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Biomarkers for targeted treatment

What are the advantages of biomarkers?

Severe asthma phenotypes have already achieved some recognition in treatment guidelines, but biomarkers for these phenotypes are still under investigation.1-2

What is a biomarker?

The term biomarkers or ‘biologic markers’ refers to a broad subcategory of medical signs, which can be measured accurately and reproducibly. They are objective, quantifiable characteristics of biologic processes. They may, but do not necessarily, correlate with a patient's experience and sense of well-being. 3

Most of the characteristics that make up phenotypes of severe asthma are rather non-specific clinical or inflammatory factors – they give little insight into the underlying pathobiology of the condition. 4As research continues, the hope is that safe and effective biomarker-driven treatment approaches for severe asthma will be established. 4

The biomarkers being explored include specific and total IgE, sputum inflammatory cell analysis, exhaled breath condensate measures and nitric oxide. 4The current markers have not yet been studied and replicated in high enough numbers of patients/cohorts, been practical for clinical practice or been sufficiently studied using a phenotype directed approach. 4(See the full details in the table below).

The biomarkers used in clinical practice

Established and potential biomarkers for severe asthma

Biomarker

Comments

FeNO

  • A marker of allergy and Th2 inflammation 1
  • Widely available 1 
  • Potentially useful to measure symptom frequency, exacerbation-prone patients and steroid responsiveness 15-6

Sputum eosinophils

  • Not well standardised or widely available 1
  • Most beneficial to severe asthma patients prone to frequent exacerbations 1

Total and allergen-specific IgE

  • A marker of allergic asthma 16
  • Measured using commercial immunoassay kits 7

Blood eosinophils

  • A marker of treatment response to certain treatments 16
  • Does not require specialised equipment, training or assays 1

Periostin

  • A marker of Th2 inflammation 1
  • Currently only available for research 1

FeNO, fraction of exhaled nitric oxide; IgE, immunoglobulin E; Th2, T-helper cell type 2.

References

  1. Chung KF, et al. Eur Respir J 2014;43:343–73.
  2. GINA 2016 © 2016 Global Initiative for Asthma, all rights reserved.  Use is by express license from the owner. www.ginasthma.org (Last accessed December 2016).
  3. Strimbu K and Tavel JA. Curr Opin HIV AIDS 2010; 5(6): 463–466.
  4. Wenzel S. Clinical & Experimental Allergy 2012; 42, 650–658.
  5. Gevorgyan A, Fokkens WJ. Primary Care Resp J 2013;22, 10–11.
  6. Szefler S, et al. J Allergy Clin Immunol 2012;129, S9–S23.
  7. Omalizumab SmPC; Novartis 2016