Prognostic molecular markers of the biological therapy effectiveness for severe bronchial asthma

Eosinophilic T2 inflammation plays a central role in the pathophysiology of most cases of severe, difficult-to-control asthma. Several monoclonal antibodies are now available that block the signaling pathways of eosinophilic T2 inflammation by binding to specific interleukins or their receptors. In order to select the optimal treatment strategy that ensures effective disease control and adequate quality of life, in addition to accurate asthma pheno-/endotyping, it is necessary to determine biomarkers that predict the effectiveness of biological therapy and disease outcome. New biomarkers are needed to identify those patients who are most likely to respond to biological drugs. The review presents an analysis of scientific publications of recent years devoted to the search for prognostic molecular biomarkers that allow assessing the activation status of eosinophils and determining the choice of a specific biological drug based on the prognosis of the possible outcome of the disease. A systematic search was performed in the electronic databases PubMed, Medline, Web of Science. The possible prognostic role of granular cytotoxic molecules (eosinophil-derived neurotoxin, eosinophil peroxidase, eosinophilic cationic protein) released during degranulation of activated eosinophils as indicators of activation status and predictors of the effectiveness of biological therapy is considered. Analysis of scientific studies shows that the serum level of eosinophil-derived neurotoxin has a quite high prognostic value, the accessible measurement of which in peripheral blood allows identifying a subpopulation of patients with a high activation status of eosinophils and a more severe form of bronchial asthma, and can be considered as a biomarker for determining optimal personalized biological therapy. However, in the absence of evidence-based studies on the usefulness of any given molecular predictor of clinical response to biological therapy, the initial choice of biological agents is determined by the experience and opinions of treating physicians and experts.