Lessons from allergic rhinitis versus asthma pathogenesis and treatment

"Hit-and-run" effects of paramyxoviruses as a basis for chronic respiratory disease

BACKGROUND

The traditional scheme for asthma pathogenesis depends on increased T helper type 2 (Th2) over T helper type 1 (Th1) responses to allergic and nonallergic stimuli and consequent airway inflammation, hyperreactivity and hypersecretion. Here we question whether the innate immune system, including airway epithelial cells, and the adaptive one may manifest an aberrant antiviral response as an additional basis for chronic inflammatory diseases, including asthma.

METHODS

We focused on the signal transduction and genetic basis for mucosal immunity, inflammation and remodeling, especially in relation to airway diseases. We concentrated on the response to paramyxoviruses because these agents are closely associated with common acute and chronic airway diseases. We used viral, cellular and mouse models, as well as human subjects, for study and made comparisons among these systems. Our approach aims to answer 2 major questions: (1) what are the factors that control acute paramyxoviral infection; and (2) how can these transient infections cause long term airway disease?

CONCLUSIONS

Our studies show that antiviral defense depends on a special network of epithelial immune response genes that signal to the adaptive immune system. Viruses ordinarily trigger this network, but it is also permanently activated in asthma, even in the absence of viral infection. In addition, we find that, in susceptible genetic backgrounds, respiratory viruses cause a "hit-and-run" phenomenon indicated by the development of an asthmatic phenotype long after the infection has cleared. On the basis of this information, we developed a new scheme for asthma pathogenesis that includes epithelial, viral and allergic components and allows viral reprogramming of host behavior.

Drug development for asthma

Asthma is characterized by abnormal immune cell accumulation and activation in the airways as well as dysfunction of specialized parenchymal cells. Research strategies to define asthma pathogenesis have focused on the hypothesis that this altered state is a consequence of an excessive allergen-driven response. Drug development for asthma has been directed at improving existing agents and expanding new modalities that target the Th2 allergic cascade. Significant opportunities are being pursued in each of these areas. However, this strategy may not account for some critical aspects of asthma pathogenesis. Alternative considerations include the need for a multidisciplinary approach to dissect the complexity of the asthma phenotype as well as a better understanding of nonallergic factors (especially viral reprogramming of airway behavior) in the development of the phenotype. Each of these considerations may provide an alternative strategy for further drug development for asthma and other complex diseases.