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首页> 外文期刊>Pulmonary pharmacology & therapeutics >TNF-alpha inhibitors in asthma and COPD: we must not throw the baby out with the bath water.
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TNF-alpha inhibitors in asthma and COPD: we must not throw the baby out with the bath water.

机译：哮喘和COPD中的TNF-α抑制剂：我们绝不能将婴儿与洗澡水一起扔出去。

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Tumor necrosis factor (TNF)-alpha, a pleiotropic cytokine that exerts a variety of effects, such as growth promotion, growth inhibition, angiogenesis, cytotoxicity, inflammation, and immunomodulation, has been implicated in several inflammatory conditions. It plays a significant role in many inflammatory diseases of lungs. Given that there is significant literature supporting the pathobiologic role of TNF-alpha in asthma, mainly in severe refractory asthma, and COPD, TNF-alpha inhibitors (infliximab, golimumab and etanercept) are now regarded as the potential new medications in asthma and COPD management. The studies reported in literature indicate that TNF-alpha inhibitors are effective in a relatively small subgroup of patients with severe asthma, possibly defined by an increased TNF axis, but they seem to be ineffective in COPD, although an observational study demonstrated that TNF-alpha inhibitors were associated with a reduction in the rate of COPD hospitalisation among patients with COPD receiving these agents to treat their rheumatoid arthritis. These findings require a smart approach because there is still good reason to target TNF-alpha, perhaps in a more carefully selected patient group. TNF-alpha treatment should, therefore, not be thrown out, or abandoned. Indeed, since severe asthma and COPD are heterogeneous diseases that have characteristics that occur with different phenotypes that remained poorly characterized and little known about the underlying pathobiology contributing to them, it is likely that definition of these phenotypes and choice of the right outcome measure will allow us to understand which kind of patients can benefit from TNF-alpha inhibitors.
机译：肿瘤坏死因子（TNF）-α是一种多效性细胞因子，可发挥多种作用，例如促进生长，抑制生长，血管生成，细胞毒性，炎症和免疫调节等，在几种炎症性疾病中都有涉及。它在许多肺部炎性疾病中起重要作用。鉴于已有大量文献支持TNF-α在哮喘（主要在重度难治性哮喘）中的病理生物学作用，而COPD则被认为是TNF-α抑制剂（英夫利昔单抗，戈利木单抗和依那西普）在哮喘和COPD治疗中的潜在新药。文献报道的研究表明，TNF-α抑制剂在严重哮喘的相对较小的亚组中有效，这可能是由TNF轴增加所决定的，但是它们似乎在COPD中无效，尽管一项观察性研究表明，TNF-α抑制剂对COPD无效。接受这些药物治疗类风湿性关节炎的COPD患者中，抑制剂与COPD住院率降低相关。这些发现需要一个明智的方法，因为仍然有充分的理由将TNF-α作为靶标，也许是在更仔细选择的患者组中。因此，不应将TNF-α治疗丢掉或放弃。的确，由于严重哮喘和COPD是异质性疾病，其特点是表现出不同的表型，而这些表型的特征仍然很差，并且对导致它们的潜在病理生物学知之甚少，因此对这些表型进行定义并选择正确的结局指标可能会允许我们了解哪种患者可以从TNF-α抑制剂中受益。

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