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Review
. 2023 Apr 20;24(8):7581.
doi: 10.3390/ijms24087581.

Severe Asthmatic Responses: The Impact of TSLP

Affiliations
Review

Severe Asthmatic Responses: The Impact of TSLP

Efthymia Theofani et al. Int J Mol Sci. .

Abstract

Asthma is a chronic inflammatory disease that affects the lower respiratory system and includes several categories of patients with varying features or phenotypes. Patients with severe asthma (SA) represent a group of asthmatics that are poorly responsive to medium-to-high doses of inhaled corticosteroids and additional controllers, thus leading in some cases to life-threatening disease exacerbations. To elaborate on SA heterogeneity, the concept of asthma endotypes has been developed, with the latter being characterized as T2-high or low, depending on the type of inflammation implicated in disease pathogenesis. As SA patients exhibit curtailed responses to standard-of-care treatment, biologic therapies are prescribed as adjunctive treatments. To date, several biologics that target specific downstream effector molecules involved in disease pathophysiology have displayed superior efficacy only in patients with T2-high, eosinophilic inflammation, suggesting that upstream mediators of the inflammatory cascade could constitute an attractive therapeutic approach for difficult-to-treat asthma. One such appealing therapeutic target is thymic stromal lymphopoietin (TSLP), an epithelial-derived cytokine with critical functions in allergic diseases, including asthma. Numerous studies in both humans and mice have provided major insights pertinent to the role of TSLP in the initiation and propagation of asthmatic responses. Undoubtedly, the magnitude of TSLP in asthma pathogenesis is highlighted by the fact that the FDA recently approved tezepelumab (Tezspire), a human monoclonal antibody that targets TSLP, for SA treatment. Nevertheless, further research focusing on the biology and mode of function of TSLP in SA will considerably advance disease management.

Keywords: asthma endotypes; biologics; severe asthma; thymic stromal lymphopoietin (TSLP).

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
SA endotypes and biomarkers.
Figure 2
Figure 2
Cellular sources and targets of TSLP. Several stimuli including microbes, pollutants, allergens, proteases and cytokines such as IL-4, IL-5, IL-13, and the macrophage-derived progranulin trigger the production of TSLP from the epithelium. TSLP acts on a variety of cells, including DCs, ILCs CD4 T cells mast cells basophils, etc., and upregulates the expression of co-stimulatory molecules (CD80, CD86, OX40). It also induces the secretion of a plethora of cytokines (IL-4, IL-5, IL-13) and chemokines (CCL1, CXCL8, CXCL1, CXCL13), further amplifying the asthmatic responses.

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