Published Online: September 14, 2014
Asthma is the most common chronic pediatric pulmonary disease worldwide, with increasing prevalence. Childhood asthma can be classified into allergic and non-allergic asthma (AA/NA). However, the pathogenesis of the different phenotypes is incompletely understood to date. Thus, AA and NA are currently treated identically—with only partial success. Now, in a study recently published in The Journal of Allergy and Clinical Immunology, D. Raedler and colleagues present novel different immune-regulatory mechanisms for AA and NA.
The authors of this study performed a cross-sectional study including 275 German children age 4-15 years without steroid-treatment in three groups, namely AA, NA and healthy controls (HC). Several dimensions of immune-regulation were investigated by assessing gene expression (microarray and qRT-PCR), quantitative and qualitative analysis of an important subset of T cells, namely regulatory T cells (Tregs), and measurement of several immune mediators, namely cytokine secretion, in peripheral blood of HC, AA and NA.
The authors were able to discriminate HC, AA and NA immunologically. Importantly, children with AA were characterized by a specific signature, namely increased Tregs, which are relevant for a healthy immune balance, and a deficiency in innate immunity regulators. Different from AA, NA were characterized with increased markers of inflammation such as IL-1b, a different inflammatory profile (neutrophilic, Th17-shifted) and less efficient function of Tregs (for specific cytokine suppression). Common pattern for both AA and NA were also shown by a Th2-biased phenotype.
This novel immunological differentiation of childhood asthma phenotypes with unique and shared aspects of immune-regulation in allergic and non-allergic asthmatics can potentially contribute to the development of biomarker-chips to better distinguish AA from NA, and for development of phenotype-specific therapies. Importantly, identification of these unique novel pathways can also serve as a profound basis for future strategies for patient-individualized prediction of asthma development, disease-course, and in the long-term also for prevention.
The Journal of Allergy and Clinical Immunology (JACI) is an official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.