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         Journal List > Korean J Intern Med > v.26(4); Dec 2011
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Korean J Intern Med. 2011 Dec;26(4):367-383.
Published online 2011 November 28.  http://dx.doi.org/10.3904/kjim.2011.26.4.367
Copyright © 2011 The Korean Association of Internal Medicine
Recent Advances in Mechanisms and Treatments of Airway Remodeling in Asthma: A Message from the Bench Side to the Clinic
Jae Youn Cho
Division of Allergy/Immunology, University of California San Diego School of Medicine, La Jolla, CA, USA.

Correspondence to Jae Youn Cho, M.D. Division of Allergy/Immunology, University of California San Diego School of Medicine, BSB 5086, 9500 Gilman dr, La Jolla, CA 92093-0635, USA. Tel: 1-858-534-2234, Fax: 1-858-534-2110, Email: jacho@ucsd.edu
Received July 25, 2011; Accepted September 15, 2011.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.


Abstract

Airway remodeling in asthma is a result of persistent inflammation and epithelial damage in response to repetitive injury. Recent studies have identified several important mediators associated with airway remodeling in asthma, including transforming growth factor-β, interleukin (IL)-5, basic fibroblast growth factor, vascular endothelial growth factor, LIGHT, tumor necrosis factor (TNF)-α, thymic stromal lymphopoietin, IL-33, and IL-25. In addition, the epithelium mesenchymal transformation (EMT) induced by environmental factors may play an important role in initiating this process. Diagnostic methods using sputum and blood biomarkers as well as radiological interventions have been developed to distinguish between asthma sub-phenotypes. Human clinical trials have been conducted to evaluate biological therapies that target individual inflammatory cells or mediators including anti IgE, anti IL-5, and anti TNF-α. Furthermore, new drugs such as c-kit/platelet-derived growth factor receptor kinase inhibitors, endothelin-1 receptor antagonists, calcium channel inhibitors, and HMG-CoA reductase inhibitors have been developed to treat asthma-related symptoms. In addition to targeting specific inflammatory cells or mediators, preventing the initiation of EMT may be important for targeted treatment. Interestingly, bronchial thermoplasty reduces smooth muscle mass in patients with severe asthma and improves asthma-specific quality of life, particularly by reducing severe exacerbation and healthcare use. A wide range of different therapeutic approaches has been developed to address the immunological processes of asthma and to treat this complex chronic illness. An important future direction may be to investigate the role of mediators involved in the development of airway remodeling to enhance asthma therapy.

Keywords: Transforming growth factor beta, Fibroblast growth factor 2, Vascular endothelial growth factor, Thymic stromal lymphopoietin, Biologic therapy.
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