Sorbonne Université, INSERM, Association Institut de Myologie, Center of Research in Myology, UMRS 974, AP-HP, Department of Internal Medicine and Clinical Immunology, DHU I2B, Pitié-Salpêtrière Hospital, F-75013, Paris, France.
Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
Brain. 2018 Jun 1;141(6):1609-1621. doi: 10.1093/brain/awy105.
Dermatomyositis is an acquired auto-immune disease characterized by skin lesions and muscle-specific pathological features such as perifascicular muscle fibre atrophy and vasculopathy. Dermatomyositis patients display an upregulation of type I interferon-inducible genes in muscle fibres, endothelial cells, skin and peripheral blood. However, the effect of type I interferon on muscle tissue has not yet been determined. Our aim was to study the pathogenicity of type I interferon in vitro and to evaluate the efficacy of the type I interferon pathway blockade for therapeutic purposes. The activation of type I interferon in differentiating myoblasts abolished myotube formation with reduced myogenin expression while in differentiated myotubes, we observed a reduction in surface area and an upregulation of atrophy-associated genes. In vitro endothelial cells exposure to type I interferon disrupted vascular network organization. All the pathogenic effects observed in vitro were abolished by ruxolitinib. Finally, four refractory dermatomyositis patients were treated with ruxolitinib and improvement ensued in skin lesions, muscle weakness and a reduced serum type I interferon levels and interferon-inducbile genes scores. We propose JAK inhibition as a mechanism-based treatment for dermatomyositis, a finding that is relevant for the design of future clinical trials targeting dermatomyositis.
皮肌炎是一种获得性自身免疫性疾病,其特征为皮肤损伤和肌特异性病理特征,如肌纤维旁束萎缩和血管病变。皮肌炎患者的肌肉纤维、内皮细胞、皮肤和外周血中存在 I 型干扰素诱导基因的上调。然而,I 型干扰素对肌肉组织的影响尚未确定。我们的目的是研究 I 型干扰素在体外的致病性,并评估 I 型干扰素通路阻断的治疗效果。在分化的成肌细胞中激活 I 型干扰素会破坏肌管的形成,减少肌生成素的表达,而在分化的肌管中,我们观察到表面积减少和萎缩相关基因的上调。体外内皮细胞暴露于 I 型干扰素会破坏血管网络组织。在体外观察到的所有致病性作用都被鲁索利替尼所消除。最后,4 例难治性皮肌炎患者接受了鲁索利替尼治疗,皮肤损伤、肌肉无力以及血清 I 型干扰素水平和干扰素诱导基因评分均有所改善。我们提出 JAK 抑制作为皮肌炎的一种基于机制的治疗方法,这一发现对未来针对皮肌炎的临床试验设计具有重要意义。
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