Pordeus V, Szyper-Kravitz M, Levy R A, Vaz N M, Shoenfeld Y
Clinical Research, Pro Cardiaco Hospital Research Center-PROCEP, Rio de Janeiro, Brazil.
Clin Rev Allergy Immunol. 2008 Jun;34(3):283-99. doi: 10.1007/s12016-007-8048-8.
For more than 2,000 years, it was thought that malignant spirits caused diseases. By the end of nineteenth century, these beliefs were displaced by more modern concepts of disease, namely, the formulation of the "germ theory," which asserted that bacteria or other microorganisms caused disease. With the emergence of chronic degenerative and of autoimmune diseases in the last century, the causative role of microorganisms has been intensely debated; however, no clear explanatory models have been achieved. In this review, we examine the current available literature regarding the relationships between infections and 16 autoimmune diseases. We critically analyzed clinical, serological, and molecular associations, and reviewed experimental models of induction of and, alternatively, protection from autoimmune diseases by infection. After reviewing several studies and reports, a clinical and experimental pattern emerges: Chronic and multiple infections with viruses, such as Epstein-Barr virus and cytomegalovirus, and bacteria, such as H. pylori, may, in susceptible individuals, play a role in the evolvement of autoimmune diseases. As the vast majority of infections pertain to our resident microbiota and endogenous retroviruses and healthy carriage of infections is the rule, we propose to focus on understanding the mechanisms of this healthy carrier state and what changes its configurations to infectious syndromes, to the restoration of health, or to the sustaining of illness into a chronic state and/or autoimmune disease. It seems that in the development of this healthy carriage state, the infection or colonization in early stages of ontogenesis with key microorganisms, also called 'old friends' (lactobacilli, bifidobacteria among others), are important for the healthy living and for the protection from infectious and autoimmune syndromes.
两千多年来,人们一直认为是恶灵导致疾病。到19世纪末,这些观念被更现代的疾病概念所取代,即“细菌学说”的形成,该学说断言细菌或其他微生物会导致疾病。随着上个世纪慢性退行性疾病和自身免疫性疾病的出现,微生物的致病作用一直备受争议;然而,尚未形成明确的解释模型。在这篇综述中,我们研究了目前关于感染与16种自身免疫性疾病之间关系的现有文献。我们批判性地分析了临床、血清学和分子关联,并回顾了通过感染诱导自身免疫性疾病以及预防自身免疫性疾病的实验模型。在回顾了多项研究和报告后,出现了一种临床和实验模式:病毒(如爱泼斯坦-巴尔病毒和巨细胞病毒)和细菌(如幽门螺杆菌)的慢性和多重感染,在易感个体中,可能在自身免疫性疾病的发展中起作用。由于绝大多数感染与我们的常驻微生物群和内源性逆转录病毒有关,而且感染的健康携带是常态,我们建议专注于了解这种健康携带状态的机制,以及是什么将其结构改变为感染综合征、恢复健康或使疾病持续发展为慢性状态和/或自身免疫性疾病。似乎在这种健康携带状态的发展过程中,个体发育早期被关键微生物(也称为“老朋友”,如乳酸杆菌、双歧杆菌等)感染或定植,对健康生活以及预防感染和自身免疫综合征很重要。