pulmoПульмонологияPULMONOLOGIYA0869-01892541-9617Scientific and Practical Journal “PULMONOLOGIYA” LLC10.18093/0869-0189-2024-34-6-788-800pulmo-4663Research ArticleПЕРЕДОВАЯ СТАТЬЯEDITORIALПерсонифицированный выбор генно-инженерных иммунобиологических препаратов для лечения тяжелой бронхиальной астмы: инструменты реальной практики и новые перспективыPersonalized approach to the biologicals’ selection in patients with severe asthma: real practice tools and new possibilitieshttps://orcid.org/0000-0002-4164-4094ПавловаК. С.PavlovaK. S.

Павлова Ксения Сергеевна – к. м. н., врач-аллерголог, ведущий научный сотрудник отделения бронхиальной астмы.

115522, Москва, Каширское шоссе, 24, стр. 2; тел.: (499) 311-67-78

Ksenia S. Pavlova - Candidate of Medicine, Allergist, Leading Researcher, Asthma Department.

Kashirskoe shosse 24, build. 2, Moscow, 115522; tel.: (499) 311-67-78

ksenimedical@gmail.comhttps://orcid.org/0000-0002-7585-1390ТимошенкоД. О.TimoshenkoD. O.

Тимошенко Дарья Олеговна – м. н. с. отделения бронхиальной астмы.

115522, Москва, Каширское шоссе, 24, стр. 2; тел.: (499) 311-67-78

Daria O. Timoshenko - Junior Researcher, Department of Bronchial Asthma.

Kashirskoe shosse 24, build. 2, Moscow, 115522; tel.: (499) 311-67-78

d.o.timoshenko@gmail.comhttps://orcid.org/0009-0006-2092-515XОсокинА. А.OsokinA. A.

Осокин Андрей Александрович – студент медико-биологического факультета.

117997, Москва, ул. Островитянова, 1; тел. (966)129-74-28

Andrey A. Osokin - Student, Faculty of Medicine and Biology.

Ul. Ostrovityanova 1, Moscow, 117997; tel.: (966) 129-74-28

unicum289@gmail.comhttps://orcid.org/0000-0001-9280-8282КофиадиИ. А.KofiadiI. A.

Кофиади Илья Андреевич – д. б. н., профессор Российской академии наук, заведующий лабораторией молекулярной иммуногенетики ГНЦ “Институт иммунологии”» Федерального медико-биологического агентства; профессор кафедры иммунологии медико-биологического факультета РНИМУ имени Н.И. Пирогова.

115522, Москва, Каширское шоссе, 24, стр. 2; 117997, Москва, ул. Островитянова, 1; тел.: (499) 311-67-78

Ilya A. Kofiadi - Doctor of Biology, Professor of the Russian Academy of Sciences; Head of the Laboratory of Molecular Immunogenetics, NRC – Institute of Immunology FM-BA of Russia; Professor, Department of Immunology, Faculty of Biomedicine, N.I. Pirogov RNRMU.

Kashirskoe shosse 24, build. 2, Moscow, 115522; ul. Ostrovityanova 1, Moscow, 117997; tel.: (499) 311-67-78

kofiadi@mail.ruhttps://orcid.org/0000-0003-3250-0694КурбачеваО. М.KurbachevaO. M.

Курбачева Оксана Михайловна – д. м. н., профессор, заведующая отделением бронхиальной астмы ГНЦ “Институт иммунологии”» Федерального медико-биологического агентства; доцент кафедры клинической аллергологии и иммунологии РУМ.

115522, Москва, Каширское шоссе, 24, стр. 2; 127006, Москва, ул. Долгоруковская, 4; тел.: (499) 311-67-78

Oksana M. Kurbacheva - Doctor of Medicine, Professor, Head of the Department of Bronchial Asthma, NRC – Institute of Immunology FM-BA of Russia; Associate Professor, Department of Clinical Allergology and Immunology, RUM.

Kashirskoe shosse 24, build. 2, Moscow, 115522; ul. Dolgorukovskaya 4, Moscow, 127006; tel.: (499) 311-67-78

