New Targets for Immune Modulation in Asthma

Abstract

Curative treatment for asthma poses a challenge. Standard asthma therapy is primarily based on immunosuppressive and bronchodilator drugs, which confer short-term symptom relief but do not cure the disease. Approximately 5–10 % of asthma patients do not respond to conventional therapy. Currently, allergen-specific immunotherapy (SIT) is the only available curative treatment for allergic asthma patients, and is most effective in monosensitized individuals. Toll-like receptor (TLR) 4 and TLR9 agonists can be used as an adjuvant to improve the efficacy of allergen-SIT. Anti-IgE therapy is currently used with varying success rates for the treatment of allergic asthma. Appropriate diagnosis and recognition of the etiology of underlying disease symptoms is essential for the success of novel immunomodulatory treatments. Disease classification based on endotypes will facilitate the appropriate choice for therapy, as endotypes describe subtypes of asthma, which are defined by distinct pathological mechanisms. Novel immunomodulatory therapies are targeting specific cytokines or cell-surface receptors and interfere with these pathological mechanisms, thereby altering the course of the disease. A range of novel immunomodulatory drugs is currently under development for the treatment of asthma. These drugs specifically target key molecules that play a role in the pathways involved in the pathogenesis of asthma, and include biologicals that primarily target cytokines and cytokine receptors, as well as small molecules that target chemokine receptors and TLRs. The safety and efficacy of many of these novel drugs still remain to be determined.