Sakane T, Suzuki N
Department of Immunology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan.
Arch Immunol Ther Exp (Warsz). 2000;48(5):417-27.
We present an overview of the role of neuro-endocrine-immune mechanisms in the pathophysiological responses of patients with rheumatoid arthritis (RA). In patients with RA, proinflammatory cytokines secreted by synovial cells provoke local inflammation in the joints and, simultaneously, initiate a systemic acute phase response. Thus, profound changes of the neuro-endocrine-immune axis could take place in the patients. Defects in the hypothalamus-pituitary-adrenal axis have been observed in patients with RA. Prolactin levels are often elevated and abnormal sex hormone levels have been described in RA patients. Defective neural regulation of inflammation involving neuropeptides at least partly plays a pathogenic role in RA. We and others have found that participants of the neuro-endocrine-immune interactions, such as hormones, neurotransmitters and neuropeptides, modulate RA synovial cell functions and that they are actually produced by, and their receptors are expressed on, cells within the inflammatory joint compartment. Thus, neuropeptides and hormones not only affect a systemic acute phase response of RA patients, but also modulate local inflammation directly in RA joints. These results suggest that defects in regulatory processes which are fundamental to RA may lie in the immune system, the nervous system, the endocrine system or the interactions of these. A better understanding of neuro-endocrine-immune interactions holds the promise of new approaches to the treatment of RA with the use of hormones, neurotransmitters, neuropeptides and/or their antagonists.
我们概述了神经 - 内分泌 - 免疫机制在类风湿性关节炎（RA）患者病理生理反应中的作用。在RA患者中，滑膜细胞分泌的促炎细胞因子引发关节局部炎症，同时引发全身急性期反应。因此，患者的神经 - 内分泌 - 免疫轴可能会发生深刻变化。在RA患者中观察到下丘脑 - 垂体 - 肾上腺轴存在缺陷。RA患者的催乳素水平通常升高，性激素水平异常。涉及神经肽的炎症神经调节缺陷至少在一定程度上在RA中起致病作用。我们和其他人发现，神经 - 内分泌 - 免疫相互作用的参与者，如激素、神经递质和神经肽，可调节RA滑膜细胞功能，并且它们实际上由炎症关节腔室中的细胞产生，其受体也在这些细胞上表达。因此，神经肽和激素不仅影响RA患者的全身急性期反应，还直接调节RA关节中的局部炎症。这些结果表明，RA基本调节过程中的缺陷可能存在于免疫系统、神经系统、内分泌系统或它们之间的相互作用中。更好地理解神经 - 内分泌 - 免疫相互作用有望为使用激素、神经递质、神经肽和/或其拮抗剂治疗RA带来新方法。
