The Role of T Helper Type 2 (Th2) Cytokines in the Pathogenesis of Eosinophilic Granulomatosis with Polyangiitis (eGPA): an Illustrative Case and Discussion.

Autor: Milne ME; Division of Rheumatology and Immunology, Department of Medicine, Duke University School of Medicine, 40 Duke Medicine Circle, Clinic 1J, Durham, NC, 27710, USA. megan.milne@case.edu., Kimball J; Department of Pathology, Duke University School of Medicine, Durham, NC, USA., Tarrant TK; Division of Rheumatology and Immunology, Department of Medicine, Duke University School of Medicine, 40 Duke Medicine Circle, Clinic 1J, Durham, NC, 27710, USA., Al-Rohil RN; Duke Physician Assistant Program, Durham, NC, USA., Leverenz DL; Division of Rheumatology and Immunology, Department of Medicine, Duke University School of Medicine, 40 Duke Medicine Circle, Clinic 1J, Durham, NC, 27710, USA.
Jazyk: angličtina
Zdroj: Current allergy and asthma reports [Curr Allergy Asthma Rep] 2022 Nov; Vol. 22 (11), pp. 141-150. Date of Electronic Publication: 2022 Sep 14.
DOI: 10.1007/s11882-022-01039-w
Abstrakt: Purposeof Review: The pathogenesis of eosinophilic granulomatosis with polyangiitis (eGPA) is driven largely by CD4 + type 2 helper T cells (Th2), B cells, and eosinophils. Interleukin (IL)-4 and IL-13 are critical cytokines in Th2 cell-mediated inflammation; however, inhibition of IL-4 and IL-13 does not reduce serum eosinophil counts and has even been associated with hypereosinophilia. This review explores the role of IL-4, IL-5, and IL-13 in Th2-mediated inflammation to consider the potential clinical consequences of inhibiting these individual cytokines in eGPA.
Recent Findings: Treatments for eosinophilic granulomatosis with polyangiitis (eGPA) are rapidly evolving through using biologic therapies to modulate the Th2 inflammatory response via eosinophil inhibition. While IL-4, IL-5, IL-13, and IL-25 can all affect eosinophils, only IL-5 inhibition has demonstrated therapeutic benefit to-date. In this review, we report a clinical vignette of a patient with adult-onset asthma who developed severe manifestations of eGPA after switching from mepolizumab (an IL-5 inhibitor) to dupilumab (an inhibitor of IL-4 and IL-13). By understanding the role of IL-4, IL-5, and IL-13 in Th2-mediated vasculitis, we can start to understand how eGPA might respond differently to focused cytokine inhibition.
(© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
Databáze: MEDLINE
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