Th2 cytokines and asthma. Interleukin-9 as a therapeutic target for asthma

Promoters can contribute to the elucidation of protein function

Protein interaction maps are valuable tools in the understanding of the actions of genes and proteins in a real-life context. However, many proteins and genes interact functionally - without physical contact - via transcriptional coregulation of the genes, which is partially manifested in functional promoter structures called promoter modules. Here, the example of interleukin 9 (IL-9) induction by IL-1 and tumour necrosis factor (TNF) is used to demonstrate how comparative promoter analysis can identify a shared promoter module and thus indicate the crucial partners. This strategy can be used for genes from a small initial set of coregulated genes, such as can be derived from expression array data. The combination of expression and promoter analysis with proteomics should be considered as an important link in functional genomics.

Role of cytokines and chemokines in bronchial hyperresponsiveness and airway inflammation

Over the last decade there has been an intense interest in the potential role of cytokines and chemokines as important mediators in various atopic diseases, including asthma and the mechanisms by which these mediators regulate airway inflammation and bronchial hyperresponsiveness. This research effort has recently culminated in the publication of clinical studies that have assessed the role of interleukin (IL)-4 [Borish et al., Am J Respir Crit Care Med 160, 1816-1823 (1999)], IL-5 [Leckie et al., Lancet 356, 2144-2148 (2000)], and IL-12 [Bryan et al., Lancet 356, 2149-2153 (2000)] in allergic asthma, and the results have been disappointing. This is not surprising given the pleiotropic role cytokines play in the allergic response confirmed by numerous animal studies providing evidence of functional redundancy. The alternative view is that our current concepts in asthma pathogenesis need significant revision. This review will summarise the evidence for the role of cytokines and chemokines in various aspects of asthma pathophysiology; namely, bronchial hyperresponsiveness, eosinophil recruitment to the airways, mucus secretion, and airway remodelling.

Cytokine modulators as novel therapies for asthma

Cytokines play a critical role in orchestrating and perpetuating inflammation in asthmatic airways and several specific cytokine and chemokine inhibitors are now in development for the treatment of asthma. Inhibition of IL-4 with soluble IL-4 receptors has shown promising early results in asthma. Anti-IL-5 antibody is very effective at inhibiting peripheral blood and airway eosinophils but does not appear to be effective in symptomatic asthma. Inhibitory cytokines, such as IL-10, interferons, and IL-12 are less promising because systemic delivery produces intolerable side effects. Inhibition of TNF-alpha may be useful in severe asthma. Many chemokines are involved in the inflammatory response of asthma, and small-molecule inhibitors of chemokine receptors are in development. CCR3 antagonists are now in clinical development for the treatment of asthma. Because so many cytokines are involved in asthma, drugs that inhibit the synthesis of multiple cytokines may prove to be more useful. Several such classes of drug are now in clinical development, and the risk of side effects with these nonspecific inhibitors may be reduced by the inhaled route of delivery.

Cytokine modulators for allergic diseases

Cytokines play a critical role in orchestrating and perpetuating inflammation in allergic diseases and several specific cytokine inhibitors now in development for the treatment of asthma and other allergic diseases. The effects of inhibiting the T helper 2 cytokines interleukin-5, interleukin-13 and interleukin-9 are discussed, together with inhibition of tumor necrosis factor-alpha. Inhibitory cytokines, such as interleukin-10, interferons and interleukin-12, are also being considered in the treatment of allergic diseases.