understanding of the molecular mechanisms of different asthma endo-
types, that reflect a highly variable response to different treatments, will lead to more precise
asthma management and better outcomes in patients.
Keywords: severe asthma, endotype, phenotype, immune cells, eosinophils, innate lymphoid
cells, mast cells, basophils
Introduction immunologic, and environmental factors that
contribute to asthma risk, pathogenesis and
Severe asthma remains a worldwide problem. underlying asthma endotypes have been de-
Even though accounts for a small proportion termined6,17,18. The identification and under-
of asthma prevalence affecting a minority of standing of the molecular mechanisms of dif-
patients, it is characterized by high require- ferent asthma endotypes, that reflect a highly
ments for treatment to partly or completely variable response to different treatments (re-
control severe and frequent symptoms, and lated to certain clinical phenotypes), will lead
as a result, the majority of medical resourc- to more precise asthma management and
es are directed toward those patients9,12,14-19. better outcomes in patients6,13,17,18.
Asthma is a highly heterogeneous disease
and its pathophysiology is not yet complete- Phenotypes and Endotypes in Severe
ly understood. Large asthma clinical hetero- Asthma
geneity and high variability in treatment re-
sponse extend beyond clinical phenotypes, Asthma heterogeneity reflects different un-
and over the last two decades several genetic, derlying mechanisms. Asthma is nowadays
https://doi.org/10.26 493/978 -961-293 -157-5.17-24
Matija Rijavec1,2 and Peter Korošec1,3
Abstract 1 University Clinic
Severe asthma accounts for a small proportion of asthma prevalence, however due to high re- of Respiratory and Allergic
quirements for treatment the majority of medical resources are directed toward those patients. Diseases Golnik, Slovenia
Asthma is a highly heterogeneous disease, an umbrella diagnosis for several diseases with var-
iable clinical presentations (phenotypes) and distinct mechanistic pathways (endotypes), and 2 Biotechnical Faculty,
its pathophysiology is not yet completely understood. Thus despite similar clinical symptoms, University of Ljubljana,
asthma patients may respond very differently to the same therapeutic interventions. Asthma Ljubljana, Slovenia
endotypes are currently regarded as type 2 high (T2-high) or non-T2. Th2 cells, innate lym-
phoid cells, eosinophils and mast cells are the most important cell types associated with T2- 3 Faculty of Pharmacy,
high asthma, on the other hand neutrophils, Th1 and Th17 cells are involved in non-T2 asth- University of Ljubljana,
ma. As more and more innate and adaptive immune cell types and mediators are identified as Ljubljana, Slovenia
important drivers of asthma, asthma endotype definitions are still fluid and continue to evolve.
The identification and understanding of the molecular mechanisms of different asthma endo-
types, that reflect a highly variable response to different treatments, will lead to more precise
asthma management and better outcomes in patients.
Keywords: severe asthma, endotype, phenotype, immune cells, eosinophils, innate lymphoid
cells, mast cells, basophils
Introduction immunologic, and environmental factors that
contribute to asthma risk, pathogenesis and
Severe asthma remains a worldwide problem. underlying asthma endotypes have been de-
Even though accounts for a small proportion termined6,17,18. The identification and under-
of asthma prevalence affecting a minority of standing of the molecular mechanisms of dif-
patients, it is characterized by high require- ferent asthma endotypes, that reflect a highly
ments for treatment to partly or completely variable response to different treatments (re-
control severe and frequent symptoms, and lated to certain clinical phenotypes), will lead
as a result, the majority of medical resourc- to more precise asthma management and
es are directed toward those patients9,12,14-19. better outcomes in patients6,13,17,18.
Asthma is a highly heterogeneous disease
and its pathophysiology is not yet complete- Phenotypes and Endotypes in Severe
ly understood. Large asthma clinical hetero- Asthma
geneity and high variability in treatment re-
sponse extend beyond clinical phenotypes, Asthma heterogeneity reflects different un-
and over the last two decades several genetic, derlying mechanisms. Asthma is nowadays
https://doi.org/10.26 493/978 -961-293 -157-5.17-24
