收稿日期: 2022-12-23
录用日期: 2023-06-26
网络出版日期: 2023-08-28
Review of CD4+ T cell subsets in asthma phenotypes: molecular mechanisms and biologic treatment options
Received date: 2022-12-23
Accepted date: 2023-06-26
Online published: 2023-08-28
哮喘是一种慢性炎症性气道疾病，主要由不同的CD4+ T细胞亚群［辅助性T细胞（helper T cell，Th细胞）］驱动。CD4+ T细胞亚群是一类重要的免疫细胞，能够分泌多种细胞因子，调节机体对各种抗原的免疫反应。根据分泌的细胞因子的不同，CD4+ T细胞可以分为Th1、Th2、Th17、滤泡性辅助性T细胞（follicular helper T cell，Tfh细胞）和调节性T细胞（regulatory T cell，Treg细胞）等亚群，它们在哮喘的发生发展中起着不同的作用。生物治疗是一种针对特定分子和途径的新治疗手段，为哮喘患者提供了更多的选择。生物制剂是一类利用生物技术制备的药物，能够特异性地识别和中和目标分子，从而干预相关的信号通路。该文回顾了各种CD4+ T细胞亚群在哮喘表型中的角色及分子机制，总结了嗜酸性粒细胞哮喘、中性粒细胞哮喘、混合性哮喘的免疫病理学特征和针对Th2、Th1、Th17、Tfh、Treg细胞相关因子的生物制剂的临床效果和安全性，以及相应生物制剂的选择和发展方向；并讨论了Treg细胞受损和树突状细胞（dendritic cell，DC）异常在哮喘发病机制中的作用，以及利用这些细胞的免疫治疗潜力。该文旨在为哮喘生物治疗的个性化选择和新药开发提供参考。
关键词： 哮喘; CD4+辅助性T细胞; 嗜酸粒细胞哮喘; 中性粒细胞哮喘; 生物治疗
赵艳红 , 王传萍 . 哮喘表型中CD4+ T细胞亚群的研究综述：分子机制和生物治疗选择[J]. 上海交通大学学报（医学版）, 2023 , 43(8) : 1064 -1070 . DOI: 10.3969/j.issn.1674-8115.2023.08.016
Asthma is a chronic inflammatory airway disease, mainly driven by different CD4+ T cell subsets [helper T cell (Th cell)]. CD4+ T cell subsets are a type of important immune cells, capable of secreting various cytokines, and regulating the immune response of the body to various antigens. According to the difference of secreted cytokines, CD4+ T cell subsets can be divided into subgroups such as Th1, Th2, Th17, follicular helper T cell (Tfh) and regulatory T cell (Treg), which play different roles in the occurrence and development of asthma. Biologic therapy is a new treatment method that targets specific molecules and pathways, and has provided more options for asthma patients. Biologics is a type of drugs prepared by biotechnology, which can specifically recognize and neutralize target molecules, thereby interfering with related signaling pathways. This article reviews the roles and molecular mechanisms of various CD4+ T cell subsets in asthma phenotypes, summarizes the immunopathological characteristics of eosinophilic asthma, neutrophilic asthma and mixed asthma, the clinical efficacy and safety of biologics targeting Th2, Th1, Th17, Tfh and Treg cell-related factors, and the selection and development direction of corresponding biologics. This article also discusses the role of impaired Treg cells and abnormal dendritic cells (DC cells) in the pathogenesis of asthma, as well as the potential of immunotherapy using these cells. This article aims to provide reference for the personalized selection and new drug development of biologic therapy for asthma.
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