Fracción de óxido nítrico exhalado como biomarcador en asma

Gustavo Adolfo Hincapié Díaz, MD., Javier Iván Lasso Apráez, MD.

Resumen


El asma es un síndrome heterogéneo en el cual la identificación y utilización de biomarcadores, puede contribuir a agrupar los pacientes en fenotipos y predecir quienes responderán a una terapia específica y evaluar además la respuesta al tratamiento. Un biomarcador ideal debe tener relevancia clínica, alta sensibilidad, ser confiable, repetible, simple, rápido, económico y contar con buena correlación con la respuesta al tratamiento. Se describen los diferentes biomarcadores utilizados en asma y se profundiza en la fracción de óxido nítrico exhalado su fisiopatología y utilidad clínica en el abordaje de pacientes asmáticos, su biosíntesis y regulación, su relación con la inflamación en el asma, se describen los estudios relacionados con el diagnóstico del asma y la fracción exhalada de óxido nítrico y como puede servir como herramienta para iniciar el tratamiento, cuáles son sus valores normales y los avances en la estandarización de la medición que han permitido que se convierta en un biomarcador que permite evaluar la inflamación de la vías aéreas.

Palabras clave


biomarcadores en asma; fracción de óxido nítrico exhalada; eosinófilos; periostina

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Referencias


Deckers J, Branco Madeira F, Hammad H. Innate immune cells in asthma. Trends Immunol. 2013;34:540–7.

Busse WW. Asthma diagnosis and treatment: filling in the information gaps. J Allergy Clin Immunol. 2011;128:740–50.

Lötvall J, Akdis CA, Bacharier LB, Bjermer L, Casale TB, Custovic A, et al. Asthma endotypes: a new approach to classification of disease entities within the asthma syndrome. J Allergy Clin Immunol. 2011;127:355–60.

Wenzel SE. Asthma phenotypes: the evolution from clinical to molecular approaches. Nat Med. 2012;18:716–25.

Bartminski G, Crossley M, Turcanu V. Novel biomarkers for asthma stratification and personalized therapy. Expert Rev Mol Diagn. 2015;15:415–30.

Hastie AT, Moore WC, Li H, Rector BM, Ortega VE, Pascual RM, et al. Biomarker surrogates do not accurately predict sputum eosinophil and neutrophil percentages in asthmatic subjects. J Allergy Clin Immunol. 2013;132:72–80.

Sidhu SS, Yuan S, Innes AL, Kerr S, Woodruff PG, Hou L, et al. Roles of epithelial cell-derived periostin in TGF-beta activation, collagen production, and collagen gel elasticity in asthma. Proc Natl Acad Sci U S A. 2010;107:14170–5.

Furchgott RF, Zawadzki JV. The obligatory role of endothelial cells in the relaxation of arterial smooth muscle by acetylcholine. Nature. 1980;288:373–6.

Szabo C. Gaseotransmitters: new frontiers for translational science. Sci Transl Med. 2010;2:59ps54.

Alving K, Weitzberg E, Lundberg JM. Increased amount of nitric oxide in exhaled air of asthmatics. Eur Respir J. 1993;6:1368–70.

Ricciardolo FLM. Multiple roles of nitric oxide in the airways. Thorax. 2003;58:175–82.

Ricciardolo FLM. cNOS-iNOS paradigm and arginase in asthma. Trends Pharmacol Sci. 2003;24:560-63.

Ricciardolo FLM. Revisiting the role of exhaled nitric oxide in asthma. Curr Opin Pulm Med. 2014;20:53–9.

Dinh-Xuan AT, Annesi-Maesano I, Berger P, Chambellan A, Chanez P, Chinet T, et al. Contribution of exhaled nitric oxide measurement in airway inflammation assessment in asthma. A position paper from the French Speaking Respiratory Society. Rev Mal Respir. 2015;32:193–215.

Ricciardolo FLM, Di Stefano A, Silvestri M, Van Schadewijk AM, Malerba M, Hiemstra PS, et al. Exhaled nitric oxide is related to bronchial eosinophilia and airway hyperresponsiveness to bradykinin in allergen-induced asthma exacerbation. Int J Immunopathol Pharmacol. 2012;25:175–82.

