The enigmatic role of the neutrophil in asthma: Friend, foe or indifferent?
File(s)CEA Review.docx (270.42 KB)
Accepted version
Author(s)
Snelgrove, RJ
Patel, DF
Patel, T
Lloyd, CM
Type
Journal Article
Abstract
Whilst severe asthma has classically been categorized as a predominantly Th2-driven pathology, there has in recent years been a paradigm shift with the realization that it is a heterogeneous disease that may manifest with quite disparate underlying inflammatory and remodelling profiles. A subset of asthmatics, particularly those with a severe, corticosteroid refractory disease, present with a prominent neutrophilic component. Given the potential of neutrophils to impart extensive tissue damage and promote inflammation, it has been anticipated that these cells are closely implicated in the underlying pathophysiology of severe asthma. However, uncertainty persists as to why the neutrophil is present in the asthmatic lung and what precisely it is doing there, with evidence supporting its role as a protagonist of pathology being primarily circumstantial. Furthermore, our view of the neutrophil as a primitive, indiscriminate killer has evolved with the realization that neutrophils can exhibit a marked anti-inflammatory, pro-resolving and wound healing capacity. We suggest that the neutrophil likely exhibits pleiotropic and potentially conflicting roles in defining asthma pathophysiology-some almost certainly detrimental and some potentially beneficial-with context, timing and location all critical confounders. Accordingly, indiscriminate blockade of neutrophils with a broad sword approach is unlikely to be the answer, but rather we should first seek to understand their complex and multifaceted roles in the disease state and then target them with the same subtleties and specificity that they themselves exhibit.
Date Issued
2018-10-01
Date Acceptance
2018-06-11
Citation
Clinical and Experimental Allergy, 2018, 48 (10), pp.1275-1285
ISSN
0954-7894
Publisher
Wiley
Start Page
1275
End Page
1285
Journal / Book Title
Clinical and Experimental Allergy
Volume
48
Issue
10
Copyright Statement
© 2018 John Wiley & Sons Ltd. This is the pre-peer reviewed version of the following article, which has been published in final form at https://onlinelibrary.wiley.com/doi/abs/10.1111/cea.13191
Sponsor
Wellcome Trust
Wellcome Trust
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/29900603
Grant Number
107059/Z/15/Z
209458/Z/17/Z
Subjects
1107 Immunology
1117 Public Health And Health Services
Allergy
Publication Status
Published
Coverage Spatial
England
Date Publish Online
2018-06-14