Biomarkers of adult asthma and personalized medicine

Da Woon Sim; Jae-Hyun Lee

doi:10.4168/aard.2016.4.1.4

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Sim and Lee: Biomarkers of adult asthma and personalized medicine

Review

Allergy, Asthma & Respiratory Disease 2016; 4(1): 4-13.

Published online: 30 January 2016

DOI: https://doi.org/10.4168/aard.2016.4.1.4

Biomarkers of adult asthma and personalized medicine

Da Woon Sim, Jae-Hyun Lee

Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.

Correspondence to: Jae-Hyun Lee. Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea. Tel: +82-2-2228-1932, Fax: +82-2-393-6884, jhleemd@yuhs.ac

Received 12 November 2015 Revised 1 December 2015 Accepted 3 December 2015

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/).

Abstract

The concept of personalized medicine for disease diagnosis, treatment, and management, considering individual variability, including susceptibility, clinical manifestations, and drug responsiveness, is a global emerging trend in medicine, which is also inevitable. However, clinical applications of personalized medicine in the real-world practice have been limited to certain cancers so far. Furthermore, this new concept to the diagnosis and treatment of adult asthma has not been applied to clinical use. Asthma is a multifactorial and heterogeneous disease. It seems to encompass a broad spectrum of clinical manifestations with different underlying pathophysiological mechanisms. Thus, it is not easy to categorize by their clinical features alone. Endotypical categorization that considering specific pathophysiological mechanisms will be more helpful in applying the concept of personalized medicine. The success of personalized medicine depends on patient selection for precise prescription of asthma medications. In the recent years, many investigators and physicians have devoted a lot of effort to the discovery of reliable biomarkers in asthmatic patients, which will be able to actualize the personalized medicine in near future. Despite such great efforts toward investigation of good biomarkers, few things have turned out to be practical in the clinic. Easily interpretable biomarkers of asthma are necessary to assess early detection, determination of treatment, prognosis prediction, and monitoring of exacerbation. Herein, we review recent studies regarding disease classifications and biomarkers of asthma.

Keywords: Asthma, Biomarkers, Phenotype, Endotype, Personalized medicine

Figures and Tables

Fig. 1

The schematic presentation of the underlying pathogenesis of allergic asthma. (A) The progress of allergic asthma demanded sensitization to an environmental allergen. Primary exposure to an allergen conducted activation of Th2 lymphocytes and ILC2. (B) Subsequently, re-exposure causes immediate reaction of the increasing production of Th2 cytokines, stimulation of IgE synthesis and accumulation of inflammatory cells in airway. PRR, pattern recognition receptor; IL, interleukin; ILC2, type 2 innate lymphoid cell; DC, dendritic cell.

Table 1

Phenotypes of asthma

NSAID, nonsteroidal anti-inflammatory drug.

Table 2

Summary of biomarkers in adult asthma for clinical purposes

Biomarker	Specimen	Easy to check	Inspection cost	Link other markers	Utility				Associated phenotype
Biomarker	Specimen	Easy to check	Inspection cost	Link other markers	D	S	P	M	Associated phenotype
Lung function	Spirometry	+	Low	2,3	v	v		v
IgE	Serum	+	Low	1,3		v	v		Atopic asthma
Eosinophil	Serum	+	Low	1,2,5		v	v		Atopic asthma
Eosinophil	Sputum	-	Low	5,6	v	v	v	v	Atopic asthma
FeNO	Exhaled air	+	High	3,4,10	v	v	v	v	Atopic asthma
Periostin	Serum	+	High	4		v	v		Th2-High asthma
LTE₄	Urine	-	High	Unclear	v		v		AERD
YKL-40	Serum	+	High	5	v			v	Obesity related
VOCs	Exhaled air	-	High	Unclear		v		v
Temperature	Exhaled air	-	High	Unclear		v	v

D, diagnostic marker; S, surrogate marker; P, prognostic marker; M, monitoring marker; FeNO, fractional exhaled nitric oxide; LTE4, leukotriene E4; YKL-40, chitinase-3-like protein 1; VOC, volatile organic compounds; AERD, aspirin exacerbated respiratory disease.

Notes

This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (Ministry of Science, ICT & Future Planning) (No. 2015R1C1A1A02036533).

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