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Volume 45, Number 1, February 2012

Higher levels of soluble Fas ligand and transforming growth factor-β after omalizumab treatment: A case report

Shu-Ling Kao, Hong-Ren Yu, Ho-Chang Kuo, Ka-Yin Tsui, Chih-Chiang Wu, Ling-Sai Chang, Chi-Di Liang, Yu-Hsiu Chung, Kuender D. Yang

Received: July 25, 2011    Revised: October 18, 2011    Accepted: November 22, 2011   


Corresponding author:

Kuender D. Yang, Department of Pediatrics, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Graduate Institute of Clinical Medical Science, Chang Gung University College of Medicine, Taiwan, ROC
Corresponding author. Chang Gung Children’s Hospital, 123 Ta-Pei Road, Niao-Sung Hsiang, Kaohsiung Hsien 833, Taiwan.


Background and purpose: 

A skewed T-helper (Th)1/Th2 immune response is considered to be the major cause of allergic disorders. Overproduction of Th2 cytokines, which promote recruitment and activation of mast cells and eosinophils, plays a key part in the pathogenesis of allergic asthma. The mechanisms by which omalizumab is effective in asthma treatment are not yet fully understood. A 16-year-old girl who was experiencing frequent asthma attacks in spite of daily administration of budesonide (640μg) and montelukast (10mg) was given omalizumab (375mg) at intervals of 2 weeks, to prevent a visit to the emergency room. Plasma levels of Th1 cytokines [interferon (IFN)-γ and interleukin (IL)-12p70], Th2 cytokines (IL-4 and IL-13), other proinflammatory and regulatory cytokines [IL-6, IL-10, IL-17, tumor necrosis factor (TNF)-α, and transforming growth factor (TGF)-β], chemokines [monocyte chemotactic protein (MCP)-1, chemokine ligand (CCL)7, and CCL17], and soluble Fas ligand (sFasL) were measured before treatment and after treatment for 8 weeks. She showed a good clinical response to omalizumab: her lung function parameters improved and the use of β2-agonist decreased. No emergency room visits were required after omalizumab treatment for 8 weeks. Plasma levels of sFasL and TGF-β showed obvious increases after omalizumab therapy. IL-12p70 levels were decreased as compared to the corresponding baseline levels. These findings suggest that the effects of omalizumab in asthma treatment are not restricted to the regulation of the skewed Th1/Th2 cytokine immune response, and sFasL-mediated apoptosis and regulatory T-cell (Treg)-mediated TGF-β seem to have important roles in the therapeutic effects of omalizumab.


Key words:

Asthma, Omalizumab, Soluble FasL, Th1, Th2