Table represents the total number of clinical trials currently registered on ClinicalTrials. gov for each of the biologic asthma therapies that are currently approved for use in children. will consider the cost effectiveness as well as potential long-term consequences of biologic therapies in pediatric asthma. strong class=”kwd-title” Keywords: monoclonal antibodies, childhood asthma, T-helper 2 asthma, anti-IgE therapy, anti-eosinophil therapy Introduction Over the last few decades there has been a paradigm shift in the approach to characterizing the multifaceted, chronic disorder known as asthma. Attempts have been made to classify asthma into phenotypes and endotypes in an effort to group individuals with common features, pathophysiology and treatment approaches1. Perhaps one of the most clearly delineated phenotypes of asthma is the allergic asthma phenotype that is often characterized by elevated T-helper 2 (TH2) cytokines and mediators2. In parallel there has also been an increase in therapeutic options for TH2 high asthma in the form of biologic therapies. Biologic therapies are treatments that have been created from living animals, plants, or cells as opposed to chemical processes. Monoclonal antibodies are produced from an identical immune cell that is a clone of a parent cell. Monoclonal antibodies are derived from mouse, humans, or humanized antibodies that originate predominately from human sources with the exception of protein-binding regions. All current biologic therapies that are used for the treatment of asthma are either humanized monoclonal antibodies Ethisterone or full Ethisterone human monoclonal antibodies (Dupilumab), thus the terms biologic therapies and monoclonal antibodies are often used interchangeably when referring to this class of asthma medications. In this review we will discuss the biologic therapies that are currently available for the management of pediatric asthma (children less than 18 years), particularly difficult to treat asthma. It is important to note, that the evidence of safety and efficacy of biologic therapies in children is rather sparse. The number of pediatric patients enrolled in the phase 3 clinical trials of currently approved biologic therapies is quite low (Figure 1). Currently there are very few registered clinical trials of biologic asthma therapies that have enrolled participants younger than 18 years of age (Figure 2). Furthermore, studies that specifically target high-risk subpopulations of children with asthma including minority children and children from low-income families are rare. Thus, future studies are necessary to further understand the benefits and risks in a broad range of children with severe asthma. Open in a separate window Figure 1: Evidence of safety and efficacy of biologic therapies in pediatric asthma is sparse. The green bars represent the total number of participants enrolled in Phase 3 clinical trials for each respective therapeutic and the blue bars represent the number of children age 12-17 years (age 6-12 years for Omalizumab) that were enrolled. Open in a separate window Figure 2: Enrollment of children in studies of biologic therapies in pediatric asthma is sparse. Table represents the total number of clinical trials currently registered on ClinicalTrials.gov for Rabbit Polyclonal to MRPL20 each of the biologic asthma therapies that are currently approved for use in children. All studies are represented by green bars and studies that have proposed to enroll children 18 years are in blue. This review will consider diagnostic criteria for using biologic therapies for pediatric asthma with special emphasis on populations that are Ethisterone likely to benefit the most from particular therapies. In addition, we will consider the cost effectiveness as well as potential long-term consequences of biologic therapies in asthma. Immunologists have largely driven the management of monoclonal antibody therapy, particularly among children with asthma. However pulmonologist often have a large referral base for difficult to manage pediatric asthma. Thus, it is Ethisterone critical that we equip ourselves to manage the range of therapies available to our pediatric patients. Overview of TH2 predominate asthma pathways Allergic asthma is thought to be a disease of airway inflammation that is triggered by a variety of complex immunologic pathways stemming from the introduction of aeroallergens, viruses and pollutant particles that come in contact with antigen presenting cells, specifically, dendritic cells. Dendritic cells mobilize to local lymph nodes where they activate na?ve T helper cells, stimulating them to differentiate into TH1 cells, TH17 cells or TH2 cells. Differentiation of na?ve T cells into TH2 cells initiates the eosinophilic or type 2 inflammatory cascade. In lymph nodes TH2 cells secrete IL4 and mediate class-switching leading B cells to.