Department of Radiology, Southwest Hospital, Third Military Medical University, Chongqing 400038, China.
Med Hypotheses. 2009 Dec;73(6):958-60. doi: 10.1016/j.mehy.2009.06.029. Epub 2009 Jul 19.
Anti-tumour necrosis factor alpha therapy has transformed the treatment of certain inflammatory diseases including rheumatoid arthritis, inflammatory bowel disease and ankylosing spondylitis, but onset of demyelinating events associated with multiple sclerosis as an adverse event was continuously reported, and such adverse events were only viewed as occasional. Multiple sclerosis is an autoimmune demyelinating disorder affecting central nervous system, with varied clinical manifestations of cognitive, visual and motor network disorder. Recently, there is increasing evidence from functional magnetic resonance that cortical reorganization, a property that allows the central nervous system to adapt itself to various brain insults, which was viewed as to limit the clinical expression of tissue damage in patients with multiple sclerosis. In light of the mentioned above, we hypothesis that cerebral tissue damage may existed in a broader aspects of patients treated with anti-tumour necrosis factor therapy, but its clinical manifestations from brain lesions were compensated by cortical reorganization. In other words, cerebral nerve reservation may be damaged by the therapy. If confirmed, the hypothesis may lead to a safety concern of the therapy, and an insight of the pathophysiology of both multiple sclerosis and certain inflammatory diseases.
抗肿瘤坏死因子 α 治疗已经改变了某些炎症性疾病的治疗方法，包括类风湿关节炎、炎症性肠病和强直性脊柱炎，但与多发性硬化症相关的脱髓鞘事件作为不良反应不断被报道，而这种不良反应仅被视为偶发事件。多发性硬化症是一种影响中枢神经系统的自身免疫性脱髓鞘疾病，具有认知、视觉和运动网络障碍等多种临床表现。最近，功能磁共振成像的证据越来越多表明，皮质重组是中枢神经系统适应各种脑损伤的特性，这被认为限制了多发性硬化症患者组织损伤的临床表达。鉴于上述情况，我们假设在接受抗肿瘤坏死因子治疗的患者中，脑组织损伤可能存在更广泛的方面，但通过皮质重组，其脑损伤的临床表现得到了代偿。换句话说，神经可能因治疗而受损。如果得到证实，这一假设可能会引发对该治疗方法的安全性担忧，并深入了解多发性硬化症和某些炎症性疾病的病理生理学。
