Abstract
Asthma is a common and burdensome chronic inflammatory airway disease that affects both children and adults. One of the main concerns with asthma is the manifestation of irreversible tissue remodelling of the airways due to the chronic inflammatory environment that eventually disrupts the whole structure of the airways. Most people with troublesome asthma are treated with inhaled corticosteroids. However, the development of steroid resistance is a commonly encountered issue, necessitating other treatment options for these patients. Biological therapies are a promising therapeutic approach for people with steroid-resistant asthma. Interleukin 5 is recently gaining a lot of attention as a biological target relevant to the tissue remodelling process.
Since IL-5-neutralizing monoclonal antibodies (mepolizumab, reslizumab and benralizumab) are currently available for clinical use, this review aims to revisit the role of IL-5 in asthma pathogenesis at large and airway remodelling in particular, in addition to exploring its role as a target for biological treatments.Graphical Abstract
A key feature of asthma pathology involves airway remodelling, characterized by structural changes often deemed irreversible. Conventional treatments like steroids primarily target inflammation not remodelling. However, emerging therapies focusing on specific receptors or cytokines could be promising. Interleukin-5 (IL-5), a key cytokine that acts mainly on eosinophils, is recently shown to affect structural cells like airway epithelial cells and fibroblasts. This prompts exploration into IL-5 potential role in remodelling and the benefits of blocking IL-5/IL-5R to mitigate or reverse remodelling.
Key messages
- Progressive airway remodelling is a major pathophysiological feature of severe asthma.
- 50% of severe asthmatic patients present with eosinophilic phenotypes and elevated IL-5 levels.
- Biologics targeting IL-5 are a promising personalized approach for severe asthma management.
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