A new study conducted by a multidisciplinary team made up of immunologists and ENT specialistsCareggi Hospital in Florence investigated the role of inflammatory eosinophils in the clinical severity of severe eosinophilic asthma, finding that treatment withmonoclonal antibody mepolizumab restores the physiological balance between the subphenotypes of eosinophils, bringing the levels of 'good' and 'bad' eosinophils back to those observed in healthy subjects and thus explaining how the drug can make it possible to control such a severe and impactful pathology.
The study published by the magazine 'Allergy' – presented yesterday in Milan – provides new evidence about a research area that had already allowed an extremely innovative article to be published in 2022. In fact, the presence of two types of eosinophils with different functions, i.e. homeostatic or inflammatory, had been demonstrated. In the recent article on Allergy – reports a note – the authors confirmed and explored these results in a total asthmatic population of 74 patients, of which approximately 85% also had chronic rhinosinitis with nasal polyposis, demonstrating that the quantity of inflammatory eosinophils is linked with the severity of the disease and suggesting a causal role in eosinophil-mediated pathologies. Finally, the study demonstrates how mepolizumab is able not only to counteract these inflammatory eosinophils, but can also restore a balance with non-inflammatory eosinophils similar to that of healthy people.
“The study – says Alessandra Voltage, researcher at the Department of Experimental and Clinical Medicine of the University of Florence, Sod Immunoallergologia Aou Careggi – therefore highlights how the presence of inflammatory eosinophils, in markedly eosinophil-mediated pathologies, could represent the biomarker of disease severity and clinical response to treatment with mepolizumab”.
The study also underlines an important aspect of severe asthma, that is, that in the majority of cases it is accompanied by other important eosinophilic pathologies such as chronic rhinosinusitis with nasal polyposis. Knowing this can allow for an earlier diagnosis of the disease, followed by more targeted treatment. In fact, there are several patients with a poor quality of life, unable to work and lead a normal life due to exacerbations, symptoms or treatments with high doses of corticosteroids with related side effects.
“We are faced with a disabling pathology often aggravated by other comorbidities such as chronic rhinosinusitis with nasal polyposis (CRSwNP) – he explains Andrea Matuccifirst level director of Sod Immunoallergology Aou Careggi – This combination, which unfortunately still today sees the frequent use of oral corticosteroids, even at high doses, which do not allow adequate long-term control of disabling symptoms to be achieved, unlike what has been demonstrated with biological therapy such as mepolizumab for example”. Both experts therefore agree that mepolizumab, as emerged from the study, by blocking the function of interleukin-5 (IL-5) is able not only to improve clinical outcomes, but also to rebalance the relationship between inflammatory and resident eosinophils, bringing it back to the condition observed in healthy subjects.
Eosinophils – remember the note – are white blood cells that can be higher in the blood when there is ongoing inflammation as they contribute to the immune response against allergens and parasitic infections. Some factors, including corticosteroid drugs often used by patients with severe eosinophilic asthma, can alter or mask the amount of eosinophils in the blood. For this reason, a correct diagnosis is very important to evaluate the presence of eosinophilic inflammation, so as to establish the correct therapeutic path. Mepolizumab is a monoclonal antibody that acts on IL-5, the molecule primarily responsible for the growth and differentiation, recruitment, activation and survival of eosinophils. Mepolizumab blocks the binding of IL-5 to the cell surface of eosinophils, and consequently inhibits the action of IL-5 and reduces the production and survival of eosinophils. It is currently indicated for the treatment of severe eosinophilic asthma, chronic rhinosinusitis with nasal polyposis, eosinophilic granulomatosis with polyangiitis (EGPA) and hypereosinophilic syndrome (HES).
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