The role of T lymphocytes in asthma.

There is now overwhelming evidence to support a major role for T cells in asthma, in particular the involvement of T helper type 2 (Th2) cells in atopic allergic asthma as well as nonatopic and occupational asthma. There may also be a minor contribution from T cytotoxic type 2 CD8+T cells. Several Th2 cytokines have potential to modulate airway inflammation, in particular interleukin-13 which induces airway hyperresponsiveness independently of IgE and eosinophilia in animal models. The identification of transcription factors controlling Th1, Th2 and T-regulatory cell (T(Reg)) development further support the Th2 hypothesis since GATA3 is overexpressed and T-bet underexpressed in the asthmatic airway and Foxp3 is induced in asthma by corticosteroid treatment. Specific T-cell-directed immunotherapy may allow induction/modulation of T-cell responses, and elucidation of the mechanisms of T(Regs) may allow further optimization of immunotherapy. Recent advances in the understanding of dendritic cell function in directing T-cell responses may uncover further therapeutic targets. Efficacy of cyclosporin and anti-CD4 treatment in chronic severe asthma argues for continued T-cell involvement, but whether remodeling contributes to pathology inaccessible to antiinflammatory treatment or T-cell immunotherapy remains an important question.