Endotyping Asthma - Profiling the Metabolic Dimension?

Asthma has long been recognised as a heterogeneous disease, and the notion of discrete endotypes of asthma has been prevalent for over a decade [1]. However, despite the success in identifying and targeting type-2 inflammation in asthma, the identification of tractable endotypes - has remained elusive; with not a single endotype defined with certainty. Here, Kelly et al, have reported putative novel asthma endotypes, defined using metabolomics (metabo-endotypes), in childhood asthma [2]. The metabolomics included unbiased multi-platform, metabolic profiling, using liquid chromatography and tandem mass spectrometry (LC-MS). The metabolic endotypes generated, were replicated against clinical outcomes in an independent cohort, underscoring both the validity and the potential importance of the approach. The work is novel and important due to the comprehensive and ‘agnostic’ metabolomics approach, enabling the quantification of metabolic fingerprints that may reflect underpinning gene-environment interactions in asthma.