Instituto Gulbenkian de Ciência, 2780-156 Oeiras, Portugal; email:
Annu Rev Immunol. 2019 Apr 26;37:405-437. doi: 10.1146/annurev-immunol-042718-041739. Epub 2019 Jan 23.
Pathogenic organisms exert a negative impact on host health, revealed by the clinical signs of infectious diseases. Immunity limits the severity of infectious diseases through resistance mechanisms that sense and target pathogens for containment, killing, or expulsion. These resistance mechanisms are viewed as the prevailing function of immunity. Under pathophysiologic conditions, however, immunity arises in response to infections that carry health and fitness costs to the host. Therefore, additional defense mechanisms are required to limit these costs, before immunity becomes operational as well as thereafter to avoid immunopathology. These are tissue damage control mechanisms that adjust the metabolic output of host tissues to different forms of stress and damage associated with infection. Disease tolerance is the term used to define this defense strategy, which does not exert a direct impact on pathogens but is essential to limit the health and fitness costs of infection. Under this argument, we propose that disease tolerance is an inherent component of immunity.
病原体对宿主健康产生负面影响，这表现在传染病的临床症状上。免疫通过感知和针对病原体的限制、杀灭或清除的抵抗机制，限制传染病的严重程度。这些抵抗机制被视为免疫的主要功能。然而，在病理生理条件下，免疫是针对感染而产生的，这会给宿主带来健康和适应度的代价。因此，在免疫开始发挥作用之前以及之后，需要额外的防御机制来限制这些代价，以避免免疫病理。这些是组织损伤控制机制，它们调整宿主组织的代谢输出，以适应与感染相关的不同形式的应激和损伤。疾病耐受是用来定义这种防御策略的术语，它不对病原体直接产生影响，但对于限制感染的健康和适应度代价是必不可少的。根据这一观点，我们提出疾病耐受是免疫的固有组成部分。
