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基于急、慢性炎症分子特征的系统性红斑狼疮治疗和管理的现行和新兴策略。

Current and emerging strategies for the treatment and management of systemic lupus erythematosus based on molecular signatures of acute and chronic inflammation.

机构信息

Jawaharlal Nehru Technological University, Kakinada, Andhra Pradesh, India; UND Life Sciences, Shaker Heights, OH, USA.

出版信息

J Inflamm Res. 2010;3:143-70. doi: 10.2147/JIR.S9425. Epub 2010 Dec 2.

Abstract

Lupus is a chronic, systemic inflammatory condition in which eicosanoids, cytokines, nitric oxide (NO), a deranged immune system, and genetics play a significant role. Our studies revealed that an imbalance in the pro- and antioxidants and NO and an alteration in the metabolism of essential fatty acids exist in lupus. The current strategy of management includes administration of nonsteroidal anti-inflammatory drugs such as hydroxychloroquine and immunosuppressive drugs such as corticosteroids. Investigational drugs include the following: 1) belimumab, a fully human monoclonal antibody that specifically recognizes and inhibits the biological activity of B-lymphocyte stimulator, also known as B-cell-activation factor of the TNF family; 2) stem cell transplantation; 3) rituximab, a chimeric monoclonal antibody against CD20, which is primarily found on the surface of B-cells and can therefore destroy B-cells; and 4) IL-27, which has potent anti-inflammatory actions. Our studies showed that a regimen of corticosteroids and cyclophosphamide, and methods designed to enhance endothelial NO synthesis and augment antioxidant defenses, led to induction of long-lasting remission of the disease. These results suggest that methods designed to modulate molecular signatures of the disease process and suppress inflammation could be of significant benefit in lupus. Some of these strategies could be vagal nerve stimulation, glucose-insulin infusion, and administration of lipoxins, resolvins, protectins, and nitrolipids by themselves or their stable synthetic analogs that are known to suppress inflammation and help in the resolution and healing of the inflammation-induced damage. These strategies are likely to be useful not only in lupus but also in other conditions, such as rheumatoid arthritis, scleroderma, ischemia-reperfusion injury to the myocardium, ischemic heart disease, and sepsis.

摘要

狼疮是一种慢性、系统性炎症性疾病,其中类二十烷酸、细胞因子、一氧化氮(NO)、紊乱的免疫系统和遗传因素起着重要作用。我们的研究表明,狼疮患者体内存在着抗氧化剂和一氧化氮的失衡以及必需脂肪酸代谢的改变。目前的治疗策略包括使用非甾体抗炎药(如羟氯喹)和免疫抑制剂(如皮质类固醇)。正在研究的药物包括:1)贝利木单抗,一种完全人源单克隆抗体,专门识别并抑制 B 淋巴细胞刺激物的生物学活性,也称为肿瘤坏死因子家族的 B 细胞激活因子;2)干细胞移植;3)利妥昔单抗,一种针对 CD20 的嵌合单克隆抗体,主要存在于 B 细胞表面,因此可以破坏 B 细胞;4)IL-27,具有很强的抗炎作用。我们的研究表明,皮质类固醇和环磷酰胺的治疗方案,以及旨在增强内皮一氧化氮合成和增强抗氧化防御的方法,导致疾病的长期缓解。这些结果表明,旨在调节疾病过程的分子特征和抑制炎症的方法可能对狼疮有显著益处。其中一些策略可以是迷走神经刺激、葡萄糖-胰岛素输注以及单独或其稳定的合成类似物(已知可抑制炎症并有助于炎症引起的损伤的消退和愈合)的脂氧素、解析素、保护素和硝化脂的给药。这些策略不仅在狼疮中而且在其他疾病(如类风湿关节炎、硬皮病、心肌缺血再灌注损伤、缺血性心脏病和脓毒症)中可能有用。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8d85/3218729/7c8a56b2f792/jir-3-143f1.jpg

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