Allergic Bronchopulmonary Aspergillosis in Asthma and Cystic Fibrosis

Figure 1

Proposed immunopathogenesis of ABPA. In the pathogenesis of ABPA, A. fumigatus proteases have a direct effect on bronchial epithelia causing epithelial cell damage with subsequent stimulation of cytokines and chemokines. Aspergillus proteins are processed via HLA-DR2/DR5 bearing dendritic cells that skew the Th0 response to a Th2 response. Th2 cytokines stimulate IgE synthesis and eosinophil activation. This leads to an eosinophilic inflammatory in the bronchial airways. Abbreviations: Af: Aspergillus fumigates, Asp fx: Aspergillus fumigatus proteins, APC: antigen presenting cell, MBP: major basic protein, ECP: eosinophil cationic protein, EDN: eosinophil derived neurotoxin, VLA: very late activation antigen, VCAM: vascular cell adhesion molecule, CxCR and CCR: chemokines receptors, MCO: monocyte chemotactic protein, sCD23: soluble CD23, cyst-LT: cysteinyl leukotriene.