固有免疫途径的遗传变异及其对全身炎症反应综合征/代偿性抗炎反应综合征争论的潜在贡献:来自人类研究和动物模型的证据。
Genetic variation in innate immunity pathways and their potential contribution to the SIRS/CARS debate: evidence from human studies and animal models.
机构信息
Hanse-Klinikum Stralsund, Department of Anaesthesiology, Intensive Care Medicine and Pain Management, Stralsund, Germany.
出版信息
J Innate Immun. 2010;2(5):381-94. doi: 10.1159/000314269. Epub 2010 Apr 30.
The lack of a causal and successful treatment for sepsis has led to a re-evaluation of the condition's pathophysiology. The failure of anti-inflammatory strategies has implied compensatory immunosuppression to play a central part in fatal clinical cases. While searching for novel therapeutic strategies, the question arose whether pro-inflammation (systemic inflammatory response syndrome, SIRS) or anti-inflammation (compensatory anti-inflammatory response syndrome, CARS) are dominant in sepsis, and may be counteracted by therapeutic measures. Here we ask whether in a given organism--man or mouse--the lack of any functional protein involved in this cascade may help in understanding the events. In humans, genetic variations exist, and some of them have functional consequences altering the inflammatory response to pathogens. In mice, knockout animals were created, which may assist us in understanding the SIRS/CARS cascade. Here we summarize data on genetic variations in the TLR- and cytokine system and their influence on course of infectious diseases and sepsis. In addition, we summarize animal experiments and conclude that both cascades may be needed for containing infection. Imbalances in both the pro- and anti-inflammatory system may be harmful. Thus, interventional strategies have to be introduced carefully, and in the future genetic profiling may be needed in order to tailor therapies in the best way.
由于缺乏针对败血症的有效治疗方法,因此重新评估了败血症的病理生理学。抗炎策略的失败意味着代偿性免疫抑制在致命的临床病例中起着核心作用。在寻找新的治疗策略时,人们提出了一个问题,即在败血症中,是促炎(全身炎症反应综合征,SIRS)还是抗炎(代偿性抗炎反应综合征,CARS)占主导地位,而治疗措施可能会对此产生影响。在这里,我们想知道在特定的生物体(人类或小鼠)中,是否缺乏参与这一级联反应的任何功能性蛋白有助于理解这些事件。在人类中,存在遗传变异,其中一些具有改变对病原体炎症反应的功能后果。在小鼠中,创建了基因敲除动物,这可能有助于我们理解 SIRS/CARS 级联反应。在这里,我们总结了 TLR 和细胞因子系统中的遗传变异及其对传染病和败血症病程的影响。此外,我们还总结了动物实验,并得出结论,这两个级联反应都可能需要用于控制感染。促炎和抗炎系统的失衡都可能有害。因此,干预策略必须谨慎引入,而在未来,可能需要进行基因分析,以便以最佳方式定制治疗方法。