Department of Dermatology, University Medical Center Schleswig-Holstein, Campus Kiel, Germany.
Br J Clin Pharmacol. 2012 Sep;74(3):424-36. doi: 10.1111/j.1365-2125.2012.04221.x.
Apart from cancer chronic (auto)immune-mediated diseases are a major threat for patients and a challenge for physicians. These conditions include classic autoimmune diseases like systemic lupus erythematosus, systemic sclerosis and dermatomyositis and also immune-mediated inflammatory diseases such as rheumatoid arthritis and psoriasis. Traditional therapies for these conditions include unspecific immunosuppressants including steroids and cyclophosphamide, more specific compounds such as ciclosporin or other drugs which are thought to act as immunomodulators (fumarates and intravenous immunoglobulins). With increasing knowledge about the underlying pathomechanisms of the diseases, targeted biologic therapies mainly consisting of anti-cytokine or anti-cytokine receptor agents have been developed. The latter have led to a substantial improvement of the induction of long term remission but drug costs are high and are not affordable in all countries. In China an extract of the herb Tripterygium wilfordii Hook F. (TwHF) is frequently used to treat autoimmune and/or inflammatory diseases due to its favourable cost-benefit ratio. Triptolide has turned out to be the active substance of TwHF extracts and has been shown to exert potent anti-inflammatory and immunosuppressive effects in vitro and in vivo. There is increasing evidence for an immunomodulatory and partly immunosuppressive mechanism of action of triptolide. Thus, compounds such as triptolide or triptolide derivatives may have the potential to be developed as a new class of drugs for these diseases. In this review we summarize the published knowledge regarding clinical use, pharmacokinetics and the possible mode of action of triptolide in the treatment of inflammatory diseases with a particular focus on psoriasis.
除癌症外，慢性（自身）免疫介导性疾病也是患者的主要威胁，也是医生面临的挑战。这些疾病包括系统性红斑狼疮、系统性硬皮病和皮肌炎等经典自身免疫性疾病，以及类风湿关节炎和银屑病等免疫介导的炎症性疾病。这些疾病的传统治疗方法包括非特异性免疫抑制剂，如类固醇和环磷酰胺，以及更具特异性的化合物，如环孢素或其他被认为具有免疫调节作用的药物（富马酸和静脉注射免疫球蛋白）。随着对疾病潜在发病机制认识的不断提高，主要由抗细胞因子或抗细胞因子受体药物组成的靶向生物疗法已经得到开发。后者显著提高了长期缓解的诱导率，但药物成本高昂，并非所有国家都能负担得起。在中国，由于其良好的成本效益比，雷公藤（TwHF）的提取物常被用于治疗自身免疫性和/或炎症性疾病。雷公藤红素已被证明是 TwHF 提取物的有效成分，具有体外和体内的强大抗炎和免疫抑制作用。雷公藤红素具有免疫调节和部分免疫抑制作用的机制已得到越来越多的证据支持。因此，雷公藤红素或雷公藤红素衍生物等化合物可能有潜力开发成为这些疾病的一类新药。在这篇综述中，我们总结了雷公藤红素在治疗炎症性疾病，特别是银屑病方面的临床应用、药代动力学和可能作用机制的已有知识。
