중증 호산구 천식에서, IL-5 항체치료는 TEC 와 혈청 EDN 치의 감소와 FEV1 예측치를 증가시키며, 혈청 EDN 치는 TEC 와 함께 치료 후 호산구 기도 염증을 평가하는 잠재적인 지표가 될 수 있다. IL-5 항체 치료제의 반응 예측에 연령, 유병기간과 발병 나이를 고려해야 한다.
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ABSTRACT
Purpose and methods: Patients with severe asthma have been suffering from frequent
asthma exacerbations, where eosinophil is a major effector cell in airway inflammation, and anti-IL5 treatment is an effective treatment modality. Thirteen patients with severe eosinophilic asthma who had been treated with anti-IL5 antibody treatment (reslizumab, 100mg monthly IV) for 6 months, were enrolled at Ajou University Hospital (Suwon, South Korea). Clinical parameters such as total blood eosinophil count (TEC), FEV1% and fractional exhaled nitric oxide (FeNO) levels were compared before/after anti-IL5 treatment. In addition, to identify potential serum biomarkers for predicting treatment response, changes in serum levels of eosinophil derived neutoxin (EDN), periostin (PON), TGF-β1 were analyzed by ELISA.
Results: Serum EDN levels as well as TEC decreased significantly after 1 month of the treatment; FEV1% increased after 2 months of treatment (P<0.05, respectively), while no
P=0.03), but no significant correlations were noted with other biomarkers. When the EDN-responder group was defined if serum EDN level decreased (more than 30%) after the first month of treatment (compared to the baseline level), TEC was significantly higher in the responder group than in the non-responder group (1,017 ± 495.6 / µL vs. 500.7 ± 252.0 / µL, P=0.039). Reduction of serum EDN levels was significantly correlated with baseline TEC and FeNO levels (r=0.58, P=0.04; r=0.65, P=0.02). When the FeNO-responder group was defined if FeNO level decreased (more than 30%) after the treatment, asthma duration was significantly shorter in the responder group than in non-responder group (5.16 ± 3.92 years vs. 21.40 ± 7.79 years, P=0.043). When the FEV1-responder group was defined if FEV1% increased (more than 15%) after the treatment, onset age was significantly lower in the responder group than in the non-responder group (30.0 ± 6.83 years vs. 53.0 ± 16.32 years, P=0.008); asthma duration was shorter in the responder group than in the non-responder group. (6.0 ± 5.99 years vs. 16.57 ± 10.23, P=0.07).
Conclusion: Changes in serum EDN levels may be a potential biomarker for predicting
eosinophilic inflammation after anti-IL5 treatment in patients with severe eosinophilic asthma, which was affected by patient’ age, onset age and asthma duration.
Keywords: Asthma, eosinophil, interleukin 5, treatment, biomarker, anti-IL5