Pharmacogenomics and Biomarker-Driven Precision Pharmacology in Paediatric Severe Asthma

Biologic therapies have transformed the management of paediatric severe asthma, yet response remains highly variable and unpredictable. A critical but underexplored dimension of this variability lies in pharmacogenomics: genetic polymorphisms in drug targets, most notably ADRB2, and in pharmacokinetic pathways shape individual responses to beta-agonists, corticosteroids, and biologic agents, yet genotype-guided prescribing remains the exception rather than the rule in paediatric respiratory practice. Beyond genetics, epigenetic modifications, microbiomic signals, and multi-omic biomarkers increasingly emerge as modulators of airway drug response, generating metabolic and immunological phenotypes that genotype alone cannot predict. Translating these pharmacological insights into validated, clinically actionable tools, specifically biomarkers that reliably predict treatment response, disease control, clinical remission, or treatment failure before the next exacerbation, remains the central unmet need in precision paediatric asthma pharmacotherapy.This Research Topic aims to advance the pharmacogenomic and biomarker science underpinning drug response variability in paediatric severe asthma. It seeks to identify, validate, and translate genetic, epigenomic, transcriptomic, metabolomic, microbiomic, and exhaled breath biomarkers that predict individual response to biologic and conventional pharmacotherapy, and to evaluate the clinical utility of genotype-guided prescribing strategies, including ADRB2-directed treatment algorithms, for reducing exacerbations, improving disease control, and optimising long-term outcomes in children. While paediatric severe asthma remains the central focus, contributions from adolescent, young-adult, and transitional-age populations are welcomed where they offer translational insights relevant to paediatric precision pharmacology. The topic further aims to characterise how environmental exposures, epigenetic reprogramming, and microbiome composition modulate airway pharmacology in ways that extend beyond genomic variation, and to examine how machine learning and digital tools can integrate multi-omic data to support precision prescribing and clinical decision-making across these populations.We welcome Original Research, Systematic Review, Meta-Analysis, Review, Mini Review, Perspective, Clinical Trial, Brief Research Report, and Case Report. Topics of interest include, but are not limited to:- Pharmacogenomics of beta-agonist, corticosteroid, and biologic therapy in paediatric asthma- Genotype-guided prescribing strategies and their clinical outcomes in children- Genomic, epigenomic, and transcriptomic predictors of biologic response, clinical remission, and long-term disease control- Metabolomic biomarkers of pharmacogenomic drug response and exhaled breath signatures as translational readouts of genetic variation- Microbiomic and epigenomic modifiers of pharmacogenomic drug response in paediatric asthma- Epigenetic reprogramming as a modifier of drug pharmacokinetics and pharmacodynamics- Multi-omic integration and machine learning for drug response prediction- Pharmacokinetic and pharmacodynamic profiling of biologics in paediatric populations- Translational pharmacogenomic studies bridging paediatric, adolescent, and young-adult severe asthma cohorts- Health equity and pharmacogenomic variability across paediatric populationsPlease note: If patient data are analyzed, a comprehensive description of the patients, including sex, age, diagnostic criteria, inclusion and exclusion criteria, disease stage, therapy received, comorbidities, as well as additional clinical information and assessment of clinical response/effects, should be included. If genetic, proteomics, metabolomics, or other omics data are analyzed, a comprehensive description of the methods and the rationale for selecting the specific data studied should be provided. Studies related to natural compounds, herbal extracts, or traditional medicine products are outside the scope of the Specialty Section Pharmacogenetics & Pharmacogenomics, and should instead be submitted to the specialty section of Ethnopharmacology. Studies solely based on the analysis of public databases or published evidence, with no further experimental insights or insufficient experimental validation, will not be included in this Research Topic.According to the Mission & Scope of the Journal (https://www.frontiersin.org/journals/pharmacology/about), studies that are purely statistical or predictive in nature, without providing novel insights into pharmacological mechanisms or drug development, are not within the scope of this journal. Topic editors: Sara Manti, Amelia Licari, Susanne Joanne Henriette Vijverberg Source: https://www.frontiersin.org/research-topics/81704/pharmacogenomics-and-biomarker-driven-precision-pharmacology-in-paediatric-severe-asthma