kurbacheva@gmail.comФедеральное государственное бюджетное учреждение «Государственный научный центр “Институт иммунологии”» Федерального медико-биологического агентстваРоссияNational Research Center – Institute of Immunology Federal Medical-Biological Agency of RussiaRussian FederationФедеральное государственное автономное образовательное учреждение высшего образования «Российский национальный исследовательский медицинский университет имени Н.И. Пирогова» Министерства здравоохранения Российской ФедерацииРоссияFederal State Autonomous Educational Institution of Higher Education “N.I. Pirogov Russian National Research Medical University” of the Ministry of Health of the Russian FederationRussian FederationФедеральное государственное бюджетное учреждение «Государственный научный центр “Институт иммунологии”» Федерального медико-биологического агентства; Федеральное государственное автономное образовательное учреждение высшего образования «Российский национальный исследовательский медицинский университет имени Н.И. Пирогова» Министерства здравоохранения Российской ФедерацииРоссияNational Research Center – Institute of Immunology Federal Medical-Biological Agency of Russia; Federal State Autonomous Educational Institution of Higher Education “N.I. Pirogov Russian National Research Medical University” of the Ministry of Health of the Russian FederationRussian FederationФедеральное государственное бюджетное учреждение «Государственный научный центр “Институт иммунологии”» Федерального медико-биологического агентства; Федеральное государственное бюджетное образовательное учреждение высшего образования «Российский университет медицины» Министерства здравоохранения Российской ФедерацииРоссияNational Research Center – Institute of Immunology Federal Medical-Biological Agency of Russia; Federal State Budgetary Educational Institution of Higher Education “Russian University of Medicine” of the Ministry of Health of the Russian FederationRussian Federation202411122024346788800Copyright © Павлова К.С., Тимошенко Д.О., Осокин А.А., Кофиади И.А., Курбачева О.М., 20242024Павлова К.С., Тимошенко Д.О., Осокин А.А., Кофиади И.А., Курбачева О.М.Pavlova K.S., Timoshenko D.O., Osokin A.A., Kofiadi I.A., Kurbacheva O.M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.pulmonology.ru/pulm/article/view/4663

В настоящее время наиболее предпочтительным подходом к лечению неконтролируемой тяжелой бронхиальной астмы (ТБА) является применение генно-инженерной биологической терапии (ГИБП). Препараты данной группы высокоэффективны и безопасны, однако следует учитывать, что они не универсальны и блокируют различные звенья патогенеза бронхиальной астмы (БА). Также выявлены различия в эффективности в отношении сопутствующих патологий. В связи с этим выбор таргетного препарата должен быть не только персонифицированным, но и эндотипи фенотип-ориентированным.

Целью данного обзора явился анализ литературных данных о ГИБП, используемых в настоящее время в терапии ТБА, инструментах фенои эндотипирования, применяемых в реальной практике в целях персонализированного выбора таргетных препаратов, а также перспективных направлениях исследований в данной области.

Заключение. В настоящее время для фенои эндотипирования ТБА применяются методы лабораторного и инструментального обследования, благодаря которым выявляется ключевой патогенетический фактор развития заболевания, на основании чего делается выбор биологического препарата. Однако биомаркеры, определяемые в ходе рутинного обследования, не являются абсолютными и имеют исключения. Также в ряде случаев, когда у пациента с ТБА определяется смешанный фенотип заболевания, который соответствует критериям назначения всех имеющихся ГИБП, решение о выборе таргетной терапии основывается на субъективном определении превалирующего механизма развития заболевания. Актуальным направлением будущих исследований остается поиск биомаркеров, прогнозирующих эффект того или иного ГИБП. Комбинированное использование результатов клинического, молекулярно-генетического обследования и оценки эпигенетических маркеров может помочь в решении данной задачи. В данном обзоре представлены актуальные данные о ГИБП, используемых в настоящее время в терапии ТБА, инструментах фенои эндотипирования, применяемых в реальной практике, описаны перспективные направления исследований определения эпигенетических биомаркеров.

Currently, the most effective approach to treating patients with severe uncontrolled asthma is the use of biologicals. These treatments are highly effective and safe, but not universal. Different biologicals block various parts of asthma pathogenesis. Also, biologicals have different effectiveness in relation to comorbidities. In this regard, the targeted therapy selection should be personalized, endotypeand phenotype-oriented.

The aim of this review was to analyze the literature data on methods for personalized biologicals’ selection in patients with severe asthma that are currently used in clinical practice, as well as new prospects in this area.

Conclusion. Laboratory and instrumental examination methods currently used for endoand phenotyping of severe asthma help in identifying the key pathogenetic factor in the disease development that serves as a basis for selection of the biological. However, biomarkers identified during routine examination are not absolute and are prone to exceptions. Also, the targeted therapy selection is based on a subjective determination of the prevailing pathogenetic mechanism when a patient with severe asthma has a mixed disease phenotype and meets the criteria for prescribing all available biologicals. Therefore, the search for biomarkers that predict the effect of a particular biological remains a relevant direction for future studies. The combined use of clinical, molecular-genetic examination results and evaluation of epigenetic markers can help in solving this problem. This review provides current data on the biologicals used in severe asthma treatment, the phenotyping and endotyping tools used in real practice, and also describes promising areas of the epigenetic biomarkers research.

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The authors declare that there are no conflicts of interest present.