Silkoff PE, Lent AM, Busacker AA, Katial RK, Balzar S, Strand M, et al. Exhaled nitric oxide identifies the persistent eosinophilic phenotype in severe refractory asthma. J Allergy Clin Immunol. 2005;116:1249–55.

See KC, Christiani DC. Normal values and thresholds for the clinical interpretation of exhaled nitric oxide levels in the US general population: results from the National Health and Nutrition Examination Survey 2007-2010. Chest. 2013;143:107–16.

Lee JE, Rhee CK, Lim JH, Lee SM, Shim YS, Lee C-T, et al. Fraction of exhaled nitric oxide in patients with acute eosinophilic pneumonia. Chest. 2012;141:1267–72.

Marcon A, Cerveri I, Wjst M, Antó J, Heinrich J, Janson C, et al. Can an airway challenge test predict respiratory diseases? A population-based international study. J Allergy Clin Immunol. 2014;133:104-14.

Calhoun KH. The role of fractional exhaled nitric oxide in asthma management. Otolaryngol Clin North Am. 2014;47:87–96.

Ciprandi G, Tosca MA, Capasso M. High exhaled nitric oxide levels may predict bronchial reversibility in allergic children with asthma or rhinitis. J Asthma Off J Assoc Care Asthma. 2013;50:33–8.

Schleich FN, Asandei R, Manise M, Sele J, Seidel L, Louis R. Is FENO50 useful diagnostic tool in suspected asthma? Int J Clin Pract. 2012;66:158–65.

Fukuhara A, Saito J, Sato S, Sato Y, Nikaido T, Saito K, et al. Validation study of asthma screening criteria based on subjective symptoms and fractional exhaled nitric oxide. Ann Allergy Asthma Immunol Off Publ Am Coll Allergy Asthma Immunol. 2011;107:480-6.

Li Z, Qin W, Li L, Wu Q, Wang Y. Diagnostic accuracy of exhaled nitric oxide in asthma: a meta-analysis of 4,691 participants. Int J Clin Exp Med. 2015;8:8516–24.

Guo Z, Wang Y, Xing G, Wang X. Diagnostic accuracy of fractional exhaled nitric oxide in asthma: a systematic review and meta-analysis of prospective studies. J Asthma Off J Assoc Care Asthma. 2016;53 404–12.

Dweik RA, Boggs PB, Erzurum SC, Irvin CG, Leigh MW, Lundberg JO, et al. An official ATS clinical practice guideline: interpretation of exhaled nitric oxide levels (FENO) for clinical applications. Am J Respir Crit Care Med. 2011;184:602–15.

Schneider A, Schwarzbach J, Faderl B, Welker L, KarschVölk M, Jörres RA. FENO measurement and sputum analysis for diagnosing asthma in clinical practice. Respir Med.2013;107:209–16.

Zeiger RS, Schatz M, Zhang F, Crawford WW, Kaplan MS, Roth RM, et al. Elevated exhaled nitric oxide is a clinical indicator of future uncontrolled asthma in asthmatic patients on inhaled corticosteroids. J Allergy Clin Immunol. 2011;128:412–4.

National Institute for Health and Care Excellence. Asthma: diagnosis and monitoring of asthma in adults, children and young people. 2016. URL: Disponible en: https://www.nice.org.uk/guidance/indevelopment/gid-cgwave0640/documents. [Acceso 27 Abr 2016].

Barnes PJ, Dweik RA, Gelb AF, Gibson PG, George SC, Grasemann H, et al. Exhaled nitric oxide in pulmonary diseases: a comprehensive review. Chest. 2010;138:682–92.

Taylor DR. Advances in the clinical applications of exhaled nitric oxide measurements. J Breath Res. 2012;6:47102.

Syk J, Malinovschi A, Johansson G, Undén A-L, Andreasson A,

Lekander M, et al. Anti-inflammatory treatment of atopic asthma guided by exhaled nitric oxide: a randomized, controlled trial. J Allergy Clin Immunol Pract. 2013;1:639-648-8.

Olin A-C, Rosengren A, Thelle DS, Lissner L, Bake B, Torén K. Height, age, and atopy are associated with fraction of exhaled nitric oxide in a large adult general population sample. Chest. 2006;130:1319–25.




DOI: http://dx.doi.org/10.30789/rcneumologia.v27.n3.2015.81

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