Pathogenetic aspects of steroid-resistant severe bronchial asthma

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Abstract

Purpose of the review. The purpose of this review was to summarize the available relevant data on pathogenetic mechanisms in the formation of steroid resistance in severe bronchial asthma.

Material and methods. The analysis of domestic sources on the CyberLeninka and e-Library scientific electronic libraries, and the search for published foreign full-text articles, reviews, systematic reviews, meta-analysis data and randomized clinical trials in PubMed/Medline were conducted to summarize relevant material on the pathophysiology of steroid-resistant asthma. In addition, a reverse search was conducted for links to relevant studies. Publications from 2020 to 2024 were considered for consideration. The analysis included full-fledged articles and the results of clinical trials containing information on key cytokines of neutrophilic asthma: IL-33, IL-17, TNF, IFNγ. A search for the term “steroid-resistant asthma” for the specified period (2020–2024) initially revealed a list of 93 articles. 62 articles presented in the form of abstracts or not corresponding to the target topic were excluded from the general list. A total of 31 publications from an electronic search in the PubMed database and 17 articles additionally found using a manual search were included in the analysis.

Results. Bronchial asthma (BA) is an extremely heterogeneous respiratory disease characterized by airway obstruction, bronchial hyperreactivity, and airway inflammation. About 3-10% of asthma patients suffer from uncontrolled severe asthma. The main difference between patients with severe form of the disease and patients with mild and moderate asthma is resistance to basic therapy drugs – glucocorticosteroids. Severe bronchial asthma is heterogeneous and includes different immunophenotypes: Th2-high (eosinophilic inflammation), Th2-low and Th17-high (non-eosinophilic inflammation accompanied by neutrophilic inflammation of the respiratory tract), mixed Th1/Th17-mediated inflammation.

Conclusion. The paper provides information for determining common points of interaction between different immune mediators and related mechanisms related to respiratory tract inflammation and the immunobiology of steroid-resistant asthma.

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About the authors

Ella V. Churyukina

Federal State Budgetary Educational Institution of Higher Education «Rostov State Medical University» of the Ministry of Healthcare of the Russian Federation; Federal State Budgetary Educational Institution of Higher Education “Kuban State Medical University” of Public Health Care of Russia

Author for correspondence.
Email: echuryukina@mail.ru
ORCID iD: 0000-0001-6407-6117

Candidate of Medical Sciences, Associate Professor. Head of the Department of Allergic and Autoimmune Diseases of the Research Institute of Obstetrics and Pediatrics, Associate Professor of the Department of Clinical Immunology, Allergology and Laboratory Diagnostics of the Faculty of Advanced Training and Professional Retraining of Specialists

Russian Federation, Nakhichevansky Lane, 29, Rostov-on-Don, 344022; M. Sedina str., 4, Krasnodar, 350063

Olga P. Ukhanova

Federal State Budgetary Educational Institution of Higher Education “Stavropol State Medical
University” of the Ministry of Health of the Russian Federation; Federal North Caucasus Federal Scientific and Clinical Center FMBA of Russia

Email: uhanova_1976@mail.ru
ORCID iD: 0000-0002-7247-0621

Doctor of Medical Sciences, Professor, Department of Clinical Immunology with the Course of Additional Professional Education, Head of the North Caucasian Center of Allergy, Immunology, and Genetically Engineered Therapies

Russian Federation, Mira str., 310, Stavropol, 355017; Sovetskaya str., 24, Yessentuki, 357600

Inga M. Kotieva

Federal State Budgetary Educational Institution of Higher Education «Rostov State Medical University» of the Ministry of Healthcare of the Russian Federation

Email: kukulik70@mail.ru
ORCID iD: 0000-0002-2796-9466

Doctor of Medical Sciences, Professor. Vice-Rector for Scientific Work, head of the Department of Pathological Physiology

Russian Federation, Nakhichevansky Lane, 29, Rostov-on-Don, 344022

Marina V. Gulyan

Federal State Budgetary Educational Institution of Higher Education «Rostov State Medical University» of the Ministry of Healthcare of the Russian Federation

Email: 25marinablik@mail.ru
ORCID iD: 0000-0001-6023-8916

Candidate of Medical Sciences, Associate Professor. Head of the Department of Scientific Policy and Organization of Scientific Research

Russian Federation, Nakhichevansky Lane, 29, Rostov-on-Don, 344022

Margarita S. Alkhusein-Kulyaginova

Federal State Budgetary Educational Institution of Higher Education «Rostov State Medical University» of the Ministry of Healthcare of the Russian Federation

Email: alhusein-kulyaginova@yandex.ru
ORCID iD: 0000-0001-5123-5289

Assistant of the Department of Pathological Physiology

Russian Federation, Nakhichevansky Lane, 29, Rostov-on-Don, 344022

Tatiana A. Iordanidi

Federal State Budgetary Educational Institution of Higher Education «Rostov State Medical University» of the Ministry of Healthcare of the Russian Federation

Email: tata.volkova@list.ru
ORCID iD: 0009-0007-9050-3582

laboratory assistant of the Department of Pathological Physiology

Russian Federation, Nakhichevansky Lane, 29, Rostov-on-Don, 344022

Syahlya S. Ivanova

Federal State Budgetary Educational Institution of Higher Education «Rostov State Medical University» of the Ministry of Healthcare of the Russian Federation

Email: vzng@bk.ru
ORCID iD: 0009-0000-0603-9350

laboratory assistant of the Department of Pathological Physiology

Russian Federation, Nakhichevansky Lane, 29, Rostov-on-Don, 344022

Daria I. De

Federal State Budgetary Educational Institution of Higher Education «Rostov State Medical University» of the Ministry of Healthcare of the Russian Federation

Email: dashuta.de@mail.ru
ORCID iD: 0009-0008-9828-3198

laboratory assistant of the Department of Pathological Physiology

Russian Federation, Nakhichevansky Lane, 29, Rostov-on-Don, 344022

Margarita A. Dodokhova

Federal State Budgetary Educational Institution of Higher Education «Rostov State Medical University» of the Ministry of Healthcare of the Russian Federation

Email: dodohova@mail.ru
ORCID iD: 0000-0003-3104-827X

Doctor of Medical Sciences, Associate Professor. head of the Central Research Laboratory, professor of the Department of Pathological Physiology

Russian Federation, Nakhichevansky Lane, 29, Rostov-on-Don, 344022

Elena V. Koreeva

State Autonomous Institution of the Rostov region “Regional Consultative and Diagnostic Center”

Email: el.koreeva@yandex.ru
ORCID iD: 0000-0002-8808-9067

Allergologist-Immunologist

Russian Federation, Pushkinskaya St., 127, Rostov-on-Don, 344000

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